Emergency Medicine

healthcare workers putting on PPE

“Mask up!” Soon, AI may be prompting healthcare workers

Researchers at Children’s National Hospital are embarking on an effort to deploy computer vision and artificial intelligence (AI) to ensure medical professionals appropriately use personal protective equipment (PPE). This strikingly common problem touches almost every medical specialty and setting.

With nearly $2.2 million in grants from the National Institutes of Health, the team is combining their expertise with information scientists at Drexel University and engineers at Rutgers University to build a system that will alert doctors, nurses and other medical professionals of mistakes in how they are wearing their PPE. The goal is to better protect healthcare workers (HCWs) from dangerous viruses and bacteria that they may encounter — an issue laid bare with the COVID-19 pandemic and PPE shortages.

“If any kind of healthcare setting says they don’t have a problem with PPE non-adherence, it’s because they’re not monitoring it,” said Randall Burd, M.D., Ph.D., division chief of Trauma and Burn Surgery at Children’s National and the principal investigator on the project. “We need to solve this problem, so the medical community will be prepared for the next potential disaster that we might face.”

The big picture

The World Health Organization has estimated that between 80,000 and 180,000 HCWs died globally from COVID-19 between January 2020 and May 2021 — an irreplaceable loss of life that created significant gaps in the pandemic response. Research has shown that HCWs had an 11-fold greater infection risk than the workers in other professions, and those who were not wearing appropriate PPE had a 1/3 higher infection risk, compared to peers who followed best practices.

Burd said the Centers for Disease Control and Prevention has recommended that hospitals task observers to stand in the corner with a clipboard to watch clinicians work and confirm that they are being mindful of their PPE. However, “that’s just not scalable,” he said. “You can’t always have someone watching, especially when you may have 50 people in and out of an operating room on a challenging case. On top of that, the observers are generally trained clinicians who could be filling other roles.”

What’s ahead

Bringing together the engineering talents at Drexel and Rutgers with the clinical and machine-learning expertise at Children’s National, the researchers plan to build a computer-vision system that will watch whether HCWs are properly wearing PPE such as gloves, masks, eyewear, gowns and shoe covers.

The team is contemplating how the system will alert HCWs to any errors and is considering haptic watch alerts and other types of immediate feedback. The emerging power of AI brings tremendous advantages over the current, human-driven systems, said Marius George Linguraru, D.Phil., M.A., M.Sc., the Connor Family Professor in Research and Innovation at Children’s National and principal investigator in the Sheikh Zayed Institute for Pediatric Surgical Innovation.

“Human observers only have one pair of eyes and may fatigue or get distracted,” Linguraru said. “Yet artificial intelligence, and computers in general, work without getting tired. We are excited to figure out how a computer can do this work – without ever blinking.”

Children’s National Hospital leads the way

Linguraru says that Children’s National and its partners make up the ideal team to tackle this vexing challenge because of their ability to assemble a multidisciplinary team of scientists and engineers who can work together with clinicians. “This is a dialogue,” he said. “A computer scientist, like myself, needs to understand the intricacies of complicated clinical realities, while a clinician needs to understand how AI can impact the practice of medicine. The team we are bringing together is intentional and poised to fix this problem.”

girl being examined by doctor

Pediatric hospitals underutilize systems to get at social challenges impacting health


girl being examined by doctor

Physicians treating hospitalized children rarely use a coding system established in 2015 for flagging social challenges and stressors that may be impacting patient health, according to new research from Children’s National Hospital.


Physicians treating hospitalized children rarely use a coding system established in 2015 for flagging social challenges and stressors that may be impacting patient health, according to new research from Children’s National Hospital published in Pediatrics. Known as social determinants of health (SDOH), these factors include food insecurity, homelessness and adverse childhood events like substance abuse at home, and they can greatly affect a child’s well-being.

“We only get so many touchpoints with our patients,” said Kaitlyn McQuistion, M.D., pediatric hospital medicine fellow at Children’s National and co-lead author of the paper. “Our research shows the screening itself provides valuable insight into our patients, making identification an important part of inpatient and post-discharge care. With this information, doctors can help families tap into social workers, community supports and other resources aimed at providing a more holistic approach to child health.”

The big picture

The American Academy of Pediatrics advises screening for unmet social needs and using the codes laid out in the International Classification of Disease, 10th Revision (ICD-10), to flag risk factors for some of a hospital’s most vulnerable patients. In 2018, the American Hospital Association (AHA) clarified that the coding can be added by any healthcare professional accessing the chart, including nurses, social workers, case managers and physicians. The study looked at data from 4,000 hospitals in 48 states and the District of Columbia and found that use of the codes has remained low, even with the AHA’s clarification.

In practice, physicians know that screening and documentation are the essential first steps to help families find resources. Yet less than 2% of pediatric inpatients were coded as needing support. Most commonly, “problems related to upbringing” – a broad category indicating social needs and adverse childhood events – was used.

What’s ahead

Some providers are using these SDOH codes, or Z Codes, more often to address and improve health disparities. “Our mental health colleagues and those working with the Native American population, in particular, are using these tools more often to capture and disseminate critical information related to their patients’ social needs,” said Stacey Stokes, M.D., a hospitalist at Children’s National and co-lead author on the paper.  “Their innovative approaches to address and improve health disparities may provide learning opportunities for institutions.”

The researchers said that more work needs to be done to take these successes to other populations, find ways to incentivize this work in billing and ensure that providers have community resources to address the needs that they uncover.

“The ultimate goal of this work is to identify patients with social needs affecting their health and connect them with resources,” said Kavita Parikh, M.D., director for the Research Division of Hospital Medicine. “There are many avenues to explore to find ways to better utilize this tool, including language learning models, improved training and stronger community resources.”

Gavel on desk

AAP names Children’s National gun violence study one of the most influential articles ever published

Gavel on desk

In 2019, firearm injuries were the second-leading cause of death for U.S. children. Presently, they are the leading cause of death.

The American Academy of Pediatrics (AAP) has named a 2019 study led by clinician-researchers at Children’s National Hospital one of the 12 most influential Pediatric Emergency Medicine articles ever published in the journal Pediatrics.

