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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

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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Article ; Online: Variation and Drivers of Costs for Emergency Department Visits Among Children in 8 States.

Freiman, Eli C / Monuteaux, Michael C / Michelson, Kenneth A

Hospital pediatrics

2024 Volume 14, Issue 4, Page(s) 258–264

Abstract: Objective: To describe variation in costs for emergency department (ED) visits among children and to assess hospital and regional factors associated with costs.: Methods: Cross-sectional study of all ED encounters among children under 18 years in 8 ... ...

Abstract	Objective: To describe variation in costs for emergency department (ED) visits among children and to assess hospital and regional factors associated with costs. Methods: Cross-sectional study of all ED encounters among children under 18 years in 8 states from 2014 to 2018. The primary outcome was each hospital's mean inflation-adjusted ED costs. We evaluated variability in costs between hospitals and determined factors associated with costs using hierarchical linear models at the state, region, and hospital levels. Models adjusted for pediatric case mix, regional wages, Medicaid share, trauma status, critical access status, ownership, and market competitiveness. Results: We analyzed 22.9 million ED encounters across 713 hospitals. The median ED-level cost was $269 (range 99-1863). There was a 5.1-fold difference in median ED-level costs between the lowest- and highest-cost regions (range 119-605). ED-level costs were associated with case mix index (+38% per 10% increase, 95% confidence interval [CI] 30 to 47); wages [+7% per 10% increase, 95% CI 5 to 9]); critical access (adjusted costs, +24%, 95% CI 13 to 35); for profit status (-20%, 95% CI -26 to -14) compared with nonprofit, lowest trauma designation (+17%, 95% CI 5 to 30); teaching hospital status (+7%, 95% CI 1 to 14); highest number of inpatient beds (+13%, 95% CI 4 to 23); and Medicaid share versus quarter (Q)1 (Q2: -12%, 95% CI -18 to -7; Q3: -13%, 95% CI -19 to -7; Q4: -11%, 95% CI -17 to -4). Conclusions: Our results suggest nonclinical factors are important drivers of pediatric health care costs.
MeSH term(s)	United States ; Humans ; Child ; Adolescent ; Cross-Sectional Studies ; Emergency Room Visits ; Emergency Service, Hospital ; Medicaid ; Health Care Costs
Language	English
Publishing date	2024-03-20
Publishing country	United States
Document type	Journal Article
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2023-007417
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Article ; Online: Characterization of pediatric beta-adrenergic antagonist ingestions reported to the National Poison Data System from 2000 to 2020.

Watson, C James / Monuteaux, Michael C / Burns, Michele M

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2023 Volume 30, Issue 11, Page(s) 1129–1137

Abstract: Background: When ingested by children, small quantities of beta-adrenergic antagonists (BAA) are described as dangerous and even potentially lethal ("one pill can kill"). We characterize demographics, clinical characteristics, and the rate of serious ... ...

Abstract	Background: When ingested by children, small quantities of beta-adrenergic antagonists (BAA) are described as dangerous and even potentially lethal ("one pill can kill"). We characterize demographics, clinical characteristics, and the rate of serious outcomes among pediatric patients with reported BAA ingestions. Methods: This study was a retrospective review of U.S. patients <20 years old with reported single-agent BAA ingestions presenting to a health care facility between January 2000 and February 2020 for whom a poison control center was consulted. Data were abstracted from the National Poison Data System (NPDS). Medical outcomes were assessed by the NPDS scale of no effect, minor effect, moderate effect, major effect, and death. All relevant NPDS fatality narratives were reviewed. Results: A total of 35,436 reported exposures were identified. A total of 29,155 (82.3%) were <6 years old, of which 29,089 (99.8%) were unintentional. Twenty-five patients (<0.1%) <6 years old had major effects. A total of 2316 (8.8%) of patients with no/mild effects were admitted to a critical care unit. Of all cases, 1460 (4.1%) had hypotension and 1403 (4.0%) had bradycardia. One hundred nineteen (0.3%) developed hypoglycemia. The only four fatalities resulted from intentional ingestions in patients >10 years old who sustained cardiac arrest in the prehospital setting. Conclusions: Reported BAA ingestions in this multiyear national pediatric cohort caused infrequent toxicity, and no fatalities resulted from an unintentional ingestion. The frequency of bradycardia, hypotension, and hypoglycemia were low. While severely poisoned patients require aggressive treatment, 8.8% of patients were admitted to a critical care unit despite having no or mild effects, which suggests an opportunity to reduce resource utilization.
MeSH term(s)	Child ; Humans ; Young Adult ; Adult ; Poisons ; Bradycardia ; Databases, Factual ; Retrospective Studies ; Adrenergic beta-Antagonists ; Hypoglycemia ; Hypotension/chemically induced ; Hypotension/epidemiology ; Eating
Chemical Substances	Poisons ; Adrenergic beta-Antagonists
Language	English
Publishing date	2023-08-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1111/acem.14769
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Zs.A 4479: Show issues

