bims-cliped Biomed News
on Clinical pediatrics
Issue of 2026–08–23
25 papers selected by
Alyssa M. Portwood, Akron’s Children
  1. Changes in Emergency Department Pediatric Readiness, Inpatient Services, and Excess Child Deaths.
  2. Caregiver Involvement in Screening and Brief Interventions for Adolescent Alcohol and Other Drug Use in Primary Care: Feasibility, Acceptability, and Utility.
  3. Variation in In-Hospital Emergency Transfer Rates Across Pediatric Hospitals.
  4. Implementing a Social Needs Screening and Intervention Program at a Pediatric Diabetes Center.
  5. Empiric MRSA Coverage for Children with Osteoarticular Infections: 2015 to 2024.
  6. Arginine Therapy for Sickle Cell Disease Acute Pain Episodes: The STArT Randomized Clinical Trial.
  7. Button Battery Ingestion and Removal Trends 2010-2015 Versus 2020-2025 at a Tertiary Care Pediatric Center.
  8. Reliability of Physical Examination Findings in Youths Diagnosed With Pneumonia.
  9. Influenza Disease Burden and Vaccine Effectiveness in Children and Adolescents With Solid Organ Transplant: 2018-2024.
  10. Bridging Hearts and Classrooms: A Collaborative Model for Building School Nurse-Cardiovascular Nursing Partnerships.
  11. Functional Outcomes of Pediatrics and Adolescent Pelvic Fractures: A Systematic Review.
  12. Developing a Contextual Framework to Understand Provider Bias When Delivering Intimate Partner Violence Universal Education in a Pediatric Emergency Department.
  13. "Lock and Protect" as a Risk Reduction Quality Improvement Project in Adolescent Outpatient Mental Health.
  14. Unidentified paediatric palliative needs: use of the Paediatric Palliative Screening Scale.
  15. Pediatric Mild Asthma: Bridging Current Gaps to Improve Future Care.
  16. Transforming central line associated blood stream infection prevention in neonates: Results from a multimodal quality improvement initiative.
  17. Pediatric Hyperlipidemia Guidelines: A Comprehensive Review of Screening, Diagnosis, and Management.
  18. Families' experiences with idiopathic short stature in the United States: A qualitative study of diagnostic pathways, care experiences, and psychosocial impacts.
  19. Trends in Emergency Department Visits for Children, 2016-2023.
  20. Trending Pediatric Injuries in the Overhead Athlete: A Narrative Review.
  21. Adenotonsillectomy in children with sickle cell disease: a systematic review.
  22. Role of the School Nurse in Providing School Health Services: Policy Statement.
  23. Pediatric Acquired Brain Injuries: A Scoping Review of Neuromotor Interventions in Acute Care.
  24. Cost-benefit analysis of universal pool fencing for Texas households with young children.
  25. Identifying Post-Discharge Needs in Pediatric Trauma Patients Through a Standardized Follow-up Telephone Program.
  1. JAMA Pediatr. 2026 Aug 17.
    Changes in Emergency Department Pediatric Readiness, Inpatient Services, and Excess Child Deaths.
    Craig D Newgard, Amber Lin, Jeremy D Goldhaber-Fiebert, Nathan Kuppermann, Katherine E Remick, Marianne Gausche-Hill, Ashley A Foster, Jennifer N B Cook, N Clay Mann, Susan Malveau, Randall S Burd, Peter C Jenkins, Andrea M Lundrigan, Nina E Glass, Stefanie G Ames, Mohsen Saidinejad, Aaron R Jensen, Tabitha Cheng, Steven McGaughey, Apoorva Salvi, Ran Wei, Myra Khushbakht, Hilary A Hewes.
       Importance: Emergency department (ED) pediatric readiness and pediatric inpatient services have changed over time in many hospitals, but the impact of these changes on pediatric outcomes is unclear.
    Objective: To evaluate pediatric mortality associated with changes to ED pediatric readiness and pediatric inpatient services over a 10-year period.
    Design, Setting, and Participants: This cohort study included data from January 1, 2012, through December 31, 2021, for 759 hospitals in 11 states that completed the 2013 and 2021 National Pediatric Readiness Program assessments. Participants were children aged 0 to 17 years who received care in an ED resulting in hospital admission, interhospital transfer, or death. Data analysis was performed from May 2025 to May 2026.
    Exposure: Changes in ED pediatric readiness and inpatient pediatric services, as measured through national assessments in 2013 and 2021. ED readiness change groups were characterized based on the weighted Pediatric Readiness Score (wPRS, range 0-100) associated with survival (wPRS ≥88 vs wPRS <88): sustained high readiness, gained, lost, or never had. Changes in pediatric inpatient services were defined as sustained, gained, lost, or never had.
    Main Outcomes and Measures: In-hospital mortality, including ED and inpatient deaths.
    Results: There were 2 416 030 children, including 337 167 who were injured (median [IQR] age, 10 [4-15] years; 4642 deaths [1.38%]) and 2 078 863 who were medically ill (median [IQR] age, 6 [1-14] years; 18 576 deaths [0.89%]). Of the 759 hospitals, the median (IQR) wPRS in 2013 vs 2021 was 71 (58-86) and 72 (62-88), respectively. Ninety-nine EDs (13.0%) had sustained high readiness, 85 (11.2%) gained readiness, 78 (10.3%) lost readiness, and 497 (65.5%) never had high readiness. For inpatient services, 225 hospitals (29.6%) sustained inpatient services, 36 (4.7%) gained services, 120 (15.8%) lost services, and 378 (49.8%) never had services. After risk adjustment, EDs that lost or never had high ED readiness were associated with 1727 (95% CI, 751-2646) and 3776 (95% CI, 2327-5143) excess deaths, respectively. Hospitals that lost or never had inpatient services were associated with 1657 (95% CI, 1214-2067) and 3745 (95% CI, 3127-4328) excess deaths, respectively.
    Conclusions and Relevance: This study found that the loss or persistent lack of high ED pediatric readiness and pediatric inpatient services were independently associated with excess mortality in children. Increasing ED readiness and adding inpatient services may augment pediatric survival in the US health care system.
    DOI:  https://doi.org/10.1001/jamapediatrics.2026.3497
  2. Clin Pediatr (Phila). 2026 Aug 17. 99228261474764
    Caregiver Involvement in Screening and Brief Interventions for Adolescent Alcohol and Other Drug Use in Primary Care: Feasibility, Acceptability, and Utility.
    Nicole P Porter, Aaron Hogue, Molly Bobek, Domingo Fortuna, Kate Tadeo, Milagro Lara, Kelly Ann Johnson, Meredith Glass, Yiyang Liu, Julia E Potter, Scott E Hadland, Shweta N Antani, Faith Summersett Williams, Maria H Rahmandar, Gregg Montalto, Lon Sherritt, Lydia A Shrier, Sion Kim Harris, Hetty Cunningham.