The findings showed that states with stricter gun laws and laws requiring universal background checks for gun purchases had lower firearm-related pediatric mortality rates but that more investigation was needed to better understand the impact of firearm legislation on pediatric mortality.

The study, State Gun Laws and Pediatric Firearm-Related Mortality, was led by Monika Goyal, M.D., M.S.C.E., associate chief of Emergency Medicine, along with Gia M. Badolato, M.P.H., coauthor; Shilpa J. Patel, M.D., MPH, coauthor and emergency medicine specialist; and Kavita Parikh, M.D., MSHS, coauthor and hospitalist, all of Children’s National.

The big picture

In 2019, firearm injuries were the second-leading cause of death for U.S. children. Presently, they are the leading cause of death.

“We have learned that interventions to tackle gun violence are not a ‘one size fits all’ and we need to start developing and scaling tailored interventions that embrace and center community voices and partnerships,” Dr. Goyal said. “The good news is that over the last 5-7 years, there has been a groundswell of energy to address the firearm epidemic in our nation that has led to the growth of investigators, funding and advocacy efforts dedicated to developing and disseminating evidence-based interventions and policies for gun violence prevention. But we need more dedicated funding to support these efforts and continue to invest in those who wish to dedicate their careers to this work.”

About the recognition

The AAP Section on Emergency Medicine (SOEM), founded in 1981, is among the AAP’s largest sections, providing a forum for advocacy, education and research on patient care in pediatric emergency medicine (PEM). The AAP Committee on PEM (COPEM), a national committee founded in 1985, is the principal author of PEM-related AAP policies.

Members of the SOEM’s executive committee and COPEM reviewed every issue from the 75-year history of Pediatrics and selected 15 landmark papers in total, which names the study led by Dr. Goyal and her team.

What they’re saying

“This paper was the result of years of hard work and the beginning of many other collaborations as a research team. I am thankful to work with this team as we continue to add to this important area of research,” said Dr. Patel.

“I was honored to have our article chosen as one of the most influential Pediatric Emergency Medicine articles. I feel encouraged by this recognition that PEM physicians and researchers can be the bridge to the community and work together to make a difference for children,” added Badolato.

Led by their determination to change the status quo and improve the quality of life for children, the clinician-research team established Safer Through Advocacy, Firearm Education and Research (SAFER). It’s a group that works to fill the gaps in hopes of stimulating the change needed to help move the national landscape towards policies that make it safer for children and communities.

“We have created collaborations with pediatricians and researchers throughout the country and continue to work to fill the gaps,” Dr. Parikh said.

Other authors of the study include: Robert McCarter Jr., ScD, co-author; and Sabah F. Iqbal, M.D., PM Pediatrics, co-author.

Lenore Jarvis, M.D. participates in congressional briefing on maternal mental health

Lenore Jarvis, M.D. participates in congressional briefing on maternal mental health

Lenore Jarvis, M.D. participates in congressional briefing on maternal mental health

Lenore Jarvis, M.D., M.Ed., recently participated in a congressional briefing about maternal mental health.

Lenore Jarvis, M.D., M.Ed., director of advocacy and health policy for the Division of Emergency Medicine and an affiliate faculty member of the Child Health Advocacy Institute at Children’s National Hospital, recently participated in a congressional briefing about maternal mental health. The goal of the briefing was to bring awareness to the devastating impact of untreated perinatal mood and anxiety disorders (PMADs) on moms, babies and families and to eliminate the pervasive stigma around seeking care, including in communities of color and military populations.

PMADs are one of the leading causes of maternal mortality and morbidity in the U.S., responsible for nearly one quarter of all maternal deaths. Evidence shows that 1 in 5 women experience a PMAD during pregnancy or the postpartum period. All maternal mental health conditions are treatable, yet over 75% go untreated.

Dr. Jarvis spoke about the importance of screening caregivers for PMADs not just in outpatient settings, but also in emergency departments and NICUs. She said that an emergency department can serve as a safety net for high-risk patient populations who may have limited access to primary or mental health care, or for those who use the emergency department at a time of increased stress, anxiety or depression. Similarly, the NICU population is comprised of caregivers coping with stressful scenarios like traumatic perinatal or birth experiences and life altering diagnoses.

“At Children’s National, our primary care clinics screen for PMADs, but we also provide universal screening by approaching caregivers with infants six months and younger in both the emergency department and the NICU. Our philosophy is that by offering this screening and education to families, we are providing a higher standard of care for the patients seen in these settings,” said Dr. Jarvis. If a caregiver screens positive, meaning they are exhibiting enough symptoms that they could be at risk for experiencing PMADs, a member of our social work team meets with that caregiver to complete an additional assessment and provide further support, including to understand if there are suicidal or infanticidal ideations and intent to act. Our social workers can then make referrals to connect them to more care and follow up with those caregivers to confirm they have connected with the appropriate resource.

Dr. Jarvis was asked how to make it easier to support caregivers and families regarding PMADs. “Caregivers need education regarding PMADs. We need them to know it’s common and it doesn’t make them bad parents. We also need to ensure that providers are screening and that they have increased time for visits that include addressing mental health concerns.” She also stressed that the healthcare system can be difficult to navigate. “We need to decrease barriers to care, like the long wait times to get into mental health care and insurance coverage issues.”

U.S. News Badges

Children’s National Hospital ranked #5 in the nation on U.S. News & World Report’s Best Children’s Hospitals Honor Roll

U.S. News BadgesChildren’s National Hospital in Washington, D.C., was ranked #5 in the nation on the U.S. News & World Report 2023-24 Best Children’s Hospitals annual rankings. This marks the seventh straight year Children’s National has made the Honor Roll list. The Honor Roll is a distinction awarded to only 10 children’s hospitals nationwide.

For the thirteenth straight year, Children’s National also ranked in all 10 specialty services, with eight specialties ranked in the top 10 nationally. In addition, the hospital was ranked best in the Mid-Atlantic for neonatology, cancer, neurology and neurosurgery.

“Even from a team that is now a fixture on the list of the very best children’s hospitals in the nation, these results are phenomenal,” said Kurt Newman, M.D., president and chief executive officer of Children’s National. “It takes a ton of dedication and sacrifice to provide the best care anywhere and I could not be prouder of the team. Their commitment to excellence is in their DNA and will continue long after I retire as CEO later this month.”

