Pediatric Otolaryngology During COVID-19: Parental Concern About Elective Surgery

Objective: To identify the concerns of parents whose children may need elective surgery during the COVID-19 pandemic. Methods: In December 2020, parents of pediatric otolaryngology patients were recruited for a survey about concerns related to elective surgery during the COVID-19 pandemic. A Likert scale quantified concern. The 1 was anchored “Not at all important” and 5 was “Most important.” Demographics included gender, age, race, education level, number of children in household, and whether their child had surgery since March 2020. Results: About 253 participants were included. Medians ranged from 1 for concerns about emotional and family support to 4 for concerns about their child being exposed to COVID-19 in the Emergency Room. Black parents were more concerned about the risks of COVID than White parents; they were more concerned about their child contracting COVID-19 during surgery compared to White parents, median was 4 versus 3 ( P = .027). Black parents had a median score of 3 for concern about medical expenses compared to a median of 2 ( P = .001). Parents of children who had surgery since March 2020 had less concern about their child being exposed to COVID-19 during hospitalization ( P = .045) and less concern about critique from others ( P = .024). Conclusion: Parents were most concerned about the risk of seeking Emergency Room care. Black parents were generally more concerned about having their child undergo elective surgery. Whether this is translated into fewer Black children undergoing important but elective surgery requires more study.

Healthcare telemonitoring and business dynamics: challenges and opportunities for SUS

OBJECTIVE: To point out challenges and opportunities for the Brazilian Unified Health System (SUS) with the use of telemonitoring to face the increasing costs of non-communicable chronic diseases, based on its general panorama in Brazil, business dynamics and reapplication of data from American studies. METHODS: Quali-quantitative approach with exploratory research. The field work focused on the analysis of the national market from private companies, since no experiences or studies related to this theme were identified in the SUS. To analyze the panorama and market dynamics, we investigated the offer of this technology based on the products and services available and their demand by reference hospitals the ten largest private health plan companies. To support the central discussion, we analyzed the reduction of costs with hospital admissions by the SUS due to chronic non-communicable diseases sensitive to telemonitoring (HCDST), using data from Datasus and some American studies from the MEDLINE/PubMed database. RESULTS: Although in the embryonic phase, business agents search for new business opportunities, whereas public initiatives for the use of telemonitoring in collective health seem inexistent. The reapplication of U.S. data would reduce spending on HCDST and provide benefits, such as the reduction in emergency room care, acute hospitalizations, readmissions and home care time, among others, which point to even greater economic gains. CONCLUSIONS: The development of a major project to reduce HCDST using this technology has the potential to advance in a comprehensive network of primary care, contribute to a greater dynamism of the national productive and innovative base and induce innovations along the chain of this emerging industry.

Cannabis Hyperemesis Syndrome: A Still Under-Recognized Syndrome

Cannabis is one of the most widely used illicit drugs in the world. Its use is associated with several short- and long-term side-effects such as changes in mood, impaired memory, impaired attention, depression and anxiety, and it is correlated with schizophrenia. Cannabinoid hyperemesis syndrome (CHS) is characterized by chronic cannabis use, cyclic intractable nausea and vomiting, and compulsive hot bathing. Patients are typically diagnosed with CHS only after multiple medical evaluations. Recent research has identified type 1 cannabinoid receptors in the intestinal nerve plexus that have an inhibitory effect on gastrointestinal motility. This effect may explain hyperemesis in cannabis users. The thermoregulatory role of endocannabinoids may be responsible for compulsive hot bathing. We describe the cases of two young men seeking repeated emergency room care with recurrent nausea and vomiting. Abstinence from cannabis led to resolution of vomiting symptoms and abdominal pain.

986. Evaluation of Moderate-to-Severe Influenza Disease in Children 6 Months to 8 Years of Age in Colorado

Background A clinical endpoint of moderate-to-severe (M/S) influenza has been proposed in children, defined as fever >39°C, otitis media, lower respiratory tract infection, or serious extrapulmonary manifestations. This definition has not been evaluated against clinically relevant outcomes like hospitalization, emergency room care, antimicrobial use, and child/parental absenteeism. Methods We conducted a prospective observational study of children aged 6 months–8 years with influenza at the Children’s Hospital Colorado Emergency Department (ED) and its affiliates during two influenza seasons (2016–2017 and 2017–2018). Children with influenza-like-illness (ILI) were enrolled and tested for influenza by polymerase chain reaction (PCR). Parents of influenza cases and matched influenza-negative controls were contacted 2 weeks later for follow-up. The primary outcome was hospitalization for M/S influenza vs. mild influenza. Secondary outcomes included recurrent ED visits, antimicrobial use, child/parental absenteeism. Interim analyses were conducted using SAS v9.4. Results Among the 1,480 enrolled children with ILI, 410 (28%) tested positive for influenza by PCR. The median age of influenza cases was 4.0 years (IQR 2.2–6.1), and 20% were considered high-risk for influenza complications. Of influenza cases, 284 (69%) met the definition for M/S influenza. Among M/S influenza subjects, 8.4% were hospitalized, compared with 1.6% with mild influenza (risk difference (RD) 6.9%; 95% CI: 3.0–10.8, P < 0.01). Subjects with M/S influenza were more likely to receive antibiotics (RD 12.0%, 95% CI: 3.4–20.6, P < 0.01) with a trend to higher antiviral use (RD 6.9%, 95% CI: −0.7–14.5, P = 0.09). There was no significant difference for recurrent ED visits nor child/parental absenteeism. After adjusting for comorbidities, age, and influenza strain, the relative risk (RR) of hospitalization or recurrent ED visits was higher among those with M/S influenza vs. mild influenza (RR 2.18, 95% CI: 1.02–4.64, P = 0.04). Conclusion Children with M/S influenza have a higher risk of hospitalization compared with mild disease. This proposed definition is a useful clinical endpoint to study the public health and clinical impact of influenza interventions in children. Disclosures S. Rao, GSK: Investigator, Research grant. E. Yanni, GSK: Employee, Salary. R. Bekkat-Berkani, GSK: Employee, Salary. A. Schuind, GSK: Employee, Salary. B. Innis, GSK: Employee, Salary. R. Mistry, GSK: Investigator, Research support. E. J. Asturias, GSK: Investigator, Research grant and Research support.

