Safety is a core value at The Children’s Hospital of Philadelphia, so it should come as no surprise that detecting and addressing safety risks is a major area where CHOP researchers advanced knowledge this year. Their work spans safety in inpatient and outpatient settings and in the community at large.
Addressing a Severe Infection Complication
Early in the year, a CHOP-led international team of researchers established the global prevalence of sepsis and other complications in pediatric intensive care units (PICUs) that can cause organ damage and death following infection. The worldwide scope of severe pediatric sepsis was previously only estimated from analyses of billing codes in administrative databases. With the new estimates from the Sepsis, Prevalence, Outcomes, and Therapies (SPROUT) study published in the American Journal of Respiratory and Critical Care Medicine, researchers now have a better idea of how many centers and patients would be available for future interventional studies of severe pediatric sepsis.
“We found an overall prevalence [of pediatric severe sepsis in PICUs] of 8.2 percent, which means that your average PICU is treating at least one child with severe sepsis at any one time,” said Scott Weiss, MD, MSCE, an attending physician in Pediatric Critical Care at CHOP who led SPROUT along with Julie Fitzgerald, MD, PhD, a CHOP pediatric intensivist. “So it is an incredibly common cause of pediatric critical illness, and it highlights the ongoing problem of severe sepsis.”
Reducing In-Hospital Risks
While sepsis is one of the most severe in-hospital safety risks, fortunately it affects relatively few children. More frequently occurring risks are also in the crosshairs for CHOP researchers whose work targets hospital safety:
- In Pediatrics, CHOP physicians reported their success improving flu vaccination rates for pediatric cancer patients by more than 20 percent — potentially preventing fatal complications for children with weakened immune systems.
- A study in The Journal of Thoracic and Cardiovascular Surgery showed potential benefits of continuous monitoring of newborns’ brains after surgery for congenital heart disease to identify otherwise-undetectable seizures.
- Researchers from leading children’s hospitals, including CHOP, reported a broad shift in pediatrics away from medical scanning technologies that can cause harmful side effects.
- A study team examining ways to improve antibiotic stewardship practices discovered that CHOP clinicians reduced unneeded antibiotic prescriptions after tonsillectomies.
- ECRI Institute honored CHOP researchers for their work studying how healthcare workers respond to excessive alarms in clinical settings — and possibly dull their responses to the rarer, more meaningful alarms.
Maintaining Patients’ Safety After Leaving the Hospital
Even after they are discharged from the hospital, children continue to benefit from CHOP safety research. Some of that research entails making sure that children’s routine care at home keeps them well enough not to return to the hospital. CHOP researchers reported in The Journal of Pediatrics that patients who filled prescriptions for asthma medication after discharge were less likely to be readmitted, and overall only about half of prescriptions were filled. They recommended that clinicians ensure patients have their medication in hand upon leaving the hospital.
Scott Lorch, MD, MSCE, an attending neonatologist at CHOP, reported in Pediatrics that consistent well visits to the pediatrician are associated with fewer negative health outcomes for preterm infants. This year, Dr. Lorch also began a new study of ways to predict risk and prevent readmission to the hospital for preterm infants and other high-risk children.
Keeping Children Safe in the Community
Even beyond the healthcare system, CHOP research keeps children safe at home, at school, and everywhere in between. Among these efforts, CHOP’s Violence Prevention Initiative aims to save and improve the quality of life for at-risk adolescents. Adolescent medicine specialist Alison Culyba, MD, MPH, reported on her findings that supportive family environments were associated with less involvement in youth violence.
Researchers led by Stephen Leff, PhD, reported lasting success from a school-based program to reduce relational aggression among African-American girls in third through fifth grades. In a randomized controlled trial, the program improved the girls’ social problem solving knowledge and decreased their levels of relational aggression.
Traffic safety and injury prevention research at CHOP reached major milestones in improving community safety this year. In November, the Center for Child Injury Prevention Studies (CChIPS) celebrated its 10th anniversary. The multi-institution, National Science Foundation-funded center has established fundamental data about how children’s bodies respond to crashes and is helping to develop safer restraint products and vehicles.
“The high rates of traffic injury and mortality among children have created a public health crisis that requires immediate research solutions,” said Flaura K. Winston, MD, PhD, founder and director of CChIPS and scientific director of CHOP’s Center for Injury Research and Prevention (CIRP).
Looking to the future, CChIPS is expanding beyond its primary focus on traffic safety to pursue topics including bicycle and pedestrian safety, aviation safety, sports injury prevention, and trauma care and treatment.