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Article ; Online: Diarrhea and Abdominal Pain in a 9-year-old Girl.

Patten, William F / McLaren, Son H / Carter, R Colin

2022 Volume 43, Issue 9, Page(s) 521–524

MeSH term(s)	Abdominal Pain/etiology ; Child ; Diarrhea/etiology ; Female ; Humans
Language	English
Publishing date	2022-08-28
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	774515-1
ISSN	1526-3347 ; 0191-9601
ISSN (online)	1526-3347
ISSN	0191-9601
DOI	10.1542/pir.2020-001560
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Article ; Online: Factors associated with mild bronchiolitis in young infants.

McLaren, Son H / Qi, Ying Shelly / Espinola, Janice A / Mansbach, Jonathan M / Dayan, Peter S / Camargo, Carlos A

Journal of the American College of Emergency Physicians open

2023 Volume 4, Issue 3, Page(s) e12966

Abstract: Objective: Bronchiolitis within the first 3 months of life is a risk factor for more severe illness. We aimed to identify characteristics associated with mild bronchiolitis in infants ≤90 days old presenting to the emergency department (ED).: Methods!# ...

Abstract	Objective: Bronchiolitis within the first 3 months of life is a risk factor for more severe illness. We aimed to identify characteristics associated with mild bronchiolitis in infants ≤90 days old presenting to the emergency department (ED). Methods: We conducted a secondary analysis of infants ≤90 days old with clinically diagnosed bronchiolitis using data from the 25th Multicenter Airway Research Collaboration prospective cohort study. We excluded infants with direct intensive care unit admissions. Mild bronchiolitis was defined as (1) sent home after the index ED visit and did not have a return ED visit or had a return ED visit without hospitalization, or (2) were hospitalized from the index ED visit to the inpatient floor for <24 hours. Multivariable logistic regression, adjusting for potential clustering by hospital site, was used to identify factors associated with mild bronchiolitis. Results: Of 373 infants aged ≤90 days, 333 were eligible for analysis. Of these, 155 (47%) infants had mild bronchiolitis, and none required mechanical ventilation. Adjusting for infant characteristics, clinical factors associated with mild bronchiolitis included older age (61-90 days vs 0-60 days) (odds ratio [OR] 2.72, 95% confidence interval [CI] 1.52-4.87), adequate oral intake (OR 4.48, 95% CI 2.08-9.66), and lowest ED oxygen saturation ≥94% (OR 3.12, 95% CI 1.55-6.30). Conclusions: Among infants aged ≤90 days presenting to the ED with bronchiolitis, about half had mild bronchiolitis. Mild illness was associated with older age (61-90 days), adequate oral intake, and oxygen saturation ≥94%. These predictors may help in the development of strategies to limit unnecessary hospitalization in young infants with bronchiolitis.
Language	English
Publishing date	2023-05-16
Publishing country	United States
Document type	Journal Article
ISSN	2688-1152
ISSN (online)	2688-1152
DOI	10.1002/emp2.12966
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Article ; Online: Otologic Examination Findings In Afebrile Young Infants Clinically Diagnosed With Acute Otitis Media.

McLaren, Son H / Shah, Nipam / Schmidt, Suzanne M / Wang, Aijin / Thompson, Julia / Dayan, Peter S / Pruitt, Christopher M

The Pediatric infectious disease journal

2022 Volume 41, Issue 7, Page(s) e290–e292

Abstract: There are limited data on examination criteria for diagnosing acute otitis media in young infants. In this 33-site retrospective study of afebrile infants ≤90 days, clinicians typically documented tympanic membrane erythema with ≥1 other otologic ... ...

Abstract	There are limited data on examination criteria for diagnosing acute otitis media in young infants. In this 33-site retrospective study of afebrile infants ≤90 days, clinicians typically documented tympanic membrane erythema with ≥1 other otologic abnormalities (64.1%) to diagnose acute otitis media. Notable differences in ear examination findings used for diagnosis existed across age subgroups.
MeSH term(s)	Humans ; Infant ; Otitis Media/diagnosis ; Retrospective Studies ; Tympanic Membrane
Language	English
Publishing date	2022-06-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	392481-6
ISSN	1532-0987 ; 0891-3668
ISSN (online)	1532-0987
ISSN	0891-3668
DOI	10.1097/INF.0000000000003537
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Article ; Online: High-throughput Sequencing to Identify Bacteremia in Children with Cancer.

McLaren, Son H / Mishra, Nischay / Hijiya, Nobuko / Ng, James / Guo, Cheng / Whittier, Susan / Mariani, Erica / Glaser, Laura / Frantzis, Irene / Vindas, Marc T / Leu, Cheng-Shiun / Dayan, Peter S

The Pediatric infectious disease journal

2023 Volume 42, Issue 8, Page(s) 695–697

Abstract: Current methods to diagnose bacteremia are limited. In this pilot study of children with cancer presenting with fever, we determined the concordance between a novel high-throughput sequencing platform called BacCapSeq and blood culture. High-throughput ... ...

