Caregiver-reported delay in presentation to pediatric emergency departments for fear of contracting COVID-19: a multi-national cross-sectional study.

OBJECTIVE: To determine if caregivers of children presenting to pediatric emergency departments (EDs) during the COVID-19 pandemic are delaying presenting to care for fear of contracting COVID-19. METHODS: This was a pre-planned secondary analysis of a cross-sectional survey study of caregivers accompanying their children aged 0-19 years to 16 pediatric EDs in 5 countries from May to June 2020. An anonymous online survey, completed by caregivers via RedCAP, included caregiver and child demographics, presenting complaints, if they delayed presentation and whether symptoms worsened during this interval, as well as caregiver concern about the child or caregiver having COVID-19 at the time of ED visit. RESULTS: Of 1543 caregivers completing the survey, 287 (18.6%) reported a delay in seeking ED care due to concerns of contracting COVID-19 in the hospital. Of those, 124 (43.2%) stated their child's symptoms worsened during the waiting interval. Caregiver relationship to child [mother] (OR 1.85, 95% CI 1.27-2.76), presence of chronic illness in child (OR 1.78. 95% CI 1.14-2.79), younger age of caregiver (OR 0.965, 95% CI 0.943-0.986), and caregiver concerns about lost work during the pandemic (OR 1.08, 95% CI 1.04-1.12) were independently associated with a COVID-19-related delayed presentation in multivariable regression analysis. CONCLUSIONS: Almost one in five caregivers reported delaying ED presentation for their ill or injured child specifically due to fear of contracting COVID-19 while in hospital, with mothers, younger caregivers, caregivers of children with chronic illness, and those concerned about lost work more likely to report delaying ED presentation.

RéSUMé: OBJECTIF: Déterminer si les aidants des enfants qui se présentent aux services d'urgence pédiatriques (SU) pendant la pandémie de COVID-19 retardent leur présentation pour prendre soin d'eux par crainte de contracter la COVID-19. MéTHODES: Il s'agissait d'une analyze secondaire planifiée à l'avance d'une étude d'enquête transversale auprès des soignants accompagnant leurs enfants âgés de 0 à 19 ans dans 16 urgences pédiatriques de 5 pays entre mai et juin 2020. Une enquête anonyme en ligne, remplie par les soignants via RedCAP, comprenait les données démographiques du soignant et de l'enfant, les plaintes présentées, s'ils ont retardé la présentation et si les symptômes se sont aggravés pendant cet intervalle, ainsi que l'inquiétude du soignant quant à la présence de COVID-19 chez l'enfant ou le soignant au moment de la visite aux urgences. RéSULTATS: Sur les 1 543 soignants ayant répondu à l'enquête, 287 (18.6 %) ont déclaré avoir retardé le recours aux urgences par crainte de contracter le COVID-19 à l'hôpital. Parmi eux, 124 (43.2%) ont déclaré que les symptômes de leur enfant s'étaient aggravés pendant l'intervalle d'attente. Dans l'analyse de régression multivariable, le lien entre la personne qui s'occupe de l'enfant et la mère (OR 1.85, IC95 % 1.27­2.76), la présence d'une maladie chronique chez l'enfant (OR 1.78, IC95 % 1.14-2.79), le jeune âge de la personne qui s'occupe de l'enfant (OR 0.965, IC95 % 0.943-0.986) et les préoccupations de la personne qui s'occupe de l'enfant concernant la perte de travail pendant la pandémie (OR 1.08, IC95 % 1.04­1.12) ont été associés de manière indépendante à une présentation tardive. CONCLUSIONS: Près d'un soignant sur cinq a déclaré avoir retardé la présentation aux urgences de son enfant malade ou blessé par crainte de contracter le COVID-19 pendant son séjour à l'hôpital, avec les mères, les jeunes aidants, les soignants d'enfants souffrant de maladies chroniques et les personnes préoccupées par la perte de travail sont plus susceptibles de retarder la présentation aux urgences.

Willingness to Vaccinate Children against Influenza after the Coronavirus Disease 2019 Pandemic.

