2024
Disparities in Guideline Adherence for Febrile Infants in a National Quality Improvement Project.
McDaniel C, Truschel L, Kerns E, Polanco Y, Liang D, Gutman C, Cunningham S, Rooholamini S, Thull-Freedman J, Jennings B, Magee S, Aronson P. Disparities in Guideline Adherence for Febrile Infants in a National Quality Improvement Project. Pediatrics 2024, 154 PMID: 39155728, PMCID: PMC11350103, DOI: 10.1542/peds.2024-065922.Peer-Reviewed Original ResearchConceptsQuality improvementDelivery of evidence-based careStandard careEmergency departmentNational quality improvement projectNon-Hispanic black infantsEvidence-based careQuality improvement projectDocumentation of follow-upAssociation of raceNon-Hispanic white infantsClinical practice guidelinesCross-sectional studyPediatrics clinical practice guidelineQI collaborativeEquitable deliveryGuideline implementationFollow-upEthnic disparitiesGuideline adherenceGuideline-concordantIntervention periodAmerican Academy of Pediatrics clinical practice guidelineImprovement projectPractice guidelinesDisposition and Follow-up for Low-Risk Febrile Infants: A Secondary Analysis of a Multicenter Study.
Kannikeswaran N, Spencer P, Tedford N, Truschel L, Chu J, Dingeldein L, Waseem M, Chow J, Lababidi A, Theiler C, Bhalodkar S, Yan X, Lou X, Fernandez R, Aronson P, Lion K, Gutman C. Disposition and Follow-up for Low-Risk Febrile Infants: A Secondary Analysis of a Multicenter Study. Hospital Pediatrics 2024, 14: e379-e384. PMID: 39113626, PMCID: PMC11358591, DOI: 10.1542/hpeds.2024-007850.Peer-Reviewed Original ResearchConceptsFebrile infantsFollow-upPrimary care providersElectronic health record documentationElectronic health recordsDischarged infantsEmergency departmentED dispositionLow riskAmerican Academy of Pediatrics guidelinesInvasive bacterial infectionsSecondary analysisCross-sectional studyMulticenter studyPost-discharge follow-upPediatric guidelinesWeekday visitsBacterial infectionsInfantsQuality of careAmerican AcademyMulticenterCare planningCare providersPatient-centeredImproving Guideline-Concordant Care for Febrile Infants Through a Quality Improvement Initiative.
McDaniel C, Kerns E, Jennings B, Magee S, Biondi E, Flores R, Aronson P. Improving Guideline-Concordant Care for Febrile Infants Through a Quality Improvement Initiative. Pediatrics 2024, 153 PMID: 38682245, DOI: 10.1542/peds.2023-063339.Peer-Reviewed Original ResearchConceptsClinical practice guidelinesFebrile infantsAmerican Academy of Pediatrics clinical practice guidelineSecondary measuresAAP clinical practice guidelinesPediatrics clinical practice guidelineInvasive bacterial infectionsQI collaborativeIntervention bundleAdherence to specific recommendationsDischarge of infantsGuideline-concordant careInfants aged 8Clinical practice guideline recommendationsPrimary measureQuality improvementOral antibioticsEmergency department dischargePositive urinalysisAssociated with improvementsQualifying infantsQuality improvement initiativesAdministered antibioticsGuideline recommendationsCerebrospinal fluidFebrile infants aged ≤60 days: evaluation and management in the emergency department.
Palladino L, Woll C, Aronson P. Febrile infants aged ≤60 days: evaluation and management in the emergency department. Pediatric Emergency Medicine Practice 2024, 21: 1-28. PMID: 38266065.Peer-Reviewed Original ResearchConceptsInvasive bacterial infectionsBacterial infectionsManagement of febrile young infantsAmerican Academy of Pediatrics clinical practice guidelineYoung infantsFebrile young infantsPediatrics clinical practice guidelineEmergency departmentUrinary tract infectionRisk stratification toolPositive viral testClinical practice guidelinesTract infectionsViral testingEmergency cliniciansSevere outcomesAmerican AcademyInfectionPractice guidelinesInfantsDepartmentFeverEmergencyPerspectives of Adolescents and Young Adults With Sickle Cell Disease and Clinicians on Improving Transition Readiness With a Video Game Intervention
Aronson P, Nolan S, Schaeffer P, Hieftje K, Ponce K, Calhoun C. Perspectives of Adolescents and Young Adults With Sickle Cell Disease and Clinicians on Improving Transition Readiness With a Video Game Intervention. Journal Of Pediatric Hematology/Oncology 2024, 46: e147-e155. PMID: 38237001, DOI: 10.1097/mph.0000000000002810.Peer-Reviewed Original ResearchConceptsVideo game interventionPediatric to adult careOptimize self-efficacyGame interventionPatient engagementSelf-efficacyAdult careIdentified 4 main themesMedical decisionsImprove transition readinessYoung adultsExperiences of cliniciansQuaternary-care hospitalSickle cell diseaseData saturationTransition readinessMultilevel determinantsSemistructured interviewsClinician experienceHome managementCareInductive analysisCell diseaseDecision-makingIntervention
2023
Clinician Management Practices for Infants With Hypothermia in the Emergency Department.
