Childbearing and Family Leave Policies for Physicians at US Children's Hospitals.

The objective of this study was to examine the childbirth and parental leave policies for physicians at children's hospitals. We obtained institutional policies from 15 hospitals in 2021. The median duration of full salaried leave was 8 weeks (range, 2-12 weeks). Leave policies vary widely among US children's hospitals.

Infant Outcomes among Teenage and Young Mothers: Racial Inequities and the Role of Educational Attainment.

OBJECTIVE: To examine the association of age-appropriate maternal educational attainment in teenage and young mothers on infant health outcomes across racial/ethnic groups. STUDY DESIGN: In this retrospective, cross-sectional study using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Natality data (2016-2017), we included live births comparing 14- to 19- year-old mothers with 20- to 24-year-old mothers. To analyze the association of maternal age-appropriate education (≥8th grade for 15-18 years of age, 9th-12th grade/completed high school for 19-24 years of age), we conducted multivariable regression adjusting for mothers' demographics, reporting adjusted incidence rate ratios with 95% CI for infant mortality rate, and logistic regression for extreme prematurity and low birth weight, reporting aORs with 95% CI. RESULTS: From 2016 to 2017, there were 1 976 334 live births among women 14-24 years of age; 407 576 (20.6%) were in 14- to 19-year-olds. In the multivariable model, increased term infant mortality rate was associated with age 14-19 years (adjusted incidence rate ratio 1.18, 95% 1.10, 1.27), age-inappropriate education (adjusted incidence rate ratio 1.38, 95% CI 1.28, 1.48), and non-Hispanic Black mothers (adjusted incidence rate ratio 1.21, 95% CI 1.12, 1.30). Extreme prematurity was associated with women age 14-19 years (aOR 1.35, 95% CI 1.30, 1.40), non-Hispanic Black (aOR 2.50, 95% CI 2.39, 2.61), and Hispanic mothers (aOR 1.09, 95% CI 1.04, 1.15). Term infant low birth weight was associated with age 14-19 years (aOR 1.14, 95% CI 1.12, 1.16), age-inappropriate education for non-Hispanic White (aOR 1.16, 95% CI 1.11, 1.21), and non-Hispanic Black (aOR 1.08, 1.04, 1.12) mothers. CONCLUSIONS: Inadequate maternal educational attainment, which is influenced by modifiable social policies, is associated with increased adverse infant outcomes in mothers 14-24 years of age.

Complexity and Severity of Pediatric Patients Treated at United States Emergency Departments.

OBJECTIVE: To compare the complexity and severity of presentation of children in general vs pediatric emergency departments (EDs). STUDY DESIGN: We performed a cross-sectional study of pediatric ED visits using the National Emergency Department Sample from 2008 to 2012. We classified EDs as "pediatric" if >75% of patients were <18 years old; all other EDs were classified as "general." The presence of an International Classification of Diseases, Ninth Revision code for a complex chronic condition was used as an indicator of patient complexity. Patient severity was evaluated with the severity classification system. In addition, rates of critical procedures and hospitalization were assessed. RESULTS: We identified 9.6 million encounters to pediatric EDs and 169 million to general EDs. Younger children account for a greater proportion of visits at pediatric EDs than general EDs; children <1 year of age account for 18% of visits to a pediatric ED compared with 9% of visits to a general ED (P < .01). Encounters at pediatric EDs had greater complexity (5% vs 2%; P < .01). Although severity classification system scores did not significantly differ by ED type, pediatric EDs had greater rates of hospitalization (10% vs 4%). CONCLUSIONS: Pediatric EDs provided care to a greater proportion of medically complex children than general EDs and had greater rates of hospitalization. This information may inform educational efforts in residency or postgraduate training to ensure high-quality care for children with complex health care needs.

Emergency department practice variation in computed tomography use for children with minor blunt head trauma.

OBJECTIVE: To describe factors associated with computed tomography (CT) use for children with minor blunt head trauma that are evaluated in emergency departments. STUDY DESIGN: Planned secondary analysis of a prospective observational study of children <18 years with minor blunt head trauma between 2004 and 2006 at 25 emergency departments. CT scans were obtained at the discretion of treating clinicians. We risk-adjusted patients for clinically important traumatic brain injuries and performed multivariable regression analyses. Outcome measures were rates of CT use by hospital and by clinician training type. RESULTS: CT rates varied between 19.2% and 69.2% across hospitals. Risk adjustment had little effect on the differential rate of CT use. In low- and middle-risk patients, clinicians obtained CTs more frequently at suburban and nonfreestanding children's hospitals. Physicians with emergency medicine (EM) residency training obtained CTs at greater rates than physicians with pediatric residency or pediatric EM training. In multivariable analyses, compared with pediatric EM-trained physicians, the OR for CT use among EM-trained physicians in children <2 years was 1.24 (95% CI 1.04-1.46), and for children >2 years was 1.68 (95% CI 1.50-1.89). Physicians of all training backgrounds, however, overused CT scans in low-risk children. CONCLUSIONS: Substantial variation exists in the use of CT for children with minor blunt head trauma not explained by patient severity or rates of positive CT scans or clinically important traumatic brain injuries.

