Characteristics of Pediatric Rapid Response Systems: Results From a Survey of PRIS Hospitals.

2021

144-152

02/2021

2154-1671

BACKGROUND: Many hospitals use rapid response systems (RRSs) to identify and intervene on hospitalized children at risk for deterioration.

OBJECTIVES: To describe RRS characteristics across hospitals in the Pediatric Research in Inpatient Settings (PRIS) network.

METHODS: We developed the survey through a series of prospective respondent, expert, and cognitive interviews. One institutional expert per PRIS hospital ( = 109) was asked to complete the web survey. We summarized responses using descriptive statistics with a secondary analysis of univariate associations between RRS characteristics and perceived effectiveness.

RESULTS: The response rate was 72% (79 of 109). Respondents represented diverse hospital types and were primarily physicians (97%) with leadership roles in care escalation. Many hospitals used an early warning score (77%) for identification with variable characteristics (46% automated versus 54% full or partially manual calculation; inputs included vital signs [98%], physical examination findings [88%], diagnoses [23%], medications [19%], and diagnostic tests [14%]). Few incorporated a validated prediction model (9%). Similarly, many RRSs used a rapid response team for intervention (93%) with variable team composition (respiratory therapists [94%], ICU nurses [93%], ICU providers [67%], and pharmacists [27%]). Some used the early warning score to trigger the rapid response team (50%). Only a few staffed a clinician to proactively surveil hospitalized children for risk of deterioration (18%), and these tended to be larger hospitals (annual admissions 12 000 vs 6000, = .007). Most responding experts stated their RRSs improved patient outcomes (92%).

CONCLUSIONS: RRS characteristics varied across PRIS hospitals.

10.1542/hpeds.2020-002659

Hosp Pediatr

33495251

Using Administrative Billing Codes to Identify Acute Musculoskeletal Infections in Children.

2023

182-195

02/2023

2154-1671

BACKGROUND AND OBJECTIVES: Acute hematogenous musculoskeletal infections (MSKI) are medical emergencies with the potential for life-altering complications in afflicted children. Leveraging administrative data to study pediatric MSKI is difficult as many infections are chronic, nonhematogenous, or occur in children with significant comorbidities. The objective of this study was to validate a case-finding algorithm to accurately identify children hospitalized with acute hematogenous MSKI using administrative billing codes.

METHODS: This was a multicenter validation study using the Pediatric Health Information System (PHIS) database. Hospital admissions for MSKI were identified from 6 PHIS hospitals using discharge diagnosis codes. A random subset of admissions underwent manual chart review at each site using predefined criteria to categorize each admission as either "acute hematogenous MSKI" (AH-MSKI) or "not acute hematogenous MSKI." Ten unique coding algorithms were developed using billing data. The sensitivity and specificity of each algorithm to identify AH-MSKI were calculated using chart review categorizations as the reference standard.

RESULTS: Of the 492 admissions randomly selected for manual review, 244 (49.6%) were classified as AH-MSKI and 248 (50.4%) as not acute hematogenous MSKI. Individual algorithm performance varied widely (sensitivity 31% to 91%; specificity 52% to 98%). Four algorithms demonstrated potential for future use with receiver operating characteristic area under the curve greater than 80%.

CONCLUSIONS: Identifying children with acute hematogenous MSKI based on discharge diagnosis alone is challenging as half have chronic or nonhematogenous infections. We validated several case-finding algorithms using administrative billing codes and detail them here for future use in pediatric MSKI outcomes.

10.1542/hpeds.2022-006821

Hosp Pediatr

36601701

Recommended Childhood and Adolescent Immunization Schedule: United States, 2022.

2022

2022 Feb 18

1098-4275

10.1542/peds.2021-056056

Pediatrics

35176158

Characteristics of Pediatric Rapid Response Systems: Results From a Survey of PRIS Hospitals.

2021

2021 Jan 25

2154-1671

<p><strong>BACKGROUND: </strong>Many hospitals use rapid response systems (RRSs) to identify and intervene on hospitalized children at risk for deterioration.</p>

<p><strong>OBJECTIVES: </strong>To describe RRS characteristics across hospitals in the Pediatric Research in Inpatient Settings (PRIS) network.</p>

<p><strong>METHODS: </strong>We developed the survey through a series of prospective respondent, expert, and cognitive interviews. One institutional expert per PRIS hospital ( = 109) was asked to complete the web survey. We summarized responses using descriptive statistics with a secondary analysis of univariate associations between RRS characteristics and perceived effectiveness.</p>

<p><strong>RESULTS: </strong>The response rate was 72% (79 of 109). Respondents represented diverse hospital types and were primarily physicians (97%) with leadership roles in care escalation. Many hospitals used an early warning score (77%) for identification with variable characteristics (46% automated versus 54% full or partially manual calculation; inputs included vital signs [98%], physical examination findings [88%], diagnoses [23%], medications [19%], and diagnostic tests [14%]). Few incorporated a validated prediction model (9%). Similarly, many RRSs used a rapid response team for intervention (93%) with variable team composition (respiratory therapists [94%], ICU nurses [93%], ICU providers [67%], and pharmacists [27%]). Some used the early warning score to trigger the rapid response team (50%). Only a few staffed a clinician to proactively surveil hospitalized children for risk of deterioration (18%), and these tended to be larger hospitals (annual admissions 12 000 vs 6000, = .007). Most responding experts stated their RRSs improved patient outcomes (92%).</p>

<p><strong>CONCLUSIONS: </strong>RRS characteristics varied across PRIS hospitals.</p>

10.1542/hpeds.2020-002659

Hosp Pediatr

33495251