A Global Health Research Checklist for clinicians.

Global health research has become a priority in most international medical projects. However, it is a difficult endeavor, especially for a busy clinician. Navigating the ethics, methods, and local partnerships is essential yet daunting.To date, there are no guidelines published to help clinicians initiate and complete successful global health research projects. This Global Health Research Checklist was developed to be used by clinicians or other health professionals for developing, implementing, and completing a successful research project in an international and often low-resource setting. It consists of five sections: Objective, Methodology, Institutional Review Board and Ethics, Culture and partnerships, and Logistics. We used individual experiences and published literature to develop and emphasize the key concepts. The checklist was trialed in two workshops and adjusted based on participants\u27 feedback

Post–COVID-19 Conditions Among Children 90 Days After SARS-CoV-2 Infection

IMPORTANCE Little is known about the risk factors for, and the risk of, developing post-COVID-19 conditions (PCCs) among children. OBJECTIVES To estimate the proportion of SARS-CoV-2-positive children with PCCs 90 days after a positive test result, to compare this proportion with SARS-CoV-2-negative children, and to assess factors associated with PCCs. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study, conducted in 36 emergency departments (EDs) in 8 countries between March 7, 2020, and January 20, 2021, included 1884 SARS-CoV-2-positive children who completed 90-day follow-up; 1686 of these children were frequency matched by hospitalization status, country, and recruitment date with 1701 SARS-CoV-2-negative controls. EXPOSURE SARS-CoV-2 detected via nucleic acid testing. MAIN OUTCOMES AND MEASURES Post-COVID-19 conditions, defined as any persistent, new, or recurrent health problems reported in the 90-day follow-up survey. RESULTS Of 8642 enrolled children, 2368 (27.4%) were SARS-CoV-2 positive, among whom 2365 (99.9%) had index ED visit disposition data available; among the 1884 children (79.7%) who completed follow-up, the median age was 3 years (IQR, 0-10 years) and 994 (52.8%) were boys. A total of 110 SARS-CoV-2-positive children (5.8%; 95% CI, 4.8%-7.0%) reported PCCs, including 44 of 447 children (9.8%; 95% CI, 7.4%-13.0%) hospitalized during the acute illness and 66 of 1437 children (4.6%; 95% CI, 3.6%-5.8%) not hospitalized during the acute illness (difference. 5.3%; 95% CI, 2.5%-8.5%). Among SARS-CoV-2-positive children, the most common symptom was fatigue or weakness (21 [1.1%]). Characteristics associated with reporting at least 1 PCC at 90 days included being hospitalized 48 hours or more compared with no hospitalization (adjusted odds ratio [aOR], 2.67 [95% CI, 1.63-4.38]); having 4 or more symptoms reported at the index ED visit compared with 1 to 3 symptoms (4-6 symptoms: aOR, 2.35 [95% CI, 1.28-4.31]; >= 7 symptoms: aOR, 4.59 [95% CI, 2.50 8.44]); and being 14 years of age or older compared with younger than 1 year (aOR, 2.67 [95% CI, 1.43-4.99]). SARS-CoV-2-positive children were more likely to report PCCs at 90 days compared with those who tested negative, both among those who were not hospitalized (55 of 1295 [4.2%; 95% CI, 3.2%-5.5%] vs 35 of 1321[2.7%; 95% CI, 1.9%-3.7%]; difference, 1.6% [95% CI, 0.2%-3.0%]) and those who were hospitalized (40 of 391[10.2%; 95% CI, 7.4%-13.7%] vs 19 of 380 [5.0%; 95% CI, 3.0%-7.7%]; difference, 5.2% [95% CI, 1.5%-9.1%]). In addition, SARS-CoV-2 positivity was associated with reporting PCCs 90 days after the index ED visit (aOR, 1.63 [95% CI, 1.14-2.35]), specifically systemic health problems (eg, fatigue, weakness, fever; aOR, 2.44 [95% CI, 1.19-5.00]). CONCLUSIONS AND RELEVANCE In this cohort study, SARS-CoV-2 infection was associated with reporting PCCs at 90 days in children. Guidance and follow-up are particularly necessary for hospitalized children who have numerous acute symptoms and are older.This studywas supported by grants from the Canadian Institutes of Health Research (operating grant: COVID-19-clinical management); the Alberta Health Services-University of Calgary-Clinical Research Fund; the Alberta Children's Hospital Research Institute; the COVID-19 Research Accelerator Funding Track (CRAFT) Program at the University of California, Davis; and the Cincinnati Children's Hospital Medical Center Division of Emergency Medicine Small Grants Program. Dr Funk is supported by the University of Calgary Eyes-High PostDoctoral Research Fund. Dr Freedman is supported by the Alberta Children's Hospital Foundation Professorship in Child Health andWellness

