Body and Mind, Stayin' Alive, ADHD Guidelines, Innovation Leadership

Welcome back to our regular roundup of research news from Children’s Hospital of Philadelphia! Research at CHOP helps children wherever they are, whether in a primary care doctor’s office, in the hospital, in the community, or at home. This week’s stories cover all the bases.

When children are in the hospital, their mental health status can affect their physical recovery — and researchers at CHOP are finding out how and discussing what to do about it. When young children with attention-related behaviors see the pediatrician, they are less likely than they once were to be diagnosed with attention-deficit hyperactivity disorder (ADHD), if it’s unwarranted. This is one of several important findings from a CHOP investigator who led a large-scale analysis of a 2011 policy change. CHOP researchers also bring us new insights into the impact of cardiopulmonary resuscitation (CPR) in helping children with sudden cardiac arrest at home or in the community. Plus, we share insights on innovation from CHOP’s CEO.

Body and Mind

Children who are hospitalized for a physical health ailment end up staying longer if they have a pre-existing mental health condition, according to CHOP researchers’ analysis of a national database of pediatric data. The researchers suggest that, as a result, policymakers and healthcare professionals should improve systems for providing mental healthcare to hospitalized children.

“Most hospitalized children and their families are eager to go home as soon as they can – extra days in the hospital are missed days at school for kids, missed days at work for parents, and a disruption to family routines,” said lead author Stephanie Doupnik, MD, a researcher in PolicyLab at CHOP. “Unfortunately, we're seeing that mental health conditions add a layer of complexity to hospital care that causes kids with mental health conditions to stay in the hospital longer and use additional resources.”

The research, published online Nov. 11 in Pediatrics, is the first study to show how comorbid mental health conditions, such as anxiety, ADHD and depression, can influence a child's care in the hospital.

Read more in the PolicyLab blog post by Dr. Doupnik.

Stayin’ Alive

In the life-or-death moment when a child experiences cardiac arrest outside of the hospital, “life” is indeed a likelier outcome if a bystander provides CPR, according to a CHOP study published in JAMA Pediatrics. But there are racial disparities in which groups of children are most likely to receive this lifesaving intervention, they also found.

“Over 5,000 children have an out-of-hospital cardiac arrest every year in the United States,” said study leader Maryam Naim, MD, of the Cardiac Center at CHOP. “The overall mortality of these arrests remains high, but we know that providing bystander CPR can improve survival. Our study offers more information relevant to saving children's lives.”

Dr. Naim and colleagues analyzed a subset of data from the Cardiac Arrest Registry to Enhance Survival (CARES), a large national database of non-traumatic cardiac arrests established by the Centers for Disease Control and Prevention. The team evaluated 3,900 cases of out-of-hospital cardiac arrest in children over a two-year period. Overall, 440 (11.3 percent) of the 3,900 children survived. In 46 percent of the 3,900 cases, someone provided bystander CPR, most commonly a family member. Children who received bystander CPR had an advantage in overall survival compared to those receiving no bystander CPR — 13.2 percent versus 9.5 percent. They also had better rates of neurologically favorable survival — 10.3 percent compared to 7.59 percent in those with no bystander CPR.

The study team found a racial disparity in those receiving bystander CPR similar to past findings in adults. White children were significantly more likely to receive bystander CPR than black or Hispanic children. Such disparities have prompted investigators with the CHOP Cardiac Center to develop CPR training programs for outreach to students in public schools that include racially diverse populations, such as the CPR Olympics.

The new study was also the first to compare two common types of bystander CPR methods in U.S. children. Conventional CPR, which includes both chest compressions and rescue breaths, is the recommended type of CPR for children. Compression-only CPR is considered equally effective to conventional CPR in adults. In the subgroup for which data was available about the type of CPR children received, neurologically favorable survival was more likely to occur after conventional CPR than after the compression-only technique.

Read more in the CHOP press release.

ADHD Guidelines

In 2011, the American Academy of Pediatrics (AAP) issued new guidelines for diagnosing preschool-age children with ADHD and for using stimulant medications, which were not recommended as a first-line treatment at this age. The rate of ADHD diagnoses among 4- and 5-year-olds was then rising, but after the AAP guidelines, the rates have remained steady. The rate of stimulant prescriptions, already in decline in 2011, did not increase. These findings came from a study led by CHOP pediatrician Alexander G. Fiks, MD, MSCE, published in Pediatrics Nov. 11.

The research was conducted through the Comparative Effectiveness Research Through Collaborative Electronic Reporting Consortium (CER²) — a “supernetwork” that Dr. Fiks leads, comprising several hundred sites. CER² investigators use electronic health record data from more than 1.2 million pediatric patients to conduct long-term pharmacology-related comparative effectiveness research.

Read more about CER² on Cornerstone.

Innovation Leadership

CHOP CEO Madeline Bell recently spoke at Philadelphia magazine’s “ThinkFest.” Her insights spanned topics from her unconventional path to leadership from her start as a CHOP nurse, to cultivating the translation of scientific research discoveries into innovative startup businesses.

“One of Bell’s favorite things to do at CHOP is to spend time with the scientists who are making breakthroughs in pediatrics,” writes Philadelphia magazine in a recap of the event. “A lot of people forget that CHOP is also a large pediatric institute with scientists who are focused on discoveries for children every day, Bell said, and the hospital’s innovation tournaments allow everyone to get involved with innovation, because the best ideas come from the people doing the work every day.”

Bell gave the example of startup company Diagnostic Driving, which was an idea born out of CHOP’s desire to advance child passenger safety. Diagnostic Driving is based on a validated simulated driving assessment software package that researchers had developed to assess driver safety and provide insight to personalized interventions to improve driving. Bell also highlighted CHOP’s mission to “raise the bar with research discoveries in digital health.”

Diagnostic Driving was also featured in Philadelphia magazine as this week’s “Startup of the Week.” Check out the in-depth story about the company’s past, present, and future, here.

Read more of Bell’s remarks and watch the video in Philadelphia magazine. Read more about Diagnostic Driving on Cornerstone. And learn about mHealth research projects already underway.

ICYMI

In case you missed it, this week on Cornerstone we discussed how pediatricians can help address health issues related to poverty in suburban communities, in a conversation with Deepak Palakshappa, MD.

Last week’s In the News post featured a study of vaccine safety concerns for an immune-compromised population, stressful situations and teen driving, globetrotting concussion expertise, and an award for an extraordinary CHOP surgeon.

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And one last housekeeping note: Starting with a week off for the upcoming Thanksgiving holiday, “In the News” will switch to a biweekly publication schedule. We may resume weekly publication after the start of the new year.