Articles: pediatrics.
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Our study details Online medical consultation (OLMC) usage for Pediatric out-of-hospital cardiac arrest (P-OHCA), including proportion of P-OHCA utilizing OLMC, the characteristics of cases using OLMC, the types of information exchanged during OLMC calls, and the outcomes in patients where Emergency Medical Services (EMS) contacted OLMC. ⋯ Pediatric-OHCA cases with OLMC tend to contact OLMC late in the resuscitation, have poor prognostic factors, and have poor survival outcomes. The information exchanged during OLMC calls was highly variable, representing a clear opportunity for improvement. Future studies should explore the potential effect of early OLMC contact on patient outcomes and if a standardized template for OLMC data exchange improves consistency in recommendations for P-OHCA.
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Characterizing respiratory syncytial virus (RSV) infections before and during the COVID-19 pandemic.
Following the onset of the COVID-19 pandemic, RSV infections deviated from a previously reliable epidemiologic pattern of presentation. To investigate whether this change in RSV seasonality resulted in a change in frequency and severity of RSV infections, this single center retrospective study compares demographic and hospital factors during RSV seasons before and after the onset of the COVID-19 pandemic. ⋯ During the first three RSV seasons after the onset of the COVID-19 pandemic, our pediatric emergency departments saw more RSV positive patients than in the last three seasons beforehand. These patients were significantly older and less likely to be admitted, which may be partly due to increased respiratory viral testing during the pandemic. However, shorter LOS and decreased intubations despite increased respiratory support among admitted patients may indicate a paradigm shift in emergency department and inpatient management of severe RSV infections, perhaps encouraged by practice changes and resource limitations due to COVID-19. This information may better guide institutions in predicting resource needs after large-scale infectious disease outbreaks in the future.
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There is a lack of uniformity across hospitals in applying inpatient versus observation status for short-stay (<48 h) pediatric hospitalizations, with negative financial implications associated with observation. Children with medical complexity (CMC) represent a growing population and incur high costs of care. The financial implications of inpatient and observation status for CMC have not been studied. ⋯ Government-paid observation encounters for CMC are associated with significant financial loss at children's hospitals. This reimbursement model may pose a threat to children's hospitals' ability to care for CMC.