Epidemiology of 30,000 Pediatric Urgent Care Telemedicine Visits in the Era of COVID-19.

Background: To describe the epidemiology of patients accessing a pediatric urgent care telemedicine platform during the COVID-19 pandemic. Study Design: We conducted a cross-sectional study of the first 30,000 pediatric patients who accessed our pediatric urgent care telemedicine platform during the beginning of the COVID-19 pandemic. The study population came from 15 states and included the dates May 15 through September 16, 2020. We also described the groups of patients referred for in-person evaluation in urgent care or emergency department (ED) settings. Results: Mean patient age was 7.6 ± 5.4 years and 51% of patients were male. Twenty-one percent were publicly insured. More than 60% of patients sought care between 12 and 7 p.m. The most common reasons for seeking care were concerns for COVID-19 (50.5%) and fever (6.8%). Antibiotics were prescribed in 4.3% of visits. Children had an in-person visit to our urgent care offices on the same day in 9% of visits. Less than 1% of children were referred to the ED. Conclusions: In this large series of telemedicine visits during the COVID-19 pandemic, fewer than 10% required escalation to an in-person office visit and fewer than 1% required escalation to an ED.

Access to Critical Health Information for Children During Emergencies: Emergency Information Forms and Beyond.

ABSTRACT: Children with chronic medical conditions rely on complex management plans for problems that cause them to be at increased risk for suboptimal outcomes in emergency situations. The emergency information form (EIF) is a medical summary that provides rapid access to critical information to physicians and other members of the health care team so that optimal emergency medical care can be provided. This statement describes an updated approach to EIFs and the information they contain. Essential common data elements are reviewed, integration with electronic health records is discussed, and broadening the rapid availability and use of health data for all children and youth is proposed. A broader approach to data accessibility and use could extend the benefits of rapid access to critical information for all children receiving emergency care as well as further facilitating emergency preparedness during disaster management.

National survey 2004 on medical services for persons with intellectual disability in residential care in Israel.

In Israel, the Office of the Medical Director of the Ministry of Social Affairs is responsible for the medical service in residential-care centers for persons with intellectual disability (ID). A standard annual questionnaire was developed during 1997-1998, and the first national survey study was conducted in 1998. This present paper presents the findings of the seventh national survey in 2004, for which the following information was gathered via questionnaires: age, gender, and level of intellectual disability of persons served at the residential care center in question, status of the population served, functional profile, nursing, medical, and allied professional staff, number of annual examinations, preventive medicine aspects, medications, number of annual cases of infectious disease, annual unintentional injuries, number of deaths, number of hospitalizations, internal residential center hospitalization, ambulatory out-patient use, use of outside laboratory examinations, and dental care. In 2004, 6,610 persons were served in nine government, 37 private, and 12 public centers. The average number of persons served per center was 113.97 (range 23 to 372). The survey in 2004 showed that 79.2% of the population with ID in residential care in Israel was between 20 and 60 years of age; 48.8% had severe or profound ID, 41% had moderate ID, and 10% had mild ID; 23% were nursing patients; 19% were confined to a wheelchair; 31% had epilepsy; 83% were receiving medication daily for chronic illness; and 52.5% were receiving psychotropic medication for psychiatric illness.

Residential care centers for persons with intellectual disability in Israel. Trends in the number of nursing care patients during 1998-2007.

Nursing care has changed over time and the focus has differed according to the need or the culture involved. One of the first descriptions of nursing of people with intellectual disability (ID) is from the United States at the New York Hospital around 1808. Over the next 200 years, ID nursing developed into a subspecialty in both the United States and England with a curriculum and certification. This process has yet to take place in Israel, but it is a change we would like to see in the coming years. The purpose of this paper was to look at the trend in the number of nursing patients in residential care centers for people with ID in Israel. Data were extracted from the 1998-2007 national annual surveys of all residential care centers in Israel. Over this 10-year period, we found that the number of nursing patients was fairly constant, ranging from 23.9% of the total population in 1998 to 26.5% in 2007. Whereas the percent of nursing patients has remained steady, the burden of nursing has increased. Specifically, due to the aging of this population, residential care centers are now dealing with an increased quantity and complexity of medical problems. As a result, we have experienced a need to establish, on a regional basis, long-term nursing care facilities within our residential care centers.

Perioperative risk factors for major complications in pediatric surgery: a study in surgical risk assessment for children.

BACKGROUND: There are numerous studies in the adult literature correlating comorbidities and pre- and intraoperative parameters with postoperative outcomes. However, there is a paucity of similar data in the pediatric population. Our goal was to elucidate which pre- and intraoperative patient characteristics in children undergoing surgery are associated with an increased risk of major complication within 30 days. STUDY DESIGN: We identified 108 children who underwent surgery at our institution between June 2005 and May 2007 and had major complication or death within 30 days of surgery. Forty-two preoperative patient characteristics and 22 intraoperative variables were evaluated. The severity of the complications was graded based on the Clavien classification system, with major complications grade III or greater. We randomly selected 723 controls who had undergone surgery within a 3-month date range of the original cohort, but did not develop complications. Statistical significance was assessed by univariate and multivariate analyses. RESULTS: Most complications were cardiovascular, occurred 1 to 3 days after surgery, and were classified as grade IIIB. We identified 5 independent risk factors on multivariate analysis: ≤36 weeks of gestation, American Society of Anesthesiologists score >3, undergoing a cardiovascular or neurosurgical procedure, and receiving an intraoperative albumin transfusion. Three scoring systems (overall, preoperative, and intraoperative complication score) were developed to provide objective risk stratification. CONCLUSIONS: We found 5 patient-specific parameters that were independent risk factors for major complications or death after pediatric surgery. Future prospective studies will help to fully stratify risk and guide interventions to improve postoperative outcomes.