OBJECTIVES: To determine factors associated with parents who plan to vaccinate their children against influenza next year, especially those who did not vaccinate against influenza last year using a global survey. STUDY DESIGN: A survey of caregivers accompanying their children aged 1-19 years old in 17 pediatric emergency departments in 6 countries at the peak of the coronavirus disease 2019 (COVID-19) pandemic. Anonymous online survey included caregiver and child demographic information, vaccination history and future intentions, and concern about the child and caregiver having COVID-19 at the time of emergency department visit. RESULTS: Of 2422 surveys, 1314 (54.2%) caregivers stated they plan to vaccinate their child against influenza next year, an increase of 15.8% from the previous year. Of 1459 caregivers who did not vaccinate their children last year, 418 (28.6%) plan to do so next year. Factors predicting willingness to change and vaccinate included child's up-to-date vaccination status (aOR 2.03, 95% CI 1.29-3.32, P = .003); caregivers' influenza vaccine history (aOR 3.26, 95% CI 2.41-4.40, P < .010), and level of concern their child had COVID-19 (aOR 1.09, 95% CI 1.01-1.17, P = .022). CONCLUSIONS: Changes in risk perception due to COVID-19, and previous vaccination, may serve to influence decision-making among caregivers regarding influenza vaccination in the coming season. To promote influenza vaccination among children, public health programs can leverage this information.

Caregivers' Willingness to Accept Expedited Vaccine Research During the COVID-19 Pandemic: A Cross-sectional Survey.

PURPOSE: This study determined the predictors of caregivers' willingness to accept an accelerated regulatory process for the development of vaccines against coronavirus disease 2019 (COVID-19). METHODS: An international cross-sectional survey was administered to 2557 caregivers of children in 17 pediatric emergency departments (EDs) across 6 countries from March 26, 2020, to June 30, 2020. Caregivers were asked to select 1 of 4 choices with which they most agreed regarding a proposed COVID-19 vaccine-approval process, in addition to questions regarding demographic characteristics, the ED visit, and attitudes about COVID-19. Univariate analyses were conducted using the Mann-Whitney U test for comparing non-normally distributed continuous variables, an independent t test for comparing normally distributed continuous variables, and a χ2 or Fisher exact test for categorical variables. Multivariate logistic regression analysis was used for determining independent factors associated with caregivers' willingness to accept abridged development of a COVID-19 vaccine. A P value of <0.05 was considered significant. FINDINGS: Almost half (1101/2557; 43%) of caregivers reported that they were willing to accept less rigorous testing and postresearch approval of a new COVID-19 vaccine. Independent factors associated with caregivers' willingness to accept expedited COVID-19 vaccine research included having children who were up to date on the vaccination schedule (odds ratio [OR] = 1.72; 95% CI, 1.29-2.31), caregivers' concern about having had COVID-19 themselves at the time of survey completion in the ED (OR = 1.1; 95% CI, 1.05-1.16), and caregivers' intent to have their children vaccinated against COVID-19 if a vaccine were to become available (OR = 1.84; 95% CI, 1.54-2.21). Compared with fathers, mothers completing the survey were less likely to approve of changes in the vaccine-development process (OR = 0.641; 95% CI, 0.529-0.775). IMPLICATIONS: Less than half of caregivers in this worldwide sample were willing to accept abbreviated COVID-19 vaccine testing. As a part of an effort to increase acceptance and uptake of a new vaccine, especially in order to protect children, public health strategies and individual providers should understand caregivers' attitudes toward the approval of a vaccine and consult them appropriately.

Predictors of Airspace Disease on Chest X-ray in Emergency Department Patients With Clinical Bronchiolitis: A Systematic Review and Meta-analysis.