Ramgopal S, Graves C, Aronson P, Cruz A, Rogers A. Clinician Management Practices for Infants With Hypothermia in the Emergency Department. Pediatrics 2023, 152 PMID: 38009075, DOI: 10.1542/peds.2023-063000.Peer-Reviewed Original ResearchConceptsSerious bacterial infectionsManagement of infantsEmergency departmentTreatment preferencesRespiratory viral testingSimplex virus infectionUS pediatric hospitalsProportion of cliniciansDays of ageClinician testingFebrile infantsED cliniciansInfants 0Pediatric hospitalViral testingClinician comfortVirus infectionAntimicrobial administrationHypothermiaYoung infantsOlder infantsInfantsBacterial infectionsCliniciansAgeEffect Modifiers of the Association of High-Flow Nasal Cannula and Bronchiolitis Length of Stay.
Winer J, Richardson T, Berg K, Berry J, Chang P, Etinger V, Hall M, Kim G, Meneses Paz J, Treasure J, Aronson P. Effect Modifiers of the Association of High-Flow Nasal Cannula and Bronchiolitis Length of Stay. Hospital Pediatrics 2023, 13: 1018-1027. PMID: 37795554, PMCID: PMC10593863, DOI: 10.1542/hpeds.2023-007295.Peer-Reviewed Original ResearchConceptsEffect of HFNCICU servicesEffect modifiersHigh-flow nasal cannula therapyMulticenter retrospective cohort studyPediatric Health Information SystemAge groupsHigh-flow nasal cannulaNon-ICU patientsRetrospective cohort studyComplex chronic conditionsMultivariable Poisson regressionFuture prospective studiesPotential effect modifiersInitial desaturationInitial tachypneaCohort studyClinical factorsNasal cannulaHospital recordsProspective studyHospitalized childrenChronic conditionsHFNCPatientsRacial and Ethnic Differences in Insurer Classification of Nonemergent Pediatric Emergency Department Visits
Pomerantz A, De Souza H, Hall M, Neuman M, Goyal M, Samuels-Kalow M, Aronson P, Alpern E, Simon H, Hoffmann J, Wells J, Shanahan K, Gutman C, Peltz A. Racial and Ethnic Differences in Insurer Classification of Nonemergent Pediatric Emergency Department Visits. JAMA Network Open 2023, 6: e2311752. PMID: 37140920, PMCID: PMC10160869, DOI: 10.1001/jamanetworkopen.2023.11752.Peer-Reviewed Original ResearchConceptsUnique ED visitsED visitsPediatric ED visitsClaims algorithmHispanic childrenMore visitsReimbursement reductionsHispanic pediatric patientsNonemergent ED visitsCurrent Procedural Terminology codesEmergency department visitsPediatric emergency departmentPrimary care servicesProcedural Terminology codesWhite childrenProfessional reimbursementCommercial health insurerRetrospective cohortDate of birthDepartment visitsPediatric patientsStudy cohortEmergency departmentMedicaid databaseDiagnosis codesPrevalence of Urinary Tract Infection, Bacteremia, and Meningitis Among Febrile Infants Aged 8 to 60 Days With SARS-CoV-2