Clinical and Demographic Factors Associated with Emergency Medical Services Arrival to a Pediatric Emergency Department

Objective: To examine demographic and clinical factors associated with emergency medical services [EMS] use in a pediatric emergency department [PED]. Methods: We performed a retrospective cross-sectional review of encounters with patients aged 0-21 years during calendar years 2014-2015 in an urban academic PED with two campuses, a tertiary-care site and an urban satellite community site. Encounters with patients arriving by interfacility or police transport were excluded. Acuity was classified by Emergency Severity Index [ESI]. Chi-square and logistic regression were used to analyze associations between demographic and clinical factors and EMS arrival. Results: There were 220,792 eligible encounters over a 2 year period, with 15,605 encounters arriving by EMS (7.1%). In bivariable analysis, patients arriving by EMS were more likely to have encounters involving seizure (OR 10.19; 95%CI 9.55-10.87), poisoning (OR 6.22; 5.51-7.03), psychiatric concerns (OR 2.05; 1.87-2.27) and injury (OR 1.86; 1.79-1.92). In multivariable analysis of demographic factors, EMS arrival was associated with gender (aOR 0.85; 95%CI 0.80-0.89 for females) and older age (aOR 0.75; 0.69-0.82 for infants, aOR 0.64; 0.60-0.68 for ages 1-4, and aOR 0.72; 0.67-0.77 for ages 5-11 compared with ages 12-21). The odds of EMS arrival for Hispanic patients was lower (aOR 0.59; 0.55-0.64) and for non-Hispanic white patients was greater (aOR 2.0; 1.86-2.19) than the odds EMS arrival for non-Hispanic black patients. These demographic associations were not significant in analysis of the highest acuity patients. Patients with public insurance had decreased odds of EMS arrival (OR 0.80; 0.77-0.83) but no significant difference after adjusting for acuity. Subgroup analysis showed patients living within the surrounding city limits with public insurance had increased odds of EMS arrival (aOR 1.30; 1.18-1.43) after adjusting for acuity. Patients arriving by EMS had increased odds of admission (OR 3.33; 3.18-3.45) and this remained true in the subgroup of lowest acuity patients, ESI levels 4-5 (aOR 2.44; 2.07-2.92). Conclusion: Pediatric encounters for seizure, ingestion, psychiatric concerns, and injury are more likely to utilize EMS. Odds of EMS arrival to PED varies with age, gender, and race. Associations between public insurance and EMS use may vary with proximity to the hospital or jurisdiction

Practice patterns and perceptions of influenza testing amongst pediatric urgent care providers

INTRODUCTION: Despite a sensitivity of 50% to 70% the rapid influenza diagnostic test (RIDT) continues to play an important role in clinical decision-making due to its quick turn-around time, high specificity, relative simplicity of use, and low cost. METHODS: A quantitative study using a web-based survey was distributed to 110 members of the Society of Pediatric Urgent Care aimed to assess RIDT use for diagnosis and management of influenza in outpatient pediatric patients. RESULTS: Responses from 61 providers were received. Forty-two percent (95% CI 29.5-54.5%) of respondents report higher confidence in their diagnosis of influenza with the aid of a positive RIDT. 28% of respondents (95% CI 16.6-39.4%) report a higher likelihood of prescribing antiviral medications to low-risk patients if an RIDT is positive than without laboratory confirmation. CONCLUSION: Most pediatric urgent care respondents reported higher confidence in their diagnosis and higher likelihood of prescribing antivirals with a positive RIDT rather than by clinical symptoms alone

Evaluation of a Selective Prehospital Pediatric Spinal Protection Protocol.