Abstract	Current methods to diagnose bacteremia are limited. In this pilot study of children with cancer presenting with fever, we determined the concordance between a novel high-throughput sequencing platform called BacCapSeq and blood culture. High-throughput sequencing had modest concordance with blood culture. Discordant organisms included those with both unlikely or potential clinical relevance.
MeSH term(s)	Child ; Humans ; Infant ; Pilot Projects ; Bacteremia/diagnosis ; Neoplasms/complications ; High-Throughput Nucleotide Sequencing
Language	English
Publishing date	2023-04-27
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	392481-6
ISSN	1532-0987 ; 0891-3668
ISSN (online)	1532-0987
ISSN	0891-3668
DOI	10.1097/INF.0000000000003948
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Article ; Online: SARS-CoV-2 Viral Shedding and Rapid Antigen Test Performance - Respiratory Virus Transmission Network, November 2022-May 2023.

Smith-Jeffcoat, Sarah E / Mellis, Alexandra M / Grijalva, Carlos G / Talbot, H Keipp / Schmitz, Jonathan / Lutrick, Karen / Ellingson, Katherine D / Stockwell, Melissa S / McLaren, Son H / Nguyen, Huong Q / Rao, Suchitra / Asturias, Edwin J / Davis-Gardner, Meredith E / Suthar, Mehul S / Kirking, Hannah L

MMWR. Morbidity and mortality weekly report

2024 Volume 73, Issue 16, Page(s) 365–371

Abstract: As population immunity to SARS-CoV-2 evolves and new variants emerge, the role and accuracy of antigen tests remain active questions. To describe recent test performance, the detection of SARS-CoV-2 by antigen testing was compared with that by reverse ... ...

Abstract	As population immunity to SARS-CoV-2 evolves and new variants emerge, the role and accuracy of antigen tests remain active questions. To describe recent test performance, the detection of SARS-CoV-2 by antigen testing was compared with that by reverse transcription-polymerase chain reaction (RT-PCR) and viral culture testing during November 2022-May 2023. Participants who were enrolled in a household transmission study completed daily symptom diaries and collected two nasal swabs (tested for SARS-CoV-2 via RT-PCR, culture, and antigen tests) each day for 10 days after enrollment. Among participants with SARS-CoV-2 infection, the percentages of positive antigen, RT-PCR, and culture results were calculated each day from the onset of symptoms or, in asymptomatic persons, from the date of the first positive test result. Antigen test sensitivity was calculated using RT-PCR and viral culture as references. The peak percentage of positive antigen (59.0%) and RT-PCR (83.0%) results occurred 3 days after onset, and the peak percentage of positive culture results (52%) occurred 2 days after onset. The sensitivity of antigen tests was 47% (95% CI = 44%-50%) and 80% (95% CI = 76%-85%) using RT-PCR and culture, respectively, as references. Clinicians should be aware of the lower sensitivity of antigen testing compared with RT-PCR, which might lead to false-negative results. This finding has implications for timely initiation of SARS-CoV-2 antiviral treatment, when early diagnosis is essential; clinicians should consider RT-PCR for persons for whom antiviral treatment is recommended. Persons in the community who are at high risk for severe COVID-19 illness and eligible for antiviral treatment should seek testing from health care providers with the goal of obtaining a more sensitive diagnostic test than antigen tests (i.e., an RT-PCR test).
MeSH term(s)	Humans ; COVID-19/diagnosis ; COVID-19/transmission ; SARS-CoV-2/isolation & purification ; SARS-CoV-2/immunology ; SARS-CoV-2/genetics ; COVID-19 Serological Testing ; Adult ; Virus Shedding ; Antigens, Viral/analysis ; Male ; Sensitivity and Specificity ; Female ; Middle Aged ; COVID-19 Nucleic Acid Testing ; Young Adult ; Adolescent ; United States/epidemiology ; Aged ; COVID-19 Testing
Chemical Substances	Antigens, Viral
Language	English
Publishing date	2024-04-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	412775-4
ISSN	1545-861X ; 0149-2195
ISSN (online)	1545-861X
ISSN	0149-2195
DOI	10.15585/mmwr.mm7316a2
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Article ; Online: Impact of Ondansetron Prescription on Return Emergency Department Visits Among Children with Acute Gastroenteritis.

McLaren, Son H / Yim, Ramy B / Fleegler, Eric W

Pediatric emergency care

2019 Volume 37, Issue 12, Page(s) e1087–e1092

Abstract: Objectives: The objective of this study was to determine if providing ondansetron prescription to children with acute gastroenteritis seen in the emergency department (ED) is associated with reduced unscheduled ED revisits.: Methods: This was a ... ...

