2021
Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes
Son MBF, Murray N, Friedman K, Young CC, Newhams MM, Feldstein LR, Loftis LL, Tarquinio KM, Singh AR, Heidemann SM, Soma VL, Riggs BJ, Fitzgerald JC, Kong M, Doymaz S, Giuliano JS, Keenaghan MA, Hume JR, Hobbs CV, Schuster JE, Clouser KN, Hall MW, Smith LS, Horwitz SM, Schwartz SP, Irby K, Bradford TT, Maddux AB, Babbitt CJ, Rowan CM, McLaughlin GE, Yager PH, Maamari M, Mack EH, Carroll CL, Montgomery VL, Halasa NB, Cvijanovich NZ, Coates BM, Rose CE, Newburger JW, Patel MM, Randolph AG. Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes. New England Journal Of Medicine 2021, 385: 23-34. PMID: 34133855, PMCID: PMC8220972, DOI: 10.1056/nejmoa2102605.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentChildChild, PreschoolCohort StudiesCombined Modality TherapyCOVID-19COVID-19 Drug TreatmentDrug Therapy, CombinationFemaleGlucocorticoidsHospitalizationHumansImmunoglobulins, IntravenousImmunomodulationInfantLogistic ModelsMalePropensity ScorePublic Health SurveillanceShockSystemic Inflammatory Response SyndromeTreatment OutcomeVentricular Dysfunction, LeftYoung AdultConceptsIntravenous immune globulinMultisystem inflammatory syndromeCardiovascular dysfunctionDay 2Immunomodulatory therapyInflammatory syndromePrimary outcomeInitial treatmentLower riskRisk of feverReal-world effectivenessYears of agePropensity-score matchingImmunomodulatory medicationsVasopressor useVentricular dysfunctionAdjunctive therapyComposite outcomeImmune globulinSecondary outcomesAdjunctive treatmentRecurrent feverInverse probability weightingDay 1GlucocorticoidsIncidence of Multisystem Inflammatory Syndrome in Children Among US Persons Infected With SARS-CoV-2
Payne AB, Gilani Z, Godfred-Cato S, Belay ED, Feldstein LR, Patel MM, Randolph AG, Newhams M, Thomas D, Magleby R, Hsu K, Burns M, Dufort E, Maxted A, Pietrowski M, Longenberger A, Bidol S, Henderson J, Sosa L, Edmundson A, Tobin-D’Angelo M, Edison L, Heidemann S, Singh AR, Giuliano JS, Kleinman LC, Tarquinio KM, Walsh RF, Fitzgerald JC, Clouser KN, Gertz SJ, Carroll RW, Carroll CL, Hoots BE, Reed C, Dahlgren FS, Oster ME, Pierce TJ, Curns AT, Langley GE, Campbell AP, Balachandran N, Murray T, Burkholder C, Brancard T, Lifshitz J, Leach D, Charpie I, Tice C, Coffin S, Perella D, Jones K, Marohn K, Yager P, Fernandes N, Flori H, Koncicki M, Walker K, Di Pentima M, Li S, Horwitz S, Gaur S, Coffey D, Harwayne-Gidansky I, Hymes S, Thomas N, Ackerman K, Cholette J. Incidence of Multisystem Inflammatory Syndrome in Children Among US Persons Infected With SARS-CoV-2. JAMA Network Open 2021, 4: e2116420. PMID: 34110391, PMCID: PMC8193431, DOI: 10.1001/jamanetworkopen.2021.16420.Peer-Reviewed Original ResearchConceptsSARS-CoV-2 infectionMultisystem inflammatory syndromeRace/ethnicityInflammatory syndromeCohort studyPacific Islander personsAge groupsCurrent SARS-CoV-2 infectionIncidence of MISPopulation-based incidenceWhite personsPopulation-based estimatesEnhanced surveillance dataSARS-CoV-2Rare complicationCOVID-19 casesLatino personsNational surveillanceMAIN OUTCOMEInfectionDisease controlIncidenceSurveillance dataCOVID-19Further studiesNeurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome
