Utility of the Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) in Pediatric Stevens-Johnson Syndrome Patients.

The Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) is a system that predicts in-hospital mortality for Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN). The system is widely utilized in adults but not pediatrics. We aim to determine the accuracy of the SCORTEN in pediatrics. A retrospective review of pediatric patients admitted to a verified pediatric burn center with SJS/TEN from 2008 to 2022 was performed. Twenty-four patients were analyzed. Ten patients had 0-1 SCORTEN risk factor, thirteen had 2 risk factors, and one had three risk factors. There was no relationship between initial BUN, bicarbonate, glucose, or initial heart rate on the length of intensive care unit (ICU) stay or ventilator days. Hospital length of stay and feeding tube days were positively related (p<0.001) along with length of stay and maximum total body surface areas (TBSA) (p<0.05 Hospital length of stay, ICU length of stay, and ventilator days were not statistically significant between those having 0-1 and 2 risk factors. This study suggests that the SCORTEN system is not useful for pediatrics and a different scoring system is needed, as SCORTEN overestimates mortality and does not have a relationship to outcome measures.

Desire for Residency-Provided Education and Support for Fertility Concerns: An Institutional Survey.

INTRODUCTION: Medical careers increase infertility risks and pregnancy complications. Residents often postpone pregnancy, contributing to these risks. Limited data exist regarding residents' family planning concerns. This study aims to evaluate fertility concerns and family planning during residency via a survey of residents and attending physicians. METHODS: Anonymous online surveys were distributed to all residents (n = 1030) and attending physicians (n = 1111) at a large, urban, single-campus academic hospital center. Data analysis was performed using chi-square analysis with significance at P < 0.05. RESULTS: Two hundred nine residents and 111 attendings submitted responses. Most respondents were female (74.7%). Slightly more than one-quarter of respondents were from a surgical specialty (26.6%). Residents compared to attending physicians indicated a higher concern for infertility during (57.4% versus 38.3%, P = 0.006) and after residency (68.9% versus 51.9%, P = 0.011) and a greater concern about pregnancy complications (67.8% versus 38.0%, P < 0.001). Most respondents felt pregnancy could negatively affect their training (67.3%). Surgical respondents were more concerned about the negative effects on colleagues (68.8% versus 51.1%, P = 0.045). Residents considered oocyte preservation more (57.9% versus 20.3%, P < 0.001). Respondents in surgical specialties had more concerns for fertility after residency (72.6% versus 57.9%, P = 0.033). Those in surgical fields trended for consideration of oocyte preservation (53.4% versus 39.7%, P = 0.084). Most respondents reported a need for education on oocyte preservation during residency (94.5%). CONCLUSIONS: Residents have increasing concerns about fertility and family planning related to their training. In addition to more institutional and residency program support, residents desire dedicated fertility and family planning education, such as oocyte preservation, as part of their curriculum.

Factors associated with an extended length of stay in the pediatric burn patient.

BACKGROUND: The Center for Medicaid and Medicare Services predicts the length of stay for pediatric burn patients based on several variables. However, many patients exceed their anticipated length. This study looks to identify aspects of patient presentation, wound characteristics, treatment, and discharge that are associated with a longer-than-predicted length of stay to identify strategies to safely reduce it. METHODS: We conducted a retrospective chart review of 535 pediatric burn patients admitted to our academic hospital from January 2018 to December 2020. 405 patients met inclusion criteria. Data were collected and analyzed. RESULTS: Average patient age was 3.36 years. 72.3% were treated for scald burns. Average length of stay was 13.5 days. 20.5% (n = 83) of patients exceeded their predicted length of stay. In comparing patients who exceeded their predicted length of stay to those who did not, the former had significant differences in burn causes, percent total body surface area burned (12.80% vs 4.24% [P = .000]), and body areas involved. Patients who exceeded length of stay had a higher incidence of endotracheal intubation (15.7% vs 1.3%), surgical intervention (85.5% vs 29.2%), need for tube-feeding (48.2% vs 4.3%), and intensive care unit admissions (22.9% vs 2.2% [P = .00 all]). They also averaged more operations, autografting (31.3% vs 1.6% [P = .00]), total operating room time (250 vs 31 minutes [P = .00]), and time to the first operation (2.32 vs 1.64 days [P = .00]). Tube-feeding averaged 9.52 vs 0.72 days (P = .00) extending patient stay after wound stability (43.9% vs 4.3% [P = .00]). These patients also required more discharge planning, with higher rates of Child Protective Services involvement (39.8% vs 10.9% [P = .00]), services consulted (1.06 vs 0.24 [P = .00]), and discharges to inpatient rehabilitation (8.6% vs 0.6% [P = .00]). 89.6% of all patients followed up in clinic. CONCLUSIONS: Twenty percent of pediatric burn patients had a longer length of stay than predicted by the Center for Medicaid and Medicare Services. Many factors were strongly associated with a longer-than-predicted length of stay. Identifying these early on might help reduce length of stay and meet the targets of the Center for Medicaid and Medicare Services.

