Florin T, Aronson P, Neuman M. Rapid Brain Magnetic Resonance Imaging: An Alternative to Head Computed Tomography for Evaluation of Ventricular Shunt Malfunction Reply. J Pediatr. 2016; 171:320-21.

In this retrospective longitudinal cohort study of Emergency Department (ED) visits from 2003-2013 across 31 pediatric hospitals, 1,319 children with VP shunt placed in 2003 visited the ED 6,636 times during the subsequent decade. Cranial computed tomography (CT), performed in half of these visits, with 20% of ED visits with CT scans associated with VP shunt revision. A very small percentage (6%) of the patients received 10 or more CT scans, yet these patients accounted for almost 40% of all of the ED visits with imaging. Importantly, the mean number of CT scans per patient varied 20-fold across hospitals, with the individual hospital accounting for the majority of variation in CT utilization. Strategies need to identify those children at risk of shunt malfunction to reduce variability in CT utilization and radiation exposure in the ED.

Bennett BL, Steele P, Dixon CA, Mahabee-Gittens EM, Peebles J, Hart KW, Lindsell CJ, Chua MS, Hirsh R. Serum Cardiac Troponin I in the Evaluation of Nonaccidental Trauma. J Pediatr. 2015; 167:669-73 e1.

This project is the first prospective study to investigate screening for occult cardiac injury in this population. This case-control study showed that troponin I is more often elevated in children with non-accidental trauma than uninjured healthy controls. Twenty-six percent of children > 3 months of age with suspected non-accidental trauma had elevation of troponin I. Elevation of troponin I in this population has the potential to illustrate the extent of injury to these young patients. The results of this study have been the impetus for including troponin I as part of the standard non-accidental trauma work-up at Cincinnati Children's and multiple other centers.

Reed J, Huppert J, Taylor R, Gillespie G, Alessandrini E, Kahn J. The Impact of Post-Visit Emergency Department Follow-up on Sexually Transmitted Infection Related Return Visits. Ann Public Health Res. 2015; 2:1-4.

This study demonstrated that Emergency Department (ED) adolescents contacted regarding sexually transmitted infection (STI) with positive results did not have significantly different ED return visits rates for STI testing than those not contacted. However, among adolescents who returned to any setting, one third returned to non-ED settings for STI care suggesting that a post-visit contact from a healthcare provider may be one strategy to improve linkage to a primary medical home.
Mahabee-Gittens EM, Khoury JC, Ho M, Stone L, Gordon JS. A smoking cessation intervention for low-income smokers in the ED. Am J Emerg Med. 2015 Aug;33(8):1056-61.
This clinical trial successfully provided a brief emergency department based cessation intervention to 200 low income caregivers who smoke. Caregivers were highly nicotine dependent (90%), and children were highly smoke exposed as 60% and 76% of caregivers allowed smoking in the home and car, respectively. Encouragingly, at follow-up, we found that our brief intervention prompted a substantial number of quit attempts and resulted in significant reductions in cigarette consumption, increased smoking bans, and reduced smoking prevalence among this underserved population. This intervention was viable to incorporate during the busy emergency department visit, acceptable by caregivers, and provided a basis for conducting future large cessation trials in the emergency department setting.