“Congratulations to the entire Children’s National team on these truly incredible results. They leave me further humbled by the opportunity to lead this exceptional organization and contribute to its continued success,” said Michelle Riley-Brown, MHA, FACHE, who becomes the new president and CEO of Children’s National on July 1. “I am deeply committed to fostering a culture of collaboration, empowering our talented teams and charting a bold path forward to provide best in class pediatric care. Our focus will always remain on the kids.”

“I am incredibly proud of Kurt and the entire team. These rankings help families know that when they come to Children’s National, they’re receiving the best care available in the country,” said Horacio Rozanski, chair of the board of directors of Children’s National. “I’m confident that the organization’s next leader, Michelle Riley-Brown, will continue to ensure Children’s National is always a destination for excellent care.”

The annual rankings are the most comprehensive source of quality-related information on U.S. pediatric hospitals and recognizes the nation’s top 50 pediatric hospitals based on a scoring system developed by U.S. News.

“For 17 years, U.S. News has provided information to help parents of sick children and their doctors find the best children’s hospital to treat their illness or condition,” said Ben Harder, chief of health analysis and managing editor at U.S. News. “Children’s hospitals that are on the Honor Roll transcend in providing exceptional specialized care.”

The bulk of the score for each specialty service is based on quality and outcomes data. The process includes a survey of relevant specialists across the country, who are asked to list hospitals they believe provide the best care for patients with the most complex conditions.

The eight Children’s National specialty services that U.S. News ranked in the top 10 nationally are:

The other two specialties ranked among the top 50 were cardiology and heart surgery, and urology.

HIV virus

NIH awards to address detection and treatment of HIV in adolescents

HIV virus

The funding will improve prevention, detection and treatment of HIV in adolescents.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health, awarded over $8 million to improve prevention, detection and treatment of HIV in adolescents through leveraging digital health for population-based screening in the emergency department (ED). The grants were awarded to multiple children’s hospitals, including Children’s National Hospital.

The big picture

The studies will play an important role in looking at how to curtail the HIV epidemic.

“This is an opportunity to make an impact on adolescent health and mitigate disparities,” said Monika Goyal, M.D., M.S.C.E., associate chief of Emergency Medicine and one of the main principal investigators of the awarded team.

Adolescents and young adults (AYA) are disproportionately affected by HIV in the United States. Despite adolescents accounting for over 20% of new infections, this age group is the least likely to be tested for HIV, linked to care and achieve viral suppression when compared to their adult counterparts. Further, AYA also have low rates of HIV awareness and initiation of HIV Pre-Exposure Prophylaxis.

“There is an urgent need to expand HIV screening and prevention strategies to nontraditional healthcare settings, such as emergency departments, to reach those adolescents who would otherwise not receive preventive healthcare,” Dr. Goyal added.

Why does this work matter?

Although adolescents frequently use the ED for access to healthcare, the ED has been underutilized as a venue for HIV screening, detection and prevention.

“We hope to curtail the HIV epidemic in youth by expanding HIV prevention and linkage to care services through the emergency department,” Dr. Goyal says.

Footnote: The grants issued by the NICHD are NICHD R01 HD110321 and UM2 HD111102-ATN.


Doctor holding notepad

In the News: Undertriage in emergency departments

“What prompted us to look into [undertriage] was a lot of our experiences. My colleagues and I have shared our stories and this is part of a larger project that we are doing to study the triage process as a quality improved tool in the emergency department (ED). We started to think about the triage process and how this really sets up the stage for the entire ED visit.”

Deena Berkowitz, M.D., M.P.H., associate division chief of Emergency Medicine, joined the American Academy of Pediatrics (AAP) to talk about rates of undertriage in the ED for children with non-English-speaking caregivers. Learn more about her thoughts and the study’s findings in this recent AAP podcast.


Panel members at the NIAID symposium

CN-NIAID Symposium seeks ways to promote child health amid challenges

Panel members at the NIAID symposium

More than 30 million children seek emergency care each year, but 80 percent of these visits happen at hospitals that aren’t designed for pediatrics — a daunting figure during pandemics and other crises in healthcare. This considerable hurdle is one of many challenges that leaders in pediatric health came to discuss during a two-day symposium on promoting child health, hosted by Children’s National Hospital, the National Institute of Allergy and Infectious Diseases and the Pediatric Pandemic Network (PPN).

The symposium laid out a multitude of issues facing children and their doctors: growing mental health diagnoses, shrinking access to care in rural areas, asthma and eczema, winter respiratory surges and more.

Joelle Simpson, M.D., chief of emergency medicine at Children’s National and PPN principal investigator, said the network is drawing on expertise from 10 pediatric hospitals to ensure communities are better prepared for whatever challenges lie ahead, through training and support, collaboration among pediatric specialists, education on best practices and the promotion of equity and inclusion.

Built on a Health Resources and Services Administration grant, the network is focusing on four key areas: infectious disease and disease outbreaks, emergency and disaster management, mental and behavioral health, and health equity and community engagement. “This year, we know we are boiling the ocean as we come together,” Simpson said.

Miss the symposium? Check out the recordings available on YouTube, including the closing Q&A with many of the panelists and Sheryl Gay Stolberg, health policy reporter with the New York Times.

Day 1 of the 6th Annual Children’s National Hospital – NIAID Symposium

Day 2 of the 6th Annual Children’s National Hospital – NIAID Symposium


Abstract Happy 2022 New Year greeting card with light bulb

The best of 2022 from Innovation District

Abstract Happy 2022 New Year greeting card with light bulbA clinical trial testing a new drug to increase growth in children with short stature. The first ever high-intensity focused ultrasound procedure on a pediatric patient with neurofibromatosis. A low dose gene therapy vector that restores the ability of injured muscle fibers to repair. These were among the most popular articles we published on Innovation District in 2022. Read on for our full top 10 list.

