Availability of Pediatric Inpatient Services in the United States

Cushing, Anna; Bucholz, Emily M.; Chien, Alyna T.; Rauch, Daniel A.; Michelson, Kenneth A.

doi:10.1542/peds.2020-041723

Cited by 100 publications

(67 citation statements)

References 51 publications

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“…The significantly higher number of admissions to WCH and less severe case-mix are likely a reflection of infrequent regional hospitalization prior to transfer. The lack of regional care is an increasing trend in North America and leads to transfer as a rule, with loss of regional pediatric capacity and little room to surge [ 27 ]. SCH and CHEO’s transfers generally hail from larger centers, Stanton Territorial Hospital (STH) in Yellowknife and Qikiqtani General Hospital (QGH) in Iqaluit, that have benefitted from improved access to on-site care from full-time pediatricians.…”

Section: Discussionmentioning

confidence: 99%

Urgent air transfers for acute respiratory infections among children from Northern Canada, 2005–2014

et al. 2022

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Background The incidence of hospitalizations for acute respiratory infections (ARI) among young Indigenous children from Northern Canada is consistently high. ARIs requiring urgent air transfer can be life-threatening and costly. We aimed to describe their epidemiology, estimate age-specific incidences, and explore factors associated with level of care required. Methods We undertook a retrospective cohort study of children <5 years old from Northern Canada transferred by urgent air transport for ARI from 2005 through 2014 to 5 pediatric tertiary care centers in Vancouver, Edmonton, Winnipeg, Ottawa and Montreal. Admissions were identified via ARI-related ICD-9/10 coding and forward sortation area. Descriptive statistics and univariable analyses were performed. Results Among 650 urgent air transfers, the majority were from Nunavut (n = 349, 53.7%) or Nunavik (n = 166, 25.5%), <6 months old (n = 372, 57.2%), and without underlying comorbidity (n = 458; 70.5%). Estimated annual tertiary care ARI admission rates in infants <1 year old from Nunavut (40.7/1000) and Nunavik (44.5/1000) were tenfold higher than in children aged 1 to 4 years. Bronchiolitis (n = 333, 51.2%) and pneumonia (n = 208, 32.0%) were the most common primary discharge diagnoses. Nearly half required critical care (n = 316, 48.6%); mechanical ventilation rates ranged from 7.2% to 55.9% across centres. The most common primary pathogen was respiratory syncytial virus (n = 196, 30.1%). Influenza A or B was identified in 35 cases (5.4%) and vaccine-preventable bacterial infections in 27 (4.1%) cases. Interpretation Urgent air transfers for ARI from Northern Canada are associated with high acuity. Variations in levels of care were seen across referral centers, age groups and pathogens.

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Section: Discussionmentioning

confidence: 99%

Urgent air transfers for acute respiratory infections among children from Northern Canada, 2005–2014

et al. 2022

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“…For those with lower socioeconomic status such a distance can be quite substantial in the potential absence of having access to a car, gasoline prices, and lack of public transportation. Effects of distance on access to pediatric cardiac care have been demonstrated by several studies [17]. Those with public insurance and higher deprivation index have been documented to be more likely to be able to complete pediatric cardiology visits, with up to 40% of new referrals not even being completed (Warren).…”

Section: Discussionmentioning

confidence: 99%

Hocus POCUS! Parental quantification of left ventricular ejection fraction using point of care ultrasound: fiction or reality?

Jaji¹,

Loomba²

2022

Preprint

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Background Point of care ultrasound has become increasingly utilized in pediatric settings. The assessment of cardiac function is one such implementation of this. This study aimed to determine the feasibility of parents in acquiring images to assess function using a handheld ultrasound probe and the correlation of shortening fraction measurements by handheld ultrasound with hospital acquired echocardiography. Methods Single-center prospective study in which parents of pediatric patients admitted to the hospital. Parents underwent a 25-minute education session on how to use the handheld ultrasound probe and then were asked to acquire a parasternal short axis and apical four chamber image on their own. Acquired images were reviewed by two physicians to determine adequacy of images to assess systolic cardiac function subjectively and objectively. Shortening fraction was measured using parent-acquired images and then compared to recent hospital acquired shortening fraction. Results A total of 25 parents of 21 patients enrolled and completed the study. Of the enrolled parents, 96% of both parasternal short axis and apical four chamber images acquired were deemed appropriate for subjective assessment of systolic function. Inter-reader variability of shortening fractioning was moderate between two readers. Correlation of shortening fraction measured from parent-acquired images versus hospital acquired images was moderate. Conclusion Parents were able to successfully obtain a parasternal short axis and apical four chamber image adequate to assess function and quantify shortening fraction after a 25-minute education session. This pilot data demonstrates that further exploration of parent performed point of care cardiac assessment may be warranted.

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“…While general (ie, non-paediatric) EDs’ paediatric readiness has been increasing in the USA, hospitals’ capability to provide definitive paediatric care has been decreasing 16. This trend has been due in part to inpatient unit closures and has led to increased ED transfers of children, even for common, basic conditions such as asthma and gastroenteritis 17 18…”

Section: Generalisabilitymentioning

confidence: 99%