      Screening and brief intervention (SBI) is widely recommended to promote detection and early intervention for alcohol and other drug (AOD) use in pediatric primary care (PC). This multi-site randomized effectiveness trial screened 550 adolescent-caregiver dyads for AOD use risk factors in 3 urban PC practices. One hundred forty-eight adolescents at-risk for AOD use problems and their caregivers were enrolled in SBI-A-Standard, which included only adolescents in all intervention activities; or SBI-A-Family, which included both adolescents and caregivers in all SBI activities. Compared with SBI-A-Standard, SBI-A-Family procedures identified and provided intervention to more adolescents at risk for AOD use problems (47% of screened dyads vs 24%). Moreover, SBI-A-Family counseling interventions, although more extensive and resource demanding, were administered to 82% of indicated cases and rated near universally as helpful by adolescents, caregivers, and providers. Results of this study demonstrate added value of family-inclusive SBI models for identifying and addressing youth AOD use in PC.
    Keywords:  adolescent substance use; brief intervention; family-based; pediatric primary care; referral to treatment; screening
    DOI:  https://doi.org/10.1177/00099228261474764
  3. Hosp Pediatr. 2026 Aug 17. pii: e2026009318. [Epub ahead of print]
    Variation in In-Hospital Emergency Transfer Rates Across Pediatric Hospitals.
    Sanjiv D Mehta, Christina L Cifra, Lisa M Rickey, Jonathan Sawicki, Trisha L Marshall, Kaitlyn T Marks, Michael F Perry, Naveen Muthu, Nicole A Hames, Justin M Lockwood, Amarpreet Kaur, Irit R Rasooly.
       BACKGROUND: Clinical deterioration with late escalation, termed emergency transfer (ET), is a key safety metric. However, national benchmarking is limited by variable definitions. We sought to estimate pooled ET rates and assess variation across pediatric hospitals.
    METHODS: We performed a cross-sectional analysis of ET events (2020-2022) at 7 pediatric tertiary care hospitals. ET was defined as unplanned transfer to the pediatric intensive care unit with intubation, vasopressors, and/or at least 60 mL/kg fluid resuscitation within 1 hour before or after transfer. We calculated ET rates per 10 000 patient-days and as a percentage of total unplanned transfers.
    RESULTS: Across 1 582 794 patient-days and 11 100 unplanned transfers, we identified 448 ET events. The most common qualifying intervention categories were endotracheal intubation in 236 ETs (53%) and vasopressor initiation in 204 ETs (46%). The pooled ET rate was 2.83 per 10 000 patient-days (95% CI, 2.57-3.11), with significant variation across sites (range, 1.2-5.1; P < .01). The pooled proportion of unplanned transfers meeting ET criteria was 4.04% (95% CI, 3.68%-4.42%), which also varied significantly (P < .01). Variation persisted when restricted to sites already institutionally tracking ETs. Metric definitions varied most regarding fluid thresholds and which medications were included in vasoactive infusion definitions.
    CONCLUSION: ET rates vary significantly across pediatric hospitals regardless of the denominator used. Variation may be related to the observed differences in ET metric definitions (eg, fluid thresholds) and hospital characteristics (eg, intensive care unit criteria). These pooled estimates provide initial benchmarks, and standardization of the ET metric definition is required to enable reliable interinstitutional comparison.
    DOI:  https://doi.org/10.1542/hpeds.2026-009318
  4. Qual Manag Health Care. 2026 Aug 12.
    Implementing a Social Needs Screening and Intervention Program at a Pediatric Diabetes Center.
    Shilpi Relan, Emily DeWit, Katelyn Evans, Michelle Manaskie, Jasmine Roghair, Heather Feingold, Samantha N Jacob, Courtney Winterer, Jeffrey D Colvin, Mark A Clements, Kelsee Halpin.
      Social risk strongly influence diabetes control and contribute to inequity in diabetes care. We aimed to improve and sustain health-related social needs (HRSNs) screening of patients with diabetes from 0 to >50% over a 2-year period at multiple clinic sites within a pediatric hospital center. Using a multidisciplinary team and quality improvement techniques, we implemented and maintained an intervention over a 2-year period to screen for HRSNs and connect those with positive screens to local resources. We used statistical process control to assess change over time. Screening for HRSNs increased from 0% to 68% within 3 months and was maintained at a mean of 62% for the subsequent 20 months. Overall, 9026 screens were completed, with 956 (11%) positive for HRSNs. Of those, 146 (15%) requested direct assistance with connecting to resources, 507 (47%) requested resources to self-navigate, and 305 (32%) declined wanting assistance. Less than 1% of screens (n = 48) required urgent intervention from clinical social workers. Implementation of universal HRSN screening within a pediatric diabetes clinic is feasible across multiple clinic locations.
    Keywords:  diabetes mellitus; mass screening; pediatrics; quality improvement; social determinants of health
    DOI:  https://doi.org/10.1097/QMH.0000000000000577
  5. Pediatrics. 2026 Aug 19. pii: e2025075407. [Epub ahead of print]
    Empiric MRSA Coverage for Children with Osteoarticular Infections: 2015 to 2024.
    Justin B Searns, Angela Dunn, Meghan Birkholz, Matt Hall, Kevin J Downes, Brittany B Hubbell, Andrew S Kern-Goldberger, Jessica L Markham, Stephanie L Rolsma, Marie E Wang, Sean T O'Leary, Samuel R Dominguez, Sarah K Parker, Matthew P Kronman.
      
    BACKGROUND AND OBJECTIVES: Staphylococcus aureus is the most common causative pathogen for children with acute hematogenous osteomyelitis (AHO) and acute bacterial arthritis (ABA). National guidelines recommend empiric coverage for methicillin-resistant S. aureus (MRSA) at hospitals where the overall MRSA rate is greater than 10% to 20%. The objective of this study was to evaluate the frequency and appropriateness of empiric MRSA coverage for AHO and ABA among hospitalized children in the United States.
    METHODS: Hospital encounters from September 2015 through December 2024 for AHO and ABA were identified using the Pediatric Health Information System (PHIS) database and were categorized based on validated, pathogen-specific discharge codes. Hospital-specific rates of methicillin resistance among all S. aureus isolates were collected directly from participating PHIS hospital antibiograms.
    RESULTS: A total of 15 841 hospitalizations from 46 PHIS hospitals were included. Among the 48% of children with a pathogen-specific discharge code assigned, 17% were MRSA. Most children without MRSA identified (58%) received empiric MRSA antimicrobial therapy. Most hospital antibiograms had an MRSA rate above 20%, although the rate of MRSA for AHO and ABA was consistently less than hospital-wide MRSA rates. Across all PHIS hospitals, the MRSA rate for AHO and ABA was half that of hospital-wide MRSA rates (0.5; range, 0.2-1.17).
    CONCLUSIONS: Most children hospitalized in the United States for AHO and ABA receive empiric MRSA therapy, although few have MRSA identified. Hospital-wide antibiograms consistently have a higher MRSA rate than seen in patients with AHO and ABA, and development of AHO- and ABA-specific antibiograms may improve targeted empiric therapy for children with osteoarticular infections.