Abstract	Objectives: The objective of this study was to determine if providing ondansetron prescription to children with acute gastroenteritis seen in the emergency department (ED) is associated with reduced unscheduled ED revisits. Methods: This was a retrospective comparative cohort study conducted in a tertiary urban pediatric ED. We evaluated otherwise healthy children 6 months to 18 years old who presented to the ED between 2010 and 2015 and were discharged home with acute gastroenteritis diagnosis. Illness severity was determined using dehydration score, emergency severity index, and presenting symptoms. The incidence of unscheduled 72-hour ED revisit among patients discharged home with ondansetron prescription was compared with those without a prescription. Results: Of the 11,785 eligible patients, 35.5% (N = 4,187) of patients were discharged home with ondansetron prescription. After adjustment for emergency severity index, age, insurance source, race, time of index visit registration, intravenous fluid use, and ED-administered ondansetron, there were no differences in the rates of ED revisit (adjusted odds ratio [aOR] = 1.12 [0.92, 1.33]) or admission after ED revisit (aOR = 0.81 [0.51, 1.27]) among children with versus without ondansetron prescription. No difference was found in the proportion of alternative diagnoses among returning patients with versus without ondansetron prescription (aOR = 0.56 [0.20, 1.59]). Conclusions: There was no association between ondansetron prescription and ED revisit among children seen in the ED with suspected acute gastroenteritis. In the appropriate setting, however, physicians may consider prescribing ondansetron for symptom control in conjunction with careful discharge instructions.
MeSH term(s)	Antiemetics/therapeutic use ; Child ; Cohort Studies ; Emergency Service, Hospital ; Gastroenteritis/drug therapy ; Humans ; Ondansetron/therapeutic use ; Prescriptions ; Retrospective Studies
Chemical Substances	Antiemetics ; Ondansetron (4AF302ESOS)
Language	English
Publishing date	2019-09-02
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.0000000000001907
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Article ; Online: Presence and Duration of Symptoms in Febrile Infants With and Without SARS-CoV-2 Infection.

McLaren, Son H / Dayan, Peter S / Zachariah, Philip / McCann, Teresa A / Lubell, Tamar R

The Pediatric infectious disease journal

2020 Volume 39, Issue 11, Page(s) e372–e374

Abstract: The clinical course of SARS-CoV-2 infection in young infants is not well understood. In this prospective cohort study, we compared the presence and duration of symptoms in febrile infants ≤60 days with (n = 7) and without (n = 16) SARS-CoV-2 infection. ... ...

Abstract	The clinical course of SARS-CoV-2 infection in young infants is not well understood. In this prospective cohort study, we compared the presence and duration of symptoms in febrile infants ≤60 days with (n = 7) and without (n = 16) SARS-CoV-2 infection. Overall, we observed overlapping symptoms and duration of illness, with longer length of cough and nasal congestion among the SARS-CoV-2-positive infants.
MeSH term(s)	Betacoronavirus/isolation & purification ; COVID-19 ; Cohort Studies ; Coronavirus Infections/diagnosis ; Coronavirus Infections/physiopathology ; Coronavirus Infections/virology ; Cough/physiopathology ; Cough/virology ; Fever/physiopathology ; Fever/virology ; Humans ; Infant ; Infant, Newborn ; Pandemics ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/physiopathology ; Pneumonia, Viral/virology ; Prospective Studies ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-10-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	392481-6
ISSN	1532-0987 ; 0891-3668
ISSN (online)	1532-0987
ISSN	0891-3668
DOI	10.1097/INF.0000000000002858
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Article ; Online: Association Between Government Health Insurance Status and Physical Activity in American Youth.

Fabricant, Peter D / McLaren, Son H / Suryavanshi, Joash R / Nwachukwu, Benedict U / Dodwell, Emily R

Journal of pediatric orthopedics

2019 Volume 39, Issue 7, Page(s) e552–e557

Abstract: Background: Health insurance plans provide health programming access and affect physical activity levels in American youth, leading to health disparities in American children. The primary purpose of the current study was to investigate the relationship ... ...

