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Article ; Online: Reflections on Pediatric Emergency Care at a Time of Transition.

Neuman, Mark I / Zorc, Joseph J

2023 Volume 40, Issue 1, Page(s) 1

MeSH term(s)	Child ; Humans ; Emergency Medical Services ; Emergency Service, Hospital ; Emergency Treatment
Language	English
Publishing date	2023-12-29
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.0000000000003096
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Zs.A 2083: Show issues

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Article ; Online: Accurate Prediction of Total PlGF (Placental Growth Factor) From Free PlGF and sFlt-1 (Soluble Fms-Like Tyrosine Kinase-1): Evidence for Markedly Elevated PlGF Levels in Women With Acute Fatty Liver of Pregnancy.

Neuman, Rugina I / Saleh, Langeza / Verdonk, Koen / van den Meiracker, Anton H / Russcher, Henk / Metselaar, Herold J / Visser, Willy / Danser, A H Jan

Hypertension (Dallas, Tex. : 1979)

2021 Volume 78, Issue 2, Page(s) 489–498

Abstract: Figure: see text]. ...

Abstract	[Figure: see text].
MeSH term(s)	Adult ; Biomarkers/blood ; Fatty Liver/blood ; Female ; Humans ; Placenta Growth Factor/blood ; Pregnancy ; Pregnancy Complications/blood ; Vascular Endothelial Growth Factor Receptor-1/blood
Chemical Substances	Biomarkers ; Placenta Growth Factor (144589-93-5) ; FLT1 protein, human (EC 2.7.10.1) ; Vascular Endothelial Growth Factor Receptor-1 (EC 2.7.10.1)
Language	English
Publishing date	2021-06-28
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	423736-5
ISSN	1524-4563 ; 0194-911X ; 0362-4323
ISSN (online)	1524-4563
ISSN	0194-911X ; 0362-4323
DOI	10.1161/HYPERTENSIONAHA.121.17258
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Zs.A 1488: Show issues

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Article ; Online: Cost of Pediatric Pneumonia Episodes With or Without Chest Radiography.

Geanacopoulos, Alexandra T / Neuman, Mark I / Michelson, Kenneth A

Hospital pediatrics

2024 Volume 14, Issue 2, Page(s) 146–152

Abstract: Background and objectives: Despite its routine use, it is unclear whether chest radiograph (CXR) is a cost-effective strategy in the workup of community-acquired pneumonia (CAP) in the pediatric emergency department (ED). We sought to assess the costs ... ...

Abstract	Background and objectives: Despite its routine use, it is unclear whether chest radiograph (CXR) is a cost-effective strategy in the workup of community-acquired pneumonia (CAP) in the pediatric emergency department (ED). We sought to assess the costs of CAP episodes with and without CXR among children discharged from the ED. Methods: This was a retrospective cohort study within the Healthcare Cost and Utilization Project State ED and Inpatient Databases of children aged 3 months to 18 years with CAP discharged from any EDs in 8 states from 2014 to 2019. We evaluated total 28-day costs after ED discharge, including the index visit and subsequent care. Mixed-effects linear regression models adjusted for patient-level variables and illness severity were performed to evaluate the association between CXR and costs. Results: We evaluated 225c781 children with CAP, and 86.2% had CXR at the index ED visit. Median costs of the 28-day episodes, index ED visits, and subsequent visits were $314 (interquartile range [IQR] 208-497), $288 (IQR 195-433), and $255 (IQR 133-637), respectively. There was a $33 (95% confidence interval [CI] 22-44) savings over 28-days per patient for those who received a CXR compared with no CXR after adjusting for patient-level variables and illness severity. Costs during subsequent visits ($26 savings, 95% CI 16-36) accounted for the majority of the savings as compared with the index ED visit ($6, 95% CI 3-10). Conclusions: Performance of CXR for CAP diagnosis is associated with lower costs when considering the downstream provision of care among patients who require subsequent health care after initial ED discharge.
MeSH term(s)	Humans ; Child ; Retrospective Studies ; Pneumonia/diagnostic imaging ; Radiography ; Emergency Service, Hospital ; Patient Discharge ; Community-Acquired Infections/diagnostic imaging
Language	English
Publishing date	2024-01-14
Publishing country	United States
Document type	Journal Article
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2023-007506
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Article ; Online: Evaluation of Insurance Type as a Proxy for Socioeconomic Status in the Pediatric Emergency Department: A Pilot Study.

Monuteaux, Michael C / Du, Michelle / Neuman, Mark I

Annals of emergency medicine

2024

Abstract: Study objective: To determine whether insurance status can function as a sufficient proxy for socioeconomic status in emergency medicine research by examining the concordance between insurance status and direct socioeconomic status measures in a sample ... ...