    DOI:  https://doi.org/10.1542/peds.2025-075407
  6. JAMA. 2026 Aug 19.
    Arginine Therapy for Sickle Cell Disease Acute Pain Episodes: The STArT Randomized Clinical Trial.
    Pediatric Emergency Care Applied Research Network (PECARN)
       Importance: Acute pain episodes are the leading cause of emergency department visits and hospitalizations for patients with sickle cell disease (SCD), yet US Food and Drug Administration-approved drugs for acute pain episodes are lacking. During acute pain episodes, patients develop acute arginine deficiency associated with longer time to crisis resolution and greater total parenteral opioid use. Multiple single-center, phase 2 randomized clinical trials have shown that arginine is safe, is opioid sparing, improves cardiopulmonary function, and reduces length of hospital stay.
    Objective: To determine the efficacy and safety of intravenous arginine for SCD acute pain episodes.
    Design, Setting, and Participants: Prospective, phase 3, double-blind randomized clinical trial conducted between June 21, 2021, and June 13, 2024, in 10 US children's hospitals enrolling patients aged 3 to 21 years presenting to the emergency department with SCD acute pain episodes requiring parenteral opioids.
    Interventions: Patients were randomized to receive intravenous arginine (200 mg/kg followed by 100 mg/kg every 8 hours until discharge; n = 129) or saline placebo (n = 142).
    Main Outcomes and Measures: The primary outcome was time to crisis resolution, defined as hours from initial study drug delivery to last intravenous opioid dose. Secondary outcomes included total parenteral opioid use (intravenous morphine equivalents in milligrams per kilogram from first study drug dose to last intravenous opioid dose), pain scores, and patient-reported outcomes.
    Results: Of 274 randomized participants, 271 received study drug; the mean age was 14.3 years (SD, 4.3 years), 51% were male, and 92% were Black. The trial was halted early for futility, as time to crisis resolution was similar in those receiving arginine vs placebo (median, 60.8 hours [IQR, 34.8-109.0 hours] vs 65.8 hours [IQR, 31.1-111.1 hours], respectively; absolute difference, 7.2 hours; 95% CI, -21.6 to 35.9 hours). No significant differences were seen in total parenteral opioid use, pain scores, patient-reported outcomes, or safety events.
    Conclusions and Relevance: Arginine therapy did not shorten time to crisis resolution compared with placebo among children and young adults with SCD acute pain episodes.
    Trial Registration: ClinicalTrials.gov Identifier: NCT04839354.
    DOI:  https://doi.org/10.1001/jama.2026.13310
  7. Laryngoscope. 2026 Aug 17.
    Button Battery Ingestion and Removal Trends 2010-2015 Versus 2020-2025 at a Tertiary Care Pediatric Center.
    Shakthi Ramasamy, Jordan Sick, Annamarie Lukish, Hengameh K Behzadpour, Diego A Preciado, LiJin Joo, Nancy M Bauman.
       OBJECTIVES: Button battery (BB) ingestion/insertion is a surgical emergency. We analyzed pediatric BB incidents at our institution between 2010-2015 (TP1) and 2020-2025 (TP2) to identify trends over time and strategies to reduce the duration of exposure.
    METHODS: All foreign body (FB) operative retrievals during study periods were reviewed. Demographics, characteristics, and outcome data of BB were compared.
    RESULTS: Sixty-two BB (3.2%) were identified from a total of 1914 FBs. The ratio of BB to all FB incidents increased from 2.3% in TP1 to 4.1% in TP2 (p = 0.03, (20/887 vs 42/1027) as did BB diameter (13.8mm/TP1, to 19.3mm/TP2, p = 0.007). The esophagus was the most common site of impaction (n=32) with 8/TP1 and 24/TP2. Caretaker suspicion of an esophageal BB incident was similar and relatively low between time periods (62.5%/TP1 vs 58.3%/TP2, p = 0.54). Caretaker-estimated esophageal exposure time before emergency department (ED) presentation was long (1404 minutes/TP1 and 3306 minutes/TP2, p = 0.72) and accounted for 85.7% and 94.5% of overall BB exposure time respectively. The decrease inriage-to-OR time between time periods was not significant (233 vs. 192 min, p = 0.16). The odds of shorter overall exposure time were associated with greater patient age (OR = 3.35, p = 0.02) and caretaker suspicion of BB incident (OR = 2.33, p = 0.03). Two-thirds of subjects were discharged < 2 days post-removal following observation alone. Long-term morbidity or mortality occurred in 9.4% (3/32) and included tracheoesophageal fistula (n = 1), esophageal stricture (n = 1), and fatal delayed tracheotomy tube obstruction (n = 1).
    CONCLUSIONS: BB pediatric ingestions are increasing with a greater proportion involving esophageal impaction and some may be life-threatening. Caregiver-estimated time to ED arrival accounted for 85.7%/TP1 and 94.5%/TP2 of total exposure time demonstrating that exposure duration is primarily driven by delays before ED presentation and not by hospital services. Thus, while clinicians must still expedite retrieval to minimize tissue damage, mitigating total exposure requires targeted public awareness campaigns for caregivers. Efforts prioritizing caregiver prevention and public awareness of emergent nature of BB ingestions may reduce exposure time and improve outcome.
    LEVEL OF EVIDENCE: 3:
    Keywords:  button battery ingestion; esophageal injury; pediatrics
    DOI:  https://doi.org/10.1002/lary.70803
  8. JAMA Netw Open. 2026 Aug 03. 9(8): e2630074
    Reliability of Physical Examination Findings in Youths Diagnosed With Pneumonia.
    Pediatric Emergency Care Applied Research Network (PECARN) PedCAPS Investigators
       Importance: Community-acquired pneumonia (CAP) accounts for nearly 2 million pediatric outpatient and 375 000 emergency department (ED) visits annually in the US. Guidelines recommend relying on physical examination findings, not imaging, to diagnose CAP in youths who can be treated as outpatients.
    Objective: To determine the interrater reliability (IRR) of physical examination findings in youths diagnosed with CAP in EDs.
    Design, Setting, and Participants: This was a planned analysis from an ongoing prospective cohort study (pediatric CAP severity [PedCAPS]). Youths aged 3 months to 17 years with CAP were recruited at 7 academic pediatric EDs within the US from August 1, 2023, until May 24, 2025; participants had signs of lower respiratory tract infections, fever within 48 hours, and pneumonia on chest radiography, if performed. Youths with chronic pulmonary diseases (except asthma), sickle cell disease, immunodeficiency, cardiac disease, neurological disorders affecting respiration, and aspiration pneumonia were excluded, as were those hospitalized within the preceding 30 days or transferred from other EDs or hospitals.
    Main Outcomes and Measures: Two examiners evaluated the same patient within 60 minutes of each other and independently recorded their findings. IRR of physical examination findings was reported by raw agreement and Fleiss κ. A lower bound of the 95% CI of 0.4 for κ was considered acceptable reliability.