LaRovere KL, Riggs BJ, Poussaint TY, Young CC, Newhams MM, Maamari M, Walker TC, Singh AR, Dapul H, Hobbs CV, McLaughlin GE, Son MBF, Maddux AB, Clouser KN, Rowan CM, McGuire JK, Fitzgerald JC, Gertz SJ, Shein SL, Munoz AC, Thomas NJ, Irby K, Levy ER, Staat MA, Tenforde MW, Feldstein LR, Halasa NB, Giuliano JS, Hall MW, Kong M, Carroll CL, Schuster JE, Doymaz S, Loftis LL, Tarquinio KM, Babbitt CJ, Nofziger RA, Kleinman LC, Keenaghan MA, Cvijanovich NZ, Spinella PC, Hume JR, Wellnitz K, Mack EH, Michelson KN, Flori HR, Patel MM, Randolph AG, Last Name* F, Gaspers M, Typpo K, Sanders R, Schwarz A, Harvey H, Zinter M, Mourani P, Coates B, Bhoojhawon G, Havlin K, Montgomery V, Sullivan J, Bradford T, Bembea M, Lipton S, Graciano A, Chen S, Kucukak S, Newburger J, Carroll R, Fernandes N, Yager P, Marohn K, Heidemann S, Cullimore M, McCulloh R, Horwitz S, Li S, Walsh R, Ratner A, Soma V, Gillen J, Zackai S, Ackerman K, Cholette J, Harwayne-Gidansky I, Hymes S, Overby P, Schwartz S, Lansell A, Koncicki M, Carcillo J, Fink E, Kimura D, Bowens C, Crandall H, Smith L, Cengiz P. Neurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome. JAMA Neurology 2021, 78: 536-547. PMID: 33666649, PMCID: PMC7936352, DOI: 10.1001/jamaneurol.2021.0504.Peer-Reviewed Original ResearchConceptsMultisystem inflammatory syndromeNeurologic involvementInflammatory syndromeLife-threatening conditionHospital dischargeTransient symptomsNeurologic conditionsPositive severe acute respiratory syndrome coronavirus 2 test resultCOVID-19Severe acute respiratory syndrome coronavirus 2Life-threatening neurologic conditionAcute respiratory syndrome coronavirus 2Long-term neurodevelopmental outcomesRespiratory syndrome coronavirus 2Fatal neurologic conditionFulminant cerebral edemaLife-threatening involvementNew neurologic deficitsAcute neurologic signsSyndrome coronavirus 2Coronavirus disease 2019Public health registriesFibrinogen equivalent unitsAdult patientsCerebral edemaCharacteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19
Feldstein LR, Tenforde MW, Friedman KG, Newhams M, Rose EB, Dapul H, Soma VL, Maddux AB, Mourani PM, Bowens C, Maamari M, Hall MW, Riggs BJ, Giuliano JS, Singh AR, Li S, Kong M, Schuster JE, McLaughlin GE, Schwartz SP, Walker TC, Loftis LL, Hobbs CV, Halasa NB, Doymaz S, Babbitt CJ, Hume JR, Gertz SJ, Irby K, Clouser KN, Cvijanovich NZ, Bradford TT, Smith LS, Heidemann SM, Zackai SP, Wellnitz K, Nofziger RA, Horwitz SM, Carroll RW, Rowan CM, Tarquinio KM, Mack EH, Fitzgerald JC, Coates BM, Jackson AM, Young CC, Son MBF, Patel MM, Newburger JW, Randolph AG. Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19. JAMA 2021, 325: 1074-1087. PMID: 33625505, PMCID: PMC7905703, DOI: 10.1001/jama.2021.2091.Peer-Reviewed Original ResearchConceptsMultisystem inflammatory syndromeOrgan system involvementInflammatory syndromeCase seriesSystem involvementCardiorespiratory involvementCOVID-19Positive severe acute respiratory syndrome coronavirus 2Higher C-reactive protein levelsPositive RT-PCR test resultsSevere acute respiratory syndrome coronavirus 2Severe acute COVID-19Acute respiratory syndrome coronavirus 2C-reactive protein levelsSevere coronavirus disease 2019Left ventricular systolic functionRT-PCR test resultsRespiratory syndrome coronavirus 2Organ system complicationsAcute COVID-19Coronary artery aneurysmsVentricular systolic functionLow platelet countAntibody test resultsIntensive care unit
2020
The New Trainee Effect in Tracheal Intubation Procedural Safety Across PICUs in North America: A Report From National Emergency Airway Registry for Children.
