CONTEXT: Risky behaviors are the main threats to adolescents’ health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. OBJECTIVE: To review studies of adolescent risk behavior screening and interventions in urgent care, emergency department (ED), and hospital settings. DATA SOURCES: Our data sources included PubMed (1965–2019) and Embase (1947–2019). STUDY SELECTION: Studies were included on the basis of population (adolescents aged 10–25 years), topic (risk behavior screening or intervention), and setting (urgent care, ED, or hospital). Studies were excluded if they involved younger children or adults or only included previously identified high-risk adolescents. DATA EXTRACTION: Data extracted were risk behavior screening rates, screening and intervention tools, and attitudes toward screening and intervention. RESULTS: Forty-six studies were included; most (38 of 46) took place in the ED, and a single risk behavior domain was examined (sexual health [19 of 46], mood and suicidal ideation [12 of 46], substance use [7 of 46], and violence [2 of 46]). In 6 studies, authors examined comprehensive risk behavior screening, demonstrating low rates at baseline (∼10%) but significant increases with clinician reminder implementation. Adolescents and clinicians were highly accepting of risk behavior screening in all settings and preferred electronic screening over a face-to-face interview. Reported barriers were time constraints and limited resources. LIMITATIONS: Only 1 included study was a randomized controlled trial, and there was large heterogeneity of included studies, potentially limiting generalizability. CONCLUSIONS: Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. Our findings outline promising tools for improving screening and intervention, highlighting the critical need for continued development and testing of interventions in these settings to improve adolescent care.

Purpose Evaluation of cardiopulmonary exercise testing (CPET) slopes such as $$d\mathrm{H}\mathrm{R}/d{\mathrm{W}\mathrm{R}}_{\mathrm{t}\mathrm{o}\mathrm{t}}$$ d H R / d W R t o t (cardiac/skeletal muscle function) and $${d \dot{V}{\text{O}} }_{2}/d{\mathrm{W}\mathrm{R}}_{\mathrm{t}\mathrm{o}\mathrm{t}}$$ d V ˙ O 2 / d W R t o t (O2 delivery/utilization), using treadmill protocols is limited because the difficulties in measuring the total work rate ($${\mathrm{W}\mathrm{R}}_{\mathrm{t}\mathrm{o}\mathrm{t}}$$ W R t o t ). To overcome this limitation, we proposed a new method in quantifying $${\mathrm{W}\mathrm{R}}_{\mathrm{t}\mathrm{o}\mathrm{t}}$$ W R t o t to determine CPET slopes. Methods CPET’s were performed by healthy patients, (n = 674, 9–18 year) 300 female (F) and 374 male (M), using an incremental ramp protocol on a treadmill. For this protocol, a quantitative relationship based on biomechanical principles of human locomotion, was used to quantify the $${\mathrm{W}\mathrm{R}}_{\mathrm{t}\mathrm{o}\mathrm{t}}$$ W R t o t of the subject. CPET slopes were determined by linear regression of the data recorded until the gas exchange threshold occurred. Results The method to estimate $${\mathrm{W}\mathrm{R}}_{\mathrm{t}\mathrm{o}\mathrm{t}}$$ W R t o t was substantiated by verifying that: $$d{ \dot{V}{\text{O}} }_{2}/d{\mathrm{W}\mathrm{R}}_{\mathrm{t}\mathrm{o}\mathrm{t}}$$ d V ˙ O 2 / d W R t o t for treadmill exercise corresponded to an efficiency of muscular work similar to that of cycle ergometer; $$d{ \dot{V}{\text{O}} }_{2}/d{\mathrm{W}\mathrm{R}}_{\mathrm{t}\mathrm{o}\mathrm{t}}$$ d V ˙ O 2 / d W R t o t (mL min−1 W−1) was invariant with age and greater in M than F older than 12 years old (13–14 years: 9.6 ± 1.5(F) vs. 10.5 ± 1.8(M); 15–16 years: 9.7 ± 1.7(F) vs. 10.6 ± 2.2(M); 17–18 years: 9.6 ± 1.7(F) vs. 11.0 ± 2.3(M), p < 0.05); similar to cycle ergometer exercise, $$dHR/d{WR}_{tot}$$ d H R / d WR tot was inversely related to body weight (BW) (r = 0.71) or $$\dot{V}{\text{O}}_{{2,{\text{~peak}}}}$$ V ˙ O 2 , peak (r = 0.66) and $$d{ \dot{V}{\text{O}} }_{2}/d{\mathrm{W}\mathrm{R}}_{\mathrm{t}\mathrm{o}\mathrm{t}}$$ d V ˙ O 2 / d W R t o t was not related to BW (r = − 0.01), but had a weak relationship with $$\dot{V}{\text{O}}_{{2,{\text{~peak}}}}$$ V ˙ O 2 , peak (r = 0.28). Conclusion The proposed approach can be used to estimate $${\mathrm{W}\mathrm{R}}_{\mathrm{t}\mathrm{o}\mathrm{t}}$$ W R t o t and quantify CPET slopes derived from incremental ramp protocols at submaximal exercise intensities using the treadmill, like the cycle ergometer, to infer cardiovascular and metabolic function in both healthy and diseased states.