A Practical Approach to Neonatal Opiate Withdrawal Syndrome

Perinatal opioid misuse and neonatal opioid withdrawal syndrome (NOWS) are a significant public health problem that has grown exponentially over the past decade. In the United States, a woman seeks emergency room care for prescription opioid misuse every 3 minutes and approximately every 25 minutes, a child is born with signs of drug withdrawal. The economic impact of perinatal opioid misuse is significant with annual hospital charges for NOWS in 2012 as $1.5 billion dollars. Perinatal opioid misuse is a complex, multifaceted problem that demands a multidisciplinary cross specialty approach. This article will review the current state of NOWS and provide medical practitioners with a practical guide to enhance evidence based practice.

Association between immigration status and inpatient psychiatric admission after attempted suicide: Results from a hospital-based observational study

IntroductionAcute suicidality or a condition after attempted suicide frequently leads patients to both voluntary or involuntary inpatient admission. Emergency room psychiatrists decide whether such patients can be treated on an outpatient basis.ObjectivesTo identify if immigration status is associated with the decision whether a patient needs a hospital admission.AimsTo detect social determinants of hospital-based health resource uses.MethodsA cross-sectional study including data from 323 patients treated in a general hospital's emergency room after a suicidal attempt during year 2014.ResultsSeventy-six patients were admitted to the hospital (23.5%). Hospitalization frequencies for immigrant and non-immigrant individuals were 6.3% and 26.5% (P = 0.002). No significant association was found between psychiatric admission and history of a diagnosed psychiatric disorder, previous suicidal attempts, previous emergency room care use, family support or current drug use. A subgroup of patients (n = 37; 9%) answered Beck's suicidal intent scale (SIS), a measure of risk in suicidal attempters. Mean SIS was found to be higher among hospitalized than discharged patients (8.5 vs. 16.5; P = 0.01). No significant difference was found in mean SIS between immigrant and non-immigrant patients (9.3 vs. 9.1; P = 0.3).ConclusionsThese preliminary results call for consideration. The highly significant lower rate of psychiatric admission among immigrant patients, without significant differences in mean SIS score in regard to non-immigrants, needs further study.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Abstract WP367: Comparison of Standard Emergency Room Care with Tele-Stroke Evaluation in Acute Intracerebral Hemorrhage Management

Introduction: Intracerebral hemorrhage (ICH) management includes rapid blood pressure (BP) control and correction of any coagulopathy. It is unknown if the addition of tele-medicine (TM) assessment by vascular neurologists would improve time to intervention of these factors. We hypothesized that TM assessment would improve the time to BP control and anticoagulation reversal compared to standard emergency physician management with telephone neurosurgical consultation (ED). Methods: Charts were retrospectively reviewed for all patients with a primary ICD-9 diagnosis of ICH who presented directly to the ED between 8/15/2013 and 5/30/2015, in three urban primary stroke centers in a Southern California integrated healthcare system that utilizes a internalized tele-stroke system. Patients who were transferred from outside hospitals were excluded. Data collected were patient demographics and specific time points to assess door to BP reduction and anticoagulant reversal initiation. These were compared for patients evaluated by ED vs TM using Fisher’s exact test, Chi-squared test, and Wilcoxon test. Results: Data for 105 ED and 19 TM patients were compared. There was no difference in gender (54.8% male), median age (67 yrs {IQR 58.5-80 yrs}), and median presenting BP (180/93 {IQR 157-207/79.5-108}). Patients seen by TM had a significantly shorter median time from onset to presentation (102.5 min {IQR 37-191 min}) compared to patients evaluated by ED (171 min {IQR 60-492 min}). Patients seen by TM were more likely to have NIHSS documented, faster times to CT head completion and interpretation, higher rates of BP agent administration with faster times to BP agent order and administration, faster time to BP control (both less than systolic 160 and 140), and faster times for anticoagulation reversal order and administration. Conclusion: TM assessment of patients with ICH improves time to BP control and anticoagulation reversal agent initiation.