Primary Children's Hospital

About: Primary Children's Hospital is a healthcare organization based out in Salt Lake City, Utah, United States. It is known for research contribution in the topics: Population & Health care. The organization has 1770 authors who have published 2594 publications receiving 107857 citations. The organization is also known as: Intermountain Primary Children's Medical Center & Intermountain Primary Children's Hospital.

Decreasing Hospital Length of Stay for Bronchiolitis by Using an Observation Unit and Home Oxygen Therapy

Abstract: Importance Pediatric observation units (OUs) offer the opportunity to safely and efficiently care for common illnesses previously cared for in an inpatient setting. Home oxygen therapy (HOT) has been used to facilitate hospital discharge in patients with hypoxic bronchiolitis. It is unknown how implementation of a hospitalwide bronchiolitis treatment protocol promoting OU-HOT would affect hospital length of stay (LOS). Objective To test the hypothesis that using OU-HOT for bronchiolitis would decrease LOS. Design and Setting Retrospective cohort study at Primary Children's Medical Center, Salt Lake City, Utah. Participants Uncomplicated bronchiolitis patients younger than 2 years admitted during the winter seasons of 2005 through 2011. Interventions Implementation of a new bronchiolitis care process encouraging use of an OU-HOT protocol. Main Outcome Measures Mean hospital LOS, discharge within 24 hours, emergency department (ED) bronchiolitis admission rates and ED revisit/readmission rates, and inflation-adjusted cost. Results A total of 692 patients with bronchiolitis from the 2010-2011 bronchiolitis season were compared with 725 patients from the 2009-2010 season. Implementation of an OU-HOT protocol was associated with a 22.1% decrease in mean LOS (63.3 hours vs 49.3 hours, P Conclusions and Relevance Implementation of an OU-HOT protocol for patients with bronchiolitis safely reduces hospital LOS with significant cost savings. Although widespread implementation has the potential for dramatic cost savings nationally, further studies assessing overall health care use and cost, including the impact on families and outpatient practices, are needed.

Blunt pediatric laryngotracheal trauma: case reports and review of the literature.

Abstract: Blunt laryngotracheal trauma can be a life-threatening event. Two cases of isolated blunt laryngotracheal trauma in pediatric patients are presented. One case involves a 12-year-old mate who suffered isolated tracheal trauma from a fall. He developed respiratory distress and required a tracheostomy. Intraoperatively he was noted to have a thyroid cartilage fracture. The other case involves a 14-year-old female who was kicked in the neck by a horse. After unsuccessful intubation attempts that completed a tracheal transection, she required an emergency cricothyrotomy and a subsequent tracheostomy. The diagnosis, differential diagnosis, associated injuries, and treatment options for blunt laryngeal trauma are reviewed.

A survey of albuterol administration practices in intubated patients in the neonatal intensive care unit.