OBJECTIVES: Maintenance intravenous fluids (IVFs) are routinely used in the care of hospitalized children. The American Academy of Pediatrics (AAP) published clinical practice guidelines in November 2018 that recommended the use of isotonic maintenance IVF. Our primary aim was to increase the proportion of hospital days pediatric inpatients were exclusively administered isotonic maintenance IVF to ≥80% by May 2020 at our institution. METHODS: We conducted a single-center quality improvement (QI) study as part of an AAP collaborative. An interdisciplinary team led QI interventions including providing targeted education to clinicians, integrating guideline recommendations into the electronic medical record, engaging hospital leaders, and providing performance data to clinicians. Our study population included children ages 28 days to 18 years admitted to inpatient wards. Our primary outcome was the proportion of hospital days with exclusive isotonic maintenance IVF use. Balancing measures included transfers to the ICU, ordering of serum sodium laboratory tests, and adverse events. Data were analyzed by using statistical process control. RESULTS: We analyzed 500 hospital admissions and found a significant increase in exclusive isotonic IVF use (63% to 95%) within 9 months of starting our QI intervention. We found no significant changes in balancing measures (serum sodium laboratory tests [24% to 25%], ICU transfer [0.3% to 1%], adverse events [0.3% to 1%]). CONCLUSIONS: Our interdisciplinary QI team led interventions that were associated with significant improvements in isotonic IVF use, in accordance with AAP clinical practice guidelines. With our study, we provide detailed guidance on successful interventions for implementing this evidence-based guideline.

BACKGROUND AND OBJECTIVES: Risky behaviors are the main threats to adolescents’ health. Consequently, guidelines recommend adolescents be screened annually for high-risk behaviors. Our objectives were to (1) determine rates of physician-documented risk behavior screening of hospitalized adolescents, (2) determine rates of positive screening results, and (3) evaluate associations between risk behavior screening and provision of risk behavior–related health care interventions. METHODS: We conducted a cross-sectional study of patients aged 12 to 24 years admitted to the pediatric hospital medicine service at an urban tertiary children’s hospital from January to December 2018. Exclusion criteria were transfer to a different service, nonverbal status, or altered mental status. We reviewed 20 charts per month. Outcomes included (1) documentation of risk behavior screening (mood, sexual activity, substance use, abuse and/or violence, and suicidal ideation), and (2) risk behavior–related health care interventions (eg, testing for sexually transmitted infections). We determined associations between screening and risk behavior–related interventions using χ2 tests. RESULTS: We found that 38% (90 of 240) of adolescents had any documented risk behavior screening, 15% (37 of 240) had screening in 4 of 5 risk behavior domains, and 2% (5 of 240) had screening in all 5 domains. The majority of screened adolescents had a positive screening result (66%), and most with positive results received a risk behavior–related health care intervention (64%–100% across domains). Adolescents with documented screening were significantly more likely to receive a risk behavior–related health care intervention. CONCLUSIONS: We found low rates of risk behavior screening documentation among hospitalized adolescents. There was a high rate of positive screen results, and those who were documented as screened were more likely to receive risk behavior–related interventions.