Emergency Medicine

illustration of bacterial outbreak

$2.2m grant to support AI-driven sepsis program for pediatric care

illustration of bacterial outbreak

Sepsis is a rapidly progressing, life-threatening condition characterized by organ dysfunction (OD) resulting from an immune response to infection.

Researchers at Children’s National Hospital are investigating pediatric sepsis, a leading cause of in-hospital death, particularly in underserved and minoritized populations.

A new Maximizing Investigators’ Research Award (MIRA) (R35) is granting over $2.2 million to Children’s National to establish a comprehensive sepsis program that will include a diagnostic artificial intelligence (AI) based, biomarker-enhanced platform for early recognition of pediatric sepsis and cutting-edge, extracellular vesicle-based therapeutics that can significantly decrease mortality and long-term disease sequelae.

MIRA provides support for research in an investigator’s laboratory that falls within the mission of The National Institute of General Medical Sciences.

Why it matters

Sepsis, defined as a rapidly progressive, is a life-threatening organ dysfunction (OD) due to an immune dysregulation as a response to infection. In the U.S., it results in over 75,000 pediatric admissions on an annual basis with an associated mortality rate of 5 to 20%.

“Sepsis has been linked to 20% of deaths worldwide and despite some recent advances in diagnostic tools, the lack of accurate definitions and heterogeneity of this clinical syndrome have led to delays in recognition and treatment with deleterious effects on the health of millions of children, especially those from minority groups,” says Ioannis Koutroulis, M.D., Ph.D., M.B.A., research director of Emergency Medicine at Children’s National. “Additionally, current sepsis therapeutic regimens are mostly supportive, lack the necessary personalization and fail to address the underlying physiological processes leading to sepsis-induced life threating organ failure.”

How does it move the field forward

High mortality rates and no significant new treatments in recent years due to sepsis presents a critical opportunity to make a global impact. Advancements in early recognition and intervention could save millions of lives. By utilizing AI and biomarkers for the early detection of sepsis in children, medical professionals could have the potential to greatly improve outcomes by enabling timely treatment.

“There is an urgent need to focus more attention on this condition and develop effective solutions to combat its devastating effects,” Dr. Koutroulis adds.

How we’re leading the way

The high-volume pediatric emergency room will serve as a crucial site for recruiting patients. With access to state-of-the-art laboratories, the research will be conducted in facilities equipped with cutting-edge technology, ensuring accurate and efficient analysis. This combination of a high patient volume and advanced research infrastructure will enable the program to deliver reliable results and make significant strides in the fight against pediatric sepsis.

“This grant will allow for early recognition of pediatric sepsis and treatment with an innovative approach using extracellular vesicle-based therapies that can directly affect immune and metabolic processes,” Dr. Koutroulis said.

collage of news logos

Children’s National in the News: 2024

Collage of news organization logos: POLITICO, The Washington Post, CNN, NBC News, TODAY, NPR, The New York Times, and Healio.In 2024, Children’s National Hospital continued to make remarkable strides across diverse areas of pediatric medicine, from groundbreaking technological innovations to critical health advocacy. The following compilation showcases ten significant stories that demonstrate the breadth and depth of the hospital’s impact, as featured in major national news outlets including NBC Nightly News, CNN, The Washington Post, The New York Times, NPR, The Today Show, Healio, and POLITICO. Delve into our 2024 news highlights for more.

1. World’s smallest pacemaker gives new hope to babies with heart defects

Charles Berul, M.D., and a patient family talk about the pill-sized pacemaker that saved the life of Abby, an infant born with deadly heart defects. (NBC Nightly News)

2. ‘A $10 death trip’: Fentanyl is killing teens. Meet one fighting for his life

Sivabalaji Kaliamurthy, M.D., addiction psychiatrist and director of the Addictions Program, spoke to CNN about the impact of drug addiction on teen health and the lack of resources available to treat opioid use disorder. (CNN)

3. Health panel urges interventions for children and teens with high BMI

Susma Vaidya, M.D., M.P.H., associate medical director of the IDEAL Clinic, shared her concerns about childhood obesity treatment recommendations issued today by a leading panel of independent U.S. health experts. (The Washington Post)

4. An Rx for food? Doctor’s offices offer groceries to those in need

Shideh Majidi, M.D., M.S.C.S., and Emily Frymark, clinical dietitian, spoke about how the food pharmacy, created in partnership with the Capital Area Food Bank, benefits patients with diabetes and other chronic conditions. (The Washington Post)

5. First patient begins newly approved sickle cell gene therapy

Kendric Cromer, a 12-year-old boy being treated at Children’s National Hospital, became the first person in the world with sickle cell disease to begin a commercially approved gene therapy that may cure the condition. “This is a big effort,” says David Jacobsohn, M.D., ScM, M.B.A. (The New York Times)

6. ‘We created this problem’: A pediatric surgeon on how gun violence affects children

Mikael Petrosyan, M.D., associate chief of General and Thoracic Surgery, discusses the stress medical staff face when treating young victims of gun violence. (NPR)

