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Article ; Online: Reduced Computed Tomography for Appendicitis in Children after Implementation of Next-day Surgery Clinic Follow-up.

Ryan, Sydney / Dudley, Nanette C / Schunk, Jeff E / Weng, Cindy / Skarda, David E / Glissmeyer, Eric W

Pediatric quality & safety

2023 Volume 8, Issue 2, Page(s) e641

Abstract: The use of computed tomography (CT) in the emergency department (ED) evaluation of pediatric patients for suspected appendicitis can be safely reduced. However, published examples of reduced CT use also report increased MRI utilization, ED length of stay, ...

Abstract	The use of computed tomography (CT) in the emergency department (ED) evaluation of pediatric patients for suspected appendicitis can be safely reduced. However, published examples of reduced CT use also report increased MRI utilization, ED length of stay, hospitalization rates, and in-ED surgical consultation. In addition, previous studies recommended follow-up for undifferentiated abdominal pain, yet none with pediatric surgeons. Therefore, we implemented a diagnostic algorithm that includes an option for next-day surgery clinic follow-up in cases where uncertainty remains after appendix ultrasound (US) to reduce CT utilization without increasing hospital-based resources. Methods: We implemented a diagnostic algorithm in January 2014. We retrospectively identified 4,577 patients who underwent an evaluation for suspected appendicitis from January 2012 to September 2015. CT utilization was compared before and after implementation using Statistical Process Control. In addition, we evaluated secondary outcomes, including US utilization, hospital admission, surgery clinic follow-up, ED surgery consultation, ED return visits within 7 days, and ED length of stay. Results: Following the implementation of the algorithm, CT utilization decreased significantly from 13.8% to 6%. Forty-eight patients were evaluated the next day in the optional pediatric surgery clinic for 21 months after implementation. There was no significant change in US utilization, hospital admission, ED surgery consultation, ED return visits within 7 days, or ED length of stay. Conclusion: We achieved decreased CT utilization without an increase in the utilization of other hospital-based resources after implementing a pediatric appendicitis evaluation algorithm that includes the option for next-day pediatric surgery clinic follow-up.
Language	English
Publishing date	2023-03-13
Publishing country	United States
Document type	Journal Article
ISSN	2472-0054
ISSN (online)	2472-0054
DOI	10.1097/pq9.0000000000000641
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Article: To Err One's Dirty Laundry.

Larsen, Gitte / Schunk, Jeff E

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

2015 Volume 16, Issue 5, Page(s) 488–489

MeSH term(s)	Diagnostic Errors/statistics & numerical data ; Female ; Humans ; Intensive Care Units, Pediatric/statistics & numerical data ; Male
Language	English
Publishing date	2015-06
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	2052349-X
ISSN	1947-3893 ; 1529-7535
ISSN (online)	1947-3893
ISSN	1529-7535
DOI	10.1097/PCC.0000000000000399
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Zs.A 5600: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 472: Show issues

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Article ; Online: Enroller Experience and Parental Familiarity of Disease Influence Participation in a Pediatric Trial.

Schunk, Jeff E / Jacobsen, Kammy K / Stephens, Dilon / Watson, Amy / Olsen, Cody S / Casper, T Charles / Glaser, Nicole S / Kuppermann, Nathan

The western journal of emergency medicine

2021 Volume 22, Issue 5, Page(s) 1176–1182

Abstract: Introduction: Acquiring parental consent is critical to pediatric clinical research, especially in interventional trials. In this study we investigated demographic, clinical, and environmental factors associated with likelihood of parental permission ... ...