Branca A, Tellez D, Berkenbosch J, Rehder KJ, Giuliano JS, Gradidge E, Shults J, Turner DA, Nett S, Krawiec C, Edwards LR, Pinto M, Harwayne-Gidansky I, Bysani GK, Shenoi A, Breuer RK, Toedt-Pingel I, Parsons SJ, Orioles A, Al-Subu A, Konyk L, Panisello J, Adu-Darko M, Tarquinio K, François T, Emeriaud G, Lee A, Meyer K, Glater-Welt LB, Polikoff L, Kelly SP, Tallent S, Napolitano N, Nadkarni V, Nishisaki A. The New Trainee Effect in Tracheal Intubation Procedural Safety Across PICUs in North America: A Report From National Emergency Airway Registry for Children. Pediatric Critical Care Medicine 2020, 21: 1042-1050. PMID: 32740182, DOI: 10.1097/pcc.0000000000002480.Peer-Reviewed Original ResearchConceptsFirst-attempt successCritical care medicine fellowsNational Emergency Airway RegistryTracheal intubationAttempt successAirway RegistryPediatric critical care medicine fellowship programsPediatric critical care medicine fellowsPediatric critical care medicine fellowshipCritical care medicine fellowshipEvent ratesAdverse tracheal intubationNorth American PICUsRetrospective cohort studyCritical care medicine fellowship programsYear of fellowshipIntubation safetyAdverse eventsCohort studyProcedural safetyIntubationSafety outcomesHigh riskPICUsClinical fellowshipMultisystem Inflammatory Syndrome in U.S. Children and Adolescents
Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, Newburger JW, Kleinman LC, Heidemann SM, Martin AA, Singh AR, Li S, Tarquinio KM, Jaggi P, Oster ME, Zackai SP, Gillen J, Ratner AJ, Walsh RF, Fitzgerald JC, Keenaghan MA, Alharash H, Doymaz S, Clouser KN, Giuliano JS, Gupta A, Parker RM, Maddux AB, Havalad V, Ramsingh S, Bukulmez H, Bradford TT, Smith LS, Tenforde MW, Carroll CL, Riggs BJ, Gertz SJ, Daube A, Lansell A, Coronado Munoz A, Hobbs CV, Marohn KL, Halasa NB, Patel MM, Randolph AG. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. New England Journal Of Medicine 2020, 383: 334-346. PMID: 32598831, PMCID: PMC7346765, DOI: 10.1056/nejmoa2021680.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentBetacoronavirusCenters for Disease Control and Prevention, U.S.ChildCoronavirus InfectionsCOVID-19Critical CareFemaleGlucocorticoidsHumansImmunoglobulins, IntravenousImmunomodulationInflammationLength of StayMaleMucocutaneous Lymph Node SyndromePandemicsPneumonia, ViralProspective StudiesRespiration, ArtificialRetrospective StudiesSARS-CoV-2Systemic Inflammatory Response SyndromeUnited StatesConceptsMultisystem inflammatory syndromeInflammatory syndromeSARS-CoV-2Antibody testingSevere acute respiratory syndrome coronavirus 2Kawasaki disease-like featuresAcute respiratory syndrome coronavirus 2Respiratory syndrome coronavirus 2Coronary artery aneurysmsIntravenous immune globulinMultisystem organ involvementEvidence of infectionOrgan system involvementSyndrome coronavirus 2Reverse transcriptase-polymerase chain reactionCoronavirus disease 2019Life-threatening illnessPediatric health centersPublic health implicationsImmunomodulating therapiesVasoactive supportImmune globulinMedian durationMost patientsOrgan involvement
2019
Angiopoietin Level Trajectories in Toddlers With Severe Sepsis and Septic Shock and Their Effect on Capillary Endothelium