Aronson P, Louie J, Kerns E, Jennings B, Magee S, Wang M, Gupta N, Kovaleski C, McDaniel L, McDaniel C, Agbim C, Amadasun O, Beam N, Beamon B, Becker H, Bedard E, Biondi E, Boulet J, Bray-Aschenbrenner A, Brooks R, Chen C, Corboy J, Dawlabani N, De Angulo G, Demie S, Drexler J, Dudley N, Ellis A, Fath K, Frauenfelder A, Gill J, Graf T, Grageda M, Greening H, Griffin A, Groen A, Guernsey III D, Gustafson S, Hancock W, Iyer S, Jaiyeola P, Jayanth A, Jennings R, Kachan-Liu S, Kamat A, Kennedy I, Khateeb L, Khilji O, Kleweno E, Kumar A, Kwon S, La A, Laeven-Sessions P, Le K, Leazer R, Levasseur K, Lewis E, Maalouli W, Mackenzie B, Mahoney K, Margulis D, Maskin L, McCarty E, Monroy A, Morrison J, Myszewski J, Nadeau N, Nagappan S, Newcomer K, Nordstrom M, Nguyen D, O'Day P, Oumarbaeva-Malone Y, Parlin U, Peters S, Piroutek M, Quarrie R, Rice K, Romano T, Rooholamini S, Schroeder C, Segar E, Seitzinger P, Sharma S, Simpson B, Singh P, Sobeih Y, Sojar S, Srinivasan K, Sterrett E, Swift-Taylor M, Szkola S, Thull-Freedman J, Topoz I, Vayngortin T, Veit C, Ventura-Polanco Y, Wallace Wu A, Weiss L, Wong E, Zafar S. Prevalence of Urinary Tract Infection, Bacteremia, and Meningitis Among Febrile Infants Aged 8 to 60 Days With SARS-CoV-2. JAMA Network Open 2023, 6: e2313354. PMID: 37171815, PMCID: PMC10182434, DOI: 10.1001/jamanetworkopen.2023.13354.Peer-Reviewed Original ResearchConceptsPrevalence of UTIUrinary tract infectionSARS-CoV-2SARS-CoV-2-positive infantsSARS-CoV-2 testingFebrile infantsBacterial meningitisTract infectionsSARS-CoV-2 positivityMulticenter cross-sectional studyInflammatory marker levelsMedical record reviewProportion of infantsCross-sectional studyQuality improvement initiativesRecord reviewEmergency departmentMarker levelsLower proportionBacteremiaMAIN OUTCOMEMeningitisInfantsAge groupsBacterial infectionsVariation in stool testing for children with acute gastrointestinal infections
Markham J, Hall M, Collins M, Shah S, Molloy M, Aronson P, Cotter J, Steiner M, McCoy E, Tchou M, Stephens J. Variation in stool testing for children with acute gastrointestinal infections. Journal Of Hospital Medicine 2023, 18: 473-482. PMID: 36988413, PMCID: PMC11340271, DOI: 10.1002/jhm.13087.Peer-Reviewed Original ResearchConceptsAcute gastrointestinal infectionsStool testingLength of stayGastrointestinal infectionsHospitalized childrenTesting ratesUtilization outcomesPediatric Health Information System databaseHealth Information System databaseOverall testing rateCross-sectional studyStool studiesDiagnostic stewardshipAcute careChildren's HospitalInformation System databaseMAIN OUTCOMEHospitalInfectionIndividual hospitalsOutcomesSignificant differencesChildrenSystem databaseTesting group
2022
Trends in Prevalence of Bacterial Infections in Febrile Infants During the COVID-19 Pandemic.
Aronson P, Kerns E, Jennings B, Magee S, Wang M, McDaniel C. Trends in Prevalence of Bacterial Infections in Febrile Infants During the COVID-19 Pandemic. Pediatrics 2022, 150 PMID: 36353853, DOI: 10.1542/peds.2022-059235.Peer-Reviewed Original ResearchConceptsUrinary tract infectionInvasive bacterial infectionsCOVID-19 prevalenceFebrile infantsOdds of UTIPrevalence of UTIBacterial infectionsMulticenter cross-sectional studyEmergency department visitsMonths of presentationCoronavirus disease 2019 (COVID-19) pandemicCross-sectional studyDisease 2019 pandemicUTI prevalenceTract infectionsBacterial meningitisDepartment visitsLower oddsPrepandemic levelsInfantsInfants 8MeningitisBacteremiaLogistic regressionPrevalenceInjury-Related Pediatric Emergency Department Visits in the First Year of COVID-19.