Initial blood cultures in pediatric patients with central line infections and short bowel syndrome can direct a treatment plan that can reduce hospital length of stay.

BACKGROUND: Children with short bowel syndrome requiring parenteral nutrition are at high risk of recurrent central line-associated bloodstream infections requiring inpatient admission. Predicting responses to treatment at admission could help revise our current treatment algorithm and reduce the length of stay. METHODS: We conducted a retrospective study of all intestinal rehabilitation clinic patients admitted for central line-associated bloodstream infections at our academic hospital between January 2018 and June 2021. Demographic, blood culture, and treatment response data were analyzed. RESULTS: There were 180 separate admissions for central line-associated bloodstream infections, involving 24 patients who met the inclusion and exclusion criteria. The average length of stay was 9.4 days, and 77.1% of the admissions exceeded the predicted length of stay. All patients were treated according to the standard protocols. In the initial blood cultures, 64.4%, 10.6%, and 25% grew a single bacterium, a single fungus, and multiple organisms, respectively. After treatment initiation, 73.3% of single bacterial infections did not show additional positive cultures. However, 78.9% and 48.9% of fungal and multiple organism infections, respectively, had multiple positive cultures, even after initiating treatment. All positive repeat cultures were treated with an ethanol lock for 24 hours in addition to continued treatment. The treatment preserved 90.5% of the catheters. CONCLUSION: Patients experiencing short bowel syndrome admitted for central line-associated bloodstream infections with initial cultures growing fungi or multiple organisms frequently had multiple positive cultures, whereas those with a single bacterial organism did not. Discharging patients who grew a single bacterial organism and placing an initial ethanol lock on those with multiple or fungal organisms could reduce the average length of stay, even if some of these patients would require readmission for line removal.

The Positive Value of Rotation-Specific Guides for Resident Education and Patient Care: A Process Improvement Study.

Introduction Providing high-quality cost-effective patient care requires knowledge of treatment protocols as well as an understanding of the institution's procedures, e.g., what orders to place and how to effectively place them. Disseminating rotation-specific evidence-based practice and institutional policies in a timely manner to medical residents rotating onto a service can be challenging. We determined, by root cause analysis, that a solution was to use a structured guide containing rotation-specific information. The purpose of this study was to evaluate the effectiveness of a rotation-specific pocket reference guide to distribute evidence-based and rotation-specific practice information to medical residents rotating through an Academic Vascular Surgery service and to evaluate this tool's ability to increase participants' perception of comfort and efficacy, all of which can be linked to high-quality and cost-effective patient care. Materials and methods We conducted a prospective study at the Detroit Medical Center, a Michigan-based level one trauma hospital, from November 2020 through February 2021. The inclusion criteria included medical residents that were on the Vascular Surgery rotation in the given time frame and that agreed to take a pre-/post-evaluation. The evaluation consisted of a quantitative test and a qualitative questionnaire. A t-test was used to analyze pre- and post-question score averages. Results There was a significant improvement in quantifiable knowledge as participants' scores increased on post-rotation testing scoring with an average of 88% post-rotation compared to 58% pre-rotation (p<0.01). Ancillary staff reported a decrease in incorrect orders, substantiating increased efficacy and inferring cost-effectiveness. Individuals evaluated post-rotation indicated the usefulness of the guide as an educational tool for the dissemination of evidence-based practice (p<0.01) and increased confidence in placing preoperative orders (p<0.01). This, coupled with a post-rotation increase in preference toward a written learning style, led to the additional conclusion that this guide would be a beneficial preparatory tool for future board examinations.  Conclusions This study supports the implementation of rotation guides as a preparatory source used to improve the dissemination of rotation-specific information, which should increase resident efficacy, improve cost-effectiveness, and potentially improve future board examination scores. We recommend a chart review of specified metrics, e.g., incorrect order frequency and related operative delays, to show to what extent the cost-effectiveness and increase in high-quality patient care manifested.