Background: Recent studies demonstrate an association between spinal immobilization and neck pain, increased use of radiographs, and increased admission rates for pediatric trauma patients. There is an increasing trend toward spinal protection protocols that limit the use of backboards in trauma patients. However, many of these protocols do not address the youngest patients. Objectives: The objective was to analyze whether implementation of a selective prehospital pediatric spinal protection protocol was associated with a reduction in spinal imaging, hospital admission rates, and Emergency Department (ED) length of stay (LOS). Methods: We conducted a single center retrospective chart review to assess the effect of implementing a new selective pediatric spinal immobilization protocol in an EMS system. Patients transported to the same center from a neighboring EMS jurisdiction without a protocol change were analyzed for comparison. We extracted data for all pediatric patients with trauma-related discharge diagnoses transported by EMS to a pediatric trauma center for one year before and after the implementation of the protocol. Results: There were 878 eligible trauma patients transported under the new protocol, compared to 782 transported prior to implementation. We did not find a significant difference in the percentage of trauma patients who received spinal imaging pre- and post-protocol change (20% vs. 18%, OR 0.84 [95% CI 0.66, 1.07]), but did observe a significant reduction in the proportion of trauma patients who were admitted to the hospital (25% vs. 18%, OR 0.66 [95% CI 0.52, 0.83]). This reduced admission rate was not observed in the neighboring jurisdiction. Conclusions: Implementation of a selective spinal immobilization protocol was associated with reduced admission rates, but did not significantly reduce rates of plain radiographs.</p

Is Cognitive Rest Following a Head Injury Associated with Prolonged Concussion Symptoms?

Background: Recent studies have suggested that cognitive rest may not lead toward a faster recovery from acute concussions. Furthermore, the latest international consensus concussion guidelines note the appropriate amount of cognitive rest remains undetermined. Additionally, somatization has recently been shown to be a risk factor for prolonged concussion symptoms (PCS). Objective: Our objective was to determine the relationship between cognitive rest and PCS. Additionally, we sought to determine the relationship between somatization and PCS, while also considering the interaction with cognitive rest. Design/Methods: A prospective cohort study of 5-18 year olds diagnosed with an acute concussion in a tertiary care children’s hospital emergency department was conducted from January through December 2017. Participants completed the post-concussion symptom inventory (PCSI) and Children’s Somatization Inventory (CSI) at diagnosis. Emergency department provider recommendations on rest from school were collected. Follow-up calls were completed at 1 week to determine time off from school as a proxy of cognitive rest. Rest was categorically analyzed. PCSI scores were re-assessed at 4 weeks. Results: A total of 89 patients have been enrolled with a median age of 10.0 (IQR: 8.5-13.0). 58% (N=52) of the patients are male. 82.0% (N=73) completed 7-day follow-up. 24.7% (N=18) of patients took no time off from school; 42.5% (N=31) took 1-2 days off; and 32.9% (N=24) took 3 or more days off from school. 24% had prolonged concussion symptoms. Logistic regression analysis was used to compare the rest tertiles to PCS, with no time off as the reference category. When compared to the shortest rest tertile, the longest rest tertile had a 1.35 fold increase in prolonged concussion symptoms, which was not statistically significant (95% CI: 0.31 – 5.91). When compared to the shortest rest tertile, the medium rest tertile had a 0.50 fold decrease in prolonged concussion symptoms, which was also not statistically significant (95% CI: 0.10 – 2.42). In the longer rest tertiles, somatization scores trended higher in the group with PCS (p = 0.15). Conclusion(s): In our preliminary pilot data, patients who took more time off from school did not show decreased likelihood of prolonged concussion symptoms. Furthermore, patients with somatization may be at particular risk of rest associated with prolonged concussion symptoms. Further larger scale studies, including randomized trials, are necessary to determine the risk of rest on prolonged concussion symptoms