Spotlighting the imbalance: Gender disparities among speakers and awardees at pediatric emergency medicine conferences.

BACKGROUND: There are wide variations in the gender makeup of speakers at national pediatric emergency medicine (PEM) conferences with no significant change in recent years. OBJECTIVE: Gender disparities exist among national speakers and award recipients. PEM represents the intersection of pediatrics, a female-dominated specialty with approximately 58% women, and emergency medicine, a male-dominated specialty. We describe the proportion of women speakers and award recipients at two national PEM conferences, the American Academy of Pediatrics (AAP) Section on Emergency Medicine (SOEM) and the Advanced PEM Assembly (APEMA), to the AAP National Conference & Exhibition (NCE), a national pediatric conference. METHODS: Data from SOEM and APEMA, obtained from 2016 to 2021 were compared to the 2021 NCE. Invited speakers, abstract presenters, and award recipients were identified. Gender was determined by searching each individual's name for self-identification. Gender proportions were compared across conferences, speaker type, and year. RESULTS: Compared to the NCE, a significantly smaller proportion of women were invited speakers at APEMA (NCE 59.9% vs. APEMA 38.8%, p < 0.001), but similar proportions of women were invited speakers (53.9%, p = 0.178) and awardees at SOEM (50% vs. 50%, p = 1.0). A larger number of women were SOEM abstract presenters than invited speakers (63.3% vs. 53.9%, p = 0.041). Between 2016 and 2021, the proportion of women invited speakers (SOEM, p = 0.744; APEMA, p = 0.947) or abstract presenters (SOEM, p = 0.632) did not significantly change. CONCLUSIONS: Compared to NCE, women are underrepresented as speakers at APEMA, but not at SOEM. Abstract presenters are more likely to be women compared to invited speakers. While awards appear equally distributed, recipients do not mirror the proportion of women in PEM. Conference organizers and leaders in PEM should ensure gender equity in national recognition.

Increased rates of suicide ideation and attempts in rural dwellers following the SARS-CoV-2 pandemic.

PURPOSE: Those factors identified to increase the risk of suicide in rural dwellers were exacerbated by the SARS-CoV-2 pandemic, specifically economic factors, substance use, access to health care, and access to lethal weapons. Because the effects of SARS-CoV-2 on suicide ideation and attempts in rural populations have not been fully characterized in published literature, this study compares: (1) the rates of suicide ideation and attempts between the 6 months affected by SARS-CoV-2 to same months of the preceding year (3/18/2020-9/18/20; 3/18/2019-9/18/19), (2) demographics (ie, age, sex, residence, race, and ethnicity), and (3) the locations in which the encounters were billed (inpatient, outpatient, and emergency department). METHODS: Deidentified claims data associated with patient encounters billed for Suicide Ideation and Suicide Attempt were grouped based on time period and analyzed using descriptive statistics, incidence rate ratio (IRR), 2-sample t-test, chi-square test of association, or Fisher's exact test. FINDINGS: Suicidal ideation encounters increased in the 6 months post-SARS-CoV-2 when compared to the 6 months of the prior year (IRR = 1.19; P < .001). Males (IRR = 1.27, P < .001), those residing rural areas (IRR = 1.22, P = .01), and Black, non-Hispanic (IRR = 1.24, P = .024) were found to have increased rates of suicide ideation post-SARS-Cov-2. In adults, White, non-Hispanics (IRR = 1.16; P < .001) had increased rates of post-SARS-CoV-2. In the pediatric subset, those who were aged 14-17 (IRR = 1.50; P < .001), resided in rural areas (IRR = 1.61, P = .009), and idenitifed as Hispanic (IRR = 1.89; P = .037) or Black, non-Hispanic (IRR = 1.61, P = .009) had increased rates post-SARS-CoV-2. CONCLUSIONS: Our study identified rural dwellers to be at increased risk for suicide ideation.

A comparison of child abuse and neglect encounters before and after school closings due to SARS-Cov-2.

BACKGROUND: Risk factors for child abuse and neglect and commonly used reporting mechanisms were highly affected by SARS-Cov-2 pandemic; yet, little is known about the effects of SARS-Cov-2 on rates of child abuse and neglect. OBJECTIVE: To compare overall rates, demographics, types of abuse and acuity of child abuse and neglect encounters seen at one university health system for the 6 months before and after school closings due to the SARS-Cov-2 pandemic. PARTICIPANTS AND SETTING: Data was extracted from a database of billed ICD10 codes for child abuse and neglect including sexual abuse codes. There were 579 encounters for patients <18 years of age and 476 unique patients. METHODS: In addition to ICD10 code and pre/post school closing, each encounter was identified to be inpatient, outpatient and/or emergency department. Demographic data such as age, gender, ethnicity, and race were extracted. Incident rate ratios in addition to descriptive statistics, Mann-Whitney U test, two-sample t-test, or the chi-square test of association were used in the analysis. RESULTS: No significant differences were identified for total rates of child abuse and neglect encounters (p = .08), physical abuse (p = .91) nor child maltreatment (p = .86) codes or in the age (p = .46), gender (p = .58), and race/ethnicity (p = .15) of patient encounters pre- versus post-school closings. The sexual abuse incidence and inpatient encounters increased by 85% (IRR = 1.85, p < .0001; IRR = 1.85, p = .004, respectively). CONCLUSIONS: Our findings provide a unique contribution to the existing literature in that we identified a significant increase in the incidence of sexual abuse and higher patient acuity as evidenced by higher rates of inpatient encounters after school closing due to SARS-Cov-2.

