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  1. Article ; Online: Variation in diagnosis and management of allergic reactions among emergency medicine and allergy immunology providers.

    Duffey, Hannah / Leonard, Jan / Mistry, Rakesh D

    Allergy and asthma proceedings

    2023  Volume 44, Issue 1, Page(s) 51–58

    Abstract: Background: ...

    Abstract Background:
    MeSH term(s) Child ; Humans ; Anaphylaxis/diagnosis ; Anaphylaxis/drug therapy ; Cross-Sectional Studies ; Epinephrine/therapeutic use ; Emergency Medicine ; Histamine Antagonists/therapeutic use ; Adrenal Cortex Hormones/therapeutic use
    Chemical Substances Epinephrine (YKH834O4BH) ; Histamine Antagonists ; Adrenal Cortex Hormones
    Language English
    Publishing date 2023-01-31
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1312445-6
    ISSN 1539-6304 ; 1088-5412
    ISSN (online) 1539-6304
    ISSN 1088-5412
    DOI 10.2500/aap.2023.44.220088
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  2. Article ; Online: Skin and Soft Tissue Infections in Ambulatory Care Settings: Setting a New Trend.

    Mistry, Rakesh D

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2019  Volume 70, Issue 12, Page(s) 2719–2720

    MeSH term(s) Ambulatory Care ; Emergency Service, Hospital ; Humans ; Incidence ; Methicillin-Resistant Staphylococcus aureus ; Soft Tissue Infections/drug therapy ; Soft Tissue Infections/epidemiology ; Staphylococcal Skin Infections
    Language English
    Publishing date 2019-10-10
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciz980
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  3. Article ; Online: Emergency management and asthma risk in young Medicaid-enrolled children with recurrent wheeze.

    Hardee, Isabel J / Zaniletti, Isabella / Tanverdi, Melisa S / Liu, Andrew H / Mistry, Rakesh D / Navanandan, Nidhya

    The Journal of asthma : official journal of the Association for the Care of Asthma

    2024  , Page(s) 1–8

    Abstract: Objectives: To describe clinical characteristics of young children presenting to the emergency department (ED) for early recurrent wheeze, and determine factors associated with subsequent persistent wheeze and risk for early childhood asthma.: Methods! ...

    Abstract Objectives: To describe clinical characteristics of young children presenting to the emergency department (ED) for early recurrent wheeze, and determine factors associated with subsequent persistent wheeze and risk for early childhood asthma.
    Methods: Retrospective cohort study of Medicaid-enrolled children 0-3 years old with an index ED visit for wheeze (e.g. bronchiolitis, reactive airway disease) from 2009 to 2013, and at least one prior documented episode of wheeze at an ED or primary care visit. The primary outcome was persistent wheeze between 4 and 6 years of age. Demographics and clinical characteristics were collected from the index ED visit. Logistic regression was used to estimate the association between potential risk factors and subsequent persistent wheeze.
    Results: During the study period, 41,710 children presented to the ED for recurrent wheeze. Mean age was 1.3 years; 59% were male, 42% Black, and 6% Hispanic. At index ED visits, the most common diagnosis was acute bronchiolitis (40%); 77% of children received an oral corticosteroid prescription. Between 4 and 6 years of age, 11,708 (28%) children had persistent wheeze. A greater number of wheezing episodes was associated with an increased odds of ED treatment with asthma medications. Subsequent persistent wheeze was associated with male sex, Black race, atopy, prescription for bronchodilators or corticosteroids, and greater number of visits for wheeze.
    Conclusions: Young children with persistent wheeze are at risk for childhood asthma. Thus, identification of risk factors associated with persistent wheeze in young children with recurrent wheeze might aid in early detection of asthma and initiation of preventative therapies.
    Language English
    Publishing date 2024-02-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 603816-5
    ISSN 1532-4303 ; 0277-0903
    ISSN (online) 1532-4303
    ISSN 0277-0903
    DOI 10.1080/02770903.2024.2314623
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  4. Article ; Online: Dog Bites in Children Surge during Coronavirus Disease-2019: A Case for Enhanced Prevention.

    Dixon, Cinnamon A / Mistry, Rakesh D

    The Journal of pediatrics

    2020  Volume 225, Page(s) 231–232

    MeSH term(s) Animals ; Betacoronavirus ; Bites and Stings/epidemiology ; Bites and Stings/prevention & control ; COVID-19 ; Child ; Coronavirus Infections/epidemiology ; Dogs ; Emergency Service, Hospital/statistics & numerical data ; Humans ; Pandemics ; Pneumonia, Viral/epidemiology ; SARS-CoV-2 ; Stress, Psychological
    Keywords covid19
    Language English
    Publishing date 2020-06-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3102-1
    ISSN 1097-6833 ; 0022-3476
    ISSN (online) 1097-6833
    ISSN 0022-3476
    DOI 10.1016/j.jpeds.2020.06.071
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  5. Article ; Online: Parental perspective on penicillin allergy delabeling in a pediatric emergency department.

