2014 top articles presentation final (clean)

1. The Academy of Pediatric Hospital
Medicine Articles and Sciences
Annual Awards Ceremony
July 26, 2014
Orlando, FL
Robert Dudas
Karen Wilson

2. Disclosures
Sadly, neither of us can disclose Hollywood
contacts, significant sources of slightly unethical
funding, or investments in highly profitable
medically-oriented corporations.
Bob is an editor for the Monthly Feature section
of Pediatrics
Karen is deputy editor of Hospital Pediatrics.
We promise these affiliations had nothing to do
with the large number of articles from those
journals, or any subliminal messaging the AAP
may or may not have inserted into the slides.

3. R3 Strategy
Recent, relevant, and reputable…
Wading through XXXX articles
Reviewed articles from August 2013-July 2014
Pediatrics, Hospital Pediatrics, Academic Pediatrics,
JAMAPeds, JAMA, NEJM, Journal of Pediatrics, Pediatric
Infectious Disease, Journal of Hospital Medicine, Pediatric
Emergency Care, and Chest
PubMed searches on common pediatric hospital
medicine topics:
Bronchiolitis, asthma, pneumonia, IV fluid therapy, ALTE,
GERD, osteomyelitis, chocolate, and hyperbilirubinemia
Sought the counsel of leaders in hospital medicine
Selected articles based on quality, general interest, and
potential to impact pediatric hospital medicine practice

4. Choosing wisely, our categories…
We loaded all of the article keywords in to a
database and then used a modified Delphinium
technique to identify emerging concepts for thematic
saturation and used factor analysis to create our final
categories.
Actually, it was a proprietary methodology.
We each read the abstracts of all potentially
hospitalist-related articles and chose the ones we
thought were most relevant.

5. Choosing wisely, our categories…cont.
We each read all of the articles from this list, and
scored from 1 (least relevant) to 3 (most relevant).
These scores were summed.
There were 9 articles that scored a 6, and 5 that
scored a 5; these were included in our Top 10 (ish)
These were placed in to categories with other high
scoring articles on a similar topic, to add suspense.

6. Disclaimers
All literature presented should be independently
evaluated prior to changing practice.
Just because we liked these articles doesn’t mean
you will.
We probably missed the most important pediatric
hospital medicine article of the year…and we are
very sorry.

7. The article most likely to help us Choose Wisely
And the nominees are:
1. Adam Hersh, Brian Lee, Erin Hedican, et al. Linezolid
Use in Hospitalized Children. Peds Inf. Dis. J.
2. Pranita Tamma, Alison Turnbull, Anthony Harris, et al.
Less Is More: Combination Antibiotic Therapy for the
Treatment of Gram-Negative Bacteremia in Pediatric
Patients. JAMA Peds.
3. Choosing Wisely in Pediatric Hospital Medicine.
Ricardo Quinonez, Matthew Garber, Alan Schroeder, and
13 of their friends. Journal of Hospital Medicine.

8. Article most likely to help
us choose wisely
3/10/2014Footer Text

9. Relevance
Someone, somewhere, said: “Pediatric Hospitalists:
No one does nothing better than us”
Waste accounts for at least 20% of healthcare
expenditures in the US
One way to reduce waste is to eliminate practices of
unproven benefit.
ABIM-F is partnering with medical societies to
identify lists of 5 tests or therapies that physicians
and patients should question.
The Society for Hospital Medicine (SHM) joined the
Choosing Wisely campaign and supported this study.

10. Design
A diverse workgroup of 13 hospitalists was convened
and charged with identifying the tests and therapies
in pediatric hospital medicine that are most
overused.
The group was charged to maintain focus on
overuse practices that had a strong basis in
evidence, and were prevalent in practice.
The group initially proposed candidate
recommendations based on feedback from
colleagues.
Based on consensus the group reduced the list
These were evaluated using:
Exhaustive literature review on each
Input from the Listserv

11. Results
The group initially identified 20 tests and therapies:
The list was narrowed to the top 11 by consensus
A literature review was done on each to determine the
strength of evidence
A modified Delphi technique was used by the group to
score the candidate tests/treatments over two rounds.
The top 5 scoring tests/treatments were highlighted for
publication.

