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  • 1
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    Online Resource
    Identifying Acute Neuropsychiatric Events in Children and Adolescents
    American Academy of Pediatrics (AAP) ; 2022
    In:  Hospital Pediatrics Vol. 12, No. 5 ( 2022-05-01), p. e152-e160
    Details
    In: Hospital Pediatrics, American Academy of Pediatrics (AAP), Vol. 12, No. 5 ( 2022-05-01), p. e152-e160
    Abstract: The objective of this study was to develop and validate an approach to accurately identify incident pediatric neuropsychiatric events (NPEs) requiring hospitalization by using administrative data. METHODS We performed a cross-sectional, multicenter study of children 5 to 18 years of age hospitalized at two US children’s hospitals with an NPE. We developed and evaluated 3 NPE identification algorithms: (1) primary or secondary NPE International Classification of Diseases, 10th Revision diagnosis alone, (2) NPE diagnosis, the NPE was present on admission, and the primary diagnosis was not malignancy- or surgery-related, and (3) identical to algorithm 2 but without requiring the NPE be present on admission. The positive predictive value (PPV) of each algorithm was calculated overall and by diagnosis field (primary or secondary), clinical significance, and NPE subtype. RESULTS There were 1098 NPE hospitalizations included in the study. A total of 857 confirmed NPEs were identified for algorithm 1, yielding a PPV of 0.78 (95% confidence interval [CI] 0.76–0.80). Algorithm 2 (n = 846) had an overall PPV of 0.89 (95% CI 0.87–0.91). For algorithm 3 (n = 938), the overall PPV was 0.86 (95% CI 0.83–0.88). PPVs varied by diagnosis order, NPE clinical significance, and subtype. The PPV for critical clinical significance was 0.99 (0.97–0.99) for all 3 algorithms. CONCLUSIONS We identified a highly accurate method to identify neuropsychiatric adverse events in children and adolescents. The use of these approaches will improve the rigor of future studies of NPE, including the necessary evaluations of medication adverse events, infections, and chronic conditions.
    Type of Medium: Online Resource
    ISSN: 2154-1663 , 2154-1671
    URL: Article
    DOI: 10.1542/hpeds.2021-006329
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2022
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  • 2
    Online Resource
    Online Resource
    Association Between Procalcitonin and Antibiotics in Children With Community-Acquired Pneumonia
    American Academy of Pediatrics (AAP) ; 2022
    In:  Hospital Pediatrics Vol. 12, No. 4 ( 2022-04-01), p. 384-391
    Details
    In: Hospital Pediatrics, American Academy of Pediatrics (AAP), Vol. 12, No. 4 ( 2022-04-01), p. 384-391
    Abstract: To determine whether empirical antibiotic initiation and selection for children with pneumonia was associated with procalcitonin (PCT) levels when results were blinded to clinicians. METHODS We enrolled children & lt;18 years with radiographically confirmed pneumonia at 2 children’s hospitals from 2014 to 2019. Blood for PCT was collected at enrollment (blinded to clinicians). We modeled associations between PCT and (1) antibiotic initiation and (2) antibiotic selection (narrow versus broad-spectrum) using multivariable logistic regression models. To quantify potential stewardship opportunities, we calculated proportions of noncritically ill children receiving antibiotics who also had a low likelihood of bacterial etiology (PCT & lt;0.25 ng/mL) and those receiving broad-spectrum therapy, regardless of PCT level. RESULTS We enrolled 488 children (median PCT, 0.37 ng/mL; interquartile range [IQR], 0.11–2.38); 85 (17%) received no antibiotics (median PCT, 0.32; IQR, 0.09–1.33). Among the 403 children receiving antibiotics, 95 (24%) received narrow-spectrum therapy (median PCT, 0.24; IQR, 0.08–2.52) and 308 (76%) received broad-spectrum (median PCT, 0.46; IQR, 0.12–2.83). In adjusted analyses, PCT values were not associated with antibiotic initiation (odds ratio [OR] , 1.02, 95% confidence interval [CI], 0.97%–1.06%) or empirical antibiotic selection (OR 1.07; 95% CI, 0.97%–1.17%). Of those with noncritical illness, 246 (69%) were identified as potential targets for antibiotic stewardship interventions. CONCLUSION Neither antibiotic initiation nor empirical antibiotic selection were associated with PCT values. Whereas other factors may inform antibiotic treatment decisions, the observed discordance between objective likelihood of bacterial etiology and antibiotic use suggests important opportunities for stewardship.