Abstract	Study objective: To determine whether insurance status can function as a sufficient proxy for socioeconomic status in emergency medicine research by examining the concordance between insurance status and direct socioeconomic status measures in a sample of pediatric patients. Methods: We conducted a cross-sectional pilot study of patients aged 5 to 17 years in the emergency department of a quaternary care children's hospital. Socioeconomic status was measured using the highest level of the caregiver's education (low: less than bachelor's degree; high: bachelor's or greater) and previous year household income (low: <$75,000; high: ≥$75,000). We calculated the misclassification rate of insurance status (low: public; high: private) using education and income as reference standards. Results were expressed as percentages with 95% confidence intervals. Results: In total, 300 patients were enrolled (median age 11 years, 44% female). Insurance status misclassified 23% (95% CI 18% to 28%) and 14% (95% CI 10% to 19%) of patients when using caregiver education and income, respectively, as reference standards. Conclusions: Insurance status misclassified socioeconomic status in up to 23% of pediatric patients, as measured by caregivers' education and income. Emergency medicine studies of pediatric patients using insurance as a covariate to adjust for socioeconomic status may need to consider this misclassification and the resulting potential for bias. These findings require confirmation in larger, more diverse samples, including adult patients.
Language	English
Publishing date	2024-01-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	603080-4
ISSN	1097-6760 ; 0196-0644
ISSN (online)	1097-6760
ISSN	0196-0644
DOI	10.1016/j.annemergmed.2023.12.013
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Zs.A 1344: Show issues

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Article ; Online: Cost and Late Hospital Care of Publicly Insured Children After Appendectomy.

Michelson, Kenneth A / Bucher, Brian T / Neuman, Mark I

The Journal of surgical research

2024 Volume 297, Page(s) 41–46

Abstract: Introduction: Immediate complications of appendicitis are common, but the prevalence of long-term complications is uncertain.: Methods: We studied all publicly-insured children in the US with uncomplicated or complicated appendicitis in 2018-2019 ... ...

Abstract	Introduction: Immediate complications of appendicitis are common, but the prevalence of long-term complications is uncertain. Methods: We studied all publicly-insured children in the US with uncomplicated or complicated appendicitis in 2018-2019 using administrative claims. The main outcome was late hospital care defined as hospitalization or abdominal procedure within 180 d of an appendicitis discharge, excluding interval appendectomies. Time to late hospital care was evaluated using Cox regression. We evaluated health-care expenditures arising from appendicitis episodes. Results: Among 95,942 children with appendicitis, 5727 (6.0%) had late hospital care, with 5062 requiring rehospitalization and 2012 (2.1%) surgery. The median time to late hospital care was 10 d (interquartile range 4-33). Age under 5 y (compared with >14 y, hazard ratio [HR] 1.88, 95% confidence interval [CI] 1.70-2.08), complex chronic conditions (HR 2.35, 95% CI 2.13-2.59), and complicated appendicitis (HR 2.81, 95% CI 2.67, 2.96) were each associated with time to late hospital care. Expenditures over 180 d were a median $6553 and $19,589 respectively in those requiring no late hospital care versus those requiring it (P < 0.001). Conclusions: Late hospital care is uncommon in pediatric appendicitis but is costly. Prevention efforts should be targeted to the youngest, most complex children, and those with complicated appendicitis at presentation.
MeSH term(s)	Humans ; Child ; Appendectomy/methods ; Appendicitis/surgery ; Medicaid ; Retrospective Studies ; Hospitals ; Length of Stay
Language	English
Publishing date	2024-03-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2024.02.003
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Zs.A 178: Show issues

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Article ; Online: Predicting pneumonia from the clinical exam.

Lipsett, Susan C / Neuman, Mark I

The Journal of pediatrics

2022 Volume 249, Page(s) 117–120

MeSH term(s)	Educational Measurement ; Humans ; Pneumonia/diagnosis
Language	English
Publishing date	2022-10-10
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2022.06.032
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Article ; Online: Interpretation of Antibiotic Trials in Pediatric Pneumonia.

Lipsett, Susan C / Hirsch, Alexander W / Bachur, Richard G / Neuman, Mark I

JAMA network open

2024 Volume 7, Issue 2, Page(s) e2354470

MeSH term(s)	Child ; Humans ; Anti-Bacterial Agents/therapeutic use ; Pneumonia/drug therapy ; Community-Acquired Infections/drug therapy
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2024-02-05
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.54470
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Article ; Online: Age Cutoffs for Hospitalization at Hospitals Without Pediatric Inpatient Capability.

Michelson, Kenneth A / Neuman, Mark I

Hospital pediatrics

2021 Volume 11, Issue 3, Page(s) 284–286

Abstract: Objectives: To determine age cutoffs that hospitals without pediatric inpatient beds apply when hospitalizing children.: Methods: We conducted a cross-sectional study of patients <25 years old visiting emergency departments in 5 states in 2016 using ... ...