1. Vosoritide shows promise for children with certain genetic growth disorders

Preliminary results from a phase II clinical trial at Children’s National Hospital showed that a new drug, vosoritide, can increase growth in children with certain growth disorders. This was the first clinical trial in the world testing vosoritide in children with certain genetic causes of short stature.
(2 min. read)

2. Children’s National uses HIFU to perform first ever non-invasive brain tumor procedure

Children’s National Hospital successfully performed the first ever high-intensity focused ultrasound (HIFU) non-invasive procedure on a pediatric patient with neurofibromatosis. This was the youngest patient to undergo HIFU treatment in the world.
(3 min. read)

3. Gene therapy offers potential long-term treatment for limb-girdle muscular dystrophy 2B

Using a single injection of a low dose gene therapy vector, researchers at Children’s National restored the ability of injured muscle fibers to repair in a way that reduced muscle degeneration and enhanced the functioning of the diseased muscle.
(3 min. read)

4. Catherine Bollard, M.D., M.B.Ch.B., selected to lead global Cancer Grand Challenges team

A world-class team of researchers co-led by Catherine Bollard, M.D., M.B.Ch.B., director of the Center for Cancer and Immunology Research at Children’s National, was selected to receive a $25m Cancer Grand Challenges award to tackle solid tumors in children.
(4 min. read)

5. New telehealth command center redefines hospital care

Children’s National opened a new telehealth command center that uses cutting-edge technology to keep continuous watch over children with critical heart disease. The center offers improved collaborative communication to better help predict and prevent major events, like cardiac arrest.
(2 min. read)

6. Monika Goyal, M.D., recognized as the first endowed chair of Women in Science and Health

Children’s National named Monika Goyal, M.D., M.S.C.E., associate chief of Emergency Medicine, as the first endowed chair of Women in Science and Health (WISH) for her outstanding contributions in biomedical research.
(2 min. read)

7. Brain tumor team performs first ever LIFU procedure on pediatric DIPG patient

A team at Children’s National performed the first treatment with sonodynamic therapy utilizing low intensity focused ultrasound (LIFU) and 5-aminolevulinic acid (5-ALA) medication on a pediatric patient. The treatment was done noninvasively through an intact skull.
(3 min. read)

8. COVID-19’s impact on pregnant women and their babies

In an editorial, Roberta L. DeBiasi, M.D., M.S., provided a comprehensive review of what is known about the harmful effects of SARS-CoV-2 infection in pregnant women themselves, the effects on their newborns, the negative impact on the placenta and what still is unknown amid the rapidly evolving field.
(2 min. read)

9. Staged surgical hybrid strategy changes outcome for baby born with HLHS

Doctors at Children’s National used a staged, hybrid cardiac surgical strategy to care for a patient who was born with hypoplastic left heart syndrome (HLHS) at 28-weeks-old. Hybrid heart procedures blend traditional surgery and a minimally invasive interventional, or catheter-based, procedure.
(4 min. read)

10. 2022: Pediatric colorectal and pelvic reconstructive surgery today

In a review article in Seminars in Pediatric Surgery, Marc Levitt, M.D., chief of the Division of Colorectal and Pelvic Reconstruction at Children’s National, discussed the history of pediatric colorectal and pelvic reconstructive surgery and described the key advances that have improved patients’ lives.
(11 min. read)

Depressed mom sitting on couch with infant

Improving post-partum depression screening in the NICU and ED

Depressed mom sitting on couch with infant

A universal screening program is a critical first step for hospitals caring for postpartum caregivers, both inpatient and outpatient.

Perinatal Mood and Anxiety Disorders (PMADs) — particularly postpartum depression — are more prevalent among parents who have newborns admitted to a Neonatal Intensive Care Unit (NICU). Children’s National Hospital sought to increase the number of parents screened for PMADs in the NICU and Emergency Department (ED), where there was a high incidence of people seeking care. The team found that a universal screening program is a critical first step for hospitals caring for postpartum caregivers, both inpatient and outpatient.

The big picture

Without treatment, PMADs affect the caregiver and disturb their interaction with their infant, impacting the child’s cognitive and emotional development.

“What surprised us was how many people we saw that screen positive for postpartum depression and anxiety disorders. The percentage of our population is higher than what is reported in the literature,” said Sofia Perazzo, M.D., program lead at Children’s National.

What we did

The team initiated a multifaceted approach, using an electronic version of the Edinburgh Postpartum Depression Screening tool.

  • A part-time family services support staff was hired to screen caregivers. Funding later expanded the team to cover more days and hours.
  • Real-time social work interventions and linkage to resources were provided to all caregivers.
  • A part-time psychologist was hired to provide telemedicine therapy to NICU parents.
  • Remote screening was implemented for those who could not be screened in-person.

In the NICU, 1,596 parents were approached from August 2018-April 2022. Of those approached, 90% completed the screen, 26% screened positive, 4% indicated having suicidal thoughts and about 13% of caregivers were fathers.

What we learned

  • Action plans need to be in place for positive screens at start.
  • Electronic tools can aid significantly in expanding screening.
  • Trained personnel and multidisciplinary approaches are key.
  • Screening in two different settings can be challenging as they present different systems.
  • Being flexible and adapting tools and the system are key to success.
  • Good team communication with the nurse is vital.

“We’re working on improving our screening system to make it more efficient. We also realized that we need to make more resources available to these families,” said Dr. Perazzo. “Our team is constantly looking for community resources that can help them along the way. There is also a big need to educate our families on mental health issues, so we use this encounter as an opportunity to do that as well.”

This work was made possible by an investment from A. James & Alice B. Clark Foundation to Children’s National that aims to provide families with greater access to mental health care and community resources. Read more about the work of the Perinatal Mental Health Task Force at Children’s National.

Boy on e-scooter with Mom

E-scooter bone injuries on the rise

Over the past decade, electric scooters (e-scooters) have been increasing in popularity across the country. But with their popularity, visits to the hospital have also been on the rise. According to a new abstract, e-scooter injuries are becoming much more common and increasingly severe.

Authors of the abstract, “National Trends in Pediatric e-Scooter Injury,” found hundreds of e-scooter injuries between 2011-2020.

Boy on e-scooter with Mom

Over the years, e-scooter injuries are becoming much more common and increasingly severe.

