OBJECTIVE: To evaluate whether differences between pediatric male and female mortality are due to differences in specific age ranges, specific disease categories, or differences in the risk of developing specific conditions versus the risk of dying once having developed the condition. METHODS: Using 1999–2008 mortality data for all deaths of individuals <20 years of age from the Centers for Disease Control and Prevention’s WONDER database, we calculated male-to-female relative risks (RRs), standardized to the 2000 US Census, by age and International Classification of Diseases, 10th revision (ICD-10), chapters. By using the Centers for Disease Control and Prevention’s record of linked birth and infant death records between 1999 and 2007, we also calculated male-to-female RRs stratified by gestational age; and by using Surveillance, Epidemiology, and End Results cancer registries for 1999–2008, we calculated incidence and mortality RRs for the 7 leading types of cancer. RESULTS: Males experience higher mortality rates in all age groups from birth to age 20 years (RR: 1.44; 95% confidence interval [CI]: 1.44–1.45) and among infant deaths in nearly all weekly gestational age strata (RR: 1.12; 95% CI: 1.11–1.12). Stratified by ICD-10 major disease categories, males experience higher mortality rates in 17 of 19 categories. For the 7 types of pediatric cancers, the overall pattern was similarly greater male incidence (RR: 1.13; 95% CI: 1.12–1.14), fatality rate (RR: 1.10; 95% CI: 1.07–1.13), and overall mortality (RR: 1.21; 1.18–1.25). CONCLUSIONS: Under 20 years of age, males die more than females from a wide array of underlying conditions. The potential genetic and hormonal mechanisms for the mortality difference between males and females warrant investigation.

Background: Patient transitions create vulnerability for care teams. Failures in the handoff process result in communication errors and knowledge gaps, mainly when the handoff occurs between resident and expert-level subspecialty clinicians. The authors set out to develop a standardized handoff using resident comfort as a proxy for implementation. The primary measurable aim of this study was to increase the percentage of pediatric residents who self-reported comfort in assuming care of patients transitioned from the cardiac intensive care unit to the cardiology acute care unit. Methods: Investigators surveyed residents at a 323-bed pediatric hospital on their handoff experiences. The study team performed a Failure Mode Effect Analysis and created a key driver diagram. Interventions included a transfer checklist and algorithm, a huddle between care teams, and education surrounding the transfer process. Results: Residents completed a survey before (n = 74) or after (n = 23) intervention. The percentage of residents who reported feeling “always” or “very often” prepared to care for patients at the time of transfer increased from 15% to 83%. The percentage of residents who reported that they “always” or “very often” had concerns about floor appropriateness decreased from 23% to 4%. Conclusions: The authors designed a transfer process to improve communication, resident-level education, and psychological safety among team members to ensure safe, thorough handoffs between providers with different levels of training. Although we cannot definitively conclude that resident comfort improved due to a small “n” postintervention, we offer a description outlining process changes, barriers to implementation, and lessons learned.

Introduction: Adolescents with CHD require transition to specialised adult-centred care. Previous studies have shown that adolescents’ knowledge of their medical condition is correlated with transition readiness. Three-dimensional printed models of CHD have been used to educate medical trainees and patients, although no studies have focused on adolescents with CHD. This study investigates the feasibility of combining patient-specific, digital 3D heart models with tele-education interventions to improve the medical knowledge of adolescents with CHD. Methods: Adolescent patients with CHD, aged between 13 and 18 years old, were enrolled and scheduled for a tele-education session. Patient-specific digital 3D heart models were created using images from clinically indicated cardiac magnetic resonance studies. The tele-education session was performed using commercially available, web-conferencing software (Zoom, Zoom Video Communications Inc.) and a customised software (Cardiac Review 3D, Indicated Inc.) incorporating an interactive display of the digital 3D heart model. Medical knowledge was assessed using pre- and post-session questionnaires that were scored by independent reviewers. Results: Twenty-two adolescents completed the study. The average age of patients was 16 years old (standard deviation 1.5 years) and 56% of patients identified as female. Patients had a variety of cardiac defects, including tetralogy of Fallot, transposition of great arteries, and coarctation of aorta. Post-intervention, adolescents’ medical knowledge of their cardiac defects and cardiac surgeries improved compared to pre-intervention (p < 0.01). Conclusions: Combining patient-specific, digital 3D heart models with tele-education sessions can improve adolescents’ medical knowledge and may assist with transition to adult-centred care.

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An 8-year-old nonverbal autistic girl presented with her parents to our emergency department (ED) with a 6-week history of a progressively worsening limp. At onset, the patient had a mild limp, left-sided antalgic gait, avoidance of using the left leg, and expressed discomfort with its manipulation, according to her parents. She was admitted to the hospital for further evaluation of worsening limp.