    Results: Among 252 youths with paired physical examinations (median [IQR] age, 5.7 [3.4-8.8] years; 127 female [50.4%]), the most frequent comorbidity was asthma (56 youths [22.2%]). In the overall study population, no physical examination finding met predefined significance for IRR. Wheezing (κ = 0.50; 95% CI, 0.39-0.62) and retractions (κ = 0.49; 95% CI, 0.37-0.60) had the highest IRR. In subanalyses of 124 youths discharged home and 128 youths who were hospitalized, IRRs of physical examinations were similar between the 2 groups.
    Conclusions and Relevance: In this study, individual auscultation findings, such as decreased breath sounds, crackles, or rhonchi, did not demonstrate sufficient reliability to be used alone for diagnosis.
    DOI:  https://doi.org/10.1001/jamanetworkopen.2026.30074
  9. Pediatr Transplant. 2026 Aug;30(8): e70433
    Influenza Disease Burden and Vaccine Effectiveness in Children and Adolescents With Solid Organ Transplant: 2018-2024.
    Daniela Barisano, Justin K Chen, Hillary Kuzaro, Anastacia Serluco, Mark D Gonzalez, Gwen Nance, Keyner Rojas, Precious Nchekwube, Elizabeth Cohen, Inci Yildirim.
       BACKGROUND: Solid organ transplant (SOT) recipients have an increased risk of influenza infection. Annual vaccination is the primary strategy to reduce the burden of influenza disease, but vaccine effectiveness (VE) varies annually for influenza. There is limited data published demonstrating influenza VE in pediatric SOT over time.
    METHODS: We conducted a retrospective, case-control study using a test-negative design to estimate influenza VE against laboratory-confirmed influenza infections among pediatric SOT recipients aged 6 months to 21 years at two large pediatric transplant centers, spanning the six influenza seasons from fall 2018 through spring 2024. Logistic regression models were used to compare odds ratios (ORs) of vaccination in cases to controls. VE was calculated as [100% × (1 - adjusted OR)], and 95% confidence intervals (CIs) were computed around the estimates.
    RESULTS: Across all 6 seasons, there were 4 585 patient encounters, of which 961 had an influenza test and were included in the study. Overall, 750 (78.0%) patients received the seasonal influenza vaccine, and 94 (9.9%) tested positive for influenza. Among vaccinated patients, the prevalence of influenza diagnosis was lower (6.8%) than among unvaccinated patients (20.4%) (OR 0.28, 95% CI 0.18-0.43). The adjusted VE against laboratory-confirmed influenza infection was 72.0% (95% CI 57.0-82.0) and varied by season. VE was similar between organ groups: Kidney (65.9%, 95% CI 29.7-83.4), heart (86.4%, 95% CI 59.0-95.5), and liver (71.7%, 95% CI 41.6-86.3).
    CONCLUSIONS: Influenza vaccination decreased the risk of influenza infection among pediatric SOT recipients for the 2018-2024 influenza seasons.
    DOI:  https://doi.org/10.1111/petr.70433
  10. J Cardiovasc Nurs. 2026 Aug 18.
    Bridging Hearts and Classrooms: A Collaborative Model for Building School Nurse-Cardiovascular Nursing Partnerships.
    Lucine Francis, Jennifer K Peterson, Laura L Hayman.
       BACKGROUND: Cardiovascular disease (CVD) and CVD risk factors, including obesity and hypertension, are increasingly prevalent among children and youth, highlighting the need for early sustained prevention. Positioned at the intersection of health and education, school nurses are uniquely equipped to support cardiovascular health in everyday practice.
    PURPOSE: We propose a collaborative model linking school nurses with the cardiovascular nursing community, drawing on the American Heart Association's Life's Essential 8 for Kids framework, the National Association of School Nurses School Nursing Practice Framework, and principles of implementation science. This partnership, including researchers, clinicians, and professional organizations, is necessary to translate evidence on heart health prevention into school settings.
    CONCLUSIONS: Through coordinated care, leadership development, quality improvement, community engagement, and adherence to professional standards, this collaborative approach can support school nurses in promoting lifelong cardiovascular health for all children and youth.
    CLINICAL IMPLICATIONS: School nurses are a vital component of the cardiovascular healthcare team, with unique skills, knowledge, and access to students at risk for CVD in the community setting.
    Keywords:  cardiovascular nursing; health promotion; heart health; school health services
    DOI:  https://doi.org/10.1097/JCN.0000000000001371
  11. J Pediatr Orthop. 2026 Aug 20.
    Functional Outcomes of Pediatrics and Adolescent Pelvic Fractures: A Systematic Review.
    Vincent Buckman, Patrick Sun, Jeffrey Blibo, Nirav Pandya.
       BACKGROUND: Pelvic fractures are rare injuries, representing 1% to 2% of fractures among pediatric and adolescent populations. Although uncommon, these injuries differ significantly from adult fractures due to skeletal immaturity and increased potential for bone remodeling. Currently, there is limited understanding of the long-term outcomes of pediatric pelvic fractures. This study aims to review the functional outcomes of pediatric and adolescent pelvic fractures.
    METHODS: Following PRISMA guidelines, a systematic review was performed using PubMed, Embase, Scopus, and Google Scholar databases. Three independent authors screened all eligible studies, extracted the data, and assessed risk of bias. The types of studies included in the analysis were retrospective and prospective human cohort studies, as well as case series. The primary outcome of interest was functional outcomes by fracture stability and management. Secondary outcomes included radiologic and structural complications. Weighted pooled analyses were conducted where feasible.
    RESULTS: Fourteen studies (n=731) were included in the review. Across reporting studies, more than 90% of patients regained independent ambulation and returned to activities of daily living regardless of management strategy and fracture stability. Pelvic asymmetry was the most frequently reported structural complication, occurring in 22 of 253 patients (8.7%). Other structural complications included limb length discrepancy (23/333; 6.9%), acetabular dysplasia (3/178; 1.7%), and nonunion (6/549; 1.1%).
    CONCLUSION: Pediatric and adolescent pelvic fractures demonstrate favorable functional outcomes when management strategies are appropriately aligned with fracture stability. However, operative fixation could be considered in selective patients with stable fractures who are hemodynamically stable and at low surgical risk to modify the risks of rare complications such as pelvic asymmetry, limb length discrepancy, and nonunion.
    LEVEL OF EVIDENCE: Level III-systematic review of level I to IV studies.
    Keywords:  acetabular fractures; functional outcomes; pediatric pelvic fractures; pelvic asymmetry; pelvic ring injuries; skeletally immature
    DOI:  https://doi.org/10.1097/BPO.0000000000003439
  12. J Interpers Violence. 2026 Aug 20. 8862605261476094
    Developing a Contextual Framework to Understand Provider Bias When Delivering Intimate Partner Violence Universal Education in a Pediatric Emergency Department.
    Leena Kasa, Ashlee Murray.
