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  1. Article: Population-based drug-related anaphylaxis in children and adolescents captured by South Carolina Emergency Room Hospital Discharge Database (SCERHDD) (2000-2002).

    West, Suzanne L / D'Aloisio, Aimee A / Ringel-Kulka, Tamar / Waller, Anna E / Clayton Bordley, W

    Pharmacoepidemiology and drug safety

    2007  Volume 16, Issue 12, Page(s) 1255–1267

    Abstract: Purpose: Anaphylaxis is a life-threatening condition; drug-related anaphylaxis represents approximately 10% of all cases. We assessed the utility of a statewide emergency department (ED) database for identifying drug-related anaphylaxis in children by ... ...

    Abstract Purpose: Anaphylaxis is a life-threatening condition; drug-related anaphylaxis represents approximately 10% of all cases. We assessed the utility of a statewide emergency department (ED) database for identifying drug-related anaphylaxis in children by developing and validating an algorithm composed of ICD-9-CM codes.
    Methods: There were 1 314,760 visits to South Carolina (SC) emergency departments (EDs) for patients <19 years in 2000-2002. We used ICD-9-CM disease or external cause of injury codes (E-codes) that suggested drug-related anaphylaxis or a severe drug-related allergic reaction. We found 50 cases classifiable as probable or possible drug-related anaphylaxis and 13 as drug-related allergic reactions. We used clinical evaluation by two pediatricians as the 'alloyed gold standard'1 for estimating sensitivity, specificity, and positive predictive value (PPV) of our algorithm.
    Results: ED-treated drug-related anaphylaxis in the SC pediatric population was 1.56/100,000 person-years based on the algorithm and 0.50/100,000 person-years based on clinical evaluation. Assuming the disease codes we used identified all potential anaphylaxis cases in the database, the sensitivity was 1.00 (95%CI: 0.79, 1.00), specificity was 0.28 (95%CI: 0.16, 0.43), and the PPV was 0.32 (0.20, 0.47) for the algorithm. Sensitivity analyses improved the measurement properties of the algorithm.
    Conclusions: E-codes were invaluable for developing an anaphylaxis algorithm although the frequently used code of E947.9 was often incorrectly applied. We believe that our algorithm may have over-ascertained drug-related anaphylaxis patients seen in an ED, but the clinical evaluation may have under-represented this diagnosis due to limited information on the offending agent in the abstracted ED records. Post-marketing drug surveillance using ED records may be viable if clinicians were to document drug-related anaphylaxis in the charts so that billing codes could be assigned properly.
    MeSH term(s) Adolescent ; Adverse Drug Reaction Reporting Systems/statistics & numerical data ; Algorithms ; Anaphylaxis/chemically induced ; Anaphylaxis/epidemiology ; Anaphylaxis/therapy ; Child ; Child, Preschool ; Databases, Factual/statistics & numerical data ; Emergency Service, Hospital/statistics & numerical data ; Humans ; Medical Records/statistics & numerical data ; Patient Discharge/statistics & numerical data ; Pilot Projects ; Product Surveillance, Postmarketing/methods ; Product Surveillance, Postmarketing/statistics & numerical data ; South Carolina/epidemiology
    Language English
    Publishing date 2007-12
    Publishing country England
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1099748-9
    ISSN 1099-1557 ; 1053-8569
    ISSN (online) 1099-1557
    ISSN 1053-8569
    DOI 10.1002/pds.1502
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit.

    Mallory, Michael D / Shay, David K / Garrett, Joanne / Bordley, W Clayton

    Pediatrics

    2002  Volume 111, Issue 1, Page(s) e45–51

    Abstract: Objective: High incidence, rising admission rates, and relatively ineffective therapies make the management of bronchiolitis controversial. Since 1980, the rate of hospitalization for children with bronchiolitis has increased by nearly 250%, whereas ... ...