    Yang, Cheryl / Graham, Jessica K / Vyles, David / Leonard, Jan / Agbim, Chisom / Mistry, Rakesh D

    Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology

    2023  Volume 131, Issue 1, Page(s) 82–88

    Abstract: Background: Penicillin (PCN) allergy is frequently mislabeled and inaccurately diagnosed in children. Successful implementation of pediatric emergency department (PED) delabeling efforts requires parental understanding and willingness for children to be ...

    Abstract Background: Penicillin (PCN) allergy is frequently mislabeled and inaccurately diagnosed in children. Successful implementation of pediatric emergency department (PED) delabeling efforts requires parental understanding and willingness for children to be delabeled as PCN-nonallergic.
    Objective: To describe the parental perspective on allergy delabeling in the PED for children identified as low risk for true PCN allergy.
    Methods: This is a cross-sectional survey of parents of children with documented PCN allergy presenting to a single tertiary-care PED. Parents were first approached to complete a PCN allergy identification questionnaire to stratify their child as high- or low-risk for true PCN allergy. Facilitators and barriers to PED-based oral challenge and delabeling were subsequently assessed by parents of low-risk children.
    Results: A total of 198 participants completed the PCN identification questionnaire. Of 198 children, 49 (25%) screened low risk for true PCN allergy. Of the 49 low-risk children, 29 (59%) parents were uncomfortable with a PED-based PCN oral challenge. Reasons include fear of allergic reaction (72%), availability of adequate alternative antibiotics (45%), and longer PED stay (17%). Reasons for willingness to delabel included PCN's low adverse effect profile (65%) and avoidance of antimicrobial resistance from alternative antibiotics (74%). Participants without a family history (FH) of PCN allergy were more comfortable with PED-based PCN oral challenge (60% vs 11%; P = .001) and delabeling (67% vs 37%; P = .04) compared with those with FH.
    Conclusion: Most parents of children with low-risk PCN allergy are uncomfortable with oral challenge or delabeling in the PED. Before implementing oral challenges in PEDs, efforts should be made to highlight the safety of oral challenging low-risk children, the benefits and risks of alternative antibiotics, and the minimal impact that FH has on PCN allergy.
    MeSH term(s) Child ; Humans ; Cross-Sectional Studies ; Penicillins/adverse effects ; Anti-Bacterial Agents ; Drug Hypersensitivity ; Emergency Service, Hospital ; Parents ; Hypersensitivity/drug therapy
    Chemical Substances Penicillins ; Anti-Bacterial Agents
    Language English
    Publishing date 2023-03-27
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1228189-x
    ISSN 1534-4436 ; 0003-4738 ; 1081-1206
    ISSN (online) 1534-4436
    ISSN 0003-4738 ; 1081-1206
    DOI 10.1016/j.anai.2023.03.023
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  7. Article ; Online: Impact of a discharge prescription for dexamethasone on outcomes of children treated in the emergency department for acute asthma exacerbations.

    Tanverdi, Melisa S / Navanandan, Nidhya / Brackman, Savannah / Huber, Lorel / Leonard, Jan / Mistry, Rakesh D

    The Journal of asthma : official journal of the Association for the Care of Asthma

    2023  , Page(s) 1–10

    Abstract: Objective: To evaluate dexamethasone prescribing practices, patient adherence, and outcomes by dosing regimen in children with acute asthma discharged from the emergency department (ED).: Study design: Prospective study of children 2-18 years treated ...

    Abstract Objective: To evaluate dexamethasone prescribing practices, patient adherence, and outcomes by dosing regimen in children with acute asthma discharged from the emergency department (ED).
    Study design: Prospective study of children 2-18 years treated with dexamethasone for acute asthma prior to discharge from an urban, tertiary care ED between 2018 and 2022. Demographics, clinical characteristics, ED treatment, and discharge prescriptions were collected via chart review. The exposure was discharge prescription (additional dose) versus no discharge prescription for dexamethasone. The primary outcome was treatment failure, defined as return ED visit, unplanned primary care visit, and/or ongoing bronchodilator use. Secondary outcomes included medication adherence, symptom persistence, quality-of-life, and school/work absenteeism. Outcomes were assessed by telephone 7-10 days after discharge.
    Results: 564 subjects were enrolled; 338 caregivers (60%) completed follow-up. Children were a median age 7 years, 30% Black or African American, 49% Hispanic, and 79% had public insurance. A discharge prescription for dexamethasone was written for 482 (86%) children and was significantly associated with exacerbation severity, number of combined albuterol/ipratropium treatments, and longer length of stay. There was no difference in treatment failure between the discharge prescription and no discharge prescription groups (RR 0.87; 0.67, 1.12), including after adjusting for potential confounders; there was no difference between groups in secondary outcomes.
    Conclusions: Prescription for an additional dexamethasone dose was not associated with reduced treatment failure or improved outcomes for children with acute asthma discharged from the ED. Single, ED-dose of dexamethasone prior to discharge may be sufficient for children with mild to moderate asthma exacerbations.
    Language English
    Publishing date 2023-12-19
    Publishing country England
    Document type Journal Article
    ZDB-ID 603816-5
    ISSN 1532-4303 ; 0277-0903
    ISSN (online) 1532-4303
    ISSN 0277-0903
    DOI 10.1080/02770903.2023.2294910
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  8. Article ; Online: Anaphylaxis in Children.