Abstract: INTRODUCTION Aerosolized albuterol is commonly used in the treatment of neonatal respiratory illnesses. Clinical and in vitro studies have identified numerous factors that affect aerosol drug delivery during neonatal mechanical ventilation, including the choice of metered-dose inhaler (MDI) or nebulizer, the use of a holding chamber, time between actuations, the volume of nebulized solution, and the position and placement of the nebulizer or MDI. Because there is no consensus on the optimal method of administration, there is probably substantial variability among institutions in how aerosolized albuterol is administered to mechanically ventilated infants in the neonatal intensive care unit (NICU). OBJECTIVE Survey academic medical centers in the United States regarding their practices of administering aerosolized albuterol to intubated newborns in the NICU. METHODS A survey instrument was developed that queried 18 aspects of albuterol administration in mechanically ventilated infants, including the frequency of MDI and nebulizer use, the average and maximum dose, the time between MDI actuations and following the final actuation, the use of a holding chamber, and the placement location of the holding chamber or nebulizer. Respiratory therapists and respiratory therapy managers having direct knowledge of neonatal clinical practices in their neonatal fellowship program NICUs were surveyed via telephone. Those who did not respond via telephone were surveyed via fax. RESULTS Eighty institutions were surveyed and there were 68 respondents (85% response rate). Responders averaged 35 +/- 13 NICU beds and 11 +/- 5 ventilators/d. Nineteen percent of the respondents reported administering albuterol via MDI 100% of the time; 22% use MDIs 75-99% of the time; 9% use MDIs 50-74% of the time; 4% use MDIs 25-49% of the time; and 43% never use MDIs to deliver albuterol. The average dose via MDI was: 1 puff: 30%; 2 puffs: 65%; and 4 puffs: 5%. The maximum dose via MDI was: 2 puffs: 30%; 3 puffs: 14%; 4 puffs: 36%; 6 puffs: 11%; and 8 puffs: 6%. Thirty-one percent of the respondents place the holding chamber in-line with the ventilator circuit, 56% administer the aerosol via manual ventilation, and 13% use both methods. Fifty-six percent place the in-line holding chamber between the endotracheal tube and ventilator circuit, and the other 44% place the in-line holding chamber in the inspiratory limb. The time between MDI actuations depended on whether the holding chamber was placed in-line or the aerosol was administered via manual ventilation (MV): < or = 0.5 min: 18% in-line and 28% MV; 1 min: 47% in-line and 43% MV; 2 min: 6% in-line and 4% MV; 3 min: 6% in-line and 0% MV. Eighty-three percent of respondents indicated that dead space introduced by a holding chamber/spacer was not a concern. Forty-three percent use nebulizers exclusively to administer albuterol to mechanically ventilated patients. Seventy-four percent of centers that nebulize albuterol use a dose of 1.25-2.5 mg. Eighty-eight percent of the surveyed institutions place nebulizers in-line with the ventilator circuit, and the other 12% use manual ventilation to administer the nebulized aerosol. Of those that use in-line nebulization, 95% place the nebulizer in the inspiratory limb of the circuit, and the other 5% place the nebulizer between the endotracheal tube and circuit Y-piece. Among centers that place the nebulizer in the inspiratory limb, 52% place it adjacent to the circuit Y-piece, 36% place it midway upstream in the inspiratory limb, and 12% place it near the humidifier. CONCLUSION There is substantial variability among NICUs in albuterol administration to mechanically ventilated infants, with the majority of institutions now administering albuterol via MDI.

The clinical presentation of pediatric pelvic fractures

Abstract: Background: Few studies have addressed the presentation and clinical impact of pediatric pelvic fractures We sought to describe pediatric blunt trauma patients with pelvic fracture (PF) and to evaluate the sensitivity and specificity of physical examination at presentation for diagnosis Methods: Retrospective analysis of all PF and control (NPF) patients from our pediatric institution over an 8-year period Results: A total of 174 patients (88 PF, 86 NPF) were included Median patient age was 8 years (range, 3 months to 18 years), with 54% males The most common mechanisms of injury for PF patients were automobile-related accidents (75%) There were 140 patients (87%) who were transported by air or ground medical services At presentation, approximately 16% of PF patients had a Glasgow Coma score of 15 indicating severe, multiple injuries Sixty-eight PF patients (77%) had severe isolated injuries (Abbreviated Injury Scale 1990 value of >3); 11% of PF patients required transfusions, and 2% died Fifteen PF patients (17% ) had no pelvic ring disruption; 39 (43%) had a single pelvic ring fracture, 22 (2%) had two pelvic ring fractures, 2(2%) had acetabular fractures, and 10 (11%) had a combination of pelvic fractures An abnormal physical examination of the pelvis was noted in 81 patients with PF (92% sensitivity, 95% confidence interval [CI] = 089-095), 15 NPF patients had an abnormal examination (79% specificity, 95% CI = 074-084) The positive predictive value of the pelvis examination was 084, and the negative predictive value was 089 The most common abnormal pelvis examination finding was pelvic tenderness in 65 PF patients (73%) A total of seven PF patients had a normal examination of the pelvis; four had a depressed level of consciousness (defined as GCS <15), and six patients had a distracting injury Conclusions: Pediatric blunt trauma patients with pelvic fracture represent a severely injured population but generally have lower transfusion rates and mortality than noted in adult studies The pelvis examination appears to be sensitive and specific in this retrospective study However, an altered level of consciousness and/or distracting injuries may affect examination sensitivity and specificity Based on this retrospective study, we cannot advocate eliminating pelvic radiographs in the severely injured, blunt trauma patient Prospective studies are recommended