12. The top 5 recommendations:
Do not order chest radiographs in children with
asthma or bronchiolitis
Do not use systemic corticosteroids in children under
2 years of age with a lower respiratory tract infection.
Do not use bronchodilators in children with
bronchiolitis.
Do not treat gastroesophageal reflux routinely in
infants with acid suppression therapy
Do not use continuous pulse oximetry in children
with acute respiratory illness unless they are on
supplemental O2.

13. Category: Best article about the diagnosis that
shall not be named
And the nominees are:
1. Alan Schroeder, Jonathan Mansbach, Michelle
Stevenson, et al. Apnea in Children Hospitalized
with Bronchiolitis. Pediatrics.
2. Kelly Flett, Kristin Breslin, Patricia Braun, and
Simon Hambidge. Outpatient Course and
Complications Associated with Home Oxygen
Therapy for Mild Bronchiolitis. Pediatrics.
3. Kavita Parikh, Matthew Hall, and Stephen Teach.
Bronchiolitis Management Before and After the AAP
Guidelines. Pediatrics.
*
.
*
**
*

14. Best Article about *
3/10/2014Footer Text
*

15. Importance
In 2006, Guidelines were released to help
standardize the treatment of bronchiolitis.
They told us everything we were doing to treat
bronchiolitis was wrong, and that we should just
stand there, and give oxygen if needed.
Skeptical about the uptake of this advice, a few
intrepid researchers used the PHIS dataset to see if
the guidelines were, in fact, followed, and if there
was a decrease in the rate of use of non-evidence
based care.

16. Design
A retrospective analysis of Pediatric Health
Information Systems (PHIS) administrative data from
41 children’s hospitals.
Data used were from November 1, 2004 to March
31, 2012.
Trends in diagnostic and treatment resource use
were compared before and after publication of the
guidelines
Segmented time-series regression analyses were
used.
Included were children 1 month to 2 years of age
with a primary discharge code for bronchiolitis
Children with CCCs, mechanical ventilation, and
LOS>10 days were excluded.

17. Results
130,262 patients were included
Median age=4 months
58% male
59% government payor

20. Results

21. Results

22. Conclusions and Relevance
The publication of the AAP’s 2006 guidelines on the
treatment of bronchiolitis was associated with a
reduction in diagnostic testing and medication use
that was unsupported by evidence in this sample.
Guidelines can, in fact, help to increase the
likelihood of the delivery of evidence-based care.

23. Category: Best article in Medical Education
And the nominees are:
Amy Starmer, O’Toole J, Rosenbluth G et al:
Development, Implementation, and Dissemination of
the I-PASS Handoff Curriculum: A Multisite
Educational Intervention to Improve Patient
Handoffs.
Brian Drolet, Whittle S, Khokhar M et al: Approval
and Perceived Impact of Duty Hour Regulations:
Survey of Pediatric Program Directors
Amy Starmer, Sectish T, Simon D et al: Rates of
Medical Errors and Preventable Adverse Events
Among Hospitalized Children Following
Implementation of a Resident Handoff Bundle

27. Best Med Ed
3/10/2014Footer Text

28. IMPORTANCE
OBJECTIVE To determine whether introduction of a
multifaceted handoff program was associated with
reduced rates of medical errors and preventable
adverse events, fewer omissions of key data in
written handoffs, improved verbal handoffs, and
changes in resident-physician workflow.

