2024
The Circumstances Surrounding Fatal Pediatric Opioid Poisonings, 2004-2020.
Gaither J, McCollum S, Bechtel K, Leventhal J, Mintz S. The Circumstances Surrounding Fatal Pediatric Opioid Poisonings, 2004-2020. Pediatrics 2024, 154 PMID: 39484873, PMCID: PMC11528886, DOI: 10.1542/peds.2024-067043n.Peer-Reviewed Original ResearchConceptsChild's own homeOpioid poisoningOwn homeHistory of maltreatmentSubstance use/abuseAge groupsDied of homicidePrimary caregiversYears of ageOpioid prescribingChildren 0Opioid fatalitiesHousehold factorsPrescription opioidsSubstance useChild maltreatmentCaregiversDecedentsReporting SystemIllicit fentanylMaltreatmentChildrenFatal opioid poisoningsAgeHome
2021
Half Century Since SIDS: A Reappraisal of Terminology
Shapiro-Mendoza C, Palusci V, Hoffman B, Batra E, Yester M, Corey T, Sens M, Moon R, Goodstein M, Abu Jawdeh E, Carlin R, Colvin J, Hwang S, Hauck F, Haney S, Sirotnak A, Asnes A, Gavril A, Greenlee Girardet R, Hoffert Gilmartin A, Heavilin N, Laskey A, Messner S, Mohr B, Nienow S, Rosado N, Agran P, Hirsh M, Johnston B, Kendi S, Lee L, Monroe K, Schaechter J, Tenenbein M, Zonfrillo M, Quinlan K, Bechtel K, Berkowitz C, Needelman H. Half Century Since SIDS: A Reappraisal of Terminology. Pediatrics 2021, 148: e2021053746. PMID: 34544849, PMCID: PMC8487943, DOI: 10.1542/peds.2021-053746.Peer-Reviewed Original ResearchConceptsNonphysician cliniciansInfant deathSudden infant deathMental health careClinician disciplineAppropriate referralPediatric specialtiesChild deathsPediatriciansDiagnostic shiftEffective interventionsPhysiciansCliniciansDeathHealth careCaregiversTragic newsConsistent terminologyOpen communicationPathophysiologyDeath terminologyInfantsReferralEtiologyMortality
2020
The Use of Experts to Evaluate a Child Abuse Guideline in Community Emergency Departments
Shum M, Asnes A, Leventhal JM, Bechtel K, Gaither JR, Tiyyagura G. The Use of Experts to Evaluate a Child Abuse Guideline in Community Emergency Departments. Academic Pediatrics 2020, 21: 521-528. PMID: 33160081, DOI: 10.1016/j.acap.2020.11.001.Peer-Reviewed Original ResearchConceptsGuideline implementationExpert recommendationsIndeterminate casesCommunity emergency departmentsEvaluation of infantsGold standard testPostguideline implementationProvider adherenceCommunity EDRetrospective reviewED providersEmergency departmentCPS reportingClinical decisionTeam consultationInfantsInjurySignificant increaseAdherenceHigh percentageInterventionConsultationProvidersAbuseGuidelinesChild Protection Team Consultation for Injuries Potentially Due to Child Abuse in Community Emergency Departments
Tiyyagura G, Emerson B, Gaither JR, Bechtel K, Leventhal JM, Becker H, Della Guistina K, Balga T, Mackenzie B, Shum M, Shapiro ED, Auerbach M, McVaney C, Morrell P, Asnes AG. Child Protection Team Consultation for Injuries Potentially Due to Child Abuse in Community Emergency Departments. Academic Emergency Medicine 2020, 28: 70-81. PMID: 32931628, DOI: 10.1111/acem.14132.Peer-Reviewed Original ResearchConceptsCommunity emergency departmentsHigh-risk injuriesChild protection teamSkeletal surveyChild protective servicesEmergency departmentClinical pathway implementationHospital child protection teamInitiation of interventionsStudy-Act approachDetection of abuseChild abuse expertsAbusive injuriesPathway implementationProvider trainingEmergency careInjuryTeam consultationInfantsMonthsProtection teamStatistical process control chartsInterventionSuch interventionsConsultation
2019
Parents’ Perceptions of Infant Crying: A Possible Path to Preventing Abusive Head Trauma
Wiley M, Schultheis A, Francis B, Tiyyagura G, Leventhal JM, Rutherford H, Mayes LC, Bechtel K. Parents’ Perceptions of Infant Crying: A Possible Path to Preventing Abusive Head Trauma. Academic Pediatrics 2019, 20: 448-454. PMID: 31629119, DOI: 10.1016/j.acap.2019.10.009.Peer-Reviewed Original ResearchOral injuries in children less than 24 months of age in a pediatric emergency department
