Pediatrics
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The purpose of this work was to determine the excess charges, both overall and according to category, and lengths of stay attributable to adverse patient-care events during pediatric hospitalization. ⋯ Some adverse events experienced during pediatric hospitalization have the potential to increase lengths of stay and charges considerably, and pediatric-specific quality indicators are useful in calculating these effects.
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The objective of this study was to determine the relationship between the frequency and total volume of intravascular volume administration and the development of intracranial hemorrhage during venoarterial extracorporeal membrane oxygenation. ⋯ The number and total volume of intravascular volume administration in the first 8 and 24 hours of venoarterial extracorporeal membrane oxygenation treatment are statistically significantly related to the development of intracranial hemorrhage.
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Children with traumatic brain injuries often show impaired executive function (the ability to carry out goal-directed behavior). The Behavior Rating Inventory of Executive Function, a caregiver-report questionnaire, measures executive function in everyday activities. In this study, our goal was to use the Behavior Rating Inventory of Executive Function to document changes in children's executive function in the first year after traumatic brain injury and identify child, family, and injury variables associated with greater dysfunction. We predicted that children with traumatic brain injury would have more executive dysfunction than children hospitalized for orthopedic fractures and that more severe traumatic brain injury would predict greater dysfunction. Children's premorbid functioning and family characteristics were expected to moderate their executive function. ⋯ Between 18% and 38% of the children with traumatic brain injury had significant executive dysfunction in the first year after injury, with greater dysfunction reported for children with more severe traumatic brain injury. Our findings support previous reports that preinjury learning and behavior problems, limited family resources, and poor family functioning adversely affect executive function. These results suggest a need for more systematic screening for executive dysfunction after traumatic brain injury to increase recognition of cognitive disability and improve access to appropriate services.
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We assessed the offering of American Academy of Pediatrics-recommended tests and prophylaxes after sexual assault to adolescents who presented to Rhode Island emergency departments for 3 categories of sexual exposures: sexual assault, consensual sex, and suspected sexual abuse. ⋯ Many adolescents did not receive American Academy of Pediatrics-recommended tests and prophylaxes after sexual assault. Boys received fewer tests than girls. Testing and prophylaxis varied by type of emergency department. Efforts are needed to improve and standardize emergency department medical management of adolescent sexual exposures.
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The purpose of this work was to describe the frequency, characteristics, and outcomes of critical events and hospitalized children requiring medical emergency team review. ⋯ Chronic and complex illnesses were prevalent among children provided with urgent medical assistance from the medical emergency team in a tertiary hospital. Children in the postoperative phase were overrepresented among those with a critical event. A critical event significantly increased the risk of hospital mortality. Greater knowledge of high-risk groups is required to further improve outcomes for hospitalized children.