29. INTERVENTIONS
Resident handoff bundle: consisting of standardized
communication and handoff training, a verbal mnemonic,
and a new team handoff structure. On one unit, a
computerized handoff tool linked to the electronic medical
record was introduced.
Pre-intervention: separate signouts-intern to intern SAR to
SAR. No structured tool but rely upon a word based document
with synopsis, plan and “to do” list
Intervention 1: 2 hour training, SIGNOUT?, unified signout,
designated space, periodic supervision
Intervention 2: same as above plus-Name, sex, age, weight,
medical record number, location, admission date, diagnosis,
allergies, medications, intravenous access, code status,
laboratories, vital signs, and problem list. It also contained
structured fields entitled “Patient Summary”, “To Do List,” and
“Contingency Planning” with free-text format

30. Horwitz LI, Moin T, Green ML. Development
and implementation of an oral sign-out skills
curriculum. J Gen Intern Med. 2007;22(10):1470-
1474.

31. Prospective intervention study of patient admissions involving pediatric resident
physicians from July-September 2009 and November 2009-January 2010 on 2
inpatient units at Boston Children’s Hospital.
Primary outcomes - rates of medical errors and preventable adverse events
Secondary outcomes - omissions in the printed handoff document and resident
time-motion activity
Design and Outcomes

32. RESULTS
A total of 1255 patient admissions (n = 642 preintervention; n = 613
postintervention) were reviewed for the presence of medical errors.
Medical errors decreased from 33.8 per 100 admissions (95%CI, 27.3-
40.3) to 18.3 per 100 admissions (95%CI, 14.7-21.9; P < .001), and
preventable adverse events decreased from 3.3 per 100 admissions
(95%CI, 1.7-4.8) to 1.5 (95%CI, 0.51-2.4) per 100 admissions (P = .04)
following the intervention.
There were fewer omissions of key handoff elements on printed handoff
documents, especially on the unit that received the computerized handoff
tool (significant reductions of omissions in 11 of 14 categories with
computerized tool; significant reductions in 2 of 14 categories without
computerized tool).
Physicians spent a greater percentage of time in a 24-hour period at the
patient bedside after the intervention 8.3% (95%CI 7.1%-9.8%) vs
10.6%(95%CI, 9.2%-12.2%; P = .03).
The average duration of verbal handoffs per patient did not change. Verbal
handoffs were more likely to occur in a quiet location (33.3%; 95%CI, 14.5%-
52.2%vs 67.9%; 95%CI, 50.6%-85.2%; P = .03) and private location (50.0%;

34. How do interns/residents spend their time?
Creating
memes

35. CONCLUSIONS AND RELEVANCE
Implementation of a handoff bundle was associated
with a significant reduction in medical errors and
preventable adverse events among hospitalized
children.
Improvements in verbal and written handoff
processes occurred, and resident workflow did not
change adversely.

36. Category: Best Nursery article

37. Category: Best Nursery article
Cora Peterson, Ailes E, Riehle-Colarusso T et al:
Late Detection of Critical Congenital Heart Disease
Among US infants
John Kelleher, Bhat R, Salas A et al:
Oronasopharyngeal suction versus wiping of the
mouth and nose at birth: a randomised equivalency
trial
David Chalmers, Wiedel C Siparsky G et al:
Discovery of Hypospadias during Newborn
Circumcision Should Not Preclude Completion of the
Procedure

40. Best Nursery article
3/10/2014Footer Text

41. Importance
Congenital heart defects affect approximately 1% of
live births in the United States; 25% are considered
critical congenital heart disease (CCHD) (defined as
requiring surgery or catheterization at or before age
1 year)
Screening for CCHD was added to the US
Recommended Uniform Screening Panel for
Newborns in 2011.
Screening performed using pulse oximetry.
Screening recommended within 24-48 hours of birth.

42. Study Objectives
To estimate the proportion of US infants with clinically
validated, nonsyndromic, screening-detectable CCHD
whose condition was detected late (>3 days after birth).
To investigate clinical and demographic factors
associated with late detection.

