Research Spotlight

Elias, J., E. Zimak, A. Sherwood, B. MacDonald, N. Lozano, J. Long and A. D. Larsen (2021). “Do parents implement pediatric neuropsychological report recommendations?” Clin Neuropsychol 35(6): 1117-1133.

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OBJECTIVE: We explored parent-reported implementation rates of medical, home/community, and school recommendations following a pediatric neuropsychological evaluation, as well as demographic group differences in, and potential barriers to, recommendation implementation. METHOD: Participants were 55 parents of children and adolescents who completed an outpatient neuropsychological evaluation in a university-based hospital neuropsychology clinic within 4 to 6 months prior to study participation. Participants were contacted by phone to complete a short interview regarding implementation of report recommendations. RESULTS: Slightly over half (52%) of all recommendations were implemented, with higher implementation rates of school (62%) and home/community recommendations (53%) than medical recommendations (40%). Results indicated significantly lower recommendation implementation for households with low income (particularly for medical recommendations). Reported reasons for not implementing recommendations included lack of time, lack of resources (geographical and financial), ambivalence about the need to implement the recommendation, not remembering the recommendation, confusion about how to implement the recommendation, and resistance from schools and teachers. CONCLUSIONS: The results for this study provide information for pediatric neuropsychologists regarding rates of recommendation implementation, with differences identified based on type of recommendation and demographic factors. Further empirical investigation is indicated in order to determine practical, concrete steps to improve recommendation implementation.

Bhalala, U. S., K. M. Gist, S. Tripathi, K. Boman, V. K. Kumar, L. Retford, K. Chiotos, A. M. Blatz, H. Dapul, S. Verma, I. A. Sayed, V. P. Gharpure, E. Bjornstad, N. Tofil, K. Irby, R. C. Sanders, Jr., J. A. Heneghan, M. Thomas, M. K. Gupta, F. E. Oulds, G. M. Arteaga, E. R. Levy, N. Gupta, M. Kaufman, A. Abdelaty, M. Shlomovich, S. S. Medar, A. M. Iqbal O’Meara, J. Kuehne, S. Menon, P. B. Khandhar, A. S. Miller, S. M. Barry, V. C. Danesh, A. K. Khanna, K. Zammit, C. Stulce, P. W. McGonagill, A. Bercow, I. G. Amzuta, S. Gupta, M. A. Almazyad, L. Pierre, P. Sendi, S. Ishaque, H. L. Anderson, 3rd, P. Nawathe, M. Akhter, P. G. Lyons, C. Chen, A. J. Walkey, A. Bihorac, I. Wada Bello, J. Ben Ari, T. Kovacevic, V. Bansal, J. T. Brinton, J. J. Zimmerman and R. Kashyap (2021). “Characterization and Outcomes of Hospitalized Children With Coronavirus Disease 2019: A Report From a Multicenter, Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) Registry.” Crit Care Med Aug 16. [Epub ahead of print].

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OBJECTIVES: Multicenter data on the characteristics and outcomes of children hospitalized with coronavirus disease 2019 are limited. Our objective was to describe the characteristics, ICU admissions, and outcomes among children hospitalized with coronavirus disease 2019 using Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: Coronavirus Disease 2019 registry. DESIGN: Retrospective study. SETTING: Society of Critical Care Medicine Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) registry. PATIENTS: Children (< 18 yr) hospitalized with coronavirus disease 2019 at participating hospitals from February 2020 to January 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was ICU admission. Secondary outcomes included hospital and ICU duration of stay and ICU, hospital, and 28-day mortality. A total of 874 children with coronavirus disease 2019 were reported to Viral Infection and Respiratory Illness Universal Study registry from 51 participating centers, majority in the United States. Median age was 8 years (interquartile range, 1.25-14 yr) with a male:female ratio of 1:2. A majority were non-Hispanic (492/874; 62.9%). Median body mass index (n = 817) was 19.4 kg/m2 (16-25.8 kg/m2), with 110 (13.4%) overweight and 300 (36.6%) obese. A majority (67%) presented with fever, and 43.2% had comorbidities. A total of 238 of 838 (28.2%) met the Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children, and 404 of 874 (46.2%) were admitted to the ICU. In multivariate logistic regression, age, fever, multisystem inflammatory syndrome in children, and pre-existing seizure disorder were independently associated with a greater odds of ICU admission. Hospital mortality was 16 of 874 (1.8%). Median (interquartile range) duration of ICU (n = 379) and hospital (n = 857) stay were 3.9 days (2-7.7 d) and 4 days (1.9-7.5 d), respectively. For patients with 28-day data, survival was 679 of 787, 86.3% with 13.4% lost to follow-up, and 0.3% deceased. CONCLUSIONS: In this observational, multicenter registry of children with coronavirus disease 2019, ICU admission was common. Older age, fever, multisystem inflammatory syndrome in children, and seizure disorder were independently associated with ICU admission, and mortality was lower among children than mortality reported in adults.

