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Maternal Child Health ‹ Child Health Notes ‹ March 09

IHS Child Health Notes

"It doesn’t matter if the cat is black or white as long as it catches mice."

- Deng Hsaio P’ing 1904-1997

This is a page for sharing "what works" as seen in the published literature as well as what is done at sites that care for American Indian/Alaskan Native children. If you have any suggestions, comments or questions please contact Steve Holve, MD, Chief Clinical Consultant in Pediatrics at steve.holve@tchealth.org

March 2009

Quote of the month

“A drug is a substance that when injected into a guinea pig produces a scientific paper.”
Anonymous.

Article of Interest
Quality of Care for Common Pediatric Respiratory Illnesses in United States Emergency Departments: Analysis of 2005 National Hospital Ambulatory Medical Care Survey Data
Jane F. Knapp, Stephen D. Simon, and Vidya Sharma
Pediatrics 2008; 122: 1165-1170.
http://pediatrics.aappublications.org/cgi/reprint/122/6/1165

The goal of this paper was to measure US emergency department care of pediatric asthma, bronchiolitis and croup as there are clear “best practices” for each of these conditions.

Physicians prescribed steroids in only 69% of the patients with moderate-severe asthma and only 31% of croup visits. Physicians ordered chest radiographs in 72% of children with bronchiolitis visits and prescribed antibiotics for 53% of children diagnosed with bronchiolitis.

The authors conclude that physicians treating children with asthma, bronchiolitis and croup are under using known effective treatments and overusing ineffective therapeutic and diagnostic treatments.

Editors Comments:
Surprisingly, despite well-publicized guidelines for these common respiratory illnesses physicians still fail to meet best practices almost half the time. What accounts for the gap between guidelines and the bedside? This study reminds us that we need to place the more effort on making sure the simplest things are done correctly.

Recent literature on American Indian/Alaskan Native Health
Michael L. Bartholomew, MD

Singleton RJ, Holman RC, Plant R, Yorita KL, Holve S, Paisano EL, Cheek JE. Trends in otitis media and myringtomy with tube placement among American Indian/Alaska native children and the US general population of children. The Pediatric Infectious Disease Journal. 2009 Feb;28(2):102-7.
http://www.ncbi.nlm.nih.gov/pubmed/19131901?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Otitis media continues to be a prevalent disease affecting children within the United States. Prior to the introduction of 7-valent pneumococcal conjugate vaccine (PCV7), estimates of OM visits accounted for over 24 million visits annually with surgical intervention ranging from 1-7% of affected children.1,2,3 Post licensure surveillance studies of PCV7 have shown a reduction of OM visits and myringotomy with insertion of tubes (MIT) procedures 2,3,4. With limited data on the occurrence of OM and MIT among American Indian/Alaska Native children since the introduction of PCV7, the authors explored the recent epidemiology and burden of OM and MIT procedures among AI/AN children less than 5 years of age between 2003-2005.

For 2003-2005, the OM-associated outpatient visit rate for AI/AN children less than 5 years of age was higher (89 per 100 children/year) than the general US population of 62.7 per 100 children/year. This rate represents a decrease from previous reported rates for AI/AN children in 1994-1996 (138 per 100 children/year)1. Regionally, Alaska had the highest OM-associated outpatient visit rate; followed by the Northern Plains, Southwest, and West regions. Additionally, the Alaska region was the only region to show an increase in OM outpatient visit rate from previous reported years of 1994-1996 (158 to181 per 100 children per year). Each IHS region had higher rates than the general US population. AI/AN infants accounted for approximately 33% of OM-associated outpatient visits and had a higher rate than AI/AN children ages 1-4 years. OM-associated outpatient visit rates for AI/AN infants were double that of the US general infant population.

AI/AN children also had a higher annual OM-associated hospitalization rate than the US child general population in 2003 (675 vs. 617 per 100,000) The majority of outpatient MIT procedures occurring at IHS/Tribal facilities occurred in the Alaska region. The AI/AN rate for outpatient MIT procedure was higher in the Alaska region (2.6 per 100/year) than any other IHS region and the general US population (1.8 per 100/year).