43. Design
Study Design: National Birth Defects Prevention Study
(NBDPS).
Ongoing, population-based, case-control study of >30 major
birth defects.
CCHD confirmed by echocardiography, catheterization,
surgery, or autopsy.
Setting
Infants born from January 1, 1998, through December 31,
2007.
Mothers lived in sampled states (Arkansas, California, Georgia,
Iowa, Massachusetts, New Jersey, New York, North Carolina,
Texas, Utah) at time of delivery.
Outcome: Late CCHD detection.
No evidence of diagnostic echocardiography prenatally or ≤3
days of birth.

44. Date of download: 6/30/2014
Copyright © 2014 American Medical
Association. All rights reserved.
From: Late Detection of Critical Congenital Heart Disease Among US Infants: Estimation of the Potential
Impact of Proposed Universal Screening Using Pulse Oximetry
JAMA Pediatr. 2014;168(4):361-370. doi:10.1001/jamapediatrics.2013.4779
Derivation of Study Sample of Infants With Critical Congenital Heart Disease (CCHD) in the National Birth Defects Prevention Study,
1998-2007aHypoxemic structural heart defects potentially detectable through pulse oximetry screening at birth hospitals include
critical aortic stenosis, coarctation of the aorta, double-outlet right ventricle, dextrotransposition of the great arteries, Ebstein
anomaly, hypoplastic left heart syndrome, pulmonary atresia, interrupted aortic arch, critical pulmonary stenosis, single ventricle,
truncus arteriosus, total anomalous pulmonary venous return, tetralogy of Fallot, and tricuspid atresia.
Figure Legend:

46. Results

47. Implications
Estimated 30% of live-born infants with
nonsyndromic CCHD in the NBDPS were diagnosed
>3 days after birth.
Varied substantially by CCHD type from 8% (pulmonary
atresia) to 62% (coarctation of the aorta).
Many infants with CCHD might benefit from
screening through pulse oximetry before birth
hospital discharge.
Whether these infants are actually detected through
screening is likely to vary by a number of factors,
including CCHD type and the presence of extracardiac
defects.
Future studies of routine screening in practice might

48. Category: Best article about pneumonia
Derek Williams, Hall M, Shah S et al: Narrow vs.
Broad-spectrum Antimicrobial Therapy for Children
Hospitalized with Pneumonia
Rachael Ross, Hersh A, Kronman M, et al: Impact of
Infectious Diseases Society of America/Pediatric
Infectious Diseases Society Guidelines on Treatment
of Community-Acquired Pneumonia in Hospitalized
Children
Queen Mary, Myers A, Hall M, et al: Comparative
Effectiveness of Empiric Antibiotics for Community-
Acquired Pneumonia

49. Best Pneumonia article
3/10/2014Footer Text

50. IMPORTANCE Broad-spectrum antibiotics are
frequently used to empirically treat children
hospitalized with community-acquired pneumonia
despite recent national recommendations to use
narrow-spectrum antibiotics.
OBJECTIVE to compare the effectiveness of empiric
therapy with narrow spectrum antibiotics with empiric
therapy with broad-spectrum antibiotics in children
hospitalized with uncomplicated CAP.

51. Design

52. Outcomes
Length of stay
Readmission
Duration of fever
Duration of supplemental oxygen
Standardized total costs

53. Results

54. Conclusions and Relevance
Compared with broad-spectrum agents, narrow-
spectrum antibiotic coverage is associated with
similar outcomes.
Royalty are an untapped source of potential medical
researchers.

55. Best article about chocolate
Hanks AS, Just DR, Wansink B. Chocolate milk
consequences: a pilot study evaluating the
consequences of banning chocolate milk in school
cafeterias. PLoS One.
Gajendragadkar PR, Moualed DJ, Nicolson PL, et al.
The survival time of chocolates on hospital wards:
covert observational study. BMJ.
Collodel G, Moretti E, Del Vecchio MT, et al. Effect
of chocolate and Propolfenol on rabbit
spermatogenesis and sperm quality following
bacterial lipopolysaccharide treatment. Syst. Biol.
Reprod. Med.