      Provider bias can create inequities in the response to intimate partner violence (IPV) within healthcare settings, negatively impacting the health of IPV survivors and their families. In our pediatric emergency department (ED), it is recommended that universal IPV education be offered to all adult caregivers presenting alone with a pediatric patient. Despite the program's standardization, quality improvement data have identified disparities in the delivery of IPV universal education and electronic medical record documentation. In a previous study, significant disparities in offering IPV universal education and documentation were found and linked to both explicit and implicit provider biases. This paper aims to apply theoretical frameworks, such as the Social Ecological Model (SEM) and the Theory of Reasoned Action/Theory of Planned Behavior, to develop a contextual framework that examines macro- and micro-level factors influencing a provider's decision to offer IPV education. Interviews with ED providers from a prior study, focusing on the role of race in addressing IPV, were analyzed to uncover specific biases that inform providers' decisions on offering IPV universal education to a caregiver. The contextual framework was used to explore the root causes of biases and how they influence a provider's behavior, leading to inequities in IPV universal education. To conclude, the contextual framework is used to identify potential interventions at various SEM levels to reduce biases in our IPV universal education program by improving IPV universal education training, increasing provider knowledge of IPV experience across diverse populations, and providing a method for providers to self-evaluate their own biases. Further studies can explore how this contextual framework can be adapted through a cross-disciplinary approach to examine other behaviors that contribute to disparities in IPV care delivery, with a goal of increasing equitable access to IPV interventions across multiple healthcare settings.
    Keywords:  health disparities; healthcare bias; intimate partner violence; pediatric emergency department; theoretical framework; universal education
    DOI:  https://doi.org/10.1177/08862605261476094
  13. J Am Psychiatr Nurses Assoc. 2026 Aug 19. 10783903261474453
    "Lock and Protect" as a Risk Reduction Quality Improvement Project in Adolescent Outpatient Mental Health.
    Kathy Stanton, Hadassah Joseph, Amelia Mathew, Julie A Thompson, Sean Convoy.
       BACKGROUND: Suicide is a leading cause of adolescent death in the United States (US), with access to lethal means significantly increasing mortality risk. Parents are crucial to prevention but often lack knowledge and confidence in lethal means restriction (LMR). Despite evidence-based support and national guidelines, LMR counseling remains inconsistently implemented in outpatient settings.
    PURPOSE: This project evaluated the feasibility, acceptability, and impact of the Lock and Protect (L&P) online decision aid in an outpatient mental health clinic, examining parent-reported changes in lethal means storage practices.
    METHODS: A 12-week quality improvement project was conducted in a suburban southeastern US outpatient mental health clinic. Parents and guardians of adolescents accessed the L&P decision aid via QR-code flyers during visits or through electronic health record portal messages. Participants completed anonymous surveys assessing the tool's usefulness, approachability, relevance, and planned storage practice changes. Descriptive statistics were used to analyze responses.
    RESULTS: Of 165 families invited, 31 completed surveys (18.8%), with in-person QR-code distribution yielding higher engagement than electronic messaging. Most participants found the tool useful (83.9%) and reported that it made discussing this difficult topic more approachable (90%). Overall, 67.7% planned to change the storage of at least one lethal means type, most commonly medications (43.3%). Among families with unsecured firearms, 66% planned to adopt more secure storage practices.
    CONCLUSION: Used in an outpatient mental health setting, the L&P decision aid demonstrated utility, approachability, and relevance with increased intent to secure lethal means. Findings support this LMR education as a scalable, low-burden suicide prevention strategy appropriate for outpatient practice.
    Keywords:  adolescent suicide prevention; lethal means restriction; lock and protect decision aid; outpatient mental health; parental education; psychiatric nursing; quality improvement
    DOI:  https://doi.org/10.1177/10783903261474453
  14. Int J Palliat Nurs. 2026 Aug 02. 32(8): 1-7
    Unidentified paediatric palliative needs: use of the Paediatric Palliative Screening Scale.
    Catarina Sofia Rodrigues Preto, Luís Miguel Pereira Condeço.
       BACKGROUND: Paediatric palliative care should be provided to children and adolescents with complex chronic, life-limiting or life-threatening conditions, from the time of diagnosis, throughout the life course and beyond death, ensuring continuity of care.
    AIMS: To identify children and adolescents with complex chronic conditions at a Portuguese healthcare unit who may be eligible for referral to paediatric palliative care.
    METHODS: An exploratory, descriptive quantitative and cross-sectional study was conducted, using the Portuguese version of the Paediatric Palliative Screening Scale. A total of 397 children and adolescents attending a paediatric developmental consultation were included in the study. Of these, 10 participants met the study's inclusion criteria and were assessed through telephone interviews with their parents.
    FINDINGS: The use of the screening tool enabled the identification of two participants (20%) who would benefit from referral.
    CONCLUSIONS: Integrating systematic tools, such as the Paediatric Palliative Screening Scale, into routine consultations may enable earlier referral to palliative care, improving quality of care and support for families.
    IMPLICATIONS FOR PRACTICE: Routine use of referral tools combined with improved palliative care literacy and communication may facilitate earlier identification of children with palliative care needs and more timely referral to specialist services. Future development of more holistic referral tools that incorporate functional, psychosocial and symptom-related needs could support more equitable, person-centred paediatric palliative care.
    Keywords:  adolescent; child; chronic disease; palliative care; referral and consultation
    DOI:  https://doi.org/10.12968/ijpn.2025.0042
  15. Pediatr Pulmonol. 2026 Aug;61(8): e71800
    Pediatric Mild Asthma: Bridging Current Gaps to Improve Future Care.
    Francesca Santamaria, Cristina Fontanella, Melissa Borrelli.
       BACKGROUND: Pediatric mild asthma is considered a benign condition, yet it accounts for a substantial proportion of morbidity. Characterization and management of children or adolescents with mild asthma are less explored than in adults, particularly due to its heterogeneous nature and variable course. Current definitions of mild asthma in pediatric populations vary across international guidelines or reports, limiting standardization. Although knowledge of asthma phenotypes and endotypes, and risk biomarkers has progressed notably, it is incomplete in the different pediatric age groups exhibiting mild or intermittent symptoms. Moreover, differing treatment recommendations may lead to uncertainty in clinical practice on whether using short-acting β2-agonist monotherapy or intermittent or daily inhaled corticosteroids or the regimen with inhaled corticosteroids plus bronchodilators combined in single-inhalers.
    METHODS: In this narrative review, we integrated evidence and recommendations from major asthma guidelines and reports complemented by selected insights from recent literature not addressed in these sources.
    RESULTS: We summarized the current knowledge of pediatric mild asthma, risk factors for exacerbation, treatment recommendations, and highlighted gaps in clinical practice or questions still unanswered.
    CONCLUSIONS: In children and adolescents, asthma may seem only apparently mild, mainly due to overlooked or poorly controlled exacerbations. A more unified approach would improve clinical outcomes and reduce its global burden. Priorities include a standardized definition of the mild asthma phenotype in children and adolescents, a detailed examination of risk factors as early predictors of poor outcomes and of the limited access to medications and healthcare resources in low-income countries. Incorporating a broader global health perspective would provide a more comprehensive understanding of the factors influencing the care of children with mild asthma worldwide.