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Article ; Online: Methodological Challenges in Studying Autism Spectrum Disorder.

Monuteaux, Michael C

Journal of the American Academy of Child and Adolescent Psychiatry

2018 Volume 57, Issue 11, Page(s) 824–825

Abstract: Evidence from genetic, animal, and epidemiologic studies have consistently implicated the serotonin (5-HT) system as an important risk factor for autism spectrum disorder (ASD). ...

Abstract	Evidence from genetic, animal, and epidemiologic studies have consistently implicated the serotonin (5-HT) system as an important risk factor for autism spectrum disorder (ASD).
MeSH term(s)	Animals ; Autism Spectrum Disorder ; Child ; Cognition ; Family ; Humans ; Risk Factors ; Serotonin
Chemical Substances	Serotonin (333DO1RDJY)
Language	English
Publishing date	2018-11-05
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	392535-3
ISSN	1527-5418 ; 0890-8567
ISSN (online)	1527-5418
ISSN	0890-8567
DOI	10.1016/j.jaac.2018.07.875
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Article ; Online: Impact of a Bronchiolitis Clinical Pathway on Management Decisions by Preferred Language.

Rosen, Robert H / Monuteaux, Michael C / Stack, Anne M / Michelson, Kenneth A / Fine, Andrew M

Pediatric quality & safety

2024 Volume 9, Issue 1, Page(s) e714

Abstract: Background: Clinical pathways standardize healthcare utilization, but their impact on healthcare equity is poorly understood. This study aims to measure the effect of a bronchiolitis pathway on management decisions by preferred language for care.: ... ...

Abstract	Background: Clinical pathways standardize healthcare utilization, but their impact on healthcare equity is poorly understood. This study aims to measure the effect of a bronchiolitis pathway on management decisions by preferred language for care. Methods: We included all emergency department encounters for patients aged 1-12 months with bronchiolitis from 1/1/2010 to 10/31/2020. The prepathway period ended 10/31/2011, and the postpathway period was 1/1/2012-10/31/2020. We performed retrospective interrupted time series analyses to assess the impact of the clinical pathway by English versus non-English preferred language on the following outcomes: chest radiography (CXR), albuterol use, 7-day return visit, 72-hour return to admission, antibiotic use, and corticosteroid use. Analyses were adjusted for presence of a complex chronic condition. Results: There were 1485 encounters in the preperiod (77% English, 14% non-English, 8% missing) and 7840 encounters in the postperiod (79% English, 15% non-English, 6% missing). CXR, antibiotic, and albuterol utilization exhibited sustained decreases over the study period. Pathway impact did not differ by preferred language for any outcome except albuterol utilization. The prepost slope effect of albuterol utilization was 10% greater in the non-English versus the English group (p for the difference by language = 0.022). Conclusions: A clinical pathway was associated with improvements in care regardless of preferred language. More extensive studies involving multiple pathways and care settings are needed to assess the impact of clinical pathways on health equity.
Language	English
Publishing date	2024-02-05
Publishing country	United States
Document type	Journal Article
ISSN	2472-0054
ISSN (online)	2472-0054
DOI	10.1097/pq9.0000000000000714
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Article ; Online: Predictors of Delayed Diagnosis of Pediatric CNS Tumors in the Emergency Department.

Young, Ann L / Monuteaux, Michael C / Cooney, Tabitha M / Michelson, Kenneth A

Pediatric emergency care

2023 Volume 39, Issue 8, Page(s) 617–622

Abstract: Objective: Central nervous system (CNS) tumor diagnoses are frequently delayed in children, which may lead to adverse outcomes and undue burdens on families. Examination of factors associated with delayed emergency department (ED) diagnosis could ... ...