Abstract	Objectives: To determine age cutoffs that hospitals without pediatric inpatient beds apply when hospitalizing children. Methods: We conducted a cross-sectional study of patients <25 years old visiting emergency departments in 5 states in 2016 using the Healthcare Cost and Utilization Project State Emergency Department and Inpatient Databases. Hospitals were classified as adult (no pediatric inpatient beds) or pediatric capable (>0 pediatric beds). Referral rates were calculated for each year of life as transfers divided by transfers plus hospitalizations. Two age cutoffs were determined for defining pediatric patients: a specific cutoff (the age at which referral rates were significantly lower than those for younger patients) and an inclusive cutoff (the age at which referral rates differed most from those for younger patients). Results: Among 389 581 transfers and hospitalizations, 91 967 (23.6%) occurred in adult hospitals. Referral rates at adult hospitals were 86.0% at age 15, 80.6% at age 16, 72.0% at age 17, and 30.5% at age 18. The specific age cutoff was 16 because referral rates were lower than those for ages 0 to 15 ( Conclusions: Children aged <16 years specifically define a population of pediatric patients, as defined by whether an adult hospital would hospitalize instead of transfer from an emergency department. Children aged <18 years inclusively define a population of pediatric patients. These age cutoffs may be used when studying patterns of national acute care for children.
MeSH term(s)	Adolescent ; Adult ; Child ; Child, Preschool ; Cross-Sectional Studies ; Emergency Service, Hospital ; Hospitalization ; Hospitals ; Humans ; Infant ; Infant, Newborn ; Inpatients ; Young Adult
Language	English
Publishing date	2021-02-09
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2020-003897
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Article ; Online: National Trends in Voiding Cystourethrograms During Hospitalization for Young Infants With Urinary Tract Infections.

Pingree, Elizabeth W / Harper, Beth D / Liu, Shanshan / Neuman, Mark I

Hospital pediatrics

2023 Volume 13, Issue 10, Page(s) 904–911

Abstract: Objectives: The American Academy of Pediatrics published a guideline in 2011 recommending against the routine use of voiding cystourethrogram (VCUG) in infants aged 2 to 24 months with first febrile urinary tract infection (UTI); however, the rates of ... ...

Abstract	Objectives: The American Academy of Pediatrics published a guideline in 2011 recommending against the routine use of voiding cystourethrogram (VCUG) in infants aged 2 to 24 months with first febrile urinary tract infection (UTI); however, the rates of VCUG for infants aged <2 months are unknown. The objective of this study was to determine the trend in VCUG performance during index hospitalization among infants aged 0 to 2 months with UTI. Methods: This retrospective cohort study included infants aged birth to 2 months hospitalized with a UTI from 2008 to 2019 across 38 institutions in the Pediatric Health Information System. Outcome measures included recurrent UTI within 1 year, vesicoureteral reflux diagnosis within 1 year and antiurinary reflux procedure performed within 2 years. Trends over time were compared between preguideline (2008-2011) and postguideline periods (2012-2019) using piecewise mixed-effects logistic regression. Results: The odds of VCUG decreased by 21% per year in the preguideline period (adjusted odds ratio, 0.79; 95% confidence interval, 0.77-0.81; P < .001) versus 20% (adjusted odds ratio, 0.80; 95% confidence interval, 0.77-0.83; P < .001) in the postguideline period. The preguideline and postguideline difference was not statistically significant (P = .60). There was no difference in the postguideline odds of UTI within 1 year (P = .07), whereas the odds of vesicoureteral reflux diagnosis (P < .001) and antiurinary reflux procedure performance (P < .001) decreased. Conclusions: VCUG performance during hospitalization has declined over the past decade among young infants hospitalized with UTI. Further work is needed to determine the optimal approach to imaging in these young infants.
MeSH term(s)	Infant ; Humans ; Child ; Vesico-Ureteral Reflux/diagnostic imaging ; Vesico-Ureteral Reflux/epidemiology ; Vesico-Ureteral Reflux/therapy ; Retrospective Studies ; Urinary Tract Infections/epidemiology ; Urinary Tract Infections/therapy ; Urinary Tract Infections/diagnosis ; Time ; Hospitalization
Language	English
Publishing date	2023-09-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2022-007045
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Article ; Online: Questions persist on the emergency department management of hypothermic young infants.

Ramgopal, Sriram / Aronson, Paul L / Neuman, Mark I / Pruitt, Christopher M

Emergency medicine journal : EMJ

2022 Volume 39, Issue 11, Page(s) 878–879

MeSH term(s)	Infant ; Humans ; Emergency Service, Hospital ; Emergency Medicine
Language	English
Publishing date	2022-02-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2040124-3
ISSN	1472-0213 ; 1472-0205
ISSN (online)	1472-0213
ISSN	1472-0205
DOI	10.1136/emermed-2021-211753
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Zs.A 1941: Show issues

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