56. Best Article about Chocolate
3/10/2014Footer Text
*

57. Methods
Multicentre prospective covert observational study
Setting: 4 wards at 3 hospitals
Subjects: Boxes of Quality Street and Roses candy
and those eating said candy
Main outcome measure: median survival time of a
chocolate

58. Results

59. Kaplan-Meier survival curve

60. Chocolate consumption by role

61. Actual figures included in the manuscript

62. Limitations
Lack of generalizability of chocolate consumption
outside of the UK
US chocolate consumption is likely to be faster

63. Conclusions
The median survival time of a chocolate on the
wards was 51 minutes.
Frequency of chocolate delivery on the wards should
be increased to account for demand, even in an era
of cost-reduction.
Chocolate box shrinkage should be vigorously fought
.
It is not good to be a chocolate in the hospital.

64. Category: Best article about Serious Bacterial
Infections. Seriously.
And the nominees are:
Tara Greenhow, Hung Y, Herz A et al: The Changing
Epidemiology of Serious Bacterial Infections in
Young Infants
James Laham, Breheny P, gardner B, et al:
Procalcitonin to Predict Bacterial Coinfection in
Infants With Acute Bronchiolitis
Jamie Librizzi, McCulloh, R, Koehn K, et al:
Appropriateness of Testing for Serious Bacterial
Infection in Children Hospitalized With Bronchiolitis
*

65. Best Article about Serious
Bacterial Infections
3/10/2014Footer Text
*

66. IMPORTANCE 200,000 annual hospitalizations for
OBJECTIVE to evaluate provider practice patterns
for evaluation of SBI in patients hospitalized with
and to assess the association of SBI testing with
LOS and ABX usage
*
*
*

67. Design
A retrospective chart review of hospitalized patients
<24 months of age with a discharge diagnosis of
from 2 separate study sites (Rhode Island and
Missouri) during 2004 to 2008
Exclusions: lack discharge diagnosis of blitis or was
initially admitted to ICU
*

68. Results
* SBI=
CBC
UA/UC
BC
CSF

69. Results
*
*

70. Results

71. Conclusions and Relevance
SBI is uncommon in children hospitalized for , and
urinary tract infection is the most common diagnosis.
In the evaluation of SBI in , providers more
frequently obtain blood cultures than urinalysis
and/or urine cultures.
Evaluation for SBI is associated with increased
antibiotic use (more than half of them) and increased
LOS.
…since we’re putting in an IV we might as well….
Remember 200,000 annual hospitalizations quickly
adds up to lots of $$
*
*

72. Best Commentary
3/10/2014Footer Text

73. Richard Smith
Editor of the BMJ until 2004
• “The poor quality of much medical research is widely
acknowledged, yet disturbingly the leaders of the
medical profession seem only minimally concerned
about the problem and make no apparent efforts to find a
solution.”
3/10/2014Footer Text

74. "We need to get away from the notion, proven wrong on a daily basis, that peer
review of any kind at any journal means that a work of science is correct. What it
means is that a few (1-4) people read it over and didn't see any major problems.
That's a very low bar in even the best of circumstances.“
Michael Eisen, a biologist at UC Berkeley, is a co-founder of the Public Library of Science

75. Category: Fluid Management
And the nominees are:
1. Jinjing Wang, Erdi Xu, and Yanfeng Xiao. Isotonic
versus Hypotonic Maintenance IV Fluids in
Hospitalized Children: A Meta-Analysis. Pediatrics
2. Francis Carandang, Andrew Anglemyer,
Christopher Longhurst, et al. Association between
Maintenance Fluid Tonicity and Hospital-Acquired
Hyponatremia. J. Pediatr.
3. Ed Oakley, Meredith Borland, Jocelyn Neutze, and
9 other friends from the Paediatric Research in
Emergency Departments International Collaborative
(PREDICT). Nasogastric hydration versus
intravenous hydration for infants with Bronchiolitis: a
Randomised Trial. Lancet.