    Tanverdi, Melisa S / Wiersma, Alexandria / Kim, Kristin M / Hicks, Allison G / Mistry, Rakesh D

    Pediatric emergency care

    2022  Volume 38, Issue 9, Page(s) 456–461

    Abstract: Abstract: Anaphylaxis is a potentially life-threatening event in children, commonly encountered in the prehospital and emergency department settings. Recently published clinical guidelines emphasize early recognition of anaphylaxis and administration of ...

    Abstract Abstract: Anaphylaxis is a potentially life-threatening event in children, commonly encountered in the prehospital and emergency department settings. Recently published clinical guidelines emphasize early recognition of anaphylaxis and administration of epinephrine as the mainstay of management. Literature regarding adjuvant therapies, biphasic reactions, observation times, and disposition of patients with anaphylaxis remains controversial. In this article, we will review the background and pathophysiology of anaphylaxis, as well as the diagnostic approach, management, and future directions of anaphylaxis in children.
    MeSH term(s) Anaphylaxis/diagnosis ; Anaphylaxis/drug therapy ; Anaphylaxis/etiology ; Child ; Emergency Service, Hospital ; Epinephrine/therapeutic use ; Humans
    Chemical Substances Epinephrine (YKH834O4BH)
    Language English
    Publishing date 2022-01-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632588-9
    ISSN 1535-1815 ; 0749-5161
    ISSN (online) 1535-1815
    ISSN 0749-5161
    DOI 10.1097/PEC.0000000000002812
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  9. Article ; Online: Updated Approaches to Cardiac Electrical Stimulation and Pacing in Pediatrics.

    Neubrand, Tara L / Topoz, Irina / Mistry, Rakesh D

    Pediatric emergency care

    2020  Volume 36, Issue 9, Page(s) 430–439

    Abstract: Cardiac electrical stimulation is a rarely used but required skill for pediatric emergency physicians. Children who are in cardiac arrest or who demonstrate evidence of hypoperfusion because of cardiac reasons require rapid diagnosis and intervention to ... ...

    Abstract Cardiac electrical stimulation is a rarely used but required skill for pediatric emergency physicians. Children who are in cardiac arrest or who demonstrate evidence of hypoperfusion because of cardiac reasons require rapid diagnosis and intervention to minimize patient morbidity and mortality. Both hospital- and community-based personnel must have sufficient access to, and knowledge of, appropriate equipment to provide potentially lifesaving defibrillation, cardioversion, or cardiac pacing. In this review, we will discuss the primary clinical indications for cardioelectrical stimulation in pediatric patients, including the use of automated external defibrillators, internal defibrillators, and pacemakers. We discuss the types of devices that are currently available, emergency management of internal defibrillation and pacemaker devices, and the role of advocacy in improving delivery of emergency cardiovascular care of pediatric patients in the community.
    MeSH term(s) Cardiac Pacing, Artificial ; Child ; Defibrillators ; Defibrillators, Implantable ; Electric Countershock ; Emergency Service, Hospital/organization & administration ; Heart Arrest/therapy ; Humans
    Language English
    Publishing date 2020-09-01
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 632588-9
    ISSN 1535-1815 ; 0749-5161
    ISSN (online) 1535-1815
    ISSN 0749-5161
    DOI 10.1097/PEC.0000000000002201
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  10. Article ; Online: Improving Antimicrobial Stewardship in Pediatric Emergency Care: A Pathway Forward.

    Mistry, Rakesh D / May, Larissa S / Pulia, Michael S

    Pediatrics

    2019  Volume 143, Issue 2

    MeSH term(s) Anti-Bacterial Agents ; Antimicrobial Stewardship ; Child ; Emergency Medical Services ; Emergency Service, Hospital ; Emergency Treatment ; Humans ; United States
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2019-01-08
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S. ; Comment
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.2018-2972
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