Growth Charts for Children With Down Syndrome in the United States

down_graphResults of the Down Syndrome Growing Up Study, which compiled 1520 measurements on 637 participants from 25 states (but mostly Pennsylvania) to create weight, height, head circumference, and body-mass index charts for children with Down syndrome through age 20 years. Comparisons to the old 1988 DS growth charts are illustrated. A supplement provides graphs and tables.

Zemel 2015 (Pediatrics) | PubMed 26504127 | Author Search

Ways to Identify Children with Medical Complexity and the Importance of Why

Comparison of 4 examples of diagnosis classification systems that have been used to identify the health problems in children with medical complexity: (1) Complex chronic conditions (CCCs), an open-source set of childhood conditions that are strongly associated with mortality, morbidity, functional limitations, high health resource utilization, and use of a complex care clinical program; (2) Clinical risk groups (CRGs), a proprietary system of hierarchical pediatric diagnosis groups ranging from healthy children without a chronic condition to unhealthy children with a catastrophic chronic condition that is associated with high morbidity and mortality; (3) Chronic condition indicators (CCIs), developed by the Agency for Healthcare Research and Quality, an open source diagnosis classification system that dichotomizes ∼14 000 ICD9 and ∼68 000 ICD10 diagnosis codes into chronic and non chronic conditions; and Patient medical complexity algorithm (PMCA), developed by Seattle Children’s Hospital, an open source, pediatric-specific, diagnosis classification system that uses ICD9 codes to group children into 1 of 3 categories: complex, chronic disease; noncomplex, chronic disease; and nonchronic disease.

Berry 2015 (J. Pediatrics) | PubMed 26028285 | Author Search

Autism Screening With Online Decision Support by Primary Care Pediatricians Aided by M-CHAT/F

An evaluation of the feasibility, validity, and reliability of the Modified Checklist for Autism in Toddlers (M-CHAT) with Follow-up Interview (M-CHAT/F) as administered via a secure web site before an 18- or 24-month well-child visit. Validation pf the primary-care process was evaluated by trained research assistants in an academic center via in-person or telephone interviews. Results were promising that this 2-step, primary-care based method was valid and had good positive predictive value.

Sturner 2016 (Pediatrics) | PubMed 27542847 | Author Search

Optimization of Drug-drug Interaction Alert Rules in a Pediatric Hospital’s Electronic Health Record System Using a Visual Analytics Dashboard

Describes an effort to reduce alert rates from drug-drug interactions, with some evidence that fewer alerts led to increased salience (lower override rates). Rates for pharmacists fell from 58.74 alerts per 100 orders to 25/100 orders. For providers, the drop in rates was less dramatic (~20 to 15/100 orders) but they were getting far fewer alerts in the first place. Pharmacists’ rate of alert overrides fell, but providers’ rates stayed the same. The basic methodology used was a visualization tool developed in a commercially available data-visualization application.

Simpao 2015 (JAMIA) | PubMed 25318641 | Author Search

Implementation of Electronic Clinical Decision Support for Pediatric Appendicitis

pas_scoreStudy of the implementation of clinical decision support on the rates of CT scanning for pediatric patients presenting with abdominal pain (and possible appendicitis) to 2 large, tertiary emergency departments. Decision support in this case consisted of an order set, a web-based risk stratification tool, and an alert presented at the time of CT ordering to guide practitioners in the use of the latter tools. Results showed about a 50% decrease in the rate of CT scan ordering, with no increase in missed appendicitis or other complications. In the studied population, 28% of patients had appendicitis.

Kharbanda 2016 (Pediatrics) | PubMed 27244781 | Author Search

Standardized Clinical Pathways for Hospitalized Children and Outcomes

15 clinical pathways

Analysis of admissions on any of 15 care pathways to Seattle Children’s Hospital over ~4 years that showed a slowing in the rate of rise of costs of care. Pathways were implemented in the electronic health record via order sets and accompanying decision support. Data on order-set use shows no clear trend toward broad increases in usage rates; for a few conditions, order-set usage improved over time (croup went from 38% to 68% over ~2 years) but most were low, stable usage rates, and some went down (cellulitis [42–>27%], femur fracture [94—>82%]). Length-of-stay data showed that LOS fell slightly for some conditions over time (0.03 days saved overall for each month following the implementation of the pathway). Quality-of-life measurement was unchanged.

Lion 2016 (Pediatrics) | PubMed 27002007 | Author Search

Performance of the Global Assessment of Pediatric Patient Safety (GAPPS) Tool

An evaluation of the Global Assessment of Pediatric Patient Safety (GAPPS) trigger tool, which measures hospital-wide rates of adverse events (AE). Reviews of 3814 charts at 16 centers showed that experts agreed with the tool in the identification of an AE 92% of the time. Triggers included medications (e.g., vitamin K after warfarin or hepatotoxic medications with elevated transaminases), hospital care (e.g., pressure ulcer, low O2 sats), healthcare-associated infections, hospital outcomes like readmissions, surgical events (e.g., abrupt drop in hematocrit after surgery, return to surgery), and ICU-related events like unplanned extubations and neonatal IVH.

Landrigan 2016 (Pediatrics) | PubMed 27221286 | Author Search

Immunization Data Exchange With Electronic Health Records

An evaluation of a project to establish automated bidirectional exchange of immunization data between New York City’s immunization information system and five community-based electronic health record systems. Using standard definition of “up to date” for defined age groups, this project demonstrated significant increased int he rate of being up to date (overall 75% to 82%, with varying rates in different age groups).

Stockwell 2016 (Pediatrics) | PubMed 27244856 | Author Search