    Abstract Objective: High incidence, rising admission rates, and relatively ineffective therapies make the management of bronchiolitis controversial. Since 1980, the rate of hospitalization for children with bronchiolitis has increased by nearly 250%, whereas mortality rates for the disease have remained constant. It has been speculated that the increasing use of pulse oximetry has lowered the threshold for admission and may have contributed to the rise in bronchiolitis-related admissions. The objective of this study was to describe pediatric emergency medicine physicians' management preferences regarding infants with moderately severe bronchiolitis and to assess the influence of specific differences in oxygen saturation as measured by pulse oximetry (SpO2) and respiratory rate (RR) on the decision to admit.
    Methods: Physicians who are members of the American Academy of Pediatrics Section of Emergency Medicine and living in the United States were randomized into 4 groups and mailed a survey that contained 1 of 4 vignettes. Vignettes were identical except for given SpO2 values (94% or 92%) and RR (50/min or 65/min). Subjects were asked to answer questions regarding laboratory tests, treatment options, and the decision to admit for the patient in their vignette.
    Results: We received completed surveys from 519 (64%) of the 812 physicians contacted. Most respondents recommended use of bronchodilators (96%), nasal suction (82%), and supplemental oxygen (57%). Few respondents recommended decongestants (9%), steroids (8%), or antibiotics (2%). When asked to rank therapies, respondents gave nasal suction 182 number 1 votes; bronchodilators received 164. The decision to admit varied with SpO2 and RR. Forty-three percent of respondents who received a vignette featuring SpO2 of 94% and a RR of 50/min recommended admission for the infant in their vignette. Fifty-eight percent recommended admission when the vignette SpO2 was 94% and RR was 65/min (chi2 = 5.021). Respondents who received a vignette with SpO2 of 92% were nearly twice as likely to recommend admission: 83% recommended admission when vignette RR was 50/min, and 85% recommended admission when vignette RR was 65/min (chi2 = 0.126).
    Conclusions: When treating infants with moderately severe bronchiolitis, pediatricians who work in emergency departments frequently use bronchodilators and nasal suction, 2 practices for which supporting data are either conflicting (bronchodilators) or nonexistent (nasal suction). In addition, their decisions to admit differ markedly on the basis of only a 2% difference in SpO2. It is possible that increased reliance on pulse oximetry has contributed to the increase in bronchiolitis hospitalization rates seen during the past 2 decades.
    MeSH term(s) Bronchiolitis/diagnosis ; Bronchiolitis/therapy ; Bronchodilator Agents/therapeutic use ; Emergency Medical Services/statistics & numerical data ; Humans ; Infant ; Oximetry ; Oxygen/therapeutic use ; Patient Admission/standards ; Patient Admission/statistics & numerical data ; Pediatrics/statistics & numerical data ; Population Surveillance ; Practice Patterns, Physicians'/statistics & numerical data ; Respiration ; Respiratory Function Tests ; United States/epidemiology
    Chemical Substances Bronchodilator Agents ; Oxygen (S88TT14065)
    Language English
    Publishing date 2002-12-24
    Publishing country United States
    Document type Clinical Trial ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.111.1.e45
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Is weekly iron and folic acid supplementation as effective as daily supplementation for decreasing incidence of anemia in adolescent girls?

    Perrin, Eliana / Rothman, Russell / Coyne-Beasley, Tamera / Ford, Carol / Bordley, W Clayton