This study is not without limitations. The 10-fold difference in MIT procedure rates for Alaska and the remainder of the IHS regions may be a result of direct access to surgical interventions in Alaska (Otitis Media Project in Alaska) or MIT procedures being preformed at non-IHS/tribal facilities in other IHS regions. The AI/AN population (active IHS/Tribal user population) used is an estimate and is not representative of all AI/AN children in the United States.

OM continues to be a significant cause of morbidity among AI/AN children. Despite decreases in OM-associated outpatient visits, OM-associated hospitalizations, and MIT procedures among American Indian populations in other IHS regions, Alaska region demonstrates an increase in OM associated morbidity among Alaska Native children. The authors conclude that these findings may suggest a decreased impact of PCV7 on non-invasive Streptococcus pneumoniae infections in Alaska Native children and the need for expanded-valency pneumococcal conjugate vaccine in this population.

References:

Curns AT, Holman RC, Shay DK, et al. Outpatient and hospital visits associated with otitis media among American Indian and Alaska Native children younger than 5 years. Pediatrics 2002;109(3)e41.
Zhou F, Shefer A, Kong Y, Nuorti JP. Trends in acute otitis media-related health care utilization by privately insured young children in the United States, 1997-2004. Pediatrics. 2008 Feb;121(2):253-60.
Grijalva CG, Poehling KA, Nuorti JP, Zhu Y, Martin SW, Edwards KM, Griffin MR. National impact of universal childhood immunization with pneumococcal conjugate vaccine on outpatient medical care visits in the United States. Pediatrics. 2006 Sep;118(3):865-73.
Poehling KA, Szilagyi PG, Grijalva CG, Martin SW, LaFleur B, Mitchel E, Barth RD, Nuorti JP, Griffin MR. Reduction of frequent otitis media and pressure-equalizing tube insertions in children after introduction of pneumococcal conjugate vaccine. Pediatrics. 2007 Apr;119(4):707-15.