    Keywords:  adolescents; asthma; children; mild asthma; wheezing
    DOI:  https://doi.org/10.1002/ppul.71800
  16. World J Clin Pediatr. 2026 Sep 09. 15(3): 118413
    Transforming central line associated blood stream infection prevention in neonates: Results from a multimodal quality improvement initiative.
    Anish Pillai, Nandkishor Kabra, Anuja Nayak, Mayuri Bhanushali, Haribalakrishna Balasubramanian, Sandesh Shivananda.
       BACKGROUND: Central line-associated bloodstream infections (CLABSI) are a major cause of morbidity and mortality among neonates in intensive care units. Quality improvement (QI) initiatives targeting CLABSI prevention can significantly enhance patient outcomes.
    AIM: To evaluate the impact of a multimodal QI initiative on reducing CLABSI incidence in a level-3 neonatal intensive care unit (NICU) and sustaining the improvement over time. The goal was to achieve a 50% reduction in CLABSI rates within 12 months and maintain results for an additional 18 months.
    METHODS: This prospective interventional study was conducted in a level-3 teaching NICU in Western India. All neonates with central venous access during NICU stay were included. Baseline CLABSI rates were measured over a pre-intervention period. The intervention bundle comprised strengthening hand hygiene practices, customizing and updating CLABSI prevention bundles, revising environmental cleaning protocols, conducting regular audits of line insertion and maintenance practices, and implementing structured nursing education sessions. Multiple Plan-Do-Study-Act cycles were used to refine interventions and monitor compliance.
    RESULTS: The baseline CLABSI rate was 6.4 per 1000 central line days, which decreased to 1.1 per 1000 central line days post-intervention; an 83% reduction. During the 18-month sustainability phase, rates remained low at 0.96 per 1000 central line days. Hand hygiene compliance, adherence to central line bundles, and nursing education coverage improved significantly throughout the intervention and maintenance phases.
    CONCLUSION: Implementation of a structured, multimodal QI bundle emphasizing hand hygiene, tailored central line care bundles, regular audits, and nursing education resulted in a substantial and sustained reduction in CLABSI rates. This approach is feasible, cost-effective, and replicable in similar resource-constrained NICU settings.
    Keywords:  Central line-associated bloodstream infections; Infection control; Neonatal sepsis; Plan-Do-Study-Act cycle; Prevention bundle; Quality improvement
    DOI:  https://doi.org/10.5409/wjcp.118413
  17. Cardiol Rev. 2026 Aug 21.
    Pediatric Hyperlipidemia Guidelines: A Comprehensive Review of Screening, Diagnosis, and Management.
    Nhi D Nguyen, Tzvi Fishkin, Amgad N Makaryus, William H Frishman, Wilbert S Aronow.
      Atherosclerotic cardiovascular disease originates in childhood, and cumulative exposure to low-density lipoprotein cholesterol (LDL-C) is a major determinant of lifetime cardiovascular risk. Multiple professional societies have published guidelines for lipid screening, diagnosis, and management in pediatric populations; yet important differences exist among these recommendations. Our objective is to review and compare major pediatric dyslipidemia guidelines and identify areas of consensus, disagreement, and remaining evidence gaps. A narrative review was conducted to compare recommendations from major professional society guidelines on lipid screening, diagnostic criteria, lifestyle management, pharmacologic therapy, and management of hypertriglyceridemia. Across guidelines, there is broad agreement that lifestyle modification is first-line therapy and that statins are safe and effective for children with familial hypercholesterolemia. Key differences exist around universal screening, the age and LDL-C thresholds for statin initiation, LDL-C treatment targets, and the role of genetic testing. More recent guideline updates support earlier identification and treatment of pediatric dyslipidemia, particularly in children with familial hypercholesterolemia. Pediatric dyslipidemia guidelines are evolving toward earlier detection and more intensive management of lipid disorders in children. However, important evidence gaps remain, including limited long-term cardiovascular outcome data following childhood lipid-lowering therapy, insufficient pediatric evidence for newer lipid-lowering agents, and persistent disparities in access to screening.
    Keywords:  clinical practice guidelines; familial hypercholesterolemia; lipid screening; pediatric dyslipidemia
    DOI:  https://doi.org/10.1097/CRD.0000000000001433
  18. J Pediatr Nurs. 2026 Aug 18. pii: S0882-5963(26)00386-6. [Epub ahead of print]91 248-254
    Families' experiences with idiopathic short stature in the United States: A qualitative study of diagnostic pathways, care experiences, and psychosocial impacts.
    Elisabeth M Oehrlein, Jessica Klass, Dianne Kremidas, Alexis Clark, Emily Landgren, Kaleigh Bulloch Whitehall, Fiona Fettes, Margaret Cho, Ankita Saxena, Joe Vandigo.
       BACKGROUND: Idiopathic short stature (ISS) is height > 2 SD below the mean for age and sex without an identifiable medical cause. In the United States, growth hormone (GH) is approved for ISS, but responses vary, long-term safety data are limited, and psychosocial effects are understudied.
    PURPOSE: To describe diagnostic pathways, treatment experiences, psychosocial impacts, and support needs among U.S. children with ISS and their caregivers.
    METHODS: Semi-structured interviews were conducted with 22 participants (10 children/adolescents and 12 parents) recruited through the MAGIC Foundation. Interviews were conducted virtually, audio-recorded, transcribed verbatim, de-identified, and thematically analyzed using a qualitative descriptive approach and codebook thematic analysis with inductive line-by-line coding.
    RESULTS: Families described variable and often delayed diagnostic pathways, frequently due to provider uncertainty or dismissal of growth concerns. Nearly all children had used GH therapy and reported benefits in height and self-confidence; however, families highlighted challenges related to daily injections, variable effectiveness, and insurance barriers. Short stature was associated with substantial psychosocial burden, particularly among boys in this sample, including bullying, stigma, and restrictions in daily activities. While families relied on healthcare providers for medical guidance, they often turned to online communities for practical advice and emotional support, underscoring unmet needs for structured education and credible resources.
    CONCLUSIONS: Children with ISS and their families experience diagnostic delays, treatment burdens, and psychosocial challenges that extend beyond physical growth. Although GH therapy provides modest benefits, families expressed a desire for more effective and less burdensome treatments. Pediatric nurses can support earlier recognition and referral, provide structured education, advocate for equitable access, and integrate psychosocial care into routine management.
    Keywords:  Growth hormone therapy; Idiopathic short stature; Patient experience; Pediatric endocrinology; Qualitative research
    DOI:  https://doi.org/10.1016/j.pedn.2026.08.018
  19. J Pediatr. 2026 Aug 19. pii: S0022-3476(26)00314-8. [Epub ahead of print] 115286
    Trends in Emergency Department Visits for Children, 2016-2023.