Woolf SM, Leventhal JM, Gaither JR, Hardikar P, Langhan ML, Bechtel K, Auerbach MA, Tiyyagura G. Oral injuries in children less than 24 months of age in a pediatric emergency department. Child Abuse & Neglect 2019, 89: 70-77. PMID: 30639971, DOI: 10.1016/j.chiabu.2019.01.006.Peer-Reviewed Original ResearchConceptsPediatric emergency departmentOral injuriesChief complaintEmergency departmentAbuse evaluationsTertiary care pediatric emergency departmentMedical chief complaintsMonths old presentingPediatric emergency medicine physiciansProspective observational studyComplete oral examinationEmergency medicine physiciansMonths of ageYoung childrenOld presentingPatient demographicsInjury detailsChildren 12Children 0Observational studyOral examinationMedicine physiciansNon-mobile childrenInjuryPatientsCharacteristics That Distinguish Abusive From Nonabusive Causes of Sudden Unexpected Infant Deaths
Bechtel K, Derbyshire M, Gaither JR, Leventhal JM. Characteristics That Distinguish Abusive From Nonabusive Causes of Sudden Unexpected Infant Deaths. Pediatric Emergency Care 2019, 37: e780-e783. PMID: 30829845, DOI: 10.1097/pec.0000000000001787.Peer-Reviewed Original ResearchConceptsSudden unexpected infant deathUnexpected infant deathChild protective services involvementTime of deathSentinel injuryManner of deathSpontaneous circulationInfant deathEmergency medical services transportEmergency department settingMaternal substance useCase-control designService involvementMedical examiner recordsClinical outcomesEmergency departmentDepartment settingCardiopulmonary resuscitationFatal child abuseServices transportSubstance useDeathFurther studiesSignificant differencesInfants
2018
Feasibility of providing child restraint devices after a motor vehicle crash in a pediatric emergency department
Violano P, Aysseh N, Lucas M, Gawel M, Morrell P, Norway C, Alfano A, Bechtel K. Feasibility of providing child restraint devices after a motor vehicle crash in a pediatric emergency department. Traffic Injury Prevention 2018, 19: 844-848. PMID: 30657709, DOI: 10.1080/15389588.2018.1496243.Peer-Reviewed Original ResearchConceptsPediatric emergency departmentMotor vehicle crashesChild restraint devicesEmergency departmentLevel 1 trauma centerRestraint devicesVehicle crashesBrief educational interventionTrauma centerChildhood morbidityMedical costsPED providersED personnelEducational interventionAppropriate ageUse statusAppropriate useChildrenPatientsSafety of childrenCaregiversCrash mechanismsGuidelinesEDDepartmentSimulation-based research to improve infant health outcomes: Using the infant simulator to prevent infant shaking
Bechtel K, Bhatnagar A, Auerbach M. Simulation-based research to improve infant health outcomes: Using the infant simulator to prevent infant shaking. Infant Behavior And Development 2018, 56: 101263. PMID: 29903429, DOI: 10.1016/j.infbeh.2018.05.006.Peer-Reviewed Original Research
2017
Nonaccidental Injury in Pediatric Patients: Detection, Evaluation, and Treatment
Tiyyagura G, Beucher M, Bechtel K. Nonaccidental Injury in Pediatric Patients: Detection, Evaluation, and Treatment. Pediatric Emergency Medicine Practice 2017, 14: 1-32. PMID: 28665574.Peer-Reviewed Original ResearchMeSH KeywordsBurnsChildChild AbuseChild, PreschoolContusionsCraniocerebral TraumaDiagnosis, DifferentialEmergency Medical ServicesEvidence-Based MedicineFemaleFractures, BoneGuidelines as TopicHumansInfantIntensive Care Units, PediatricMaleMandatory ReportingPhysical ExaminationPhysician's RolePractice Patterns, Physicians'Retinal HemorrhageUnited StatesWounds and InjuriesPrevention of Pediatric Abusive Head Trauma: Time to Rethink Interventions and Reframe Messages