The findings show that the rate of hospital admittance for patients increased from fewer than 1 out of every 20 e-scooter injuries in 2011 to 1 out of every 8 requiring admittance into a hospital for care in 2020.

“The number of annual e-scooter injuries has increased from 2011 to 2020, likely due in some part to the rise in popularity of rideshare e-scooter apps,” said lead author Harrison Hayward, M.D., Emergency Medicine fellow at Children’s National Hospital. “Our study has characterized the spectrum of injuries that occur in children, which helps emergency room doctors prepare for taking care of them and helps parents and families to practice better safety.”

The most common injuries were arm fractures (27%), followed by minor abrasions (22%) and lacerations needing stitches (17%). The average age was 11.1 years and 59% of patients were male.

With the alarming rise in injuries, Dr. Hayward and other experts are saying the use of helmets are a must since over 10% of the reported cases were head injuries.

“Research has broadly demonstrated that helmets save lives for bicycle riders, and we should think similarly about e-scooters,” he said.

You can read more about the findings on the American Academy of Pediatrics website.

Monika Goyal

Researchers to address pain management inequities with over $4M NIH award

Monika Goyal

Over the years, research led by Dr. Goyal documented racial and ethnic inequities in the ED.

The National Institutes of Health (NIH) awarded Children’s National Hospital with over $4.2 million to address inequities in pain management for children that come into the emergency department (ED).

Why this matters

The ED is a strategic venue for addressing health inequities, where children account for more than 30 million visits annually.

“There are widespread inequities in the quality-of-care delivery for children. Because the factors contributing to these disparities arise on both individual and systemic levels, it is imperative that we develop interventions to achieve health equity,” said Monika Goyal, M.D., M.S.C.E., associate chief of Emergency Medicine at Children’s National Hospital and recipient of the award.

Over the years, research led by Dr. Goyal documented racial and ethnic inequities in the ED management of pain among children with long bone fractures and appendicitis and disparities in the management of pain reduction for minoritized children.

“These findings indicate there are differences in health care quality even in settings with universal access,” she added.

The research goal

Dr. Goyal and her team aim to mitigate, and ultimately eradicate, health care inequities through evidence-based interventions. With the research support from the NIH, the team will advance this goal by:

  • Measuring how clinician (physician and nursing) implicit bias is associated with quality of care for pain management in children presenting to the ED with appendicitis or long bone fractures.
  • Using a stakeholder-engaged approach to develop patient- and caregiver-informed quality metrics related to pain management.
  • Develop and measure the impact of ‘Equity Report Cards’ and electronic health record (EHR)-embedded clinical decision support (CDS) tools to mitigate inequities in care delivery.

The bottom line

Most research to date has focused on documenting disparities. This research has the potential to move the needle in equity research by developing and testing interventions that seek to eradicate inequities in care delivery.

a quote from Joelle Simpson

Five leading children’s hospitals secure funding to enhance future pandemic readiness

a quote from Joelle Simpson A group of children’s hospitals from across the country will coordinate on the response to future pandemics and other disasters through a new $29 million grant from the Health Resources and Services Administration (HRSA). The group, known as the Pediatric Pandemic Network (PPN), will focus on the unique needs and challenges to children during pandemics and disasters, ensuring that health equity is at the forefront of emergency planning.

The five hospitals are:

  • Children’s National Hospital in Washington, D.C. (lead institution)
  • Ann & Robert H. Lurie Children’s Hospital of Chicago
  • University of Alabama at Birmingham Department of Pediatrics at Children’s of Alabama
  • Children’s Mercy Kansas City
  • Seattle Children’s

“As the current pandemic has proven to the world, pandemics and public health crises magnify pre-existing environmental, health, social and economic inequities,” said Joelle Simpson, M.D., M.P.H., principal investigator of this grant and division chief of Emergency Medicine and medical director of Emergency Preparedness at Children’s National. “Communities of color not only feel the impact of pandemics and disasters far more severely than others, but also have more difficulty obtaining aid and assistance. If the needs of vulnerable populations are not addressed in emergency planning, the national disaster preparedness strategy could fail for all.”

The hospitals recognize that while the COVID-19 pandemic has been devastating for the entire world, the pediatric population in particular has been challenged by a lack of established coordination among pediatric care providers. In addition to addressing health equity, the funding facilitates the following:

  • Establishing pathways to gather and disseminate research-informed insights into how to care for children in a future pandemic to both medical providers and community organizations.
  • Developing a telehealth infrastructure to support the care of acutely ill children and expand mental health access.
  • Expanding pediatric-focused emergency preparedness and planning with a focus on behavioral health, social support, and educational services, all of which are typically provided by community organizations.

The hub for this grant will be located at the newly opened Children’s National Research & Innovation Campus – the site of the former Walter Reed Army Medical Center in Washington, D.C. Work will take place in the renovated Armed Forces Institute of Pathology, where past investigators made seminal discoveries in infectious diseases and pandemics. The former campus was named after Walter Reed because of his work around discovering the cause and prevention of outbreaks of yellow fever. This modern-day team of physician researchers intends to make equally important contributions to future pandemics and other disasters to help preserve the health of our nation’s children.

In September 2021, HRSA launched the Regional PPN by funding five pediatric hospitals to support the planning and preparation of children’s hospitals to respond to a global health threat. This new grant doubles the size and reach of the network in order to benefit all children in the nation.

Monika Goyal

Monika Goyal, M.D., recognized as the first endowed chair of Women in Science and Health

Monika Goyal

Dr. Goyal’s tireless efforts continue to push boundaries.

Children’s National Hospital named Monika Goyal, M.D., M.S.C.E., associate chief of Emergency Medicine, as the first endowed chair of Women in Science and Health (WISH) for her outstanding contributions in biomedical research.

About the award

Women have long been underrecognized in science. The WISH endowed chair, provided by the Children’s National Research Institute, hopes to change this, explained Vittorio Gallo, Ph.D., interim chief academic officer at Children’s National.

“Recent research shows that women academics in medicine are less likely to hold an endowed chair position than their male peers,” he said. “Therefore, it is crucial our institutions fully commit to exceptional women researchers by providing strong support and recognizing their accomplishments and contributions.”