    Sriram Ramgopal, Timothy T Phamduy, Elizabeth M Keating, Daniel J Shapiro, Oluwakemi Badaki-Makun, Mohamed Eltorki, Kelly R Bergmann, Frank Gonzalez, Alexandra T Geanacopoulos, Chris A Rees, Pradip P Chaudhari, Mark I Neuman.
       OBJECTIVE: To evaluate longitudinal changes in diagnoses related to emergency department (ED) utilization and associated costs among children in US EDs.
    STUDY DESIGN: We performed a serial cross-sectional study using the 2016-2023 Nationwide Emergency Department Sample, a nationally representative all-payor ED sample. We evaluated longitudinal changes in diagnoses (using the Diagnosis Grouping System) and costs (inflation adjusted 2023 dollars) over time overall utilizing negative binomial regression and log-linear regression, respectively. We then performed interrupted time-series analyses to account for the onset of the COVID-19 pandemic in 2020.
    RESULTS: We identified 198,256,299 ED encounters. Overall trends shifted by diagnosis, with increases in psychiatric/behavioral diseases and substance abuse (+2.8% annually; 95% CI, 1.2, 4.4) and endocrine/metabolic/nutritional diseases (+3.7%; 95% CI, 0.4, 7.2). Several diagnoses declined, including skin/soft tissue disease (-9.0%; 95% CI, -13.0, -4.8), urinary tract disease (-4.9%; 95% CI, -7.1, -2.7), and trauma (-4.6%; 95% CI, -7.1, -2.1). In time series analyses, the COVID-19 pandemic was associated with sharp declines in encounters, followed by post-pandemic increases, especially for eye disease (+27.8% annually; 95% CI, 21.5, 34.5), ear, nose and throat (ENT), dental/mouth disease (+20.0%; 95% CI, 15.4, 24.7), fluid/electrolyte disorders (+19.7%; 95% CI, 13.9, 25.7), and respiratory disease (+18.7%; 95% CI, 6.2, 32.6). Inflation-adjusted costs increased in psychiatric/behavioral diseases and substance abuse (+10.6%; 95% CI, 8.2, 12.9), systemic states (+9.5%; 95% CI, 3.9, 15.3), and endocrine/metabolic/nutritional diseases (+6.3%; 95% CI, 0.7, 12.3). Post-pandemic cost increase was greatest for ENT/dental/mouth disease (+24.6%; 95% CI, 16.9, 32.7), eye disease (+24.1%; 95% CI, 15.3, 33.6), and psychiatric/behavioral diseases and substance abuse (+12.1%; 95% CI, 5.1, 19.6).
    CONCLUSIONS: We identified changes in ED presentations and costs over time, with notable changes for psychiatric/behavioral and substance abuse conditions. These findings have implications for health systems and policymakers amid major shifts in ED use over the past decade.
    DOI:  https://doi.org/10.1016/j.jpeds.2026.115286
  20. HSS J. 2026 Aug 17. 15563316261474789
    Trending Pediatric Injuries in the Overhead Athlete: A Narrative Review.
    Joseph Molony, Donna Merkel, Kathryn McElheny, Yukiko Matsuzaki, Michelle Yang.
      Pediatric overhead athlete injuries are increasing in frequency, many of them unique to the youth musculoskeletal system. Conditions relate not only to growth centers but also to subchondral bone and joint instability linked to immature connective tissue. Diagnosis depends on a thorough patient history, correct examination techniques, and use of imaging. Management of these patients requires a greater focus on neuromuscular rehabilitation principles than is needed for adults. There is a lack of consensus on the role of functional testing in rehabilitation decisions, and further investigation is necessary. In addition, practitioners need to be mindful of the psychosocial dynamics among players, parents, and coaches, who may not understand appropriate workloads for young athletes and feel pressured to accelerate the pace of recovery. This narrative review covers the most current principles of diagnosis, treatment, and return-to-play strategies for pediatric overhead athlete injuries including preventing of recurrent injuries and avoiding long-term sequelae.
    Keywords:  overhead athlete; pediatric; upper extremity; young athlete; youth sports
    DOI:  https://doi.org/10.1177/15563316261474789
  21. Am J Otolaryngol. 2026 Aug 13. pii: S0196-0709(26)00121-3. [Epub ahead of print]47(5): 104905
    Adenotonsillectomy in children with sickle cell disease: a systematic review.
    Francesca Galluzzi, Werner Garavello.
       OBJECTIVE: Adenotonsillectomy (ADT) is a common indication for children with sickle cell disease (SCD) and comorbid obstructive sleep apnea (OSA) or recurrent infections (adenoidits and tonsillitis), despite the paucity of data in this population. This review aims to evaluate the surgical outcomes of ADT in pediatric patients with SCD.
    METHODS: We conducted a systematic review by searching the PubMed and Embase electronic databases. The PRISMA guidelines were followed, and the review protocol was registered in PROSPERO. A qualitative analysis was performed.
    RESULTS: Ten studies, comprising a total of 454 subjects, were included. The mean age ranged from 6 to 12 years, with a comparable sex distribution between groups. The combined cohort consisted of 303 cases of HbSS, 24 of HbSC, 16 of HbS/β-thalassemia, and 3 cases of HbSS-HPFH. Baseline hemoglobin (Hb) levels ranged from 6.7 to 9.3 g/dL, while mean Hb levels at the time of surgery varied between 8.9 and 11.4 g/dL. The proportion of patients receiving preoperative transfusions ranged from 72% to 100%. Follow-up duration spanned from 1 month to 1 year. The primary surgical indications were OSA and recurrent infections. Regarding surgical outcomes, the improvement in the AHI ranged from 50.56% to 82.90%, with mean hospital stays of 2 and 3.5 days. Postoperative acute chest syndrome and emergency department visits decreased significantly, whereas the reduction in vaso-occlusive crises was not significant. Finally, surgical complications were reported in 5.2% to 11.3% of cases.
    CONCLUSION: ADT may provide clinical benefits for children with SCD. However, given the limited evidence, outcomes must be interpreted with caution, and a multidisciplinary approach is required to manage potential complications.
    Keywords:  Adenotonsillectomy; Children; Obstructive sleep apnea; Review; Sickle cell disease
    DOI:  https://doi.org/10.1016/j.amjoto.2026.104905
  22. Pediatrics. 2026 Aug 17. pii: e2026078284. [Epub ahead of print]
    Role of the School Nurse in Providing School Health Services: Policy Statement.
