Monroe Carell Jr. Children's Hospital at Vanderbilt

About: Monroe Carell Jr. Children's Hospital at Vanderbilt is a based out in . It is known for research contribution in the topics: Population & Medicine. The organization has 1046 authors who have published 1262 publications receiving 28063 citations. The organization is also known as: Vanderbilt Children's Hospital.

Trends of ED visits, admissions, and deaths for pediatric traumatic brain injury comparing sport and non-sport mechanisms

Abstract: Traumatic brain injuries (TBI) in children result in significant morbidity and mortality. There are many mechanisms, both sport and non-sport related, which cause these injuries. Studies have reported that Emergency Department (ED) visits for pediatric TBI caused by sports are increasing; however, no subsequent study has evaluated the trend in non-sport TBI. The objective of this study was to evaluate ED visits, admissions, and deaths for non-sport TBI compared to those caused by sports. A retrospective study of children 5–19 years of age was performed at a pediatric, level 1 trauma center from 2002 to 2012. Subjects with a primary or secondary diagnosis of TBI were identified from the hospital’s trauma registry, and mechanism of injury, disposition, injury severity score, and length of stay were recorded. Frequencies were used to characterize the population, Chi-square analysis was performed to determine differences between groups, and linear trend lines were calculated for sport-related and non-sport TBI by year. Thirteen thousand two hundred ninty one subjects were seen in the ED between 2002 and 2012 for a TBI; 9527 (72%) were from a non-sport mechanism, and 3764 (28%) were from a sport mechanism. Subjects with a non-sport TBI were more likely to be younger (p < 0.001), African American (p < 0.001), and have Medicare/Medicaid (p < 0.001). Subjects with a non-sport TBI were admitted to the hospital 15% of the time, and subjects with a sport-related TBI were admitted 10% of the time (p < 0.001). When evaluating all TBI by mechanism of injury, sport had the lowest injury severity score (mean 4.4) and the shortest length of stay (mean 1.6 days) of any mechanism. There were six deaths reported from non-sport TBI and none from sport-related TBI. ED visits for sport-related TBI increased 92%, and non-sport TBI increased 22% over 10 years. There was a peak in TBI, in both groups, seen in 2009. ED visits for both sport and non-sport TBI have increased over the past 10 years. TBI from a non-sport mechanism was more likely to result in hospitalization or death. Prevention efforts should be expanded to include all high-risk TBI mechanisms, not just sports.

Know It When You See It: Identifying and Using Special Cause Variation for Quality Improvement

Abstract: In this month’s Hospital Pediatrics , Liao et al1 share their team’s journey to improve the accuracy of their institution’s electronic health record (EHR) problem list. They presented their results as statistical process control (SPC) charts, which are a mainstay for visualization and analysis for improvers to understand processes, test hypotheses, and quickly learn their interventions’ effectiveness. Although many readers might understand that 8 consecutive points above or below the mean signifies special cause variation resulting in a centerline “shift,” there are many more special cause variation rules revealed in these charts that likely provided valuable real-time information to the improvement team. These “signals” might not be apparent to casual readers when looking at the complete data set in article form. Shewhart2 first introduced SPC charts to the world with the publication of Economic Control of Quality of Manufactured Product in 1931. Although control charts were initially used more broadly in industrial settings, health care providers have also recently begun to understand that the use of SPC charts is vital in improvement work.3,4 Deming,5 often seen as the “grandfather” of quality improvement (QI), saw SPC charts as vital to understanding variation as part of his well-known Theory of Profound Knowledge, outlined in his book The New Economics for Industry, Government, Education . Improvement science harnesses the scientific method in which improvers create and rapidly test hypotheses and learn from their data to determine if their hypotheses are correct.6 This testing is central to the Model for Improvement’s plan-do-study-act cycle.3 Liao et al1 nicely laid out their hypotheses in a key driver diagram, and they tested these hypotheses …

