The Top 10+ Studies According to Pediatric Hospitalists

This transcript has been edited for clarity.

Christopher J. Chiu, MD: Welcome back. We are The Cribsiders, the pediatric medicine podcast where we interview leading experts in the fields to bring you clinical pearls and practice-changing knowledge, and answer lingering questions about core topics in pediatric medicine. So, Justin, do you want to tell our audience what we're going to talk about today?

Justin L. Berk, MD, MPH, MBA: Today we are reviewing our podcast about the top 10-ish articles of the past year or two in collaboration with the 2021 conference. Our guests, Dr Rhonda Acholonu and Dr John Morrison, joined us from the Pediatric Hospital Medicine Conference 2021 to discuss the top articles in the field of pediatric hospital of medicine over the past year. It was a great episode and we got a lot of great pearls.

Chiu: Yeah, I had a lot of fun talking to these two experts, and we covered a lot. Do you want to tell us about some of their top choices?

Berk: They picked 11 or 12 studies, and in our podcast we go into a deep discussion on these topics. Some of our favorite pearls are worth sharing, including the following.

First was a study about independent rounding for pediatric trainees. Many of our listeners are in academia — attendings, residents, students. They looked at letting senior residents lead rounds in the morning without the attending around and then essentially tried to determine whether this was effective or not. The bottom line is that the seniors felt ownership and loved it, but the teachers didn't love it. They had some FOMO — they felt that they missed out on teaching and feedback opportunities. But overall, patients did just fine. This can definitely be used to augment pediatric medical education training.

The second study that was really high yield was about adverse events among children of parents with limited comfort with English. This was a paper from Kahn and colleagues in 2020 that showed that hospitalized children of parents expressing low comfort with English were twice as likely to experience harms due to medical care. Unfortunately, this is no surprise, but it really quantifies the importance of being able to communicate with patients. An earlier study from 2015 actually found that families only received 1.5 interpretations per patient day, so most clinical interactions with families occurred without an interpreter. The current article provides some guidance and ideas on how to improve our communications with these families.

The next article is about the use of physical restraints in children admitted for behavioral health concerns, by Dalton and colleagues. This was essentially a quality improvement project that showed that with some training and EMR supports, kids can be kept out of restraints. This facility reduced the use of restraints in pediatric patients from 2.6% to 0.9% by risk-stratifying patients and training staff on de-escalation strategies and alternatives to physical restraints. This could be replicated by other hospitals.

Another report that I wanted to shine a light on was about peripheral IV patency in children. This 2020 study basically compared "keep vein open" (KVO) orders, which involved running 2-5 mL of fluid per hour to keep the catheter patent so it doesn't clot vs using a saline lock; you can release kids from their IV poles and let them run around. And it turns out there is no difference in primary outcomes. Both worked just the same, with no difference in patency of the IVs. So feel free to let kids run around even without that IV pole.

Chui: What else did we talk about?

Berk: We also talked about new research on brief resolved, unexplained events and which factors were the highest risk. We talked about racial and social disparities in COVID-19 infections among children. We talked about multisystem inflammatory syndrome (MIS-C) in children and a new way to phototherapy for hyperbilirubinia. We talked about gender disparities in pediatric hospital medicine leadership and an article about a new early-onset neonatal sepsis calculator. All of this and more can be found in our podcast, PHM 2021: The Top 10ish Articles in Pediatric Hospital Medicine.

Chiu: Thanks again for joining us for another Medscape video recap of The Curbsiders pediatric podcast. Remember, you can download full episodes on any podcast player or check out our website.

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