Pierce RW, Shabanova V, Canarie M, Pinto M, da Silva YS, Bhandari V, Giuliano JS. Angiopoietin Level Trajectories in Toddlers With Severe Sepsis and Septic Shock and Their Effect on Capillary Endothelium. Shock 2019, 51: 298-305. PMID: 30286031, PMCID: PMC6375782, DOI: 10.1097/shk.0000000000001172.Peer-Reviewed Original ResearchConceptsSevere sepsis/septic shockSepsis/septic shockTumor necrosis factorHuman dermal microvascular endothelial cellsCultured human dermal microvascular endothelial cellsSIRS/sepsisSeptic shockAngpt-1Severe sepsisAngpt-2Diagnostic biomarkersSevere sepsis/shockTertiary care pediatric hospitalEndothelial cellsAngpt-2 levelsOlder childrenSepsis/shockInflammatory response syndromeProspective observational studyTransendothelial electrical resistance measurementsDermal microvascular endothelial cellsAppropriate diagnostic biomarkersMicrovascular endothelial cellsYoung childrenEnzyme-linked immunoassay
2018
A Qualitative Study of Multidisciplinary Providers' Experiences With the Transfer Process for Injured Children and Ideas for Improvement
Gawel M, Emerson B, Giuliano JS, Rosenberg A, Minges KE, Feder S, Violano P, Morrell P, Petersen J, Christison-Lagay E, Auerbach M. A Qualitative Study of Multidisciplinary Providers' Experiences With the Transfer Process for Injured Children and Ideas for Improvement. Pediatric Emergency Care 2018, 34: 125-131. PMID: 29346234, PMCID: PMC5792311, DOI: 10.1097/pec.0000000000001405.Peer-Reviewed Original ResearchConceptsPediatric trauma centerTrauma centerInjured childrenTransport teamLevel I pediatric trauma centerProvider experienceRegional pediatric trauma centerCommunity hospital emergency departmentHospital emergency departmentEmergency departmentCommunity hospitalEmergency providersInterprofessional providersProvider confidenceQualitative studyMultidisciplinary teamChildrenConstant comparative methodProvidersNew HavenParticipantsEnd-Tidal Carbon Dioxide Use for Tracheal Intubation
Langhan ML, Emerson BL, Nett S, Pinto M, Harwayne-Gidansky I, Rehder KJ, Krawiec C, Meyer K, Giuliano JS, Owen EB, Tarquinio KM, Sanders RC, Shepherd M, Bysani GK, Shenoi AN, Napolitano N, Gangadharan S, Parsons SJ, Simon DW, Nadkarni VM, Nishisaki A. End-Tidal Carbon Dioxide Use for Tracheal Intubation. Pediatric Critical Care Medicine 2018, 19: 98-105. PMID: 29140968, DOI: 10.1097/pcc.0000000000001372.Peer-Reviewed Original ResearchConceptsCapnography useTracheal intubationCardiac arrestEmergency departmentEsophageal intubationOxygen desaturationWaveform capnographyAdverse tracheal intubation-associated eventsMulticenter retrospective cohort studyNational Emergency Airway RegistryTracheal intubation-associated eventsEnd-tidal carbon dioxide measurementPrimary tracheal intubationsRetrospective cohort studyUse of capnographyTracheal intubation procedureQuality improvement initiativesAirway RegistryCohort studyProvider characteristicsSafety outcomesIntubationIntubation procedureCapnographyImprovement initiatives
2017
Endothelial Cell Function and Dysfunction in Critically Ill Children
Pierce RW, Giuliano JS, Pober JS. Endothelial Cell Function and Dysfunction in Critically Ill Children. Pediatrics 2017, 140: e20170355. PMID: 28759412, PMCID: PMC9923607, DOI: 10.1542/peds.2017-0355.Peer-Reviewed Original ResearchConceptsEndothelial cellsCritical illnessIll childrenCritically Ill ChildrenImmune cell recruitmentBiology of ECsEndothelial cell functionBroad anatomic distributionEntire vascular systemPathologic responseAnatomic distributionClinical correlationMaintenance of homeostasisBlood flowCell recruitmentBlood fluiditySystemic homeostasisCell functionSegmental differencesEC functionVascular systemIllnessChildrenHomeostasisSpecific role
2016
A regional cohort study of the treatment of critically ill children with bronchiolitis