Tripathi, S., I. A. Sayed, H. Dapul, J. S. McGarvey, J. A. Bandy, K. Boman, V. K. Kumar, V. Bansal, L. Retford, S. Cheruku, M. Kaufman, S. F. Heavner, V. C. Danesh, C. A. St Hill, A. K. Khanna, U. Bhalala, R. Kashyap, O. Gajic, A. J. Walkey and K. M. Gist (2021). “Risk Factors for Critical Coronavirus Disease 2019 and Mortality in Hospitalized Young Adults: An Analysis of the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) Coronavirus Disease 2019 Registry.” Crit Care Explor 3(8): e0514.

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IMPORTANCE: Even with its proclivity for older age, coronavirus disease 2019 has been shown to affect all age groups. However, there remains a lack of research focused primarily on the young adult population. OBJECTIVES: To describe the epidemiology and outcomes of coronavirus disease 2019 and identify the risk factors associated with critical illness and mortality in hospitalized young adults. DESIGN SETTINGS AND PARTICIPANTS: A retrospective cohort study of the Society of Critical Care Medicine’s Viral Infection and Respiratory Illness Universal Study registry. Patients 18-40 years old, hospitalized from coronavirus disease 2019 from March 2020 to April 2021, were included in the analysis. MAIN OUTCOMES AND MEASURES: Critical illness was defined as a composite of mortality and 21 predefined interventions and complications. Multivariable logistic regression was used to assess associations with critical illness and mortality. RESULTS: Data from 4,005 patients (152 centers, 19 countries, 18.6% non-U.S. patients) were analyzed. The median age was 32 years (interquartile range, 27-37 yr); 51% were female, 29.4% Hispanic, and 42.9% had obesity. Most patients (63.2%) had comorbidities, the most common being hypertension (14.5%) and diabetes (13.7%). Hospital and ICU mortality were 3.2% (129/4,005) and 8.3% (109/1,313), respectively. Critical illness occurred in 25% (n = 996), and 34.3% (n = 1,376) were admitted to the ICU. Older age (p = 0.03), male sex (adjusted odds ratio, 1.83 [95% CI, 1.2-2.6]), and obesity (adjusted odds ratio, 1.6 [95% CI, 1.1-2.4]) were associated with hospital mortality. In addition to the above factors, the presence of any comorbidity was associated with critical illness from coronavirus disease 2019. Multiple sensitivity analyses, including analysis with U.S. patients only and patients admitted to high-volume sites, showed similar risk factors. CONCLUSIONS: Among hospitalized young adults, obese males with comorbidities are at higher risk of developing critical illness or dying from coronavirus disease 2019.

Ahmed, K. W., T. Cox, J. Olvera, N. Gittus, K. Ryan and C. Columbus (2021). “Abstracts from the Seventh Annual Baylor University Medical Center Medical Education Research Forum 2021.” Proc (Bayl Univ Med Cent) 34(5): 575-580.

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The Baylor University Medical Center Department of Medical Education hosted its seventh annual Medical Education Research Forum on April 21, 2021, to showcase the research efforts of its medical students, residents, and fellows. Thirty-six posters were shared and 18 oral presentations were given. Here we present 17 award-winning abstracts.

Gill, J., C. A. Hebert and G. B. Colbert (2021). “COVID-19-associated atypical hemolytic uremic syndrome and use of Eculizumab therapy.” J Nephrol Aug 24;1-5. [Epub ahead of print].

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There is a high incidence of acute kidney injury with COVID-19 infections. The etiologies of acute kidney injury could be ischemic acute tubular necrosis or a complex process of complement activation leading to thrombotic microangiopathy. We present a case of 32-year-old Hispanic male with a history of heart transplant, admitted with COVID-19 and atypical hemolytic uremic syndrome, which was successfully treated with Eculizumab.