Leventhal JM, Asnes AG, Bechtel K. Prevention of Pediatric Abusive Head Trauma: Time to Rethink Interventions and Reframe Messages. JAMA Pediatrics 2017, 171: 218-220. PMID: 28135369, DOI: 10.1001/jamapediatrics.2016.4512.Peer-Reviewed Original Research
2016
Development of a Child Abuse Checklist to Evaluate Prehospital Provider Performance
Alphonso A, Auerbach M, Bechtel K, Bilodeau K, Gawel M, Koziel J, Whitfill T, Tiyyagura GK. Development of a Child Abuse Checklist to Evaluate Prehospital Provider Performance. Prehospital Emergency Care 2016, 21: 222-232. PMID: 27700209, DOI: 10.1080/10903127.2016.1229824.Peer-Reviewed Original ResearchConceptsInter-rater reliabilityClinical experiencePrehospital providersLight's kappaEmergency medical services (EMS) providersCronbach's alphaAuthors' clinical experienceOverall Cronbach's alphaOverall inter-rater reliabilityInternal consistencyChild abuseSubstantial inter-rater reliabilityDelphi review processStrong content validityMedical service providersSemi-structured qualitative interviewsFinal checklistSelf-reported confidenceProvider experienceParticipant characteristicsItem completionLevel of trainingDelphi reviewContent validityProvider performanceDrugs, guns and cars: how far we have come to improve safety in the United States; yet we still have far to go
Dodington J, Violano P, Baum CR, Bechtel K. Drugs, guns and cars: how far we have come to improve safety in the United States; yet we still have far to go. Pediatric Research 2016, 81: 227-232. PMID: 27673424, DOI: 10.1038/pr.2016.193.Peer-Reviewed Original ResearchConceptsPoison Prevention Packaging ActMotor vehicle crashesInjury preventionPrevention researchVehicle crashesInjury prevention researchOpioid overdose preventionPublic health approachChild passenger safetySignificant reductionInjury morbidityUnintentional injuriesLeading causeOpiate overdosesFirearm injuriesOverdose preventionInjury dataInjuryHealth approachMajor causeYoung adultsDriver’s license lawChild passenger safety lawsPreventionAdolescentsBarriers and Facilitators to Recognition and Reporting of Child Abuse by Prehospital Providers
Tiyyagura GK, Gawel M, Alphonso A, Koziel J, Bilodeau K, Bechtel K. Barriers and Facilitators to Recognition and Reporting of Child Abuse by Prehospital Providers. Prehospital Emergency Care 2016, 21: 46-53. PMID: 27436455, DOI: 10.1080/10903127.2016.1204038.Peer-Reviewed Original ResearchConceptsPrehospital care providersCare providersChief complaintInfant abusive head traumaReal-time decision supportPresence of caregiversAbusive head traumaPediatric patientsHead traumaPatient's airwayProtective servicesRecognition of signsDecision supportHospital providersPatients' thoughtsPrehospital providersCaregiver reactionsThematic saturationChild protective servicesChild abuseFocused educationKey taskAirwayPatientsScene safety
2012
Sudden Unexpected Infant Death
Bechtel K. Sudden Unexpected Infant Death. Pediatric Emergency Care 2012, 28: 1085-1089. PMID: 23034500, DOI: 10.1097/pec.0b013e31826d1e9a.Peer-Reviewed Original ResearchConceptsSudden unexpected infant deathSudden infant death syndromeInfant death syndromeUnexpected infant deathEmergency departmentInfant deathDeath syndromeInterviews of caregiversChild death review teamsLocal medical examinersObvious causeED practitionersFatal child abuseED guidelinesCompassionate mannerMedical examinersDeathSyndromeReview teamCauseChild abuseInfants
2010
Hepatosplenomegaly and Reticulocytopenia as Prominent Features of Atypical Hemolytic Uremic Syndrome