Carroll CL, Faustino EV, Pinto MG, Sala KA, Canarie MF, Li S, Giuliano JS, Consortium T. A regional cohort study of the treatment of critically ill children with bronchiolitis. Journal Of Asthma 2016, 53: 1006-1011. PMID: 27177013, DOI: 10.1080/02770903.2016.1180697.Peer-Reviewed Original ResearchConceptsRSV bronchiolitisChildren's HospitalMechanical ventilationIll childrenChest physiotherapyICU lengthCohort studyMedical CenterConnecticut Children's Medical CenterHigh-flow nasal cannulaYale-New Haven Children's HospitalRegional cohort studyInvasive mechanical ventilationLonger ICU lengthRetrospective cohort studyRisk of intubationMortality risk scoreIntrapulmonary percussive ventilationChildren's Medical CenterUse of therapiesIntensive care courseClinical characteristicsNasal cannulaHypertonic salineMore frequent use
2014
Angiopoietin-1, Angiopoietin-2 and Bicarbonate as Diagnostic Biomarkers in Children with Severe Sepsis
Wang K, Bhandari V, Giuliano JS, O′Hern C, Shattuck MD, Kirby M. Angiopoietin-1, Angiopoietin-2 and Bicarbonate as Diagnostic Biomarkers in Children with Severe Sepsis. PLOS ONE 2014, 9: e108461. PMID: 25255212, PMCID: PMC4178003, DOI: 10.1371/journal.pone.0108461.Peer-Reviewed Original ResearchConceptsPediatric intensive care unitSepsis severityAngiopoietin-2Angiopoietin-1Severe pediatric sepsisSeverity of sepsisIntensive care unitTime of admissionHigh mortality rateSevere sepsisPediatric sepsisCare unitAng-2Ill childrenClinical dataAng-1Mortality rateSepsisSingle biomarkerDiagnostic biomarkersBiomarkersSeverityPlasma samplesMultiple biomarkersChildrenThe Effect of Modified Ultrafiltration on Angiopoietins in Pediatric Cardiothoracic Operations
Lang SM, Syed MA, Dziura J, Rocco E, Kirshbom P, Bhandari V, Giuliano JS. The Effect of Modified Ultrafiltration on Angiopoietins in Pediatric Cardiothoracic Operations. The Annals Of Thoracic Surgery 2014, 98: 1699-1704. PMID: 25258157, PMCID: PMC4253712, DOI: 10.1016/j.athoracsur.2014.06.053.Peer-Reviewed Original ResearchConceptsIntensive care unit admissionCare unit admissionModified ultrafiltrationUnit admissionCardiopulmonary bypassAngpt-2Interleukin-8Proinflammatory mediatorsClinical benefitAngpt-2 concentrationsInterleukin-10 levelsProspective cohort studySystemic inflammatory responseChildren 18 yearsEnzyme-linked immunosorbentCohort studyAntiinflammatory mediatorsInterleukin-10Inflammatory responseAngiopoietin-2Angpt-1Cardiothoracic operationsPatient's bloodAdmissionCytokine removalUse of procalcitonin for the prediction and treatment of acute bacterial infection in children
Pierce R, Bigham MT, Giuliano JS. Use of procalcitonin for the prediction and treatment of acute bacterial infection in children. Current Opinion In Pediatrics 2014, 26: 292-298. PMID: 24739491, DOI: 10.1097/mop.0000000000000092.Peer-Reviewed Original ResearchConceptsAntibiotic therapySerum procalcitoninTreatment failureNoninfectious systemic inflammatory response syndromeBacterial infectionsSystemic inflammatory response syndromeSerial PCT measurementsDuration of therapyCentral venous cathetersInflammatory response syndromeAcute bacterial infectionUse of procalcitoninC-reactive proteinInvasive bacterial infectionsPresence of infectionReliable serum markerSickle cell diseaseNoninfectious inflammationPCT levelsVenous cathetersResponse syndromeBacterial sepsisSerum markersPrognostic utilityPatient populationThe Temporal Kinetics of Circulating Angiopoietin Levels in Children With Sepsis