76. Best article(s) in fluid
management
3/10/2014Footer Text
*

77. Importance
Maintenance IV fluids maintain homeostasis when
patients are unable to take in water, electrolytes, and
energy.
The Holliday and Segar method has traditionally
been used to calculate fluid and electrolyte needs,
but it may underestimate electrolyte needs for
hospitalized children, especially those prone to
SIADH
There has been increasing concern about the
potential for iatrogenic hyponatremia in patients
receiving hypotonic IV fluids such as ¼ or ½ normal
saline.
This study is a meta-analysis of the most recent

78. Design
Meta-analysis using the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) statement
Multiple databases and reference lists searched for relevant
articles
2 authors independently screened all titles and abstracts
Included: RCTs, hospitalized children 1 month-17 years, and
comparing isotonic (NS or LR), to hypotonic (.45%/.3%/.18%
NS)
Primary outcome was NA<136 mmol/L
Methodologic quality assessed with Cochrane risk-of-bias tool
Relative risks, mean differences, and CIs were pooled
A random-effects model was used
Sensitivity analysis was done where biases were identified
Heterogeneity was determined using I2 statistic
The lower the I2 percent, the less variability between the studies
that can’t be explained by chance
Analyses done in RevMen 5.1

79. Results

80. Results
The risk of bias tool identified potential issues in all of the
studies, which were addressed in subsequent sensitivity
analyses where possible.
Overall, the RR of hyponatremia with hypotonic fluids vs.
isotonic fluids was 2.24 (95% CI 1.58-3.37; I2=14%).
The RR of severe hyponatremia (Na<130 mmol/L) was
5.29; 95% CI 1.74-16.06; I2=0%.
The fall in pNa was significantly greater in children
receiving hypotonic IV fluids (3.49 mmol/L; 95% CI 5.63-
1.35; p<.001; I2=87%).
There were no differences between the groups in
hypernatremia (RR .73; 95% CI .22-2.48; I2=0%)
These results held up with sensitivity analyses.

81. Conclusions and Relevance
Isotonic fluids are less likely to cause hyponatremia
than hypotonic fluids in hospitalized children.
Isotonic fluids are not more likely to cause
hypernatremia.
However there were still methodological concerns
with most of the included RCTs.
Is there a better way?

82. Best article(s) in fluid
management
3/10/2014Footer Text
*

83. Importance
Many children admitted with that diagnosis are
unable to take in enough fluids by mouth to stay
hydrated
In many institutions, IV fluid hydration is the default.
However IV fluid is a medication (see last article)
and can have negative effects
Naso-gastric hydration may be a more physiologic
approach.

84. Design
Multi-centre randomized trial of infants 2-12 months
of age in Australia and New Zealand.
Diagnosis of bronchiolitis
Randomly allocated to receive NG or IV hydration
Primary outcome was length of stay
Secondary outcomes included rates of ICU
admission, adverse events, and success of insertion.
750 infants would give 80% power to detect a
difference of 10-14 hours in length of stay between
groups at α=.05.
Intention to treat
T-tests, Kaplan-Meier curves, using Stata 11.1.

85. Results

86. Results

87. Results

88. Results

89. Conclusions and Relevance
This was a nicely done RCT with sufficient power to
detect differences.
There were no differences in length of stay, ICU
admission, or adverse events between the two
groups
NG insertion was more likely to be successful than
IV insertion.
Parents were equally satisfied.
Consider NG hydration first!

90. Best Article.
3/10/2014Footer Text
*

91. Alternatives to the handshake
The familiar hand wave
Right palm over the heart
The bow
The Namaste
The wai gesture
The salaam
Interestingly, no mention of the fist bump or the high
five

93. Best RCT about nebulized saline
1. Wu S, Baker C, Lang M, et al. Nebulized
Hypertonic Saline for Bronchiolitis: A Randomized
Clinical Trial. JAMA Peds.
2. Florin T, Shaw K, Kittick M, et al. Nebulized
Hypertonic Saline for Bronchiolitis in the Emergency
Room: A Randomized Clinical Trial. JAMA Peds.
3. Jonathan Jacobs, Megan Foster, Jim Wan, and
Jay Pershad. 7% Saline in Bronchiolitis. Pediatrics.

