Fellow Physician University of Pittsburgh PITTSBURGH, Pennsylvania, United States
Background: Children with complex chronic conditions (CCC) represent a frequently encountered population in the pediatric clinical setting; paradoxically, they remain significantly underrepresented in pediatric research. A notable subgroup includes those with chronic neurological illnesses (CNI), often hypothermic on arrival to the emergency department. Hypotheses include disruption of thermoregulation, stemming from anterior hypothalamus dysfunction, often affected by global neurological insult. To date, only one study has addressed this concern—an isolated case series of four patients from 1994. Consequently, even in the absence of other symptoms, most children undergo a comprehensive infectious evaluation, are treated with broad-spectrum parenteral antibiotics, and are frequently managed in an intensive care setting. Objective: We aim to identify pediatric CNI cohort presenting to a pediatric emergency department (PED) with hypothermia. We will describe demographics, clinical characteristics, clinical course, and outcomes. We aim to describe associations between critical care resource utilization with secondary outcomes including mortality and serious bacterial infections. Design/Methods: This study will be a single-center retrospective chart review querying the PHIS database for children >60 days and < 18 years old with CNI presenting to the PED utilizing the CCC v2 system. Patients will be linked to the EMR to identify those with a recorded ED temperature of < 36C. Through EMR query, we will obtain demographic information, underlying diagnoses, associated symptoms, vital signs, laboratory results, imaging data and outcomes. We define critical care resource utilization as vasopressor requirement or escalation of respiratory care. We will perform multivariate analysis factors independently associated with critical care resource utilization and serious bacterial infections. This study is approved by the IRB of the University of Pittsburgh. Data collection will begin in November 2023 with data analysis completed in February 2024.
