Author
Erin Stucky Fisher
Other affiliations: Society of Hospital Medicine, Boston Children's Hospital, University of California
Bio: Erin Stucky Fisher is an academic researcher from University of California, San Diego. The author has contributed to research in topics: Bronchiolitis & Patient safety. The author has an hindex of 11, co-authored 32 publications receiving 480 citations. Previous affiliations of Erin Stucky Fisher include Society of Hospital Medicine & Boston Children's Hospital.
Topics: Bronchiolitis, Patient safety, Intensive care, Medicine, Interpreter
Papers
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TL;DR: In this multicenter study of children requiring intensive care for bronchiolitis, substantial institutional variability in testing and treatment, including use of CPAP, intubation, and HFNC was identified.
Abstract: Objective: To determine the extent of variability in testing and treatment of children with bronchiolitis requiring intensive care. Methods: This prospective, multicenter observational study included 16 academic children’s hospitals across the United States during the 2007 to 2010 fall and winter seasons. The study included children Results: Respiratory distress severity scores and intraclass correlation coefficients were calculated. The study patients’ median age was 2.6 months, and 59% were male. Across the 16 sites, the median respiratory distress severity score was 5.1 (interquartile range: 4.5–5.4; P Conclusions: In this multicenter study of children requiring intensive care for bronchiolitis, we identified substantial institutional variability in testing and treatment, including use of CPAP, intubation, and HFNC. These differences were not explained by between-site differences in patient characteristics, including severity of illness. Further research is needed to identify best practices for intensive care interventions for this major cause of pediatric hospitalization.
74 citations
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TL;DR: In this prospective, multicenter study of children hospitalized with bronchiolitis, inpatient apnea was associated with younger corrected age, lower birth weight, history of apnea, and preadmission clinical factors including low or high respiratory rates and low room air oxygen saturation.
Abstract: OBJECTIVE: To identify risk factors for inpatient apnea among children hospitalized with bronchiolitis. METHODS: We enrolled 2207 children, aged RESULTS: Inpatient apnea was identified in 108 children (5%, 95% confidence interval [CI] 4%–6%). Statistically significant, independent predictors of inpatient apnea included: corrected ages of 70 (OR 2.26), compared with 40 to 49; and having a preadmission room air oxygen saturation CONCLUSIONS: In this prospective, multicenter study of children hospitalized with bronchiolitis, inpatient apnea was associated with younger corrected age, lower birth weight, history of apnea, and preadmission clinical factors including low or high respiratory rates and low room air oxygen saturation. Several bronchiolitis pathogens were associated with apnea, with similar apnea risk across the major viral pathogens.
70 citations
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TL;DR: Low birth weight and tachypnea were significantly associated with subsequent transfer to the ICU and/or use of mechanical ventilation in this multicenter study of children hospitalized with bronchiolitis.
61 citations
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University of Cincinnati1, University of Washington2, Drexel University3, University of Arkansas for Medical Sciences4, Indiana University5, University of Colorado Denver6, University of California, San Diego7, Baylor College of Medicine8, Harvard University9, Brown University10, Boston Children's Hospital11, University of California, Davis12, University of Utah13, University of Texas at Austin14
TL;DR: The current knowledge regarding hospital-to-home transitions is reviewed, the challenges of measuring and reducing readmissions are outlined, and research gaps are highlighted and potential measures for transition quality are highlighted.
Abstract: The Seamless Transitions and (Re)admissions Network (STARNet) met in December 2012 to synthesize ongoing hospital-to-home transition work, discuss goals, and develop a plan to centralize transition information in the future. STARNet participants consisted of experts in the field of pediatric hospital medicine quality improvement and research, and included physicians and key stakeholders from hospital groups, private payers, as well as representatives from current transition collaboratives. In this report, we (1) review the current knowledge regarding hospital-to-home transitions; (2) outline the challenges of measuring and reducing readmissions; and (3) highlight research gaps and list potential measures for transition quality. STARNet met with the support of the American Academy of Pediatrics’ Quality Improvement Innovation Networks and the Section on Hospital Medicine.
59 citations
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TL;DR: Wide variations in diagnostic test utilization and management interventions seen among children with bronchiolitis treated on the inpatient wards at 16 US hospitals were not attributable to demographic or clinical patient characteristics, and further support efforts to standardize care for bronchiola through active quality improvement strategies.
52 citations
Cited by
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TL;DR: It is suggested that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units, outpatients, and referrals to social services, but for house doctors to assess overdoses would provide no economy for the psychiatric or social services.
Abstract: admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER
4,497 citations
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TL;DR: This guideline is a revision of the clinical practice guideline, “Diagnosis and Management of Bronchiolitis,” published by the American Academy of Pediatrics in 2006, and indicates level of evidence, benefit-harm relationship, and level of recommendation.
Abstract: guideline is a revision of the clinical practice guideline, "Diagnosis and Management of Bronchiolitis," published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted. Each key action state- ment indicates level of evidence, benefit-harm relationship, and level of recommendation. Key action statements are as follows: Pediatrics 2014;134:e1474-e1502
1,245 citations
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TL;DR: This review on bronchiolitis in young children considers the viruses involved, the current understanding of pathogenesis, host genetic factors and the environment, and the role of season, race, and sex on attack rates and subsequent episodes of wheezing.
Abstract: This review on bronchiolitis in young children considers the viruses involved, the current understanding of pathogenesis, host genetic factors and the environment, and the role of season, race, and sex on attack rates and subsequent episodes of wheezing.
507 citations
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TL;DR: In young infants with moderate to severe AVB, initial management with HFNC did not have a failure rate similar to that of nCPAP, and the success rate with the alternative respiratory support, intubation rate, durations of noninvasive and invasive ventilation, skin lesions, and length of PICU stay were comparable between groups.
Abstract: Nasal continuous positive airway pressure (nCPAP) is currently the gold standard for respiratory support for moderate to severe acute viral bronchiolitis (AVB). Although oxygen delivery via high flow nasal cannula (HFNC) is increasingly used, evidence of its efficacy and safety is lacking in infants. A randomized controlled trial was performed in five pediatric intensive care units (PICUs) to compare 7 cmH2O nCPAP with 2 L/kg/min oxygen therapy administered with HFNC in infants up to 6 months old with moderate to severe AVB. The primary endpoint was the percentage of failure within 24 h of randomization using prespecified criteria. To satisfy noninferiority, the failure rate of HFNC had to lie within 15% of the failure rate of nCPAP. Secondary outcomes included success rate after crossover, intubation rate, length of stay, and serious adverse events. From November 2014 to March 2015, 142 infants were included and equally distributed into groups. The risk difference of −19% (95% CI −35 to −3%) did not allow the conclusion of HFNC noninferiority (p = 0.707). Superiority analysis suggested a relative risk of success 1.63 (95% CI 1.02–2.63) higher with nCPAP. The success rate with the alternative respiratory support, intubation rate, durations of noninvasive and invasive ventilation, skin lesions, and length of PICU stay were comparable between groups. No patient had air leak syndrome or died. In young infants with moderate to severe AVB, initial management with HFNC did not have a failure rate similar to that of nCPAP. This clinical trial was recorded in the National Library of Medicine registry (NCT 02457013).
193 citations
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162 citations