Several influential women in health and science from across Children’s National strongly supported Dr. Goyal’s nomination, including Joelle Simpson, M.D., Naomi Luban, M.D., Catherine Bollard, M.D., M.B.Ch.B., Randy Streisand, Ph.D., Lisa Guay-Woodford, M.D., and Denice Cora-Bramble, M.D., M.B.A.

The big picture

With a track record of research focused on health equity – including studies on racial inequities in managing pain in the emergency department, racial and socioeconomic disparities in COVID rates among children, and development of interventions to mitigate disparities in sexual health outcomes for youth –  Dr. Goyal’s tireless efforts continue to push boundaries. Her research shines a spotlight on the toll of racism, bias and discrimination on the health of children.

“I am inspired by how far we’ve come yet humbled by how far we have yet to go,” Dr. Goyal said. “I hope to continue to be part of the movement that works to achieve equity both in health care outcomes as well as in our workforce.”

What they’re saying

After being named the first endowed chair of WISH, Dr. Goyal said she felt hopeful that times are changing and women are increasingly being recognized for their accomplishments.

“I am grateful for all the mentors and sponsors who have helped clear the path for me and excited to continue on this journey, helping pave new roads and build new bridges for all those who are on their way,” she said.

Dr. Goyal has been a trailblazer and has shone a spotlight on the power of pediatric emergency medicine, said Dr. Simpson, division chief of Emergency Medicine at Children’s National.

“She not only touches the lives of her patients though her research, but she’s a mentor to her colleagues and trainees,” she added. “Part of being recognized as a leader woman in science and health is symbolic of what others can achieve in this career when you’re passionate about what you do.”

Dr. Cora-Bramble, chief diversity officer at Children’s National and one of Dr. Goyal’s mentors, said she has proudly watched her mentee blossom. According to Dr. Cora-Bramble, Dr. Goyal blends unique skills as a brilliant child health equity researcher and a passionate advocate for those impacted by her work.

“Monika has earned this honor,” she said. “She is unrelenting in her quest to answer vexing questions and can communicate, at times troubling, findings from her research fluently and transparently.”

bacterium Neisseria gonorrhoeae

Tackling sexually transmitted infections with ED based intervention

bacterium Neisseria gonorrhoeae

The study proposes to leverage digital health technology in the ED to support the adolescent population.

Children’s National Hospital will develop an emergency department (ED) based intervention to tackle the sexually transmitted infections (STI) epidemic through implementation of broad screening into the clinical workflow. The work is being led by Monika Goyal, M.D., M.S.C.E, associate chief of Emergency Medicine at Children’s National, through a $4.1M award from the NIH’s National Institute of Allergy and Infectious Diseases.

Why it matters

STI’s disproportionately affect adolescents, and adolescents often rely on ED’s for care.

“Adolescent sexual health, and in particular, diagnosis and management of sexually transmitted infections, is of substantial public health importance yet understudied and underfunded,” says Dr. Goyal.

The details

The study proposes to leverage digital health technology in the ED by:

  • Integrating patient reported outcomes into the electronic health record to drive patient-engaged clinical decision support for improved STI detection.
  • Using mobile health through two-way text messaging to impact STI treatment adherence for improved adolescent sexual health outcomes and mitigation of disparities in the STI epidemic.

Dr. Goyal’s team cares for a diverse patient population with high rates of STIs. This grant, she says, is timely and needed, as it may confer significant public health impact and is consistent with the mission of Healthy People 2030, a U.S. Department of Health and Human Services initiative.

What’s unique

“I have had a longstanding commitment to improving the sexual health of adolescents,” Dr. Goyal adds. “It is exciting to have an opportunity to leverage digital health by harnessing the strengths of electronic health and text messaging platforms to improve care for youth.”

Research reported in this publication was supported by the National Institute Of Allergy And Infectious Diseases of the National Institutes of Health under Award Number R01AI163232. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

emergency signs

Social risk interventions significantly reduce asthma-related ED visits

emergency signs

In a systematic review and meta-analysis published in JAMA Pediatrics, researchers at Children’s National Hospital found that interventions focused on health, environment and community were associated with the greatest reduction in asthma-related emergency department visits and hospitalizations among children.

In a systematic review and meta-analysis published in JAMA Pediatrics, researchers at Children’s National Hospital found that interventions focused on health, environment and community were associated with the greatest reduction in asthma-related emergency department visits and hospitalizations among children. The findings suggest that addressing social risks may be a crucial component of pediatric asthma care to improve health outcomes.

“There are persistent and striking disparities in asthma outcomes among children,” said Jordan Tyris, M.D., hospitalist fellow at Children’s National and lead author. “Understanding how to address these is of utmost importance.”

“Literature on the spectrum of social factors, including social needs, social risks and social determinants, has increased recently across many aspects of health care,” adds Dr. Tyris. “But much of this literature has focused on adults with chronic conditions, for example diabetes or high blood pressure.”

The study authors searched PubMed, Scopus, PsychINFO, SocINDEX and CINAHL from January 2008 to June 2021 for U.S.-based studies evaluating the associations of interventions addressing one or more social risks with asthma-related emergency department visits and hospitalizations among children. The systematic review included 38 of the original 641 identified articles (6%), and the meta-analysis included 19 articles (3%). Overall, participation in social risk–based interventions, particularly those that addressed health literacy, home environmental conditions and peer support were associated with significantly reduced risks for asthma-related emergency department visits and hospitalizations among children.

You can read the full study, “Social Risk Interventions and Health Care Utilization for Pediatric Asthma: A Systematic Review and Meta-analysis” in JAMA Pediatrics.

stressed mom holding baby

An integrated approach to address perinatal mental health treatment

stressed mom holding baby

Perinatal mood and anxiety disorders (PMADs) are the most common complication of childbirth, with suicide as a leading cause of postpartum deaths.

Perinatal mood and anxiety disorders (PMADs) are the most common complication of childbirth, with suicide as a leading cause of postpartum deaths. PMADs are associated with poor maternal, infant and family outcomes. A new advocacy case study in Pediatrics led by a collaborative team of physicians at Children’s National Hospital describes the creation of the Task Force to formalize collaboration between hospital divisions, promote systems-level change and advocate for health care policy solutions.