Color vision disturbances secondary to oral tranexamic acid.

Tranexamic acid (TXA) is an antifibrinolytic commonly used to reduce blood loss due to surgical procedures, heavy menstruation, trauma, bleeding disorders, among other uses. Possible adverse reactions associated with TXA include abdominal pain, headache, fatigue, cerebral thrombosis, dizziness, retinal artery occlusion, chromatopsia, and more. We present a case of acute color vision disturbance developed soon after initiation of oral TXA for epistaxis prophylaxis in the setting of factor VII deficiency. To our knowledge we report the only case of color vision disturbance in a pediatric patient and the only case after receiving oral TXA. Soon after discontinuing oral TXA the patient's altered perception of color vision resolved. The patient was subsequently discharged home with a prescription for an alternative antifibrinolytic (aminocaproic acid) and follow-up with neuro-ophthalmology.

An emergency department medical record review for adolescent intentional self-harm injuries.

BACKGROUND: Non-suicidal self-injury and suicide attempts are increasing problems among American adolescents. This study developed a definition for identifying intentional self-harm (ISH) injuries in emergency department (ED) records coded with International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. The definition is based on the injury-reporting framework proposed by the Centers for Disease Control and Prevention. The study sought to estimate the definition's positive predictive value (PPV), and the proportion of ISH injuries with intent to die (i.e., suicide attempt). METHODS: The study definition, based on first-valid external cause-of-injury ICD-10-CM codes X71-X83, T14.91, T36-T65, or T71, captured 207 discharge records for initial encounters for ISH in one Kentucky ED. Medical records were reviewed to confirm provider-documented diagnosis for ISH, and identify intent to die or suicide ideation. The PPV of the study definition for capturing provider-documented ISH injuries was reported with its 95% confidence interval (95% CI). RESULTS: The estimated PPV for the study definition to capture ISH injuries was 88.9%, 95% CI (83.8%, 92.8%). The estimated percentage of ISH with intent to die was 45.9, 95% CI (47.1, 61.0%). The ICD-10-CM code "suicide attempt" (T14.91) captured only 7 cases, but coding guidelines restrict assignment of this code to cases in which the mechanism of the suicide attempt is unknown. CONCLUSIONS: The proposed case definition supported a robust PPV for ISH injuries. Our findings add to the evidence that the current ICD-10-CM coding system and coding guidelines do not allow identification of ISH with intent to die; modifications are needed to address this issue.

A Comparison of Pediatric Traumatic Injuries on Farms and Residences from 2009 to 2014.

PURPOSE: Children injured on farms in the United States are hospitalized at 14 times the rate of children with injuries unrelated to farming. This study characterizes pediatric injuries occurring on farms compared to injuries in homes. METHODS: We examined the National Trauma Data Bank from 2009 to 2014 to identify children ages 0-17 with ICD-9 E-codes reflecting a farm or residential place of injury occurrence. Appropriate nonparametric tests were used to compare patient, injury, and hospitalization characteristics by injury locale. Mixed effects models for binary responses were used to examine the odds of an injury occurring on a farm versus at home, and we controlled for random effects of trauma center after adjustment for potential confounding variables including age, sex, and categorical injury severity. FINDINGS: There were 2,776 injuries on farms, and 133,119 injuries at homes. Children injured on farms had a median age of 10 years compared to 4 years at homes (P < .001). Machinery injuries were 19 times more frequent on farms (P < .001), and injuries to multiple anatomic locations were twice as frequent on farms (P < .001). Children injured on farms required helicopter transport 4 times as often as those injured at home. Additionally, children injured on farms were nearly 2.5 times more likely to have a length of stay greater than 7 days. CONCLUSION: Injuries occur during the course of childhood; however, injuries sustained in a farming environment are more severe and require greater clinical management than injuries which occur in the home.

Rhabdomyolysis in a neonate due to very long chain acyl CoA dehydrogenase deficiency.

Very long chain acyl CoA dehydrogenase deficiency (VLCADD) is an inborn error in long chain fatty acid oxidation with significant variability in the severity and timing of its clinical presentation. Neonatal presentations of VLCADD have included hypoglycemia and cardiomyopathy while rhabdomyolysis is usually a later onset complication. We describe a neonate with VLCADD presenting with rhabdomyolysis prior to the return of an abnormal newborn screen. This report suggests that evaluating for rhabdomyolysis, in addition to a cardiac and hepatic work-up, is an important part of the initial evaluation of an infant with an abnormal newborn screen suggesting a diagnosis of VLCADD.