Giuliano JS, Tran K, Li FY, Shabanova V, Tala JA, Bhandari V. The Temporal Kinetics of Circulating Angiopoietin Levels in Children With Sepsis. Pediatric Critical Care Medicine 2014, 15: e1-e8. PMID: 24141659, PMCID: PMC3947338, DOI: 10.1097/pcc.0b013e3182a553bb.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAngiopoietin-1Angiopoietin-2BiomarkersCase-Control StudiesChildChild, PreschoolFemaleHumansIntensive Care Units, PediatricLength of StayMalePredictive Value of TestsProspective StudiesSepsisSeverity of Illness IndexShock, SepticSystemic Inflammatory Response SyndromeTime FactorsConceptsSevere sepsis/shockSepsis/shockSystemic inflammatory response syndrome/sepsisPediatric patientsShock groupAngiopoietin-2Day 2Angiopoietin-1Days of illnessHours of admissionIll pediatric patientsInflammatory response syndromeRisk stratification scoresProspective observational studyCritical care physiciansVascular growth factorsEnzyme-linked immunosorbentAngiopoietin levelsPICU lengthPICU patientsSevere sepsisSepsis severityResponse syndromeStratification scoresCare physicians
2013
The SNAP index does not correlate with the State Behavioral Scale in intubated and sedated children
Thompson C, Shabanova V, Giuliano JS. The SNAP index does not correlate with the State Behavioral Scale in intubated and sedated children. Pediatric Anesthesia 2013, 23: 1174-1179. PMID: 24103039, PMCID: PMC3880626, DOI: 10.1111/pan.12258.Peer-Reviewed Original ResearchConceptsState Behavioral ScalePediatric intensive care unitSNAP indexSedation levelIll childrenIll pediatric patientsIntensive care unitLevel of sedationPediatric critical careBehavioral scalesIntravenous sedationPediatric patientsSNAP-IICare unitSBS scoresSubjective sedationBedside nursesSedated childrenCritical careObservational studySedationScoring toolInformed consentPatientsBrain activityCorticosteroid Therapy in Critically Ill Pediatric Asthmatic Patients*
Giuliano JS, Faustino EV, Li S, Pinto MG, Canarie MF, Carroll CL. Corticosteroid Therapy in Critically Ill Pediatric Asthmatic Patients*. Pediatric Critical Care Medicine 2013, 14: 467-470. PMID: 23628833, DOI: 10.1097/pcc.0b013e31828a7451.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAdolescentAdrenal Cortex HormonesAdultAlbuterolAsthmaCanadaChildCritical IllnessCross-Sectional StudiesGuideline AdherenceHumansIntensive Care Units, PediatricLogistic ModelsMethylprednisoloneMiddle AgedPractice Guidelines as TopicPractice Patterns, Physicians'United StatesConceptsBlood Institute guidelinesStarting doseNational HeartInstitute guidelinesClinical experienceMultivariate logistic regression analysisIll patient populationInitial corticosteroid doseMajority of asthmaticsNorth American PICUsPediatric asthmatic patientsSpecific dosing recommendationsEvidence-based dataLogistic regression analysisContinuous albuterolCorticosteroid dosageCorticosteroid doseCorticosteroid therapyIll asthmaticsPICU experienceAsthmatic patientsAsthmatic childrenIndependent predictorsDosing recommendationsMost intensivists
2012
Transport Disposition Using the Transport Risk Assessment in Pediatrics (TRAP) Score
Kandil SB, Sanford H, Northrup V, Bigham MT, Giuliano JS. Transport Disposition Using the Transport Risk Assessment in Pediatrics (TRAP) Score. Prehospital Emergency Care 2012, 16: 366-373. PMID: 22443350, PMCID: PMC3360797, DOI: 10.3109/10903127.2012.664246.Peer-Reviewed Original ResearchConceptsPediatric patientsPICU admissionTransport teamPediatric intensive care unit admissionIntensive care unit admissionCare unit admissionTertiary care centerPediatric specialty transport teamInitial assessmentUnit admissionChart reviewChildren's HospitalDirect admissionCare centerObservational studyHigher scoresPatientsPediatric scoresPhysiologic variablesScore's abilityAdmissionLogistic regressionTriage decisionsSpecialized teamTRAP scores