    Archives of pediatrics & adolescent medicine

    2002  Volume 156, Issue 2, Page(s) 128–130

    MeSH term(s) Adolescent ; Adult ; Anemia/drug therapy ; Anemia/epidemiology ; Child ; Cost-Benefit Analysis ; Drug Administration Schedule ; Female ; Folic Acid/administration & dosage ; Folic Acid/therapeutic use ; Hematinics/administration & dosage ; Hematinics/therapeutic use ; Hematocrit ; Humans ; Iron/administration & dosage ; Iron/therapeutic use ; Nepal/epidemiology ; Prevalence ; Reproducibility of Results
    Chemical Substances Hematinics ; Folic Acid (935E97BOY8) ; Iron (E1UOL152H7)
    Language English
    Publishing date 2002-02
    Publishing country United States
    Document type Clinical Trial ; Comment ; Journal Article ; Randomized Controlled Trial
    ZDB-ID 1179374-0
    ISSN 1538-3628 ; 1072-4710
    ISSN (online) 1538-3628
    ISSN 1072-4710
    DOI 10.1001/archpedi.156.2.128
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  4. Article ; Online: Office preparedness for pediatric emergencies: a randomized, controlled trial of an office-based training program.

    Bordley, W Clayton / Travers, Debbie / Scanlon, Patricia / Frush, Karen / Hohenhaus, Sue

    Pediatrics

    2003  Volume 112, Issue 2, Page(s) 291–295

    Abstract: Objective: Many children enter the emergency medical system through primary care offices, yet these offices may not be adequately prepared to stabilize severely ill children. We conducted this study to evaluate the effectiveness of an office-based ... ...

    Abstract Objective: Many children enter the emergency medical system through primary care offices, yet these offices may not be adequately prepared to stabilize severely ill children. We conducted this study to evaluate the effectiveness of an office-based educational program designed to improve the preparation of primary care practices for pediatric emergencies.
    Methods: A prospective, randomized, controlled trial was conducted of primary care practices (pediatric, family practice, and health departments) that were recruited from an existing database of North Carolina practices. Practices that agreed to participate were randomly assigned to either the intervention or the control group. Unannounced mock codes were conducted in the intervention practices by 2 emergency medicine clinicians (medical doctor and/or registered nurse). Practices were expected to respond to the mock code using their own staff, equipment, and local emergency medical system. After the exercise, the emergency medicine clinicians and the local emergency medical system team led a structured debriefing session providing constructive feedback to the staff on their performance, a review of the office's equipment, and a resource manual designed for the project. The primary outcome measures were obtained by survey 3 to 6 months postintervention and included 1) purchase of new pediatric emergency equipment and medications, 2) receipt or updating of basic life support/pediatric advanced life support/advanced life support training by staff members, and 3) development of written emergency pediatric protocols. The control practices received no interventions during the trial and completed a similar outcome survey.
    Results: Thirty-nine practices (20 intervention, 19 control) completed the trial. There were no significant differences in practice characteristics between the 2 groups. Intervention practices were more likely to develop written office protocols (60% vs 21%); more staff in the intervention practices received additional basic life support/pediatric advanced life support/advanced life support training 3 to 6 months after the intervention (118 vs 54). There were no significant differences in the purchase of new equipment or medications. Ninety percent of the intervention practices rated the intervention as useful for their practice, and 95% believed that the program should be continued.
    Conclusions: The findings suggest that the intervention was well received and motivated practices to take concrete actions to prepare for pediatric emergencies.
    MeSH term(s) Child ; Emergencies ; Emergency Medicine/education ; Emergency Treatment ; Family Practice ; Humans ; North Carolina ; Pediatrics/education ; Physicians' Offices ; Primary Health Care ; Prospective Studies
    Language English
    Publishing date 2003-07-23
    Publishing country United States
    Document type Clinical Trial ; Journal Article ; Randomized Controlled Trial
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.112.2.291
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  5. Article: The association of handgun ownership and storage practices with safety consciousness.

    Coyne-Beasley, Tamera / McGee, Kara S / Johnson, Renee M / Bordley, W Clayton

    Archives of pediatrics & adolescent medicine

    2002  Volume 156, Issue 8, Page(s) 763–768

    Abstract: Background: As with other injury prevention practices, education about safe firearm storage is recommended to prevent injuries to children.: Objective: To assess whether parents who are safety conscious in other respects also practice firearm safety.! ...