    Type of Medium: Online Resource
    ISSN: 2154-1663 , 2154-1671
    URL: Article
    DOI: 10.1542/hpeds.2021-006510
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2022
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  • 3
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    Online Resource
    Characteristics Associated With Serious Self-Harm Events in Children and Adolescents
    American Academy of Pediatrics (AAP) ; 2023
    In:  Pediatrics Vol. 151, No. 6 ( 2023-06-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 151, No. 6 ( 2023-06-01)
    Abstract: To identify patterns of psychiatric comorbidity among children and adolescents with a serious self-harm event. METHODS We studied children aged 5 to 18 years hospitalized with a neuropsychiatric event at 2 children’s hospitals from April 2016 to March 2020. We used Bayesian profile regression to identify distinct clinical profiles of risk for self-harm events from 32 covariates: age, sex, and 30 mental health diagnostic groups. Odds ratios (ORs) and 95% credible intervals (CIs) were calculated compared with a reference profile with the overall baseline risk of the cohort. RESULTS We included 1098 children hospitalized with a neuropsychiatric event (median age 14 years [interquartile range (IQR) 11–16] ). Of these, 406 (37%) were diagnosed with a self-harm event. We identified 4 distinct profiles with varying risk for a self-harm diagnosis. The low-risk profile (median 0.035 [IQR 0.029–0.041]; OR 0.08, 95% CI 0.04–0.15) was composed primarily of children aged 5 to 9 years without a previous psychiatric diagnosis. The moderate-risk profile (median 0.30 [IQR 0.27–0.33] ; reference profile) included psychiatric diagnoses without depressive disorders. Older female adolescents with a combination of anxiety, depression, substance, and trauma disorders characterized the high-risk profile (median 0.69 [IQR 0.67–0.70]; OR 5.09, 95% CI 3.11–8.38). Younger males with mood and developmental disorders represented the very high-risk profile (median 0.76 [IQR 0.73–0.79] ; OR 7.21, 95% CI 3.69–15.20). CONCLUSIONS We describe 4 separate profiles of psychiatric comorbidity that can help identify children at elevated risk for a self-harm event and subsequent opportunities for intervention.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2022-059817
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2023
    detail.hit.zdb_id: 1477004-0
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  • 4
    Online Resource
    Online Resource
    Population-Based Incidence of Influenza-Associated Serious Neuropsychiatric Events in Children and Adolescents
    American Medical Association (AMA) ; 2023
    In:  JAMA Pediatrics Vol. 177, No. 9 ( 2023-09-01), p. 967-
    Details
    In: JAMA Pediatrics, American Medical Association (AMA), Vol. 177, No. 9 ( 2023-09-01), p. 967-
    Abstract: This cohort study assesses the incidence of influenza-associated serious neuropsychiatric events among US children and adolescents.
    Type of Medium: Online Resource
    ISSN: 2168-6203
    URL: Article
    DOI: 10.1001/jamapediatrics.2023.2304
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2023
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  • 5
    Online Resource
    Online Resource
    Positive Predictive Value of ICD-10 Codes to Identify Acute Suicidal and Self Harm Behaviors
    American Academy of Pediatrics (AAP) ; 2023
    In:  Hospital Pediatrics Vol. 13, No. 8 ( 2023-08-01), p. e207-e210
    Details
    In: Hospital Pediatrics, American Academy of Pediatrics (AAP), Vol. 13, No. 8 ( 2023-08-01), p. e207-e210
    Abstract: The accuracy of diagnosis codes to identify suicidal behaviors, including suicide ideation (SI) and self-harm (SH) events, is unknown. The objective of this study was to determine the positive predictive value (PPV) of International Classification of Disease, 10th Revision codes to identify SI/SH events that may be used in studies using administrative and claims data. METHODS We performed a secondary analysis of a cross-sectional study of children 5 to 17 years of age hospitalized at 2 US children’s hospitals with a discharge diagnosis of a neuropsychiatric event, including an SI or SH event. A true International Classification of Disease, 10th Revision SI or SH diagnosis was defined as SI or SH present on admission and directly related to hospitalization as compared with physician record review. PPV with 95% confidence intervals (CIs) were calculated overall and stratified by diagnosis order and age (5 to 11 years vs 12 to 17 years). RESULTS There were 376 children or adolescents with a discharge diagnosis of an SI or SH event. The median age was 14 years, and the majority of individuals were female (58%), non-Hispanic White (69%), and privately insured (57%). A total of 332 confirmed SI/SH cases were identified with a PPV of 0.88 (95% CI 0.85–0.91). PPVs were similar when stratified by diagnosis order: primary 0.94 (95% 0.88–0.97) versus secondary 0.86 (95% CI 81–90). PPVs were also similar in adolescents (0.89, CI 0.85–0.92) compared with children (0.84, 95% CI 0.74–0.91). CONCLUSIONS The use of these validated code sets to identify SI or SH events may minimize misclassification in future studies of suicidal and self-harm hospitalizations.
    Type of Medium: Online Resource
    ISSN: 2154-1663 , 2154-1671
    URL: Article
    DOI: 10.1542/hpeds.2023-007220
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2023
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