Abstract	Introduction: Acquiring parental consent is critical to pediatric clinical research, especially in interventional trials. In this study we investigated demographic, clinical, and environmental factors associated with likelihood of parental permission for enrollment in a study of therapies for diabetic ketoacidosis (DKA) in children. Methods: We analyzed data from patients and parents who were approached for enrollment in the Pediatric Emergency Care Applied Research Network (PECARN) Fluid Therapies Under Investigation in DKA (FLUID) trial at one major participating center. We determined the influence of various factors on patient enrollment, including gender, age, distance from home to hospital, insurance status, known vs new onset of diabetes, glycemic control (hemoglobin A1c), DKA severity, gender of the enroller, experience of the enroller, and time of enrollment. Patients whose parents consented to participate were compared to those who declined participation using bivariable and multivariable analyses controlling for the enroller. Results: A total of 250 patient/parent dyads were approached; 177 (71%) agreed to participate, and 73 (29%) declined. Parents of patients with previous episodes of DKA agreed to enroll more frequently than those with a first DKA episode (94.3% for patients with 1-2 previous DKA episodes, 92.3% for > 2 previous episodes, vs 64.9% for new onset diabetes and 63.2% previously diagnosed but no previous DKA). Participation was also more likely with more experienced enrollers (odds ratio [95% confidence interval] of participation for an enroller with more than two years' experience vs less than two years: 2.46 [1.53, 3.97]). After adjusting for demographic and clinical factors, significant associations between participation and both DKA history and enroller experience remained. Patient age, gender, distance of home from hospital, glycemic control, insurance status, and measures of DKA severity were not associated with likelihood of participation. Conclusion: Familiarity with the disease process (previously diagnosed diabetes and previous experience with DKA) and experience of the enroller favorably influenced the likelihood of parental permission for enrollment in a study of DKA in children.
MeSH term(s)	Adolescent ; Biomedical Research ; Child ; Clinical Trials as Topic ; Diabetes Mellitus, Type 1/complications ; Diabetic Ketoacidosis/epidemiology ; Diabetic Ketoacidosis/etiology ; Diabetic Ketoacidosis/therapy ; Female ; Fluid Therapy ; Humans ; Male ; Parental Consent/psychology ; Parents/psychology ; Surveys and Questionnaires
Language	English
Publishing date	2021-09-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375700-0
ISSN	1936-9018 ; 1936-9018
ISSN (online)	1936-9018
ISSN	1936-9018
DOI	10.5811/westjem.2021.4.54647
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Article ; Online: Pediatric head injury.

Schunk, Jeff E / Schutzman, Sara A

Pediatrics in review

2012 Volume 33, Issue 9, Page(s) 398–410; quiz 410–1

MeSH term(s)	Advanced Trauma Life Support Care ; Airway Management ; Child ; Craniocerebral Trauma/diagnosis ; Craniocerebral Trauma/epidemiology ; Craniocerebral Trauma/physiopathology ; Craniocerebral Trauma/therapy ; Encephalocele/physiopathology ; Glasgow Coma Scale ; Humans ; Oxygen Inhalation Therapy ; Tomography, X-Ray Computed
Language	English
Publishing date	2012-09
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	774515-1
ISSN	1526-3347 ; 0191-9601
ISSN (online)	1526-3347
ISSN	0191-9601
DOI	10.1542/pir.33-9-398
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Article ; Online: Relationships among biochemical measures in children with diabetic ketoacidosis.

Glaser, Nicole S / Stoner, Michael J / Kwok, Maria Y / Quayle, Kimberly S / Brown, Kathleen M / Schunk, Jeff E / Trainor, Jennifer L / McManemy, Julie K / Tzimenatos, Leah / Rewers, Arleta / Nigrovic, Lise E / Bennett, Jonathan E / Myers, Sage R / Smith, McKenna / Casper, T Charles / Kuppermann, Nathan

Journal of pediatric endocrinology & metabolism : JPEM

2023 Volume 36, Issue 3, Page(s) 313–318

Abstract: Objectives: Investigating empirical relationships among laboratory measures in children with diabetic ketoacidosis (DKA) can provide insights into physiological alterations occurring during DKA. We determined whether alterations in laboratory measures ... ...