Bicycle helmet laws are associated with a lower fatality rate from bicycle-motor vehicle collisions.

OBJECTIVE: To assess the association between bicycle helmet legislation and bicycle-related deaths sustained by children involved in bicycle-motor vehicle collisions. STUDY DESIGN: We conducted a cross-sectional study of all bicyclists aged 0-16 years included in the Fatality Analysis Reporting System who died between January 1999 and December 2010. We compared fatality rates in age-specific state populations between states with helmet laws and those without helmet laws. We used a clustered Poisson multivariate regression model to adjust for factors previously associated with rates of motor vehicle fatalities: elderly driver licensure laws, legal blood alcohol limit (<0.08% vs ≥ 0.08%), and household income. RESULTS: A total of 1612 bicycle-related fatalities sustained by children aged <16 years were evaluated. There were no statistically significant differences in median household income, the proportion of states with elderly licensure laws, or the proportion of states with a blood alcohol limit of >0.08% between states with helmet laws and those without helmet laws. The mean unadjusted fatality rate was lower in states with helmet laws (2.0/1,000,000 vs 2.5/1,000,000; P = .03). After adjusting for potential confounding factors, lower fatality rates persisted in states with mandatory helmet laws (adjusted incidence rate ratio, 0.84; 95% CI, 0.70-0.98). CONCLUSION: Bicycle helmet safety laws are associated with a lower incidence of fatalities in child cyclists involved in bicycle-motor vehicle collisions.

Pediatric traumatic brain injury and radiation risks: a clinical decision analysis.

OBJECTIVE: To determine the optimal imaging strategy for young children with minor head injury considering health-related quality of life and radiation risk. In children with minor head trauma, the risk of missing a clinically important traumatic brain injury (ciTBI) must be weighed against the risk of radiation-induced malignancy from computed tomography (CT) to assess impact on public health. STUDY DESIGN: We included children <2 years old with minor blunt head trauma defined by a Glasgow Coma Scale score of 14-15. We used decision analysis to model a CT-all versus no-CT strategy and assigned values to clinical outcomes based on a validated health-related quality of life scale: (1) baseline health; (2) non-ciTBI; (3) ciTBI without neurosurgery, death, or intubation; and (4) ciTBI with neurosurgery, death, or intubation >24 hours with probabilities from a prospective study of 10000 children. Sensitivity analysis determined the optimal management strategy over a range of ciTBI risk. RESULTS: The no-CT strategy resulted in less risk with the expected probability of a ciTBI of 0.9%. Sensitivity analysis for the probability of ciTBI identified 4.8% as the threshold above which CT all becomes the preferred strategy and shows that the threshold decreases with less radiation. The CT all strategy represents the preferred approach for children identified as high-risk. CONCLUSION: Among children <2 years old with minor head trauma, the no-CT strategy is preferable for those at low risk, reserving CT for children at higher risk.

Intracranial hemorrhage after blunt head trauma in children with bleeding disorders.

OBJECTIVE: To determine computerized tomography (CT) use and prevalence of traumatic intracranial hemorrhage (ICH) in children with and without congenital and acquired bleeding disorders. STUDY DESIGN: We compared CT use and ICH prevalence in children with and without bleeding disorders in a multicenter cohort study of 43 904 children <18 years old with blunt head trauma evaluated in 25 emergency departments. RESULTS: A total of 230 children had bleeding disorders; all had Glasgow Coma Scale (GCS) scores of 14 to 15. These children had higher CT rates than children without bleeding disorders and GCS scores of 14 to 15 (risk ratio, 2.29; 95% CI, 2.15 to 2.44). Of the children who underwent imaging with CT, 2 of 186 children with bleeding disorders had ICH (1.1%; 95% CI, 0.1 to 3.8) , compared with 655 of 14 969 children without bleeding disorders (4.4%; 95% CI, 4.1-4.7; rate ratio, 0.25; 95% CI, 0.06 to 0.98). Both children with bleeding disorders and ICHs had symptoms; none of the children required neurosurgery. CONCLUSION: In children with head trauma, CTs are obtained twice as often in children with bleeding disorders, although ICHs occurred in only 1.1%, and these patients had symptoms. Routine CT imaging after head trauma may not be required in children without symptoms who have congenital and acquired bleeding disorders.