Jeffrey D. Colvin

Sleep Environment Risks for Younger and Older Infants

OBJECTIVE: Sudden infant death syndrome and other sleep-related causes of infant mortality have several known risk factors. Less is known about the association of those risk factors at different times during infancy. Our objective was to determine any associations between risk factors for sleep-related deaths at different ages. METHODS: A cross-sectional study of sleep-related infant deaths from 24 states during 2004–2012 contained in the National Center for the Review and Prevention of Child Deaths Case Reporting System, a database of death reports from state child death review teams. The main exposure was age, divided into younger (0–3 months) and older (4 months to 364 days) infants. The primary outcomes were bed-sharing, objects in the sleep environment, location (eg, adult bed), and position (eg, prone). RESULTS: A total of 8207 deaths were analyzed. Younger victims were more likely bed-sharing (73.8% vs 58.9%, P < .001) and sleeping in an adult bed/on a person (51.6% vs 43.8%, P < .001). A higher percentage of older victims had an object in the sleep environment (39.4% vs 33.5%, P < .001) and changed position from side/back to prone (18.4% vs 13.8%, P < .001). Multivariable regression confirmed these associations. CONCLUSIONS: Risk factors for sleep-related infant deaths may be different for different age groups. The predominant risk factor for younger infants is bed-sharing, whereas rolling into objects in the sleep area is the predominant risk factor for older infants. Parents should be warned about the dangers of these specific risk factors appropriate to their infant’s age.

Socioeconomic Status and In-Hospital Pediatric Mortality

OBJECTIVE: Socioeconomic status (SES) is inversely related to pediatric mortality in the community. However, it is unknown if this association exists for in-hospital pediatric mortality. Our objective was to determine the association of SES with in-hospital pediatric mortality among children’s hospitals and to compare observed mortality with expected mortality generated from national all-hospital inpatient data. METHODS: This is a retrospective cohort study from 2009 to 2010 of all 1 053 101 hospitalizations at 42 tertiary care, freestanding children’s hospitals. The main exposure was SES, determined by the median annual household income for the patient’s ZIP code. The main outcome measure was death during the admission. Primary outcomes of interest were stratified by income and diagnosis-based service lines. Observed-to-expected mortality ratios were created, and trends across quartiles of SES were examined. RESULTS: Death occurred in 8950 (0.84%) of the hospitalizations. Overall, mortality rates were associated with SES (P < .0001) and followed an inverse linear association (P < .0001). Similarly, observed-to-expected mortality was associated with SES in an inverse association (P = .014). However, mortality overall was less than expected for all income quartiles (P < .05). The association of SES and mortality varied by service line; only 3 service lines (cardiac, gastrointestinal, and neonatal) demonstrated an inverse association between SES and observed-to-expected mortality. CONCLUSIONS: Within children’s hospitals, SES is inversely associated with in-hospital mortality, but is lower than expected for even the lowest SES quartile. The association between SES and mortality varies by service line. Multifaceted interventions initiated in the inpatient setting could potentially ameliorate SES disparities in in-hospital pediatric mortality.

Diagnosis and acute management of patients with concussion at children's hospitals

Objectives To describe the number of hospital admissions for concussion at paediatric hospitals in the USA. To describe the use of imaging and medications for acute concussion paediatric patients. Design Cross-sectional study. Setting Childrens hospitals participating in the Pediatric Health Information System in the USA during a 10-year period. Patients All emergency department (ED) visits and inpatient admissions with the primary diagnosis of concussion, defined as International Classification of Diseases, Ninth Revision, Clinical Modification codes for: (1) concussion, (2) postconcussion syndrome or (3) skull fracture without mention of intracranial injury with concussion. Main outcome measures The proportion of concussion patients who were hospitalised, underwent imaging or received medication, and the adjusted costs of visits for concussion. Results The number of ED visits for concussion increased between 2001 and 2010 (2126 (0.36% of all ED visits) vs 4967 (0.62% of all ED visits); p<0.001), while the number of admissions remained stable. Of ED visits for concussion, 59.9% received CT and 47.7% received medications or intravenous fluids. Non-narcotic analgesics were the most common medication administered. Adjusted costs of patient visits were significantly higher when imaging was obtained (US

Community Household Income and Resource Utilization for Common Inpatient Pediatric Conditions

695, IQR US

Sofas and Infant Mortality

472–

Intravenous Versus Oral Antibiotics for Postdischarge Treatment of Complicated Pneumonia.

1009, vs US

Multiple Behavior Change Intervention to Improve Detection of Unmet Social Needs and Resulting Resource Referrals.

191, IQR US

Hospitalizations of Low-Income Children and Children With Severe Health Conditions: Implications of the Patient Protection and Affordable Care Act

114–

Childhood obesity and in‐hospital asthma resource utilization

287). An ED visit with CT, however, cost less than a hospitalisation without CT (US

Opioid-Related Critical Care Resource Use in US Children’s Hospitals

1907, IQR US