    Council on School Health
      School nursing has evolved into an essential field bridging health care and education. School nurses play multifaceted roles, addressing direct care, care coordination, public health, leadership, and quality improvement. They manage communicable diseases, chronic conditions, mental health, and emergencies while promoting safe, equitable learning environments. Collaboration with pediatricians enhances outcomes for students, families, and communities by addressing shared challenges like the rising prevalence of children and youth with special health care needs (CYSHCN), mental health concerns, and health inequities. Despite these contributions, disparities in school nurse access persist. The 2024 National School Nurse Workforce Study revealed only 65.7% of schools have access to full-time nurses, with pronounced disparities depending on school type, geography, and socioeconomic factors. Lack of access to a full-time school nurse limits the ability to meet the growing health demands of students, including chronic disease management, mental health interventions, and pandemic-related setbacks like delayed immunizations and screenings. By fostering partnerships with school nurses, pediatricians can support preventive care, improve care coordination, and advocate for equitable resources. Collaborative efforts in health policy, emergency preparedness, and technology-driven communication enhance team-based care. Investing in school nursing is an investment in children's health, safety, and academic success. Advocacy, research, and sustainable funding models are crucial to expanding access and addressing disparities, ensuring school health services remain integral to promoting health equity and academic achievement.
    DOI:  https://doi.org/10.1542/peds.2026-078284
  23. Phys Occup Ther Pediatr. 2026 Aug 17. 1-20
    Pediatric Acquired Brain Injuries: A Scoping Review of Neuromotor Interventions in Acute Care.
    Roberta Giustetto, Martina Allighieri, Matteo Pirinu.
       AIMS: Acute care is essential for pediatric acquired brain injury (ABI), but finding precise guidelines for implementing and characterizing early neuromotor interventions is challenging. This scoping review explored the modalities and characteristics of neuromotor interventions, aligned with International Classification of Functioning, Disability and Health (ICF) and FITT (frequency, intensity, time, and type) criteria, for pediatric populations with ABI in acute care settings.
    METHODS: Following PRISMA-ScR framework, searches were conducted in PubMed, Embase, Scopus, Cochrane, and PEDro for English studies, limited to primary sources of evidence, published between 2000 and October 2025. Inclusion criteria focused on children aged one month to 18 years with ABI in acute care settings. Two reviewers screened and synthesized data on study characteristics, demographic data, clinical variables and types/characteristics of neuromotor interventions.
    RESULTS: Five of 3,497 screened articles were included. Primary interventions targeted mobilization/visual training (body structures and functions) and balance/gait training (activities). While "frequency" and "type" were consistently reported, "time" and "intensity" were frequently omitted. Outcomes were mixed for traumatic injuries but positive for inflammatory pathologies.
    CONCLUSIONS: Early neuromotor intervention for pediatric ABI is feasible and safe, but methodological heterogeneity and inconsistent parameter reporting underscore the need for standardized protocols and a core outcome set.
    Keywords:  Acquired brain injury; acute care; early mobilization; pediatric; physical rehabilitation interventions
    DOI:  https://doi.org/10.1080/01942638.2026.2718155
  24. Inj Epidemiol. 2026 Aug 17. pii: 56. [Epub ahead of print]13(Suppl 1):
    Cost-benefit analysis of universal pool fencing for Texas households with young children.
    James Rhodes, Linh Nguyen, Rohit P Shenoi.
       BACKGROUND: Texas bears a disproportionate burden of pediatric drowning in the United States. Functional pool fencing prevents pediatric drownings, but its economic impact on drowning-related costs remains unclear. We estimated the potential cost savings of implementing a universal pool fencing program for households with young children.
    METHODS: We conducted a cost-benefit analysis of universal pool fencing for Texas households with one or more children ages 1-9 years. Drowning burden was estimated from Texas data with a case-fatality rate of 1:6. Direct medical and lifetime indirect costs per patient and caregiver were derived from hospital discharge data and literature. Prevented drownings were estimated using a population-wide risk model incorporating fence effectiveness and current fence coverage (percent of homes with functional fences). Average pool fence cost was obtained from industry experts, assuming a 10-year lifespan and no maintenance costs. Population and household estimates were derived from U.S. Census data to determine the number of fences required. Total program costs were calculated by multiplying the number of fences required by the average cost per fence. Annual cost savings were calculated from prevented cases and per-case costs. Benefits over a 10-year period were estimated as the present value of annual savings discounted at 5%. Net benefit was defined as 10-year benefits minus total fencing program costs.
    RESULTS: The annual fatal and non-fatal drowning burden in Texas among children ages 1-9 years is 264 cases. With 76% fence effectiveness and 38% current fence coverage, an estimated 174 drownings could be prevented annually. The average cost per drowning is $337,435 (direct medical: $60,860; lifetime indirect: $276,575). With 7% of Texas households having a pool, an estimated 98,905 new fences are required at a cost of $3,343 each, totaling $330,642,758 in program costs. Annual cost savings are $58,713,690, corresponding to $453,371,551 in 10-year benefits and a net benefit of $122,728,793.
    CONCLUSIONS: Universal pool fencing in Texas could prevent pediatric drownings and yield significant economic savings. These findings support stronger residential pool safety standards, including statewide mandates, robust inspection and enforcement tied to permitting, and financial incentives such as rebates or insurance discounts to offset installation costs.
    Keywords:  Cost-benefit analysis; Drowning prevention; Injury Prevention; Isolation Pool Fencing; Pediatric drowning; Public health economics; Residential pool safety; Swimming pools
    DOI:  https://doi.org/10.1186/s40621-026-00706-0
  25. J Pediatr Surg. 2026 Aug 17. pii: S0022-3468(26)00480-X. [Epub ahead of print] 163398
    Identifying Post-Discharge Needs in Pediatric Trauma Patients Through a Standardized Follow-up Telephone Program.
    Alexandra Chimento, Morgan L Brown, Mallory Cash, David C Yu, Jessica A Zagory.
       INTRODUCTION: Although advances in pediatric trauma care have improved survival, many patients experience unmet medical, social, and psychological needs after hospital discharge. Strategies to identify these needs remain limited. This study aimed to characterize unmet post-discharge needs among pediatric trauma patients and identify patient populations most likely to require additional support.
    METHODS: A retrospective review was conducted of prospectively collected follow-up data from patients < 18 years who presented as Tier 1 or 2 trauma activations to an American College of Surgeons-verified Level II trauma center trauma between February 2023-December 2023 and October 2024-December 2024. All patients received a standardized telephone call 30 days after discharge assessing medical, social, and psychological needs.
    RESULTS: A total of 419 patients were included, and 237 (57%) completed the 30-day follow-up phone call. Follow-up rates were highest among patients residing out of state (66%), those with child protective services involvement (63%), those with private insurance (65%), and non-English-speaking families (71%). Among patients reached, 66 (27%) requested further intervention, including mental health services, appointment scheduling or referrals, transportation assistance, or Women, Infants, and Children (WIC) social services. Unmet needs were most common among patients who attend public or charter schools (37%) and among patients injured by animal attacks (25%), burn/fireworks (25%), and gunshot wounds (GSW) (20%).
    CONCLUSIONS: Many pediatric trauma patients continue to have unmet needs after discharge. Structured follow-up calls may help identify barriers to recovery and facilitate access to needed medical, social, and psychological resources for patients and families after traumatic injury.
    TYPE OF STUDY: Retrospective LEVEL OF EVIDENCE: III.
    Keywords:  Pediatric trauma; follow-up; socioeconomic barriers
    DOI:  https://doi.org/10.1016/j.jpedsurg.2026.163398
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