Pause and Pulse: Radiation Dose in Pediatric Fluoroscopy

Abstract: 1. Beverley Newman, MD* 2. Susan John, MD† 3. Marilyn Goske, MD‡ 4. Marta Hernanz-Schulman, MD§ 1. *Professor of Radiology, Department of Pediatric Radiology, Lucile Packard Children's Hospital at Stanford University, Stanford, CA. 2. †Professor of Diagnostic Imaging and Pediatrics, University of Texas Houston Medical School, Houston, TX. 3. ‡Staff Radiologist, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 4. §Medical Director, Vanderbilt University Medical Center, Diagnostic Imaging, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN. After completing this article, readers should be able to: 1. Understand the issues and concerns surrounding ionizing radiation in children and the relative doses associated with different imaging procedures. 2. Recognize the role of the pediatrician in patient and parent preparation, providing useful clinical information, and collaborating with radiology to obtain the most appropriate imaging study at an experienced and properly equipped facility. 3. Describe the most important dose-saving measures available in pediatric fluoroscopy. 4. Access the Image Gently online educational materials on pediatric radiation dose reduction, including the most recent Pause and Pulse fluoroscopy initiative. A mother brings her 9-week-old infant to your office. The child is lethargic and has a history of bilious vomiting. You suspect a malrotation complicated by a midgut volvulus. You consult the pediatric radiologist with whom you collaborate and request an upper gastrointestinal (UGI) examination. The radiologist calls to inform you that the child, indeed, has a malrotation with mid-gut volvulus. You call the emergency department and expedite her admission to the hospital for urgent surgery, which later confirms your clinical diagnosis. Medical imaging has revolutionized patient care, expediting management and obviating unnecessary surgery and more invasive procedures. As in the case study, medical imaging has the potential to help diagnose potentially life-threatening conditions. Yet, many imaging techniques, such as radiographs, fluoroscopy, computed tomography (CT) scan, and nuclear medicine, use ionizing radiation to produce diagnostic images. The medical community, government agencies, and the news media all have expressed concern about medical radiation dosing. (1)(2)(3)(4) Rare instances of medical error leading to excessive radiation and patient injury have been highlighted in …

Bacteria and asthma: more there than we thought

Abstract: Evaluation of: Huang YJ, Nelson CE, Brodie EL et al. Airway microbiota and bronchial hyperresponsiveness in patients with suboptimally controlled asthma. J. Allergy Clin. Immunol. 127(2), 372–381, e371–e373 (2011).In a recently performed case–control study, characteristics of the airway microbiota in suboptimally controlled adult asthmatics were compared with those of healthy, nonasthmatic adult subjects. Bacterial burden was significantly greater in asthmatic subjects. Further, increased airway microbiota variability and diversity were correlated with increased bronchial hyper-responsiveness. Although several limitations are present, this study provides an intriguing initial insight into the possible relationship between the airway microbiota and asthma pathogenesis.

Inhaled corticosteroids for the prevention of asthma exacerbations.

Abstract: Objective To provide an overview of the risk factors and mechanisms underlying asthma exacerbations and the role of inhaled corticosteroids (ICSs) in preventing exacerbations. Data Sources Queries for asthma exacerbations and ICSs were conducted using PubMed, searching for primary articles and reviews. Study Selections Studies written in English, with a focus on well-designed randomized controlled clinical trials. Results Asthma exacerbations remain a major source of morbidity, with future exacerbations most likely among patients with previous exacerbations and among those with peripheral blood eosinophilia. Exacerbations are often triggered by viral respiratory tract infections, but recent evidence supports nonviral triggers as well. In terms of exacerbation prevention, several approaches to ICS therapy have been found to be effective, including intermittent high-dose ICS without use of background controller in preschool children with recurrent episodic wheezing, intermittent high-dose ICS without use of background controller in adults with mild asthma, and as-needed ICS dosing whenever rescue treatment is needed among children, adolescents, and adults with mild asthma not receiving daily controller therapy. Conclusion ICSs are highly effective in preventing exacerbations of asthma. Multiple dosing strategies have been found to reduce exacerbation risk, allowing for a personalization of approaches based on individual patient phenotypes and preferences.