Matthew P. Myrvik

Mental health disorders influence admission rates for pain in children with sickle cell disease.

Patients with sickle cell disease (SCD) experience a broad range of mental health disorders placing them at risk for more complicated hospitalizations for pain. The current study examined the impact of mental health disorders on admission rates and hospital length of stay (LOS) for vaso‐occlusive pain events (VOE) in pediatric patients with SCD.

Clinically Meaningful Measurement of Pain in Children with Sickle Cell Disease

Limited understanding of the interpretability of patient‐reported pain scores may impact pain management. The current study assessed the minimal clinically significant improvement in pain and pain scores signifying patient‐reported need for medication and treatment satisfaction in patients with sickle cell disease (SCD).

Impact of Psychiatric Diagnoses on Hospital Length of Stay in Children With Sickle Cell Anemia

Patients with sickle cell anemia (SCA) experience a broad range of psychiatric disorders, placing them at risk for more complicated and longer hospitalizations for vaso‐occlusive crises (VOC). The current study examined the frequency of psychiatric disorders in SCA patients (ages birth to 20 years) admitted for VOC in a nationally representative sample and the association between psychiatric disorders and hospital length of stay (LOS).

Academic Attainment Findings in Children with Sickle Cell Disease.

BACKGROUND Children with sickle cell disease (SCD) demonstrate deficits in cognitive and academic functioning. This study compared the academic attainment of children with SCD relative to national, state, and local school district rates for African American students. METHODS A retrospective chart review of children with SCD was completed and academic information was collected from caregiver report and school records. One-sample tests of proportions were calculated to compare academic attainment rates in children with SCD relative to national, state, and local school district normative data of African American students. RESULTS Overall, 197 patient records were reviewed. A higher proportion of children with SCD were retained a grade relative to national, state, and local school district rates for African American students. In addition, a higher proportion of children with SCD received special education services relative to the national, state, and local school district rates for African American students. CONCLUSION Children with SCD demonstrate higher rates of special education services and grade retention relative to African American peers. Overall, children with SCD demonstrate poorer academic attainment relative to healthy, African American peers highlighting the need for increased focus on special education services to address school performance issues within this population.

Examination of the Factor Structure of the Adolescent Sleep-Wake Scale (ASWS).

This study examined the factor structure of the Adolescent Sleep–Wake Scale (ASWS) among 491 adolescents (12–18 years) with and without pediatric health conditions. Exploratory factor analyses were conducted using iterated principal axis factoring with varimax rotation. Highly cross-loading items were systematically removed and analyses were rerun until a clean solution was attained. The final solution explained 57.1% of the total model variance, including 10 items and three factors: Falling Asleep and Reinitiating Sleep-Revised, returning to Wakefulness-Revised, and Going to Bed-Revised. Internal consistency reliability scores were acceptable to good, with the exception of the Going to Bed-Revised subscale for the healthy sample. Adolescents with chronic pain reported significantly poorer overall sleep quality and more problems in falling asleep, reinitiating sleep, and returning to wakefulness as compared to healthy adolescents, providing preliminary evidence for construct validity of the new factors. The resulting ASWS version is a concise assessment tool with empirically derived, distinct behavioral sleep dimensions that can be used for clinical and research purposes.

A Comparison of Pain Assessment Measures in Pediatric Sickle Cell Disease: Visual Analog Scale Versus Numeric Rating Scale.

Given the availability of various pain severity scales, greater understanding of the agreement between pain scales is warranted. We compared Visual Analog Scale (VAS) and Numeric Rating Scale (NRS) pain severity ratings in children with sickle cell disease (SCD) to identify the relationship and agreement between pain scale ratings. Twenty-eight patients (mean±SD age, 14.65±3.12 y, 50% female) receiving pain interventions within the emergency department completed serial VAS and NRS pain severity ratings every 30 minutes. Data were used to calculate the relationship (Spearman correlation) and agreement (Bland-Altman approach) between the VAS and NRS. One hundred twenty-eight paired VAS-NRS measurements were obtained. VAS and NRS ratings were significantly correlated for the initial assessment (rs=0.88, P<0.001) and all assessments (rs=0.87, P<0.001). Differences between VAS and NRS means were −0.52 (P=0.006) for the initial assessment and −0.86 (P<0.001) across all assessments. The difference between VAS and NRS ratings decreased as pain severity increased across all assessments (P=0.027), but not the initial assessment. Within pediatric patients with SCD, VAS and NRS ratings were found to trend together; however, VAS scores were found to be significantly lower than NRS scores across assessments. The agreement between the 2 measures improved at increasing levels of pain severity. These findings demonstrate that the VAS and NRS are similar, but cannot be used interchangeably when assessing self-reported pain in SCD.

Single-session biofeedback-assisted relaxation training in children with sickle cell disease.

Sickle cell disease (SCD) pain remains difficult to manage. This pilot study evaluated single-session biofeedback-assisted relaxation training (BART) for SCD pain in children. Ten participants (mean=12.1 y) completed a 1-hour BART session using thermal biofeedback and home practice. Participants demonstrated changes in peripheral body temperature after the training session (d=1.08) and at 6-week follow-up (d=0.97) relative to their baseline visit. Reductions in patient-reported pain frequency were found after completing BART. Health-related quality of life and pain-related disability improvements were observed; however, effect sizes were small to minimal. Single-session BART may be a promising, complementary approach to medical management of pediatric SCD pain.

Should Potential Risk of Chronic Traumatic Encephalopathy Be Discussed with Young Athletes

As participation in youth sports has risen over the past two decades, so has the incidence of youth sports injuries. A common topic of concern is concussion, or mild traumatic brain injury, in young athletes and whether concussions sustained at a young age could lead to lifelong impairment such as chronic traumatic encephalopathy (CTE). While the pathway from a concussed young athlete to an adult with CTE remains unknown, current research is attempting to provide more clarity. This article discusses how health care professionals can help foster an informed, balanced decision-making process regarding participation in contact sports that involves the parents as well as the children.

Parents’ pain medication underdosing is associated with more emergency department visits in sickle cell disease

To determine the association between health literacy, medication knowledge, and pain treatment skills with emergency department (ED) use of parents of children with sickle cell disease (SCD).

Attention Deficit Hyperactivity Disorder in Children With Sickle Cell Disease Referred for an Evaluation

Neuropsychological deficits, including difficulties with attention, are well described in children with sickle cell disease (SCD). Very little is known about attention deficit hyperactivity disorder (ADHD) in children with SCD. The objective of this study was to determine the proportion of ADHD in children with SCD referred for neuropsychological evaluation. This prospective, cross-sectional study included patients (age, 4 to 18 y) with SCD and completion of a neuropsychological evaluation between December 2013 and March 2016. Patients were referred for neuropsychological evaluation because of concern regarding school performance, development, and/or behavior. The diagnosis of ADHD was made by a neuropsychologist on the basis of the diagnostic criteria in the Diagnostic Statistical Manual—Fourth or Fifth Editions. ADHD medication usage rate was obtained by medical record review. Of the 89 patients with SCD referred for neuropsychological evaluation, 25% (95% confidence interval, 16%-35%) met diagnostic criteria for ADHD. Only 21% of the patients with SCD and ADHD were prescribed an ADHD medication. Our study supports routine ADHD screening in children with SCD who have poor school performance or behavioral concerns. Despite the benefits of pharmacologic treatment, the majority of patients with SCD and ADHD did not receive a medication for management of their ADHD.