94. Best RCT on nebulized saline
3/10/2014Footer Text
*

95. Importance
What could be more important that finding out if
nebulized saline actually works?

96. Design
Double-blind randomized clinical trial comparing 3%
saline with .9% saline
Recruited in the ED; treated in the ED and after
admission
Pre-dosed with albuterol
3 bronchiolitis seasons in 2 CA hospitals
Age <24 months, no prior wheeze
Outcome measures:
Hospital admission rate
Respiratory Assessment Change Score:
30 minutes post-treatment
Respiratory Distress Assessment Instrument (RDAI)
Respiratory parameters
Length of stay

97. Analysis
Intention to treat analysis
Χ2 and t-tests used for bivariate comparisons
Logistic and multivariate linear regression for
treatment effects
Controlling for demographic and clinical confounders
Analyses done in SPSS

99. Results
Hospital admission rates were 42.6% for NS vs.
28.9% for HS (p<.01); adjusted OR .49 (.28-.71).
There were no differences in RDAI, RACS, or LOS
No differences in study withdrawal or complications
However there were significant differences by site
Primarily Hispanic population

100. Best other RCT on nebulized saline
3/10/2014Footer Text
*

101. Design
Double-blind randomized clinical trial comparing 3%
saline with .9% saline
Recruited in the ED; treated in the ED
After nasal suctioning and a trial of albuterol
2 bronchiolitis seasons in 1 PA hospital
Age 2 months to <24 months, no prior wheeze
Outcome measures:
Hospital admission rate
Respiratory Assessment Change Score:
1 hour post treatment
Respiratory Distress Assessment Instrument (RDAI)
Respiratory parameters
Clinical parameters
Parent perceptions

102. Analysis
Intention to treat analysis
Χ2 and t-tests used for bivariate comparisons
Median differences analyzed using Mann-Whitney
test.
Analyses done in Stata v.12

105. Limitations
Small sample size
But there was a significant increase in RACS!

106. Take home points
These were both well done RCTs using very similar
methods in similar populations, that found divergent
results.
Editorial

107. Category: NUMBER 1
And the nominees are:
Diana Averbuch, Nir-Paz R, Tenenbaum A et al.
Factors Associated with Bacteremia in young Infants
with Urinary Tract Infection
RIVUR Trial Investigators: Antimicrobial Prophylaxis
for Children with Vesicoureteral Reflux.
Susanna Hernandez-Bou, Trenchs V, Alarcon, et al:
Afebrile Very Young Infants With Urinary Tract
Infection and the Risk for Bacteremia

108. Best article(s) about
Urine
3/10/2014Footer Text
*

109. Importance
Children with febrile urinary tract infection commonly
have vesicoureteral reflux (30-40%)
The utility of antimicrobial prophylaxis to prevent
recurrences in children with reflux remains
controversial

110. Design
2 year, 19 site, randomized, double blind, placebo-
controlled
2-71 months of age with grade I-IV vesicoureteral
reflux
Trimethoprim-sulfamethoxazole vs placebo
OUTCOME(S):
Primary: recurrence over 2 years
Secondary:
Renal scarring
Failure of prophylaxis
Antimicrobial resistance

111. Results

112. Relevance/Importance
Bactrim prophylaxis in children less than 6 years
with VUR diagnosed after UTI is associated with a
decrease in the risk of UTI recurrence
Rates of renal scarring were the SAME in both
groups

113. Final thoughts
A special thanks to the authors and contributors who
have been such great sports through this process.
And huge thank you to our ‘people” Samantha and
Kris for shepherding us through this process.
And a big raspberry to the planning committee who
coerced us into this 