    Abstract Background: As with other injury prevention practices, education about safe firearm storage is recommended to prevent injuries to children.
    Objective: To assess whether parents who are safety conscious in other respects also practice firearm safety.
    Methods: Data come from responses to a baseline survey administered as part of an intervention study. Participants were consenting adults who brought a child into an emergency department. These analyses were restricted to those parents who had young children (<7 years) and who kept a firearm in their house. A safety consciousness score was developed; participants earned a point for each of 7 home and car safety behaviors they reported practicing. The relationship between safety consciousness with handgun ownership and firearm storage practices was assessed with Wilcoxon-Mann-Whitney test.
    Results: Of the 221 participants, most reported that they keep poisonous substances out of children's reach (92%), always keep children restrained when in cars (90%), have the telephone number for a poison control center (82%), change smoke alarm batteries annually (73%), keep electrical outlets capped (72%), and keep their tap water temperature at 120 degrees F (49 degrees C) or less (65%). Only 22% reported checking smoke alarm batteries monthly. The median safety score was 4 (mean [SD], 3.99 [1.4]). Fifty-six percent said there was a handgun in their home, 27% reported an unlocked gun, 20% reported a loaded gun, and 7% reported a loaded and unlocked gun. Results were not consistent with safety consciousness being associated with safe firearm storage practices or the absence of a handgun.
    Conclusion: Compliance with safety practices may not be associated with safe firearm storage.
    MeSH term(s) Accident Prevention ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Firearms/statistics & numerical data ; Health Knowledge, Attitudes, Practice ; Housekeeping/statistics & numerical data ; Humans ; Infant ; Male ; Middle Aged ; Safety ; Statistics, Nonparametric ; United States ; Wounds, Gunshot/prevention & control
    Language English
    Publishing date 2002-08
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1179374-0
    ISSN 1538-3628 ; 1072-4710
    ISSN (online) 1538-3628
    ISSN 1072-4710
    DOI 10.1001/archpedi.156.8.763
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Pharmacologic treatment of bronchiolitis in infants and children: a systematic review.

    King, Valerie J / Viswanathan, Meera / Bordley, W Clayton / Jackman, Anne M / Sutton, Sonya F / Lohr, Kathleen N / Carey, Timothy S

    Archives of pediatrics & adolescent medicine

    2004  Volume 158, Issue 2, Page(s) 127–137

    Abstract: Background: Bronchiolitis is the most common lower respiratory tract infection in infants. Up to 3% of all children in their first year of life are hospitalized with bronchiolitis. Bronchodilators and corticosteroids are commonly used treatments, but ... ...

    Abstract Background: Bronchiolitis is the most common lower respiratory tract infection in infants. Up to 3% of all children in their first year of life are hospitalized with bronchiolitis. Bronchodilators and corticosteroids are commonly used treatments, but little consensus exists about optimal management strategies.
    Objective: To conduct a systematic review of the effectiveness of commonly used treatments for bronchiolitis in infants and children.
    Data sources: We searched MEDLINE and the Cochrane Controlled Trials Register for references to randomized controlled trials of bronchiolitis treatment published since 1980.
    Study selection: Randomized controlled trials of interventions for bronchiolitis in infants and children were included if they were published in English between 1980 and November 2002 and had a minimum sample size of 10.
    Data extraction: We abstracted data on characteristics of the study population, interventions used, and results of studies meeting entry criteria into evidence tables and analyzed them by drug category.
    Data synthesis: Interventions were grouped by drug category and qualitatively synthesized.
    Results: Of 797 abstracts identified in the literature search, we included 54 randomized controlled trials. This review includes 44 studies of the most common interventions: epinephrine (n = 8), beta2-agonist bronchodilators (n = 13), corticosteroids (n = 13), and ribavirin (n = 10). Studies were, in general, underpowered to detect statistically significant outcome differences between study groups. Few studies collected data on outcomes that are of great importance to parents and clinicians, such as the need for and duration of hospitalization.
    Conclusions: Overall, little evidence supports a routine role for any of these drugs in treating patients with bronchiolitis. A sufficiently large, well-designed pragmatic trial of the commonly used interventions for bronchiolitis is needed to determine the most effective treatment strategies for managing this condition.
    MeSH term(s) Adrenal Cortex Hormones/therapeutic use ; Antiviral Agents/therapeutic use ; Bronchiolitis/drug therapy ; Bronchodilator Agents/therapeutic use ; Child ; Child, Preschool ; Epinephrine/therapeutic use ; Humans ; Infant ; Infant, Newborn ; Randomized Controlled Trials as Topic ; Ribavirin/therapeutic use
    Chemical Substances Adrenal Cortex Hormones ; Antiviral Agents ; Bronchodilator Agents ; Ribavirin (49717AWG6K) ; Epinephrine (YKH834O4BH)
    Language English
    Publishing date 2004-02
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Review
    ZDB-ID 1179374-0
    ISSN 1538-3628 ; 1072-4710
    ISSN (online) 1538-3628
    ISSN 1072-4710
    DOI 10.1001/archpedi.158.2.127
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  7. Article: Diagnosis and testing in bronchiolitis: a systematic review.