Bechtel K, Iragorri S. Hepatosplenomegaly and Reticulocytopenia as Prominent Features of Atypical Hemolytic Uremic Syndrome. Pediatric Emergency Care 2010, 26: 510-511. PMID: 20622633, DOI: 10.1097/pec.0b013e3181e5bffb.Peer-Reviewed Original ResearchConceptsHemolytic uremic syndromeAtypical hemolytic uremic syndromeUremic syndromeDiagnosis of HUSIncorrect initial diagnosisInvasive pneumococcal diseaseProminent clinical featureClinical characteristicsPneumococcal diseaseRenal injuryClinical featuresInitial diagnosisAcute leukemiaHematologic malignanciesDifferential diagnosisAtypical casesDiagnosisHepatosplenomegalyReticulocytopeniaSyndromeMorbidityMalignancyInjuryLeukemiaProminent feature
2009
Utility of Hepatic Transaminases to Recognize Abuse in Children
Lindberg D, Makoroff K, Harper N, Laskey A, Bechtel K, Deye K, Shapiro R. Utility of Hepatic Transaminases to Recognize Abuse in Children. Pediatrics 2009, 124: 509-516. PMID: 19620197, DOI: 10.1542/peds.2008-2348.Peer-Reviewed Original ResearchMeSH KeywordsAbdominal InjuriesAlanine TransaminaseAspartate AminotransferasesChild AbuseChild, PreschoolEmergency Service, HospitalFemaleHumansInfantInfant, NewbornLiver Function TestsMagnetic Resonance ImagingMaleMass ScreeningPhysical ExaminationPredictive Value of TestsProspective StudiesReference ValuesReferral and ConsultationROC CurveTomography, X-Ray ComputedConceptsIU/LAbdominal injuriesAbdominal bruisingHepatic transaminasesPhysical abuseElevated transaminase levelsClinical examination findingsStandard of careChild abuse teamPopulation of childrenPossible physical abuseSubspecialty evaluationALT levelsTransaminase levelsClinical findingsExamination findingsObservational studyRoutine screeningAbdominal imagingImportant causeInjuryUniversal imagingTransaminaseChild physical abusePatients
2004
Characteristics That Distinguish Accidental From Abusive Injury in Hospitalized Young Children With Head Trauma
Bechtel K, Stoessel K, Leventhal JM, Ogle E, Teague B, Lavietes S, Banyas B, Allen K, Dziura J, Duncan C. Characteristics That Distinguish Accidental From Abusive Injury in Hospitalized Young Children With Head Trauma. Pediatrics 2004, 114: 165-168. PMID: 15231923, DOI: 10.1542/peds.114.1.165.Peer-Reviewed Original ResearchConceptsAbusive head injuryAccidental head injuryAbnormal mental statusMonths of ageUnilateral retinal hemorrhageRetinal hemorrhagesHead injuryProportion of childrenScalp hematomaMental statusHead traumaOutcome measuresSecondary outcome measuresHead injury groupSerial neurologic examinationsMain outcome measuresAbusive head traumaChild abuse specialistInjury groupEye examinationVitreous hemorrhageClinical featuresInitial presentationNeurologic examinationOphthalmoscopic examinationA Randomized Trial of Nebulized Epinephrine vs Albuterol in the Emergency Department Treatment of Bronchiolitis
Mull CC, Scarfone RJ, Ferri LR, Carlin T, Salvaggio C, Bechtel KA, Trephan MA, Rissman RL, Gracely EJ. A Randomized Trial of Nebulized Epinephrine vs Albuterol in the Emergency Department Treatment of Bronchiolitis. JAMA Pediatrics 2004, 158: 113-118. PMID: 14757602, DOI: 10.1001/archpedi.158.2.113.Peer-Reviewed Original ResearchConceptsEpinephrine-treated groupEmergency department treatmentED dischargeClinical scoresNebulized epinephrineIll infantsOutcome measuresAntecedent upper respiratory tract infectionRespiratory rateRoom air oxygen saturationUpper respiratory tract infectionNew-onset wheezingRoom air saturationDouble-blind fashionProportion of patientsRespiratory tract infectionsMean clinical scoreSecondary outcome measuresPrimary outcome measureMonths of ageNebulized albuterolTract infectionsRelapse rateMedian timeRacemic epinephrine
2003
Accidental and abusive head injury in young children
Listman DA, Bechtel K. Accidental and abusive head injury in young children. Current Opinion In Pediatrics 2003, 15: 299-303. PMID: 12806261, DOI: 10.1097/00008480-200306000-00013.Peer-Reviewed Original Research