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  1. 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
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: A Novel Risk Score to Guide the Evaluation of Acute Hematogenous Osteomyelitis in Children.

    Stephan, Alexander M / Platt, Shari / Levine, Deborah A / Qiu, Yuqing / Buchhalter, Lillian / Lyons, Todd W / Gaines, Nakia / Cruz, Andrea T / Sudanagunta, Sindhu / Hardee, Isabel J / Eisenberg, Jonathan R / Tamas, Vanessa / McAneney, Constance / Chinta, Sri S / Yeung, Claudia / Root, Jeremy M / Fant, Colleen / Dunnick, Jennifer / Pifko, Elysha /
    Campbell, Christine / Bruce, Madison / Srivastava, Geetanjali / Pruitt, Christopher M / Hueschen, Leslie A / Ugalde, Irma T / Becker, Callie / Granda, Elena / Klein, Eileen J / Kaplan, Ron L

    Pediatrics

    2024  Volume 153, Issue 2

    Abstract: Objectives: To identify independent predictors of and derive a risk score for acute hematogenous osteomyelitis (AHO) in children.: Methods: We conducted a retrospective matched case-control study of children >90 days to <18 years of age undergoing ... ...

    Abstract Objectives: To identify independent predictors of and derive a risk score for acute hematogenous osteomyelitis (AHO) in children.
    Methods: We conducted a retrospective matched case-control study of children >90 days to <18 years of age undergoing evaluation for a suspected musculoskeletal (MSK) infection from 2017 to 2019 at 23 pediatric emergency departments (EDs) affiliated with the Pediatric Emergency Medicine Collaborative Research Committee. Cases were identified by diagnosis codes and confirmed by chart review to meet accepted diagnostic criteria for AHO. Controls included patients who underwent laboratory and imaging tests to evaluate for a suspected MSK infection and received an alternate final diagnosis.
    Results: We identified 1135 cases of AHO matched to 2270 controls. Multivariable logistic regression identified 10 clinical and laboratory factors independently associated with AHO. We derived a 4-point risk score for AHO using (1) duration of illness >3 days, (2) history of fever or highest ED temperature ≥38°C, (3) C-reactive protein >2.0 mg/dL, and (4) erythrocyte sedimentation rate >25 mm per hour (area under the curve: 0.892, 95% confidence interval [CI]: 0.881 to 0.901). Choosing to pursue definitive diagnostics for AHO when 3 or more factors are present maximizes diagnostic accuracy at 84% (95% CI: 82% to 85%), whereas children with 0 factors present are highly unlikely to have AHO (sensitivity: 0.99, 95% CI: 0.98 to 1.00).
    Conclusions: We identified 10 predictors for AHO in children undergoing evaluation for a suspected MSK infection in the pediatric ED and derived a novel 4-point risk score to guide clinical decision-making.
    MeSH term(s) Child ; Humans ; Retrospective Studies ; Case-Control Studies ; Osteomyelitis/diagnosis ; Acute Disease ; Risk Factors ; Fever
    Language English
    Publishing date 2024-01-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.2023-063153
    Database MEDical Literature Analysis and Retrieval System OnLINE

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