BACKGROUND: An abnormal chest X-ray (CXR) inconsistent with simple bronchiolitis is found in 7%-23% of cases. Despite national guidelines stating "current evidence does not support routine radiography in children with bronchiolitis"; the use of CXR in these patients remains high. Inappropriate use of CXR not only exposes children to excess radiation, but also increases medical costs. The majority of the time, CXRs are obtained to diagnose or rule out pneumonia. We aim to provide an evidence-based approach defining the utility of CXR in bronchiolitis for the diagnosis and treatment of bacterial pneumonia. OBJECTIVES: We performed a systematic review and meta-analysis to describe potential predictors of a CXR with airspace disease in patients with bronchiolitis. METHODS: We searched the medical literature from 1965 to June 2015 in PubMed/EMBASE using the following PICO formulation of our clinical question, "What characteristic(s) of history/physical examination (H&P) and vital signs (VS) in a child with bronchiolitis should prompt the physician to order a CXR?": Patients-pediatric emergency department (ED) patients (<2 years) with clinical bronchiolitis; Intervention-H&P and VS; Comparator-a CXR positive for airspace disease (+CXR), defined as atelectasis versus infiltrate or infiltrate/consolidation; and Outcome-operating characteristics of H&P and VS predicting an +CXR were calculated: sensitivity, specificity, and likelihood ratios (LR+ or LR-). The methodologic quality of the studies was assessed using the quality assessment of studies of diagnostic accuracy tool (QUADAS-2). We created a test-treatment threshold model based on the operating characteristics of the CXR to accurately identify a child with bronchiolitis and a superimposed bacterial pneumonia while accounting for the risks of a CXR and risks of treating patients with and without a bacterial infection. RESULTS: We found five studies including 1,139 patients meeting our inclusion/exclusion criteria. Prevalence of a +CXR ranged from 7% to 23%. An oxygen saturation < 95% was the predictor with highest LR+ of 2.3 (95% confidence interval = 1.3 to 3.07) to predict a +CXR. None of the H&P and VS variables were found to have sufficiently low LR- to significantly decrease the pretest probability of finding a +CXR. Our test-treatment threshold model showed that hypoxia (O2 Sat < 95%) alone complicating bronchiolitis did not show a benefit to obtaining a CXR. Our model only suggested that a CXR maybe indicated for a child with hypoxia (O2 Sat < 95%) and respiratory failure requiring ventilatory support. CONCLUSION: No single predictor of a +CXR was of sufficient accuracy to either support or refute ordering a CXR in a child with clinical bronchiolitis. We provide a decision threshold model to estimate a test threshold for obtaining a CXR and a treatment threshold for administering antibiotics. Application of this model requires the clinician to approximate the empiric benefit of antibiotics based on the clinical situation, highlighting the importance of clinical assessment.

Ventriculoperitoneal Shunt Complications In Children: An Evidence-Based Approach To Emergency Department Management.

Although much is known about ventriculoperitoneal shunts, there are still large gaps in the literature and no evidence-based guidelines on management. To date, there is no general consensus on workup and treatment, and there are many differing diagnostic and therapeutic strategies for management of complications. Ventriculoperitoneal shunt complications can be separated into 3 categories: mechanical failure, infection, and functional failure. Knowing the basic anatomy of ventriculoperitoneal shunts, the time of shunt placement, and the clinical manifestations suggestive of potential complications can help with the management of patients with ventriculoperitoneal shunts. This review summarizes the literature on complications of ventriculoperitoneal shunts, examines the literature regarding the workup and management of patients with ventriculoperitoneal shunts, and makes recommendations for the management of these patients in the emergency department.

Hepatitis B awareness and knowledge in hepatitis B surface antigen-positive parturient immigrant women from West Africa in the Bronx, New York.

An increasing proportion of foreign-born residents in the Bronx, New York are African immigrants from West Africa, a region with a very high hepatitis B surface antigen (HBsAg) prevalence. Charts of 114 HBsAg positive parturients who gave birth between 2004 and 2008 in a community hospital in the Bronx were retrospectively reviewed. Most were of West-African origin (88%). Acute hepatic inflammation was rare (4%). Active viral replication (Hepatitis B e-antigen positivity) was noted in a minority (7%), but in 3/5 (60%) HIV co-infected women. Among the West-African immigrant women who agreed to be interviewed (n = 39), only half (54%) had ever heard of hepatitis B virus (HBV) infection, and their knowledge of HBV was mostly incomplete. This study shows that pregnancy-related health interventions may offer unique opportunities to link such women to specialist care and initiate culturally sensitive HBV-relevant education for the index case and her family.