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Objectives To determine the efficacy of a video-based dog bite prevention intervention at increasing child knowledge and describe any associated factors; and to assess the acceptability of providing this intervention in a pediatric emergency department (PED). Methods This cross-sectional, quasi experimental study enrolled a convenience sample of 5–9 year old patients and their parents, presenting to a PED with non-urgent complaints or dog bites. Children completed a 14-point simulated scenario test used to measure knowledge about safe dog interactions pre-/post- a video intervention. Based on previous research, a passing score (≥11/14) was defined a priori. Parents completed surveys regarding sociodemographics, dog-related experiential history and the intervention. Results There were 120 child/parent pairs. Mean child age was 7 (SD 1) and 55% were male. Of parents, 70% were white, 2/3 had more than high school education, and half had incomes <$40,000. Current dog ownership was 77%; only 6% of children had received prior dog bite prevention education. Test pass rate was 58% pre-intervention; 90% post-intervention. Knowledge score increased in 83% of children; greatest increases were in questions involving stray dogs or dogs that were fenced or eating. Younger child age was the only predictor of failing the post-test (p<0.001). Nearly all parents found the intervention informative; 93% supported providing the intervention in the PED. Conclusions Child knowledge of dog bite prevention is poor. The video-based intervention we tested appears efficacious at increasing short-term knowledge in 5–9 year old children and is acceptable to parents. Parents strongly supported providing this education.

Objective Hospital-based data reveal that children who have secondhand smoke exposure (SHSe) experience severe respiratory illnesses and greater resource utilization. Our objective was to assess the relationship between SHSe and illness severity/resource utilization among children presenting to the pediatric emergency department (PED) with three common respiratory conditions—asthma, bronchiolitis, and pneumonia. Methods A retrospective review of a yearlong consecutive sample of PED patients with SHSe status documentation and asthma, bronchiolitis, or pneumonia diagnoses was performed. PED illness severity/resource utilization variables included triage categorization, initial oxygen saturation, evaluation/testing (influenza A & B, respiratory syncytial virus, chest X-ray), procedures/interventions performed (supplemental oxygen, suctioning, intubation), medications administered, and disposition. Logistic and linear regression models were conducted to determine differences in each diagnosis group while controlling for sociodemographics, medical history, seasonality, and insurance type. Results There were 3,229 children with documentation of SHSe status and an asthma (41%), bronchiolitis (36%), or pneumonia (23%) diagnosis. Across diagnosis groups, approximately 1/4 had positive documentation of SHSe. Asthmatic children with SHSe were more likely to receive corticosteroids (odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.19, 2.44) and/or magnesium sulfate (OR = 1.66, 95% CI = 1.14, 2.40). Children with SHSe and bronchiolitis were more likely to receive racemic epinephrine (OR = 2.48, 95% CI = 1.21, 5.08), have a chest X-ray (OR = 1.36, 95% CI = 1.00, 1.85), and/or be admitted (OR = 1.46, 95% CI = 1.09, 1.95). No differences in illness severity/resource utilization were identified for children with pneumonia. Conclusions SHS-exposed children with asthma or bronchiolitis have greater illness severity/resource utilization. Our findings highlight the importance of SHSe assessment, cessation, and research efforts in the PED setting.

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Objectives To determine what children know about preventing dog bites and parental desires for dog bite prevention education. Study design This cross-sectional study sampled 5-15 year olds and their parents/guardians presenting to a pediatric emergency department with non-urgent complaints or dog bites. Pairs completed surveys and knowledge-based simulated scenario tests developed from American Academy of Pediatrics (AAP) and Center for Disease Control and Prevention (CDC) dog bite prevention recommendations. Regression analyses modeled knowledge test scores and probability of passing; a passing score was ≥11/14 questions. Results Of 300 parent/child pairs, 43% of children failed the knowledge test. Older children had higher odds of passing the knowledge test than younger children, as did children with white parents versus non-white parents. No associations were found between knowledge scores and other sociodemographic or experiential factors. Over 70% of children had never received dog bite prevention education, although 88% of parents desired it. Conclusion Dog bites are preventable injures disproportionately affecting children. Dog bite prevention knowledge in our sample was poor, particularly among younger children and children with non-white parents. Formal dog bite prevention education is warranted and welcomed by a majority of parents.

Objective Tobacco smoke exposure (TSE) causes significant childhood morbidity and is associated with a multitude of conditions. National organizations recommend TSE screening at all pediatric clinical encounters. Data regarding TSE screening in the pediatric emergency department (PED) is sparse, although children with TSE-associated conditions commonly present to this setting. We aimed to determine the frequency and outcome of TSE screening in the PED, and assess associated sociodemographic/clinical characteristics. Methods This retrospective review included pediatric patients presenting to a large PED in Cincinnati, Ohio between 2012 and 2013. Variables extracted included: age, sex, race/ethnicity, insurance, child’s TSE status, triage acuity, diagnosis, and disposition. Regression analyses examined predictors of TSE screening and TSE status. Results 116,084 children were included in the analysis. Mean child age was 6.20 years (SD ±5.6); 52% were male. Nearly half of children did not undergo TSE screening; only 60% of children with TSE-related illnesses were screened. Predictors of TSE screening were: younger age, male, African American, non-commercial insurance, high acuity, TSE-related diagnoses and non-intensive care admission. Of children screened for TSE, 28% were positive. Children more likely to screen positive were non-Hispanic, had non-commercial insurance and TSE-related diagnoses. Non-African American children triaged as low acuity were more likely to have TSE, yet less likely to be screened. Conclusion Despite national recommendations, current TSE screening rates are low and fail to identify at risk children. PED visits for TSE-associated conditions are common, thus further research is needed to develop and assess standardized TSE screening tools/interventions in this setting.

Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P &lt; 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P &lt; 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P &lt; 0.001). Conclusion Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.

Objective The pediatric emergency department (PED) is a venue that underutilizes parental tobacco screening and brief cessation counseling. We sought to explore PED practitioners’ attitudes and perceived barriers regarding the implementation and adoption of tobacco screening/cessation counseling of parental smokers in the PED setting, and to solicit suggestions for improving the sustainability and maintenance of such practices. Methods We conducted an exploratory, qualitative study of a convenience sample of PED practitioners using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Individual, focused interviews were conducted to determine factors that would maximize the implementation and maintenance of parental tobacco screening and intervention counseling as standard PED practice. Results Thirty interviews were conducted from which relevant data, patterns, and themes were identified. Reach factors included targeting parental smokers with children with respiratory diseases, having adequate training of practitioners, and providing “pre-arranged” counseling packages. Effectiveness factors included practitioner desire for outcome data about intervention effectiveness (e.g., changes in children’s secondhand smoke exposure and parental quit rates). Solutions to increase intervention adoption included quick electronic health record prompts and the provision of on-site tobacco cessation experts. Implementation suggestions emphasized the importance of financial support and the alignment of tobacco screening/counseling with strategic plans. Maintenance factors included institutional and technical support, and the importance of intervention “champions” in the PED. Conclusions By highlighting important viewpoints of practitioners regarding tobacco screening and counseling, the findings can help guide and direct the development and evaluation of sustainable interventions to facilitate tobacco use treatment in the PED.