    Bordley, W Clayton / Viswanathan, Meera / King, Valerie J / Sutton, Sonya F / Jackman, Anne M / Sterling, Laura / Lohr, Kathleen N

    Archives of pediatrics & adolescent medicine

    2004  Volume 158, Issue 2, Page(s) 119–126

    Abstract: Background: The diagnosis of bronchiolitis is based on typical history and results of a physical examination. The indications for and utility of diagnostic and supportive laboratory testing (eg, chest x-ray films, complete blood cell counts, and ... ...

    Abstract Background: The diagnosis of bronchiolitis is based on typical history and results of a physical examination. The indications for and utility of diagnostic and supportive laboratory testing (eg, chest x-ray films, complete blood cell counts, and respiratory syncytial virus testing) are unclear.
    Objectives: To review systematically the data on diagnostic and supportive testing in the management of bronchiolitis and to assess the utility of such testing.
    Design: In conjunction with an expert panel, we generated admissibility criteria and derived relevant terms to search the literature published from 1980 to November 2002 in MEDLINE and the Cochrane Collaboration Database of Controlled Clinical Trials. Trained abstractors completed detailed data collection forms for each article. We summarized the data in tables after performing data integrity checks.
    Results: Of the 797 abstracts identified, we present evidence from 82 trials that met our inclusion criteria (17 are primary articles on diagnosis of bronchiolitis and 65are reports of treatment or prevention trials). Numerous studies demonstrate that rapid respiratory syncytial virus tests have acceptable sensitivity and specificity, but no data show that respiratory syncytial virus testing affects clinical outcomes in typical cases of the disease. Seventeen studies presented chest x-ray film data. Abnormalities on chest x-ray films ranged from 20% to 96%. Insufficient data exist to show that chest x-ray films reliably distinguish between viral and bacterial disease or predict severity of disease. Ten studies included complete blood cell counts, but most did not present specific results. In one study, white blood cell counts correlated with radiologically defined disease categories of bronchiolitis.
    Conclusions: A large number of studies include diagnostic and supportive testing data. However, these studies do not define clear indications for such testing or the impact of testing on relevant patient outcomes. Given the high prevalence of this disease, prospective studies of the utility of such testing are needed and feasible.
    MeSH term(s) Bronchiolitis/diagnosis ; Bronchiolitis/virology ; Child ; Child, Preschool ; Clinical Laboratory Techniques ; Diagnosis, Differential ; Humans ; Infant
    Language English
    Publishing date 2004-02
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1179374-0
    ISSN 1538-3628 ; 1072-4710
    ISSN (online) 1538-3628
    ISSN 1072-4710
    DOI 10.1001/archpedi.158.2.119
    Database MEDical Literature Analysis and Retrieval System OnLINE

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