Objective At a time when the COVID19 vaccine was approved for everyone > 12 years of age, we sought to identify characteristics and beliefs associated with COVID-19 vaccination acceptance. Methods We conducted a cross-sectional survey study of parents of children aged 3-16 years presenting to one of 9 emergency departments from June-August 2021 to assess parental acceptance of COVID-19 vaccines. Using multiple variable regression, we ascertained which factors were associated with parental and pediatric COVID-19 vaccination acceptance. Results Of 1491 parents approached, 1298 (87%) participated of which 50% of parents and 27% of their children > 12 years of age were vaccinated. Characteristics associated with parental COVID-19 vaccination were trust in scientists [adjusted odds ratio (aOR) 5.11, 95% confidence interval (CI) 3.65-7.15], recent influenza vaccination (aOR 2.66, 95% CI 1.98-3.58), college degree (aOR 1.97, 95% CI: 1.36-2.85), increasing parental age (aOR 1.80, 95% CI 1.45-2.22), friend/family member hospitalized with COVID-19 (aOR 1.34, 95% CI 1.05-1.72) and higher income (aOR 1.60, 95% CI 1.27-2.00). Characteristics associated with pediatric COVID-19 vaccination (≥ 12 years) or intended COVID-19 pediatric vaccination (children < 12 years) were parental trust in scientists (aOR 5.37, 95% CI 3.65-7.88), recent influenza vaccination (aOR 1.89, 95% CI 1.29-2.77), trust in the media (aOR 1.68, 95% CI 1.19-2.37), parental college degree (aOR 1.49, 95% CI: 1.01-2.20), and increasing parental age (aOR 1.26, 95% CI 1.01-1.57). Conclusions COVID-19 vaccination acceptance was low. Trust in scientists had the strongest association with parental COVID-19 vaccine acceptance for both parents and their children.
Most states/territories use some formal PDT system; few have 1 standardized approach. JumpSTART is predominantly used and is preferred by most respondents. With all systems, there is marked variation in number of patients prompting activation although the reported nature of incidents prompting activation is similar.
BACKGROUND: There is a paucity of data describing pediatric patients transferred to an ICU within 24 hours of hospital admission from the emergency department (ED). METHODS: We conducted a retrospective cohort study of patients ≤21 years old transferred from an inpatient floor to an ICU within 24 hours of ED disposition from 2007 to 2016 in a tertiary children’s hospital. Patients transferred to an ICU after planned operative procedures were excluded. Rate of transfer, clinical course, and baseline demographic and/or clinical characteristics of these patients are described. RESULTS: The study cohort consisted of 841 children, representing 1% of 82 397 non-ICU ED admissions over the 10-year period. Median age was 5.1 years, 43% had ≥1 complex chronic condition, and 47% were hospitalized within the previous year (27% in the ICU). The majority of transfers were for respiratory conditions (65%) and cardiovascular compromise (18%). Median time from hospitalization to ICU transfer was 9.1 hours (interquartile range 5.1–14.9 hours). Thirty-eight percent of transfers received 1 or more critical interventions within 72 hours of hospitalization, most commonly positive pressure ventilation (29%) and vasoactive infusion (9%). Median time to intervention from hospitalization was 13.6 hours (interquartile range 7.5–21.6 hours), 0.8% of children died within 72 hours of hospitalization, and 2.4% died overall. CONCLUSIONS: In this single pediatric academic center, 1% of hospitalized children were transferred to an ICU within 24 hours of ED disposition. One-third of patients received a critical intervention, and 2.4% died. Although most ED dispositions are appropriate, future efforts to identify patients at the highest risk of deterioration are warranted.
Introduction: The purpose of this study was to quantify the effects of the coronavirus disease 2019 (COVID-19) pandemic on pediatric emergency departments (PED) across the United States (US), specifically its impact on trainee clinical education as well as patient volume, admission rates, and staffing models. Methods: We conducted a cross-sectional study of US PEDs, targeting PED clinical leaders via a web-based questionnaire. The survey was sent via three national pediatric emergency medicine distribution lists, with several follow-up reminders. Results: There were 46 questionnaires included, completed by PED directors from 25 states. Forty-two sites provided PED volume and admission data for the early pandemic (March-July 2020) and a pre-pandemic comparison period (March-July 2019). Mean PED volume decreased >32% for each studied month, with a maximum mean reduction of 63.6% (April 2020). Mean percentage of pediatric admissions over baseline also peaked in April 2020 at 38.5% and remained 16.4% above baseline by July 2020. During the study period, 33 (71.1%) sites had decreased clinician staffing at some point. Only three sites (6.7%) reported decreased faculty protected time. All PEDs reported staffing changes, including decreased mid-level use, increased on-call staff, movement of staff between the PED and other units, and added tele-visit shifts. Twenty-six sites (56.5%) raised their patient age cutoff; median was 25 years (interquartile ratio 25-28). Of 44 sites hosting medical trainees, 37 (84.1%) reported a decrease in number of trainees or elimination altogether. Thirty (68.2%) sites had restrictions on patient care provision by trainees: 28 (63.6%) affected medical students, 12 (27.3%) affected residents, and two (4.5%) impacted fellows. Fifteen sites (34.1%) had restrictions on procedures performed by medical students (29.5%), residents (20.5%), or fellows (4.5%). Conclusion: This study highlights the marked impact of the COVID-19 pandemic on US PEDs, noting decreased patient volumes, increased admission rates, and alterations in staffing models. During the early pandemic, educational restrictions for trainees in the PED setting disproportionately affected medical students over residents, with fellows’ experience largely preserved. Our findings quantify the magnitude of these impacts on trainee pediatric clinical exposure during this period.
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