Spearheaded by the Division of Emergency Medicine, the Goldberg Center for Community Pediatric Health and the Division of Neonatology at Children’s National, the #1 rated neonatology program in the country, the physicians who led this case study hope it can serve as a model for advocates looking to integrate PMAD screening within their own institutions. Children’s National is currently one of only a few children’s hospitals in the country that have implemented universal PMADs screening.

Lenore Jarvis, M.D., director of advocacy and health policy for the Division of Emergency Medicine at Children’s National, and Lamia Soghier, M.D., medical director of the Neonatal Intensive Care Unit (NICU) and the NICU Quality and Safety Officer at Children’s National, discussed this important work:

Q: What were you looking at with this case study?

A: Dr. Jarvis: This case study describes the implementation and outcomes of a multidisciplinary Perinatal Mental Health Task Force created at Children’s National in Washington, D.C. It was created to promote systems change and health care policy solutions for improved identification and treatment of PMADs.

Using the social-ecological model as a framework, the Task Force addressed care at the individual, interpersonal, organizational, community and policy levels. It then applied lessons learned from division-specific screening initiatives to create best practices and make hospital-wide recommendations.

This foundational work enabled us to build community bridges and break down internal barriers to shift our hospital toward prioritizing perinatal mental health. As a result, screening expanded to multiple hospital locations and the Perinatal Mental Health Screening Tool Kit was created and disseminated within the community. Task Force members also testified in governmental hearings and joined national organizations to inform policy, and Task Force and community collaborations resulted in significant grant funding.

Q: How is this work benefitting patients?

A: Dr. Soghier: Identification and early intervention for PMADs are imperative for improving health outcomes – not only for mothers but for their children and families too. Given the prevalence and negative consequences of untreated PMADs, we continue to innovate to improve the care we provide for infants and their families. We hope that this case study inspires others who value family mental health and are looking to integrate PMAD screening within their institutions.

Q: What are some of the barriers to getting this work implemented more widely?

A: Dr. Jarvis: One important thing to note is that families and medical providers alike may be unaware of how common PMADs truly are. On top of that, they’re unaware of the downstream negative impact it can have on the infant and family.

As a society, we must realize that PMADs can affect paternal caregivers. We need to have resources that also address fathers in addition to culturally and racially competent systems and resources for referral and linkage to care.

A: Dr. Soghier: Within medical systems, fragmented and siloed care delivery systems continue to be a barrier. Medical staff may also feel untrained and uncomfortable with addressing positive PMADs screens. Within the pediatric practice, differential access to services and reimbursement continue to be a concern, especially in a system where the parent is technically “not our patient.”

Identifying PMADs in our families and providing real-time resources and linkage to care has been invaluable to us. Ultimately, we seek to improve the care we provide to our infants and families and improve patient-family outcomes.

Read the full case study in the journal Pediatrics.

Timeline of major Task Force events

Timeline of major Task Force events. CES-D, Center for Epidemiologic Studies Depression Scale; DC, District of Columbia; PCORI, Patient-Centered Outcomes Research Institute.

Meghan Delaney

Meghan Delaney, D.O., M.P.H., receives 2021 James Blundell Award

Meghan Delaney

The British Blood Transfusion Society (BBTS) recognized Meghan Delaney, D.O., M.P.H., division chief of Pathology and Lab Medicine and director of Transfusion Medicine at Children’s National Hospital, with the James Blundell Award.

The James Blundell Award is the most prestigious award given by the BBTS. Introduced in 1984, this award is given to recipients for original research resulting in an important and significant contribution to the body of medical and or scientific knowledge within the field of blood transfusion.

“I am honored to receive this award from the British Blood Transfusion Society,” says Dr. Delaney. “The field of transfusion medicine is dynamic and provides an important part of our healthcare infrastructure.  It’s wonderful to have this recognition and I am grateful to the society for the award.”

She is professor of Pathology and Pediatrics at the George Washington University with over 100 manuscripts, 25 book chapters and over 60 presented abstracts. Dr. Delaney serves as a member of the Board of Directors for the Association for the Advancement of Blood & Biotherapies (AABB), is a Scientific Member of the BEST Collaborative and is a member of the American Board of Pathology Test Development and Advisory Committee. She serves as the chair of the National Institutes of Health’s BLOODSAFE Program that aims to improve access to safe blood in Sub Saharan Africa.

Dr. Delaney received the award on September 14 at the 2021 BBTS Annual Conference, where she presented the lecture titled: “Access to safe blood transfusion in low- and middle-income nations: From ‘big data’ to mosquitos.”

Drs. Katie Donnelly, Panagiotis Kratimenos, Rana Hamdy, Shayna Coburn and Brynn Marks

Five Children’s National Hospital faculty named to Society for Pediatric Research

Drs. Katie Donnelly, Panagiotis Kratimenos, Rana Hamdy, Shayna Coburn and Brynn Marks

The Society for Pediatric Research (SPR) announced five new members from Children’s National Hospital: Drs. Rana Hamdy, Panagiotis Kratimenos, Brynn Marks, Shayna Coburn and Katie Donnelly.

The Society for Pediatric Research (SPR) announced five new members from Children’s National Hospital. Established in 1929, SPR’s mission is to create a multi-disciplinary network of diverse researchers to improve child health.

Membership in SPR is a recognized honor in academic pediatrics. It requires nomination by academic peers and leaders as well as recognition of one’s role as an independent, productive child health researcher.

“I am so proud of our faculty and all that they have accomplished. I am thrilled that they have been recognized for their achievements,” said Beth A. Tarini, M.D., M.S., SPR president and associate director for the Center for Translational Research at Children’s National Hospital.