Wells J, Rodean J, Cook L, Sills M, Neuman M, Kornblith A, Jain S, Hirsch A, Goyal M, Fleegler E, DeLaroche A, Aronson P, Leonard J. Injury-Related Pediatric Emergency Department Visits in the First Year of COVID-19. Pediatrics 2022, 150 PMID: 35836331, DOI: 10.1542/peds.2021-054545.Peer-Reviewed Original ResearchConceptsInjury-related visitsInjury-related ED visitsHospital emergency departmentEmergency departmentED visitsSARS-CoV-2 pandemic periodAcute respiratory syndrome coronavirus 2 pandemicSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemicChildren's hospital emergency departmentPediatric Health Information SystemUnited States children's hospitalsPrimary discharge diagnosisMechanism of injurySprains/strainsPediatric emergency departmentCoronavirus 2 pandemicCross-sectional studySARS-CoV-2 pandemicFirst yearPatient characteristicsChildren's HospitalDischarge diagnosisInjury patternsInjury typeAdministrative databasesDisparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocol
Gutman C, Lion K, Aronson P, Fisher C, Bylund C, McFarlane A, Lou X, Patterson M, Lababidi A, Fernandez R. Disparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocol. BMJ Open 2022, 12: e063611. PMID: 36127098, PMCID: PMC9490627, DOI: 10.1136/bmjopen-2022-063611.Peer-Reviewed Original ResearchConceptsLow-risk febrile infantsFebrile infantsEmergency departmentClinical carePediatric Emergency Medicine Collaborative Research CommitteeFlorida Institutional Review BoardLocal institutional review board approvalPediatric ED physiciansInstitutional review board approvalMultivariable logistic regressionCross-sectional studyPhysician-patient communicationReview board approvalClinical guideline implementationMethods study protocolInstitutional review boardMulticenter analysisPrimary outcomeED physiciansPhysician assessmentRecommended careGuideline implementationLumbar punctureStudy protocolEmergency settingVariation in bacterial pneumonia diagnoses and outcomes among children hospitalized with lower respiratory tract infections
Cotter J, Hall M, Shah S, Molloy M, Markham J, Aronson P, Stephens J, Steiner M, McCoy E, Collins M, Tchou M. Variation in bacterial pneumonia diagnoses and outcomes among children hospitalized with lower respiratory tract infections. Journal Of Hospital Medicine 2022, 17: 872-879. PMID: 35946482, PMCID: PMC11366396, DOI: 10.1002/jhm.12940.Peer-Reviewed Original ResearchConceptsBacterial community-acquired pneumoniaLower respiratory tract infectionsCommunity-acquired pneumoniaRespiratory tract infectionsProportion of childrenTract infectionsDiagnosis groupsMulticenter cross-sectional studyLength of stayCross-sectional studyCause revisitsClinical outcomesBlood testsChildren's HospitalViral causeCaP diagnosisChest radiographsMAIN OUTCOMEMultivariable regressionPneumonia diagnosisHospitalDiagnosisOutcomesReadmissionSignificant differencesPrevalence and Management of Invasive Bacterial Infections in Febrile Infants Ages 2 to 6 Months
Green R, Sartori L, Lee B, Linn A, Samuels M, Florin T, Aronson P, Chamberlain J, Michelson K, Nigrovic L. Prevalence and Management of Invasive Bacterial Infections in Febrile Infants Ages 2 to 6 Months. Annals Of Emergency Medicine 2022, 80: 499-506. PMID: 35940993, DOI: 10.1016/j.annemergmed.2022.06.014.Peer-Reviewed Original ResearchConceptsInvasive bacterial infectionsCase-control studyBacterial infectionsFebrile infantsInfants 2Emergency departmentEligible patient encountersOlder febrile infantsCerebrospinal fluid culturesInfection prevalenceAge-matched infantsEvidence-based guidelinesInfants ages 2Months of ageLow-value testingFebrile neonatesOverall cohortRetrospective cohortSecondary outcomesPrimary outcomeAntibiotic administrationBacterial cultureFluid cultureCerebrospinal fluidLower risk
2019
A Prediction Model to Identify Febrile Infants ≤60 Days at Low Risk of Invasive Bacterial Infection