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	Maternal Child Health ‹ Child Health Notes ‹ March 09 IHS Child Health Notes "It doesn’t matter if the cat is black or white as long as it catches mice." - Deng Hsaio P’ing 1904-1997 This is a page for sharing "what works" as seen in the published literature as well as what is done at sites that care for American Indian/Alaskan Native children. If you have any suggestions, comments or questions please contact Steve Holve, MD, Chief Clinical Consultant in Pediatrics at steve.holve@tchealth.org March 2009 Quote of the month “A drug is a substance that when injected into a guinea pig produces a scientific paper.” Anonymous. Article of Interest Quality of Care for Common Pediatric Respiratory Illnesses in United States Emergency Departments: Analysis of 2005 National Hospital Ambulatory Medical Care Survey Data Jane F. Knapp, Stephen D. Simon, and Vidya Sharma Pediatrics 2008; 122: 1165-1170. http://pediatrics.aappublications.org/cgi/reprint/122/6/1165 The goal of this paper was to measure US emergency department care of pediatric asthma, bronchiolitis and croup as there are clear “best practices” for each of these conditions. Physicians prescribed steroids in only 69% of the patients with moderate-severe asthma and only 31% of croup visits. Physicians ordered chest radiographs in 72% of children with bronchiolitis visits and prescribed antibiotics for 53% of children diagnosed with bronchiolitis. The authors conclude that physicians treating children with asthma, bronchiolitis and croup are under using known effective treatments and overusing ineffective therapeutic and diagnostic treatments. Editors Comments: Surprisingly, despite well-publicized guidelines for these common respiratory illnesses physicians still fail to meet best practices almost half the time. What accounts for the gap between guidelines and the bedside? This study reminds us that we need to place the more effort on making sure the simplest things are done correctly. Recent literature on American Indian/Alaskan Native Health Michael L. Bartholomew, MD Singleton RJ, Holman RC, Plant R, Yorita KL, Holve S, Paisano EL, Cheek JE. Trends in otitis media and myringtomy with tube placement among American Indian/Alaska native children and the US general population of children. The Pediatric Infectious Disease Journal. 2009 Feb;28(2):102-7. http://www.ncbi.nlm.nih.gov/pubmed/19131901?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum Otitis media continues to be a prevalent disease affecting children within the United States. Prior to the introduction of 7-valent pneumococcal conjugate vaccine (PCV7), estimates of OM visits accounted for over 24 million visits annually with surgical intervention ranging from 1-7% of affected children.1,2,3 Post licensure surveillance studies of PCV7 have shown a reduction of OM visits and myringotomy with insertion of tubes (MIT) procedures 2,3,4. With limited data on the occurrence of OM and MIT among American Indian/Alaska Native children since the introduction of PCV7, the authors explored the recent epidemiology and burden of OM and MIT procedures among AI/AN children less than 5 years of age between 2003-2005. For 2003-2005, the OM-associated outpatient visit rate for AI/AN children less than 5 years of age was higher (89 per 100 children/year) than the general US population of 62.7 per 100 children/year. This rate represents a decrease from previous reported rates for AI/AN children in 1994-1996 (138 per 100 children/year)1. Regionally, Alaska had the highest OM-associated outpatient visit rate; followed by the Northern Plains, Southwest, and West regions. Additionally, the Alaska region was the only region to show an increase in OM outpatient visit rate from previous reported years of 1994-1996 (158 to181 per 100 children per year). Each IHS region had higher rates than the general US population. AI/AN infants accounted for approximately 33% of OM-associated outpatient visits and had a higher rate than AI/AN children ages 1-4 years. OM-associated outpatient visit rates for AI/AN infants were double that of the US general infant population. AI/AN children also had a higher annual OM-associated hospitalization rate than the US child general population in 2003 (675 vs. 617 per 100,000) The majority of outpatient MIT procedures occurring at IHS/Tribal facilities occurred in the Alaska region. The AI/AN rate for outpatient MIT procedure was higher in the Alaska region (2.6 per 100/year) than any other IHS region and the general US population (1.8 per 100/year). This study is not without limitations. The 10-fold difference in MIT procedure rates for Alaska and the remainder of the IHS regions may be a result of direct access to surgical interventions in Alaska (Otitis Media Project in Alaska) or MIT procedures being preformed at non-IHS/tribal facilities in other IHS regions. The AI/AN population (active IHS/Tribal user population) used is an estimate and is not representative of all AI/AN children in the United States. OM continues to be a significant cause of morbidity among AI/AN children. Despite decreases in OM-associated outpatient visits, OM-associated hospitalizations, and MIT procedures among American Indian populations in other IHS regions, Alaska region demonstrates an increase in OM associated morbidity among Alaska Native children. The authors conclude that these findings may suggest a decreased impact of PCV7 on non-invasive Streptococcus pneumoniae infections in Alaska Native children and the need for expanded-valency pneumococcal conjugate vaccine in this population. References: Curns AT, Holman RC, Shay DK, et al. Outpatient and hospital visits associated with otitis media among American Indian and Alaska Native children younger than 5 years. Pediatrics 2002;109(3)e41. Zhou F, Shefer A, Kong Y, Nuorti JP. Trends in acute otitis media-related health care utilization by privately insured young children in the United States, 1997-2004. Pediatrics. 2008 Feb;121(2):253-60. Grijalva CG, Poehling KA, Nuorti JP, Zhu Y, Martin SW, Edwards KM, Griffin MR. National impact of universal childhood immunization with pneumococcal conjugate vaccine on outpatient medical care visits in the United States. Pediatrics. 2006 Sep;118(3):865-73. Poehling KA, Szilagyi PG, Grijalva CG, Martin SW, LaFleur B, Mitchel E, Barth RD, Nuorti JP, Griffin MR. Reduction of frequent otitis media and pressure-equalizing tube insertions in children after introduction of pneumococcal conjugate vaccine. Pediatrics. 2007 Apr;119(4):707-15. Return to top of page