Multisystem Inflammatory Syndrome in Children and Cardiac Involvement: A Quaternary Center Experience.

We prospectively analyzed clinical and laboratory characteristics associated with cardiac involvement and severe presentation in multisystem inflammatory syndrome in children. Of 146 patients, 66 (45.2%) had cardiac dysfunction and 26 (17.8%) had coronary artery abnormalities. Lower serum albumin levels, absolute lymphocyte and platelet counts, and elevated ferritin, fibrinogen, d-dimer and interleukin-6 levels were associated with cardiac dysfunction. Possible treatment complications were identified.

Healthy families: study protocol for a randomized controlled trial of a screening, brief intervention, and referral to treatment intervention for caregivers to reduce secondhand smoke exposure among pediatric emergency patients.

BACKGROUND: Involuntary exposure to secondhand smoke (SHSe) is an important cause of morbidity in children who present to the pediatric emergency department (PED) and urgent care (UC). SHSe interventions delivered in the PED and UC would benefit both the smoker and child, but there have been no large trials testing the efficacy of such interventions. The Healthy Families program is the first randomized controlled trial to test whether a screening, brief intervention, and referral to treatment (SBIRT) intervention delivered in the PED and UC will be effective in decreasing SHSe in children and increasing cessation in smokers. METHODS/DESIGN: This trial uses a randomized, two-group design in which caregiver-smokers of children 0-17 years old are recruited from the PED and UC. Eligible caregiver-smokers are randomized to either the: 1) SBIRT Condition with face-to-face, tailored counseling that focuses on the child's illness, the importance of reducing child SHSe, caregiver smoking cessation, and the option to receive nicotine replacement therapy; or 2) Healthy Habits Control Condition which includes face-to-face, tailored attention control "5-2-1-0" counseling that focuses on improving the child's health. Dyadic assessments are conducted in-person at baseline, and via email, phone, or in-person at 6-weeks and 6-months. The primary outcomes are biochemically-verified, 7-day point prevalence and prolonged smoking abstinence. Secondary outcomes are cigarettes smoked per week, 24 h quit attempts, and biochemically validated child SHSe at each time point. The costs of this intervention will also be analyzed. DISCUSSION: This study will test an innovative, multilevel intervention designed to reduce child SHSe and increase smoking cessation in caregivers. If effective and routinely used, this SBIRT model could reach at least one million smokers a year in the U.S., resulting in significant reductions in caregivers' tobacco use, SHSe-related pediatric illness, and healthcare costs in this population of children. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02531594. Date of registration: August 4, 2015.

Prevalence of male adolescent dating violence in the pediatric emergency department.

BACKGROUND: Adolescent dating violence (DV) is a growing problem in the United States. Identifying the most optimal venue for screening and determining risk factors for DV is important for treatment and prevention programs. The purposes of this study were to determine the prevalence of DV among male teens presenting to a Midwestern pediatric emergency department (PED) and to determine risk factors, types of injuries sustained, and interest in social service assistance. METHODS: Males (13-21 year old) presenting to a PED were prospectively enrolled. Exclusions included never dated, non-English speaking, critically ill, active psychosis, or caregiver nonwillingness to leave during study participation. The computerized survey consisted of demographics, a validated DV screen, risk factor assessment, and injuries from DV. At completion, all participants received DV educational materials and were offered social service referral. RESULTS: Of the 262 eligible approached participants, 198 (75.6%) were enrolled. The mean ± SE age of participants was 16.2 ± 0.13 years, with 106 white (53%) and 77 African American (39%). A total of 99 (50%) had DV education in the past; 39 (19.7%) screened positive for DV. Risk factors for those who screened positive include the following: 9 (29%) endorse riding in a car with a dating partner who was driving intoxicated, 27 (87%) admitted to drinking alcohol, and 11 (35%) have been treated for an sexually transmitted infection. Almost all injuries sustained as a result of DV (83%) were minor (scratches or scrapes). Only 2 (5%) accepted social service intervention and none for their DV exposure. CONCLUSION: One in five teen males who present to a PED in our population screened positive for DV. Using specific risk factors could aid practitioners in identifying those children more likely to screen positive. Injuries sustained were mild, and most did not accept social services consultation.

Eliminating disparity in evaluation for abuse in infants with head injury: use of a screening guideline.

PURPOSE: Minority and disadvantaged children are evaluated for nonaccidental trauma (NAT) at higher rates than other children. At our institution, we implemented a guideline to perform skeletal surveys to screen for occult fractures in all infants with unwitnessed head injury (UHI). The goal was to determine if this guideline decreased disparities in the screening of African American (AA) and uninsured children. PATIENTS AND METHODS: For 54 months, rates of skeletal surveillance and abuse determination were compared between AA and white infants admitted with UHI before and after implementation of our guideline. Logistic regression was used to control for confounders. RESULTS: Before the guideline, AAs underwent skeletal surveillance more than whites (n = 208; 90.5% vs 69.3%; P = .01), with 20% of screened infants determined to be probable victims of NAT. Whites with private insurance were less likely to be screened compared to those without private insurance (50.0% vs 88.1%; P < .001). After the guideline, AA and whites were surveyed equally (n = 52; 92.3% vs 84.6%; P = 1.0), with 22% found to be probable cases of NAT. CONCLUSIONS: This is the first report of a successful policy-based intervention to decrease disparity in care. The maintenance of a stable rate of NAT determination despite increased screening suggests more victims of abuse may be identified with guideline use, and therefore, this may be an additional benefit of the guideline.