Aronson PL, Shabanova V, Shapiro ED, Wang ME, Nigrovic LE, Pruitt CM, DePorre AG, Leazer RC, Desai S, Sartori LF, Marble RD, Rooholamini SN, McCulloh RJ, Woll C, Balamuth F, Alpern ER, Shah SS, Williams DJ, Browning WL, Shah N, Neuman MI. A Prediction Model to Identify Febrile Infants ≤60 Days at Low Risk of Invasive Bacterial Infection. Pediatrics 2019, 144: e20183604. PMID: 31167938, PMCID: PMC6615531, DOI: 10.1542/peds.2018-3604.Peer-Reviewed Original ResearchConceptsInvasive bacterial infectionsAbsolute neutrophil countFebrile infantsControl patientsNeutrophil countUrinalysis resultsBacterial infectionsAbnormal urinalysis resultsNormal urinalysis resultsComplex chronic conditionsCase-control studyMultiple logistic regressionDate of visitEmergency departmentChronic conditionsCerebrospinal fluidLower riskInfantsLogistic regressionPatientsHospitalScoresInfectionDaysLow probabilityPhysicians’ and Nurses’ Perspectives on the Decision to Perform Lumbar Punctures on Febrile Infants ≤8 Weeks Old
Aronson PL, Schaeffer P, Fraenkel L, Shapiro ED, Niccolai LM. Physicians’ and Nurses’ Perspectives on the Decision to Perform Lumbar Punctures on Febrile Infants ≤8 Weeks Old. Hospital Pediatrics 2019, 9: 405-414. PMID: 31113814, PMCID: PMC6537124, DOI: 10.1542/hpeds.2019-0002.Peer-Reviewed Original ResearchConceptsFebrile infantsPrimary care pediatriciansLumbar punctureClinical experienceGeneral emergency medicine physiciansEmergency medicine nursesPhysicians' clinical experienceEmergency medicine physiciansAcademic medical centerPhysicians' valuesPhysician assessmentClinical equipoiseMedical CenterMedicine physiciansNurses' perspectivesPhysician usePhysician's decisionInfantsPhysician practicesPhysiciansNursesParents' preferencesPediatriciansConstant comparative methodPuncture
2018
Risk Stratification of Febrile Infants ≤60 Days Old Without Routine Lumbar Puncture
Aronson PL, Wang ME, Shapiro ED, Shah SS, DePorre AG, McCulloh RJ, Pruitt CM, Desai S, Nigrovic LE, Marble RD, Leazer RC, Rooholamini SN, Sartori LF, Balamuth F, Woll C, Neuman MI. Risk Stratification of Febrile Infants ≤60 Days Old Without Routine Lumbar Puncture. Pediatrics 2018, 142: e20181879. PMID: 30425130, PMCID: PMC6317769, DOI: 10.1542/peds.2018-1879.Peer-Reviewed Original ResearchConceptsInvasive bacterial infectionsPhiladelphia criteriaFebrile infantsBacterial meningitisRisk stratificationCSF testingRochester criteriaEmergency departmentLower riskRoutine CSF testingCerebrospinal fluid testingComplex chronic conditionsRoutine lumbar punctureCase-control studyDate of visitLow-risk infantsLumbar punctureChronic conditionsHigh riskInfantsBacterial infectionsDay oldsFluid testingMeningitisRiskFactors Associated with Adverse Outcomes among Febrile Young Infants with Invasive Bacterial Infections
Pruitt CM, Neuman MI, Shah SS, Shabanova V, Woll C, Wang ME, Alpern ER, Williams DJ, Sartori L, Desai S, Leazer RC, Marble RD, McCulloh RJ, DePorre AG, Rooholamini SN, Lumb CE, Balamuth F, Shin S, Aronson PL, Collaborative F, Nigrovic L, Browning W, Mitchell C, Peaper D, Feldman E. Factors Associated with Adverse Outcomes among Febrile Young Infants with Invasive Bacterial Infections. The Journal Of Pediatrics 2018, 204: 177-182.e1. PMID: 30297292, PMCID: PMC6309646, DOI: 10.1016/j.jpeds.2018.08.066.Peer-Reviewed Original ResearchConceptsInvasive bacterial infectionsFebrile young infantsAdverse outcomesBacterial meningitisYoung infantsIll appearanceFebrile infantsBacterial infectionsRetrospective cohort studyMedical record reviewLocal microbiology laboratoryMixed-effects logistic regressionElectronic medical record systemDays of ageIll appearingNeurologic sequelaeCohort studyMedical record systemClinical factorsMedication receiptMechanical ventilationRecord reviewClinical dataInclusion criteriaMeningitisTime to Pathogen Detection for Non-ill Versus Ill-Appearing Infants ≤60 Days Old With Bacteremia and Meningitis
Aronson PL, Wang ME, Nigrovic LE, Shah SS, Desai S, Pruitt CM, Balamuth F, Sartori L, Marble RD, Rooholamini SN, Leazer RC, Woll C, DePorre AG, Neuman MI. Time to Pathogen Detection for Non-ill Versus Ill-Appearing Infants ≤60 Days Old With Bacteremia and Meningitis. Hospital Pediatrics 2018, 8: 379-384. PMID: 29954839, PMCID: PMC6145376, DOI: 10.1542/hpeds.2018-0002.Peer-Reviewed Original ResearchConceptsBacterial meningitisCerebrospinal fluidOverall low prevalenceIll appearanceChildren's HospitalClinical appearanceEmergency departmentBlood culturesMedical recordsBacteremiaLow prevalenceMeningitisInfantsDay oldsMicrobiology laboratoryDemographic characteristicsBloodPathogen detectionHospitalBacterial pathogensHoursLower proportionDaysPathogensInfection