Abstract	Objective: Central nervous system (CNS) tumor diagnoses are frequently delayed in children, which may lead to adverse outcomes and undue burdens on families. Examination of factors associated with delayed emergency department (ED) diagnosis could identify approaches to reduce delays. Study design: We performed a case-control study using data from 2014 to 2017 for 6 states. We included children aged 6 months to 17 years with a first diagnosis of CNS tumor in the ED. Cases had a delayed diagnosis, defined as 1 or more ED visits in the 140 days preceding tumor diagnosis (the mean prediagnostic symptomatic interval for pediatric CNS tumors in the United States). Controls had no such preceding visit. Results: We included 2828 children (2139 controls, 76%; 689 cases, 24%). Among cases, 68% had 1 preceding ED visit, 21% had 2, and 11% had 3 or more. Significant predictors of delayed diagnosis included presence of a complex chronic condition (adjusted odds ratio [aOR], 9.73; 95% confidence interval [CI], 6.67-14.20), rural hospital location (aOR, 6.37; 95% CI, 1.80-22.54), nonteaching hospital status (aOR, 3.05, compared with teaching hospitals; 95% CI, 1.94-4.80), age younger than 5 years (aOR, 1.57; 95% CI, 1.16-2.12), public insurance (aOR, 1.49, compared with private; 95% CI, 1.16-1.92), and Black race (aOR, 1.42, compared with White; 95% CI, 1.01-1.98). Conclusions: Delayed ED diagnosis of pediatric CNS tumors is common and frequently requires multiple ED encounters. Prevention of delays should focus on careful evaluation of young or chronically ill children, mitigating disparities for Black and publicly insured children, and improving pediatric readiness in rural and nonteaching EDs.
MeSH term(s)	Child ; Humans ; United States/epidemiology ; Case-Control Studies ; Delayed Diagnosis ; Emergency Service, Hospital ; Insurance Coverage ; Retrospective Studies
Language	English
Publishing date	2023-04-21
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.0000000000002943
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Zs.A 2083: Show issues

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Article ; Online: Severity of Illness in Bronchiolitis Amid Unusual Seasonal Pattern During the COVID-19 Pandemic.

Shanahan, Kristen H / Monuteaux, Michael C / Bachur, Richard G

Hospital pediatrics

2022 Volume 12, Issue 4, Page(s) e119–e123

Abstract: Objective: We aimed to characterize recent trends in bronchiolitis at US children's hospitals and to compare severity of illness in bronchiolitis in the most recent year to the previous seasonal epidemics.: Methods: This is a cross-sectional study of ...

Abstract	Objective: We aimed to characterize recent trends in bronchiolitis at US children's hospitals and to compare severity of illness in bronchiolitis in the most recent year to the previous seasonal epidemics. Methods: This is a cross-sectional study of visits for bronchiolitis in infants <24 months old from October 2016 to September 2021 at 46 US children's hospitals participating in the Pediatric Health Information Systems database. Study years were defined by 12-month periods beginning in October to account for typical winter epidemics that crossover calendar years. We used logistic and Fourier Poisson regression models to examine trends in outcomes and compare seasonality, respectively. Results: The study included 389 411 emergency visits for bronchiolitis. Median age of infants with bronchiolitis was higher in October 2020 to September 2021 compared to previous epidemics (8 and 6 months, respectively, P < .001) The odds of hospitalization, ICU admission, invasive mechanical ventilation, and noninvasive ventilation did not differ in October 2020 to September 2021 compared to previous epidemics from October 2016 to September 2020 (all P > .05 for unadjusted models and models adjusted for age). Seasonality varied significantly among these 2 periods (P < .001). Conclusions: Although the seasonality of bronchiolitis differed in October 2020 to September 2021, severity of illness in infants with bronchiolitis was consistent with previous epidemics.
MeSH term(s)	Bronchiolitis/epidemiology ; Bronchiolitis/therapy ; COVID-19/epidemiology ; Child ; Child, Preschool ; Cross-Sectional Studies ; Humans ; Infant ; Pandemics ; Seasons ; Severity of Illness Index
Language	English
Publishing date	2022-03-28
Publishing country	United States
Document type	Journal Article
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2021-006405
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Article ; Online: Nonoperative Management of Uncomplicated Appendicitis.

Lipsett, Susan C / Monuteaux, Michael C / Shanahan, Kristen H / Bachur, Richard G

Pediatrics

2022 Volume 149, Issue 5

Abstract: Background and objectives: Several studies have revealed the success of nonoperative management (NOM) of uncomplicated appendicitis in children. Large studies of current NOM utilization and its outcomes in children are lacking.: Methods: We queried ... ...

