A real-world evaluation of the effectiveness and Sufficiency of Current Emergency Department Preventative Strategies for Reducing Emergency Department revisits in a Canadian children's hospital: a retrospective cohort study.

BACKGROUND: Despite asthma guidelines' recommended emergency department preventative strategies (EDPS), repeat asthma-related emergency department (ED) visits remain frequent. METHODS: We performed a retrospective cohort study of children aged 1-17 years presenting with asthma to the Children's Hospital of Eastern Ontario (CHEO) ED between September 1, 2014 - August 31, 2015. EDPS was defined as provision of education on trigger avoidance and medication technique plus documentation of an asthma action plan, a prescription for an inhaled controller medication or referral to a specialist. Logistic regression was used to identify factors associated with receipt of EDPS. We further compared the odds of repeat presentation to the ED within the following year among children who had received EDPS versus those who had not. RESULTS: 1301 patients were included, and the mean age of those who received EDPS was 5.0 years (SD = 3.7). Those with a moderate (OR = 3.67, 95% CI: 2.49, 5.52) to severe (OR = 3.69, 95% CI: 2.50, 5.45) asthma presentation were most likely to receive EDPS. Receiving EDPS did not significantly reduce the adjusted odds of repeat ED visits, (OR = 0.82, 95% CI: 0.56, 1.18, p = 0.28). CONCLUSIONS: Patients with higher severity asthma presentations to the ED were more likely to receive EDPS, but this did not appear to significantly decrease the proportion with a repeat asthma ED visit. These findings suggest that receipt of EDPS in the ED may not be sufficient to prevent repeat asthma ED visits in all children.

Predictors of future acute asthma visits among children receiving guideline recommended emergency department discharge management.

BACKGROUND: Asthma emergency department (ED) visits remain frequent among children, prompting ongoing pursuit of preventative strategies. OBJECTIVE: We identified factors associated with future acute asthma ED visits among children who had already received guideline recommended discharge management following a prior asthma ED visit. METHODS: We performed a retrospective cohort study of children ages 1-17 years with a first asthma ED visit to the Children's Hospital of Eastern Ontario in Canada between September 2014-August 2015. Children who received recommended discharge management including an inhaled corticosteroids prescription and/or an asthma action plan were included. We used multivariable logistic regression to identify factors associated with a future acute asthma visits one year following the first ED visit. RESULTS: Among 909 children with a first asthma ED visit, 24% had a future acute asthma visit within one year. Future acute asthma visits were more likely in children with a nut/peanut allergy (OR 1.76, 95% CI: 1.15, 2.70), higher severity symptoms (OR 2.04, 95% CI: 1.23, 3.39), a primary care physician (OR 2.23, 95% CI: 1.26, 3.93), or a prior diagnosis of asthma (OR 1.53, 95% CI: 1.03, 2.28). CONCLUSION: Children at risk for repeat acute asthma ED visits despite having a primary care provider and receiving recommended discharge management at their first ED visit can be identified by factors such as having a nut/peanut allergy, a prior asthma diagnosis, and higher severity symptoms at ED presentation. These factors can be used to target more intensive preventative interventions to those most in need.

Trends in Pediatric Complicated Pneumonia in an Ontario Local Health Integration Network.

Following the introduction of 7-valent pneumococcal vaccine (PCV7), while overall rates of invasive pneumococcal disease and pneumococcal pneumonia in children declined, rates of empyema increased. We examined changes in the incidence of hospitalization for pediatric complicated pneumonia (PCOMP) in Eastern Ontario, Canada, particularly since the introduction of the 13-valent vaccine (PCV13). A retrospective chart review was carried out evaluating previously healthy children admitted with PCOMP, which included empyema, parapneumonic effusion, necrotizing pneumonia, and lung abscess between 2002 and 2015. Three-hundred seventy-one children were included. Subjects had a median age of four years, and 188/370 (50.8%) required a chest tube. Admission rates changed markedly during this time period. The number of admissions per year rose most sharply between 2009 and 2012, corresponding to the period following introduction of PCV7 and then the occurrence of pandemic influenza A (H1N1). In children who likely received PCV13, the incidence of PCOMP returned to approximately pre-PCV7 levels. In contrast, rates of PCOMP in older children (who would not have received PCV13) remained elevated during the post-PCV13 time period. While rates of PCOMP, particularly in older children, remain elevated following the introduction of PCV13, this might be expected to resolve with more widespread vaccine coverage with PCV13 and herd immunity.

Pediatric Absence Status Epilepticus: Prolonged Altered Mental Status in an 8-Year-Old Boy.

Absence status epilepticus is characterized by a prolonged state of impaired consciousness or altered sensorium with generalized electroencephalographic abnormalities. It is most commonly diagnosed in patients with known idiopathic generalized epilepsy; however, it may also be the first presentation of epilepsy. Due to the subtle and variable manifestations of the condition, absence status epilepticus may be underrecognized, particularly in children. We present the case of an 8-year-old boy who experienced two episodes of prolonged altered mental status, subsequently determined to be absence status epilepticus with idiopathic generalized epilepsy with phantom absences. We discuss the classification, pathophysiology, clinical presentation, and electroencephalographic findings of pediatric absence status epilepticus and provide a practical overview for management.

The Persian Checklist of Pleasant Events (PCPE): Development, Validity and Reliability.

OBJECTIVE: Experiencing pleasant events during daily life has a significant positive role in the personal mental health and acts as a keystone for "behavioral activation" (BA) interventions. There are serious differences in the pleasant event schedules in different cultures and countries. We aimed to develop a Persian checklist of pleasant events (PCPE) to provide and validate a culturally compatible checklist for Iranians. METHODS: To develop a checklist of pleasant events, inspired by Pleasant Events Schedule (PES) (MacPhillamy & Lewinsohn, 1982), we held three focused group discussions with 24 normal healthy participants from both genders (female = 12) and asked them to mention as much pleasant events as possible. When the list reached saturation level, the inappropriate items with respect to legal, cultural and religious concerns were omitted. The final checklist of PCPE consists of two subscales: Frequency (frequency of events during last month) and pleasantness (perceived pleasantness of events). The total score consists of frequency multiplied by pleasantness. To test the reliability and validity of the checklist, the PCPE, Depression, Anxiety and Stress Scale (DASS), the Persian version of WHO Quality of Life and the Demographic Questionnaire were administered in a sample of 104 participants (50 male and 54 female). RESULTS: Frequency, pleasantness and the total scores of PCPE showed high levels of internal consistency (Cronbach's alpha, .976, .976 & .974, respectively). Further support for the convergent validity of the PCPE was obtained via moderate negative correlations with depression, anxiety, stress scores in DASS and positive correlation with quality of life as well as respondent's perceived happiness. There were negative correlations between frequency, pleasantness and total scores and age of the participants (Pearson correlation coefficient, r = -.194, p<0.05; r = -.270, p<0.01 & r = -.234, p<0.05, respectively). Conclusion : PCPE as an assessment tool has shown to have good reliability and validity among Iranians. Further steps should be taken to validate this instrument in different psychopathologies such as depression, addiction and obesity. .