SPR 2021 active new members from Children’s National are:

    • Katie Donnelly, M.D., M.P.H., attending physician in the Emergency Department at Children’s National Hospital. She is the medical director for Safe Kids DC, an organization dedicated to preventing accidental injuries in children in Washington DC. Her personal research interest is in preventing firearm injuries in children and she is a member of Safer through Advocacy, Firearm Education and Research (SAFER), a multidisciplinary team dedicated to firearm injury prevention at Children’s National. She is also the medical director of the newly founded hospital-based violence intervention program at Children’s National and an associate professor of pediatrics and emergency medicine at The George Washington University.“To be recognized by my peers as a researcher with a significant contribution to our field is very validating. It also opens a world of potential collaborations with excellent scientists, which is very exciting!” said Dr. Donnelly. “I am grateful for the immense support offered to me by the Division of Emergency Medicine to complete the research I am passionate about, especially my mentor Monika Goyal.”
    • Panagiotis Kratimenos, M.D., Ph.D., newborn intensivist and neuroscientist at Children’s National. He studies mechanisms of brain injury in the neonate, intending to prevent its sequelae later in life. Dr. Kratimenos’ interest lies in identifying therapies to prevent or improve neurodevelopmental disabilities of sick newborns caused by prematurity and perinatal insults.“Being a member of SPR is a deep honor for me. SPR has always been a ‘mentorship home’ for me since I was a trainee and a member of the SPR junior section,” said Dr. Kratimenos. “A membership in the SPR allows us to access a very diverse, outstanding team of pediatric academicians and researchers who support the development of physician-scientists, honors excellence through prestigious grants and awards, and advocates for children at any level either locally, nationally, or internationally.”
    • Rana Hamdy, M.D., M.P.H., M.S.C.E., pediatric infectious diseases physician at Children’s National and Director of the Antimicrobial Stewardship Program. She is an assistant professor of pediatrics at George Washington University School of Medicine and Health Sciences. Her area of expertise focuses on the prevention and treatment of antimicrobial resistant infections and the promotion of good antimicrobial stewardship in inpatient and outpatient settings.“It’s an honor to be joining the Society for Pediatric Research and becoming part of this distinguished multidisciplinary network of pediatric researchers,” said Dr. Hamdy. “I look forward to the opportunity to meet and work with SPR members, make connections for future collaborations, as well as encourage trainees to pursue pediatric research through the opportunities that SPR offers.”
    • Shayna Coburn, Ph.D., director of Psychosocial Services in the Celiac Disease Program at Children’s National. She is a licensed psychologist specializing in coping and interpersonal relationships in chronic illness treatment, particularly for conditions involving specialized diets. She holds an appointment as assistant professor of psychiatry and behavioral sciences at The George Washington University School of Medicine and Health Sciences. Her work has focused on promoting effective doctor-patient communication, reducing healthcare disparities and supporting successful adherence across the developmental span of childhood and adolescence. She currently has a Career Development Award from National Institute of Diabetes and Digestive and Kidney Diseases to refine and test a group intervention designed to improve self-management and quality of life in teens with celiac disease.
      “I hope that my background as a psychologist researcher will help diversify SPR. As an SPR member, I hope to encourage more opportunities for training, awards, and other programs that would be inclusive of clinician researchers who may not hold a traditional medical degree,” said Dr. Coburn.
    • Brynn Marks, M.D., M.S.-H.P.Ed., endocrinologist at Children’s National. As a clinical and translational scientist her goal is to use unique personal experiences and training to optimize both patient and provider knowledge of and behaviors surrounding diabetes technologies thereby realizing the potential of diabetes technologies improve the lives and clinical outcomes of all people living with diabetes. Her experiences as a person living with Type 1 diabetes have undoubtedly shaped her clinical and research interests in diabetes management and medical education.
      “It is an honor to be accepted for membership in the Society for Pediatric Research,” said Dr. Marks.  “Being nominated and recognized by peers in this interprofessional pediatric research community will allow me networking and growth opportunities as I continue to advance my research career.”
illustration of lungs with coronavirus inside

Study compares outcomes of SARS-CoV-2 versus other respiratory viruses

illustration of lungs with coronavirus inside

Until now, little was known about the incidence and virus-specific patient outcome of SARS-CoV-2 compared to common seasonal respiratory viruses in children — including respiratory syncytial virus (RSV), human parainfluenza (hPIV), human metapneumovirus (hMPV), respiratory adenovirus and human rhinovirus (hHRV) and respiratory enterovirus (rENT).

Common respiratory viral infections were associated with a higher proportion of inpatient admissions but were similar in intensive care unit (ICU) admissions and death rates in hospitalized pediatric patients when compared to SARS-CoV-2, according to Children’s National Hospital researchers that led a study published in Infection Control & Hospital Epidemiology.

Until now, little was known about the incidence and virus-specific patient outcome of SARS-CoV-2 compared to common seasonal respiratory viruses in children — including respiratory syncytial virus (RSV), human parainfluenza (hPIV), human metapneumovirus (hMPV), respiratory adenovirus and human rhinovirus (hHRV) and respiratory enterovirus (rENT).

The researchers also noted that there was an overall substantial decrease in seasonal respiratory viral infections, especially the severe forms that require hospitalization. They believe that this correlation might be associated with the adoption of COVID-19 public health mitigation efforts, which played a major role in the reduction of these viruses that often circulate in fall and winter. The retrospective cross-sectional cohort study analyzed over 55,000 patient admissions between Match 15 and December 31, 2020. The findings shed light on the incidences of eight common seasonal respiratory viral infections before and during the COVID-19 pandemic. It also compared patient outcomes associated with COVID-19 and these other viral infections among pediatric patients at Children’s National.

Xiaoyan Song, Ph.D., M.Sc., chief infection control officer at Children’s National, spoke to us about the study.

Q: Why is this important work?

A: This is the first study to date that has described and compared hospitalization rates, ICU admission rates and death associated with COVID-19, RSV, seasonal influenza, rhinovirus, enterovirus and other common respiratory viral infections in children in one study. Previously, studies have compared one or two viruses at a time. This study compared 8 viruses, including the most detected ones – COVID-19, RSV, seasonal flu, rhinovirus and enterovirus.

Q: How will this work benefit patients?

A: This study will inform patients, families and the public that preventative measures like masking, hand hygiene, avoiding crowds and avoiding people who are ill are good practices that work to protect children from getting COVID-19 but also from getting infected with RSV, influenza and other viruses. Any of these respiratory viruses could harm a patient to a point where the child may have to be hospitalized or receive ICU care.

You can read the full study published in Infection Control & Hospital Epidemiology.