Abstract	Background: Health insurance plans provide health programming access and affect physical activity levels in American youth, leading to health disparities in American children. The primary purpose of the current study was to investigate the relationship between health insurance status and physical activity level in American youth. Methods: A national, United States census weighted cross-sectional survey was performed analyzing 2002 noninstitutionalized children living in the United States between the ages of 10 to 18 years, equally split by age and sex, with state of residency and race/ethnicity proportional to the 2010 census distribution. Multiple linear regression was performed to investigate the relationship between insurance status and activity level (measured by HSS Pedi-FABS activity score) while controlling for relevant demographic and socioeconomic covariables. Results: HSS Pedi-FABS activity scores were normally distributed with a mean of 15.4±8.5 points (of 30 possible points). Patients with an insurance status of "government/Medicaid," "other," or "none" each demonstrated significantly lower physical activity scores (14.2±8.5 vs. 13.6±9.0 vs. 10.1±8.5) than children with private insurance (16.5±8.2) (one-way ANOVA with Dunnett-adjusted pairwise comparisons, P<0.001), which remained statistically significant while controlling for Area Deprivation Index, age, gender, race/ethnicity, and Body Mass Index (β=-1.8, P<0.001). Conclusions: Government/Medicaid health insurance status and lack of health care coverage are associated with low levels of physical activity in American children, even while controlling for socioeconomic confounders. Collaborative work between health care providers and community/ school-based programs may be a reasonable approach to expanding access to recreation, organized sports, and physical activity for publicly and uninsured children. Level of evidence: Level II-Prognostic Study.
MeSH term(s)	Adolescent ; Body Mass Index ; Child ; Cross-Sectional Studies ; Ethnic Groups ; Exercise ; Female ; Government ; Health Services Accessibility ; Humans ; Insurance Coverage ; Insurance, Health ; Male ; Medicaid ; Sports/statistics & numerical data ; United States
Language	English
Publishing date	2019-01-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	604642-3
ISSN	1539-2570 ; 0271-6798
ISSN (online)	1539-2570
ISSN	0271-6798
DOI	10.1097/BPO.0000000000001329
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Article ; Online: Guideline Adherence in Diagnostic Testing and Treatment of Community-Acquired Pneumonia in Children.

McLaren, Son H / Mistry, Rakesh D / Neuman, Mark I / Florin, Todd A / Dayan, Peter S

Pediatric emergency care

2019 Volume 37, Issue 10, Page(s) 485–493

Abstract: Objectives: The objective of this study was to determine emergency department (ED) physician adherence with the 2011 Pediatric Infectious Diseases Society (PIDS) and Infectious Diseases Society of America (IDSA) guidelines for outpatient management of ... ...

Abstract	Objectives: The objective of this study was to determine emergency department (ED) physician adherence with the 2011 Pediatric Infectious Diseases Society (PIDS) and Infectious Diseases Society of America (IDSA) guidelines for outpatient management of children with mild-to-moderate community-acquired pneumonia (CAP). Methods: A cross-sectional survey of physicians on the American Academy of Pediatrics Section on Emergency Medicine Survey listserv was conducted. We evaluated ED physicians' reported adherence with the PIDS/IDSA guidelines through presentation of 4 clinical vignettes representing mild-to-moderate CAP of presumed viral (preschool-aged child), bacterial (preschool and school-aged child), and atypical bacterial (school-aged child) etiology. Results: Of 120 respondents with analyzable data (31.4% response rate), use of chest radiograph (CXR) was nonadherent to the guidelines in greater than 50% of respondents for each of the 4 vignettes. Pediatric emergency medicine fellowship training was independently associated with increased CXR use in all vignettes, except for school-aged children with bacterial CAP. Guideline-recommended amoxicillin was selected to treat bacterial CAP by 91.7% of the respondents for preschool-aged children and by 75.8% for school-aged children. Macrolide monotherapy for atypical CAP was appropriately selected by 88.2% and was associated with obtaining a CXR (adjusted odds ratio, 3.9 [95% confidence interval, 1.4-11.1]). Guideline-adherent antibiotic use for all vignettes was independently associated with congruence between respondent's presumed diagnosis and the vignette's intended etiologic diagnosis. Conclusions: Reported ED CXR use in the management of outpatient CAP was often nonadherent to the PIDS/IDSA guidelines. Most respondents were adherent to the guidelines in their use of antibiotics. Strategies to increase diagnostic test accuracy are needed to improve adherence and reduce variation in care.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Child ; Child, Preschool ; Community-Acquired Infections/diagnosis ; Community-Acquired Infections/drug therapy ; Cross-Sectional Studies ; Diagnostic Tests, Routine ; Guideline Adherence ; Humans ; Pneumonia/diagnosis ; Pneumonia/drug therapy ; United States
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2019-02-13
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.0000000000001745
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Article: Presence and Duration of Symptoms in Febrile Infants With and Without SARS-CoV-2 Infection

McLaren, Son H / Dayan, Peter S / Zachariah, Philip / McCann, Teresa A / Lubell, Tamar R

Pediatr Infect Dis J

Abstract	The clinical course of SARS-CoV-2 infection in young infants is not well understood. In this prospective cohort study, we compared the presence and duration of symptoms in febrile infants ≤60 days with (n = 7) and without (n = 16) SARS-CoV-2 infection. Overall, we observed overlapping symptoms and duration of illness, with longer length of cough and nasal congestion among the SARS-CoV-2-positive infants.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #873112
Database	COVID19

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