Abstract	Background and objectives: Several studies have revealed the success of nonoperative management (NOM) of uncomplicated appendicitis in children. Large studies of current NOM utilization and its outcomes in children are lacking. Methods: We queried the Pediatric Health Information System database to identify children <19 years of age with a diagnosis code for appendicitis. We used linear trend analysis to assess the subsequent utilization and outcomes of NOM in children with nonperforated appendicitis over time. We calculated the proportion of children experiencing treatment failure, defined as either a subsequent appendectomy or hospitalization with a diagnosis code of perforated appendicitis. Results: We identified 117 705 children with appendicitis over the 9-year study period. Of the 73 544 children with nonperforated appendicitis, 10 394 (14.1%) underwent NOM. The odds of NOM significantly increased (odds ratio 1.10 per study quarter, 95% confidence interval [CI] 1.05-1.15). The 1-year and 5-year failure rates were 18.6% and 23.3%, respectively. Children who experienced failure of NOM had higher rates of perforation at the time of failure than did the general cohort at the time of initial presentation (45.7% vs 37.5%, P < .001). Patients undergoing NOM had higher rates of subsequent related emergency department visits (8.0% vs 5.1%, P < .001) and hospitalizations (4.2% vs 1.4%, P < .001) over a 12-month follow-up period. Conclusions: NOM of nonperforated appendicitis in children is increasing. Although the majority of children who undergo NOM remain recurrence-free years later, they carry a substantial risk of perforation at the time of recurrence and may experience a higher rate of postoperative complications than children undergoing an immediate appendectomy.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Appendectomy ; Appendicitis/drug therapy ; Appendicitis/surgery ; Child ; Cohort Studies ; Humans ; Postoperative Complications/drug therapy ; Postoperative Complications/epidemiology ; Retrospective Studies ; Treatment Outcome
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-04-17
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.2021-054693
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Um IV Zs.131: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 357: Show issues

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Article ; Online: The authors reply.

Shanahan, Kristen H / Monuteaux, Michael C / Nagler, Joshua / Bachur, Richard G

Critical care medicine

2022 Volume 50, Issue 7, Page(s) e654–e655e

Language	English
Publishing date	2022-06-13
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000005552
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Zs.A 1261: Show issues

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Article ; Online: Resolution of Fever in the Pediatric Emergency Department and Bacteremia.

Baker, Alexandra H / Monuteaux, Michael C / Michelson, Kenneth A / Neuman, Mark I

Clinical pediatrics

2022 Volume 62, Issue 5, Page(s) 474–480

Abstract: To determine whether a lack of response to antipyretics was associated with bacteremia, we performed a cross-sectional study involving children with an initial temperature ≥38°C presenting to a pediatric emergency department (ED) from 2012 to 2020 who ... ...

Abstract	To determine whether a lack of response to antipyretics was associated with bacteremia, we performed a cross-sectional study involving children with an initial temperature ≥38°C presenting to a pediatric emergency department (ED) from 2012 to 2020 who received an antipyretic and had a blood culture obtained. We assessed the association of resolution of fever at specific time points after antipyretic administration with bacteremia adjusting for age, complex chronic condition, blood culture source, type of antipyretic, and height of temperature. Among 6319 febrile children, 242 (3.8%) had bacteremia. The adjusted odds ratio of bacteremia was 1.6 (95% confidence interval: 1.2-2.2) among children who remained febrile at 180 minutes and 1.7 (1.2-2.4) among children who remained febrile at 240 minutes. Among febrile children presenting to a tertiary care ED for whom a blood culture was obtained, the response to an antipyretic varies based on the presence or absence of bacteremia.
MeSH term(s)	Fever/drug therapy ; Fever/etiology ; Bacteremia/diagnosis ; Bacteremia/drug therapy ; Emergency Service, Hospital ; Antipyretics/therapeutic use ; Pediatrics ; Humans ; Male ; Female ; Child, Preschool ; Child ; Cross-Sectional Studies ; Infant
Chemical Substances	Antipyretics
Language	English
Publishing date	2022-11-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	207678-0
ISSN	1938-2707 ; 0009-9228
ISSN (online)	1938-2707
ISSN	0009-9228
DOI	10.1177/00099228221138212
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