Abstract	Objectives: Investigating empirical relationships among laboratory measures in children with diabetic ketoacidosis (DKA) can provide insights into physiological alterations occurring during DKA. We determined whether alterations in laboratory measures during DKA conform to theoretical predictions. Methods: We used Pearson correlation statistics and linear regression to investigate correlations between blood glucose, electrolytes, pH and PCO Results: pH and bicarbonate levels were strongly correlated (r=0.64), however, pH and PCO Conclusions: Elevated glucose levels at DKA presentation largely reflect alterations in glomerular filtration rate. pH and PCO
MeSH term(s)	Humans ; Child ; Diabetic Ketoacidosis ; Blood Glucose ; Glucose ; Glomerular Filtration Rate ; Diabetes Mellitus
Chemical Substances	Blood Glucose ; Glucose (IY9XDZ35W2)
Language	English
Publishing date	2023-01-16
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1231070-0
ISSN	2191-0251 ; 0334-018X
ISSN (online)	2191-0251
ISSN	0334-018X
DOI	10.1515/jpem-2022-0570
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Zs.A 2258: Show issues

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Article ; Online: Improving Head CT Scan Decisions for Pediatric Minor Head Trauma in General Emergency Departments: A Pragmatic Implementation Study.

Knighton, Andrew J / Wolfe, Doug / Hunt, Angelene / Neeley, Allison / Shrestha, Neer / Hess, Steven / Hellewell, James / Snow, Gregory / Srivastava, Rajendu / Nelson, Douglas / Schunk, Jeff E

Annals of emergency medicine

2022 Volume 80, Issue 4, Page(s) 332–343

Abstract: Study objective: To measure the effectiveness of a multimodal strategy, including simultaneous implementation of a clinical decision support system, to sustain adherence to a clinical pathway for care of children with minor head trauma treated in ... ...

Abstract	Study objective: To measure the effectiveness of a multimodal strategy, including simultaneous implementation of a clinical decision support system, to sustain adherence to a clinical pathway for care of children with minor head trauma treated in general emergency departments (EDs). Methods: Prospective, type III hybrid effectiveness-implementation cohort study with a nonrandomized stepped-wedge design and monthly repeated site measures. The study population included pediatric minor head trauma encounters from July 2018 to December 2020 at 21 urban and rural general ED sites in an integrated health care system. Sites received the intervention in 1 of 2 steps, with each site providing control and intervention observations. Measures included guideline adherence, the computed tomography (CT) scan rate, and 72-hour readmissions with clinically important traumatic brain injury. Analysis was performed using multilevel hierarchical modeling with random intercepts for the site and physician. Results: During the study, 12,670 pediatric minor head trauma encounters were cared for by 339 clinicians. The implementation of the clinical pathway resulted in higher odds of guideline adherence (adjusted odds ratio 1.12 [95% confidence interval 1.03 to 1.22]) and lower odds of a CT scan (adjusted odds ratio 0.96 [95% confidence interval 0.93 to 0.98]) in intervention versus control months. Absolute risk difference was observed in both guideline adherence (site median: +2.3% improvement) and the CT scan rate (site median: -6.6% reduction). No 72-hour readmissions with confirmed clinically important traumatic brain injury were identified. Conclusion: Implementation of a minor head trauma clinical pathway using a multimodal approach, including a clinical decision support system, led to sustained improvements in adherence and a modest, yet safe, reduction in CT scans among generally low-risk patients in diverse general EDs.
MeSH term(s)	Brain Injuries, Traumatic ; Child ; Cohort Studies ; Craniocerebral Trauma/diagnostic imaging ; Craniocerebral Trauma/epidemiology ; Craniocerebral Trauma/therapy ; Emergency Service, Hospital ; Humans ; Prospective Studies ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2022-06-23
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	603080-4
ISSN	1097-6760 ; 0196-0644
ISSN (online)	1097-6760
ISSN	0196-0644
DOI	10.1016/j.annemergmed.2022.04.030
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Zs.A 1344: Show issues

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Article ; Online: An Administrative Data-based Surrogate Definition Identifies Children Evaluated Beyond Physical Examination for Suspected Appendicitis.

Glissmeyer, Eric W / Ryan, Sydney / Dudley, Nanette C / Schunk, Jeff E / Nielsen, Jeremy / Weng, Cindy / Skarda, David E

Pediatric quality & safety

2020 Volume 5, Issue 6, Page(s) e343

Abstract: Previous studies have reported on the evaluation of patients diagnosed with appendicitis. Very little is known about all patients evaluated for suspected appendicitis. Patients evaluated beyond physical examination with laboratory and imaging testing, ... ...

