Patients are increasingly turning to online physician ratings, just as they have sought ratings for other products and services. Much of what is known about these sites comes from studies of the ratings left on them. 1 Little is known about the public's awareness and use of online physician ratings, and whether these sites influence decisions about selecting a physician.

Mortality from severe pediatric sepsis is associated with patient illness severity, comorbid illness, and multiple organ dysfunction. Many characteristics are associated with resource consumption, including type of hospital, source of admission, and illness severity.

Context Although recent trends in obesity have been well documented, generational patterns of obesity from early childhood through adulthood across birth cohorts, which account for the recent epidemic of childhood obesity, have not been well described. Such trends may have implications for the prevalence of obesity-associated conditions among population subgroups, including type 2 diabetes. Objective Our objective was to evaluate trajectories of obesity over the life course for the US population, overall and by gender and race. Design, Setting, and Participants We conducted an age, period, and birth cohort analysis of obesity for US individuals who participated in the National Health and Nutrition Examination Surveys (1971-2006). Main Outcome Measures Obesity was defined as a body mass index ≥ 95th percentile for individuals aged 2-16 years or ≥ 30 kg/m2 among individuals older than 16 years. Age was represented by the age of the individual at each NHANES survey, period was defined by the year midpoint of each survey, and cohort was calculated by subtracting age from period. Results Recent birth cohorts are becoming obese in greater proportions for a given age, and are experiencing a greater duration of obesity over their lifetime. For example, whereas the 1966-75 and 1976-85 birth cohorts had reached an estimated obesity prevalence of at least 20% by 20-29 years of age, this level was only reached by 30-39 years for the 1946-55 and 1956-65 birth cohorts, by 40-49 years for the 1936-45 birth cohort, and by 50-59 years of age for the 1926-35 birth cohort. Trends are particularly pronounced for female compared with male, and black compared with white cohorts. Conclusions The increasing cumulative exposure to excess weight over the lifetime of recent birth cohorts will likely have profound implications for future rates of type 2 diabetes, and mortality within the US population.

A combination of PPP and PVP imaging is sufficient for detection of pancreatic adenocarcinoma, because it provides maximal pancreatic parenchymal and peripancreatic vascular enhancement. AP imaging can be reserved for patients in whom CT angiography is required.

This national analysis indicates a clinically and statistically significant reduction in varicella-related hospitalizations for children and adults associated with childhood varicella immunization in the United States and a corresponding significant decrease in hospital charges.

BACKGROUND Little is known about emergency department (ED) use among pediatric patients with cancer. We explored reasons prompting emergency department (ED) visits and factors associated with hospital admission. PROCEDURE A retrospective cohort analysis of pediatric ED visits from 2006-2010 using the Nationwide Emergency Department Sample, the largest all-payer database of United States ED visits. Pediatric patients with cancer (ages ≤19 years) were identified using Clinical Classification Software. Proportion of visits and disposition for the top ten-ranking non-cancer diagnoses were determined. Weighted multivariate logistic regression was performed to analyze factors associated with admission versus discharge. RESULTS There were 294,289 ED visits by pediatric patients with cancer in the US over the study period. Fever and fever with neutropenia (FN) were the two most common diagnoses, accounting for almost 20% of visits. Forty-four percent of pediatric patients with cancer were admitted to the same hospital, with admission rates up to 82% for FN. Risk factors for admission were: FN (odds ratio (OR) 8.58; 95% confidence interval (CI) 5.97-12.34); neutropenia alone (OR 7.28; 95% CI 5.08-10.43), ages 0-4 years compared with 15-19 years (OR 1.19; 95% CI 1.08-1.31) and highest median household income ZIP code (OR 1.27; 95% CI 1.08-1.49) compared with lowest. “Self-pay” visits had lower odds of admission (OR 0.42; 95% CI 0.35-0.51) compared with public payer. CONCLUSION FN was the most common reason for ED visits among pediatric patients with cancer and is the condition most strongly associated with admission. Socioeconomic factors appear to influence ED disposition for this population.

Discharges for children associated with LTMV require substantively greater inpatient resource use than other children with CCCs. As the number of discharges and associated aggregate charges increase over time, additional research must examine patterns of care for specific clinical subgroups of LTMV, especially children aged 4 years and younger.

WOOLFORD, SUSAN J., ACHAMYELEH GEBREMARIAM, SARAH J. CLARK, AND MATTHEW M. DAVIS. Incremental hospital charges associated with obesity as a secondary diagnosis in children. Obesity. 2007; 15:1895-1901. Objective: The objective was to evaluate the association of obesity as a comorbidity with hospital charges, by comparing charges for pediatric hospitalizations with vs. without obesity as a secondary diagnosis. Methods: Using the 2000 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID), a nationally representative sample of pediatric hospital discharges, we identified the most common non-pregnancy-related principal diagnoses for children 2 to 18 years of age: asthma, pneumonia, affective disorders, and appendicitis. For each we compared mean charges and mean length of stay for hospitalizations with vs. without obesity as a secondary diagnosis, adjusting for relevant socio-demographics and hospital type. Results: Among children's discharges in 2000, 1.1% listed obesity as a secondary diagnosis. These had a disproportionate likelihood of being older, black, Medicaid beneficiaries, and hospitalized at a general hospital. Adjusted mean hospital charges were significantly higher for discharges with obesity as a secondary diagnosis vs. those without: appendicitis ($14,134 vs. $11,049; p Ͻ 0.01), asthma ($7766 vs. $6043; p Ͻ 0.05), pneumonia ($12,228 vs. $9688; p Ͻ 0.05), and affective disorders ($8292 vs. $7769; p Ͻ 0.01). Whereas obesity as a secondary diagnosis was associated with a pattern of increased adjusted mean length of stay, only asthma and affective disorders had statistically significant differences (0.6 days) (p Ͻ 0.01). Conclusion:This national analysis suggests obesity as a secondary diagnosis is associated with significantly higher charges for the most common reasons for pediatric hospitalizations. This presents a financial imperative for further research to evaluate factors that contribute to higher inpatient charges related to obesity as a comorbidity and underscores the need for obesity prevention initiatives.