Abstract	Previous studies have reported on the evaluation of patients diagnosed with appendicitis. Very little is known about all patients evaluated for suspected appendicitis. Patients evaluated beyond physical examination with laboratory and imaging testing, then found not to have appendicitis, are more difficult to identify. Data readily available in administrative databases may be used to identify these patients. Methods: A multidisciplinary team developed a surrogate definition for evaluating suspected appendicitis in children based on available administrative data. Appendicitis was "suspected" if the patient underwent ultrasonography of the appendix or had a chief complaint of abdominal pain with both complete blood count performed and the word "appendicitis" in the ED provider note. Performance characteristics described the surrogate definition's ability to retrospectively identify patients evaluated for suspected appendicitis through comparison to a population identified via chart review. Results: Compared with manual chart review of 498 patients from June 2014, the surrogate definition identified patients evaluated beyond physical examination for suspected appendicitis with a sensitivity of 79.8%, a specificity of 96.3%, a positive predictive value of 83.3%, and a negative predictive value of 95.3%. Of the 94 patients evaluated beyond physical examination for suspected appendicitis, 37 (39%) underwent appendectomy. Conclusions: Health systems can retrospectively identify children evaluated beyond physical examination for appendicitis using discrete administrative data and a word search of clinical notes. This surrogate definition for evaluation of suspected appendicitis enables research in quality improvement efforts and health care resource utilization.
Language	English
Publishing date	2020-10-23
Publishing country	United States
Document type	Journal Article
ISSN	2472-0054
ISSN (online)	2472-0054
DOI	10.1097/pq9.0000000000000343
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Article ; Online: Pediatric emergency department triage-based pain guideline utilizing intranasal fentanyl: Effect of implementation.

Schoolman-Anderson, Kristin / Lane, Roni D / Schunk, Jeff E / Mecham, Nancy / Thomas, Richard / Adelgais, Kathleen

The American journal of emergency medicine

2018 Volume 36, Issue 9, Page(s) 1603–1607

Abstract: Background: Pain management guidelines in the emergency department (ED) may reduce time to analgesia administration (TTA). Intranasal fentanyl (INF) is a safe and effective alternative to intravenous opiates. The effect of an ED pain management ... ...

Abstract	Background: Pain management guidelines in the emergency department (ED) may reduce time to analgesia administration (TTA). Intranasal fentanyl (INF) is a safe and effective alternative to intravenous opiates. The effect of an ED pain management guideline providing standing orders for nurse-initiated administration of intranasal fentanyl (INF) is not known. The objective of this study was to determine the impact of a pediatric ED triage-based pain protocol utilizing intranasal fentanyl (INF) on time to analgesia administration (TTA) and patient and parent satisfaction. Methods: This was a prospective study of patients 3-17 years with an isolated orthopedic injury presenting to a pediatric ED before and after instituting a triage-based pain guideline allowing for administration of INF by triage nurses. Our primary outcome was median TTA and secondary outcomes included the proportion of patients who received INF for pain, had unnecessary IV placement, and patient and parent satisfaction. Results: We enrolled 132 patients; 72 pre-guideline, 60 post-guideline. Demographics were similar between groups. Median TTA was not different between groups (34.5 min vs. 33 min, p = .7). Utilization of INF increased from 41% pre-guideline to 60% post-guideline (p = .01) and unnecessary IV placement decreased from 24% to 0% (p = .002). Patients and parents preferred the IN route for analgesia administration. Conclusion: A triage-based pain protocol utilizing INF did not reduce TTA, but did result in increased INF use, decreased unnecessary IV placement, and was preferred by patients and parents to IV medication. INF is a viable analgesia alternative for children with isolated extremity injuries.
MeSH term(s)	Administration, Intranasal ; Adolescent ; Analgesics, Opioid/administration & dosage ; Child ; Child, Preschool ; Female ; Fentanyl/administration & dosage ; Guideline Adherence ; Humans ; Male ; Pain/prevention & control ; Pain Measurement ; Practice Guidelines as Topic ; Prospective Studies ; Self Report ; Tertiary Care Centers ; Tertiary Healthcare ; Treatment Outcome ; Triage/methods
Chemical Substances	Analgesics, Opioid ; Fentanyl (UF599785JZ)
Language	English
Publishing date	2018-01-16
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Observational Study
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2018.01.042
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Zs.A 2005: Show issues

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Article ; Online: A Randomized Controlled Trial of Positioning for Lumbar Puncture in Young Infants.

Hanson, Amy L / Schunk, Jeff E / Corneli, Howard M / Soprano, Joyce V

Pediatric emergency care

2016 Volume 32, Issue 8, Page(s) 504–507

Abstract: Objective: The lateral and sitting positions are those most widely used to perform lumbar puncture (LP) in infants. This study sought to compare LP success rates by position. Secondary outcomes were successful LP on the first attempt and rates of ... ...

Abstract	Objective: The lateral and sitting positions are those most widely used to perform lumbar puncture (LP) in infants. This study sought to compare LP success rates by position. Secondary outcomes were successful LP on the first attempt and rates of procedural complications. Methods: Infants aged 1 to 90 days undergoing LP in our pediatric emergency department between June 1, 2012 and October 31, 2013 were randomized to 1 position or the other. Successful LP was defined as collection of cerebrospinal fluid with a red blood cell count of less than 10,000 cells/mm on either of the first 2 attempts. Electronic medical records were reviewed for patient information, cerebrospinal fluid results, and procedural complications. Providers completed a questionnaire detailing their previous LP experience and technique. Primary results were analyzed using the intention-to-treat principle. Results: We enrolled 168 infants. Of 167 with data eligible for analysis, 82 (49%) were randomized to the lateral position. There was no statistically significant difference in LP success rate between the lateral (77%, 63/82) and sitting (72%, 61/85) positions (difference, 5.1%; 95% confidence interval, -8.2%-18.3%). There were no significant differences in success on the first LP attempt or the rates of procedural complications. Conclusions: Among infants 1 to 90 days of age, this study found no difference in LP success between the lateral and sitting positions.
MeSH term(s)	Emergency Service, Hospital ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Patient Positioning/adverse effects ; Patient Positioning/methods ; Spinal Puncture/methods ; Surveys and Questionnaires ; Treatment Outcome
Language	English
Publishing date	2016-08
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial
ZDB-ID	632588-9
ISSN	1535-1815 ; 0749-5161
ISSN (online)	1535-1815
ISSN	0749-5161
DOI	10.1097/PEC.0000000000000469
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Article ; Online: Sunflower rectal bezoar presenting with an acute abdomen in a 3-year-old child.

Lane, Roni D / Schunk, Jeff E

Pediatric emergency care

2010 Volume 26, Issue 9, Page(s) 662–664

Abstract: This is a case of a 3-year-old boy with a sunflower-seed rectal bezoar who presented to our emergency department with fever, abdominal pain, leukocytosis, vomiting, and an examination concerning for appendicitis. A failed diagnostic imaging attempt ... ...

Abstract	This is a case of a 3-year-old boy with a sunflower-seed rectal bezoar who presented to our emergency department with fever, abdominal pain, leukocytosis, vomiting, and an examination concerning for appendicitis. A failed diagnostic imaging attempt ultimately led to the diagnosis. Children with rectal bezoars typically present with diarrhea, rectal pain, and tenesmus. Our patient presented atypically and developed significant colitis secondary to the bezoar. We discuss bezoars and the uncommon rectal seed bezoar. This case illustrates an atypical complication (colitis) of an unusual condition (rectal bezoar) mimicking a relatively common illness (appendicitis).
MeSH term(s)	Abdomen, Acute/diagnostic imaging ; Abdomen, Acute/etiology ; Bezoars/complications ; Bezoars/diagnostic imaging ; Child, Preschool ; Diagnosis, Differential ; Helianthus ; Humans ; Male ; Radiography, Abdominal ; Rectum ; Tomography, X-Ray Computed
Language	English
Publishing date	2010-09
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	632588-9
ISSN	1535-1815 ; 0749-5161
ISSN (online)	1535-1815
ISSN	0749-5161
DOI	10.1097/PEC.0b013e3181f048d6
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