7. 7th grade boy rings bell after final round of chemotherapy

Landon, an 11-year-old patient, rang the bell at Children’s National Hospital with family, friends, doctors and nurses cheering after finishing his final round of chemotherapy. (The Today Show)

8. Study: One in three adolescents experience ‘period poverty’

Monika Goyal, M.D., M.S.C.E., pediatric emergency medicine specialist and co-director of the Center for Translational Research, emphasized the need for awareness in addressing period poverty in teenagers and young adults. (Healio)

9. The AI assurance labs are coming

Kolaleh Eskandanian, Ph.D., M.B.A., P.M.P., vice president and chief innovation officer, participates in a panel discussion covering AI data collection, associated risks, reliance and other topics related to artificial intelligence. (POLITICO)

10. First day of a ‘new life’ for a boy with sickle cell

Children’s National patient Kendric Cromer, 12, became one of the first children ever to be treated with a newly approved gene therapy that will free him from the sickle cell disease that has stolen his childhood. (The New York Times)

2024 with a lightbulb instead of a zero

The best of 2024 from Innovation District

2024 with a lightbulb instead of a zero2024 marked another groundbreaking year for Children’s National Hospital, showcasing remarkable advances across the spectrum of pediatric medicine, research and healthcare innovation. From pioneering surgical procedures to breakthrough artificial intelligence applications, the institution continued to push the boundaries of what’s possible in children’s healthcare. Read on for our list of the most popular articles we published on Innovation District in 2024.

1. Prenatal COVID exposure associated with changes in newborn brain

A study led by researchers at Children’s National Hospital showed that babies born during the COVID-19 pandemic have differences in the size of certain structures in the brain, compared to infants born before the pandemic. The findings suggest that exposure to the coronavirus and being pregnant during the pandemic could play a role in shaping infant brain development.
(3 min. read)

2. Children’s National Hospital again ranked among the best in the nation by U.S. News & World Report

Children’s National Hospital was ranked as a top hospital in the nation by the U.S. News & World Report 2024-25 Best Children’s Hospitals annual rankings. This marks the eighth 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.
(2 min. read)

3. Children’s National performs first ever HIFU procedure on patient with cerebral palsy

In January 2023, a team of multidisciplinary doctors performed the first case in the world of using bilateral high intensity focused ultrasound (HIFU) pallidotomy on Jesus, a 22-year-old patient with dyskinetic cerebral palsy. The procedure is part of a clinical trial led by Chima Oluigbo, M.D., pediatric neurosurgeon at Children’s National Hospital.
(3 min. read)

4. Novel ultrasound device gets FDA breakthrough designation with Children’s National support

A novel ultrasound device developed by Bloom Standard received the Food and Drug Administration’s valued breakthrough device designation with the help of Children’s National Hospital. The device that enables autonomous, hands-free ultrasound scans to be performed anywhere, by any user.
(2 min. read)

5. First-of-its-kind pilot study on the impacts of Lyme disease in pregnancy and infant development

Understanding the effects of Lyme disease on the developing fetal brain is essential to ensure timely prenatal and postnatal treatments to protect the fetus and newborn. In response to this need, Children’s National Hospital is leading a pilot study to establish the groundwork needed for a larger study to determine the effect of in utero exposure to Lyme disease on pregnancy and early childhood neurodevelopmental outcomes.
(3 min. read)

6. Earliest hybrid HLHS heart surgery kids thrive 5 years later

Five years ago, Cayden was born 6 weeks early weighing less than four pounds and at risk of dying from her critical congenital heart disease. Today, she’s a happy five-year-old. Early diagnosis of her hypoplastic right ventricle, double inlet left ventricle and critical coarctation of the aorta allowed for the team at Children’s National Hospital to create a careful plan for safe delivery and to offer an innovative hybrid HLHS surgical approach at the hospital within 24 hours after she was born.
(1 min. read)

7. Wayne J. Franklin, M.D., F.A.C.C., named senior vice president of the Children’s National Heart Center

Children’s National Hospital appointed Wayne J. Franklin, M.D., F.A.C.C., as the new senior vice president (SVP) of the Children’s National Heart Center. In this role, Dr. Franklin oversees the full spectrum of heart care services including cardiac imaging and diagnostics, interventional cardiology, electrophysiology, cardiac anesthesia, cardiac surgery and cardiac intensive care.
(2 min. read)

8. Artificial – and accelerated – intelligence: endless applications to expand health equity

By pioneering artificial intelligence (AI) innovation programs at Children’s National Hospital, Marius George Linguraru, D.Phil., M.A., M.Sc., and the AI experts he leads are ensuring patients and families benefit from a coming wave of technological advances. The team is teaching AI to interpret complex data that could otherwise overwhelm clinicians.
(4 min. read)

9. Evidence review: Maternal mental conditions drive climbing death rate in U.S.

Painting a sobering picture, a research team led by Children’s National Hospital culled years of data demonstrating that maternal mental illness is an under-recognized contributor to the death of new mothers. They called for urgent action to address this public health crisis.
(3 min. read)

10. Nathan Kuppermann, M.D., M.P.H., named chief academic officer and chair of Pediatrics

Children’s National Hospital appointed Nathan Kuppermann, M.D., M.P.H., as its new executive vice president, chief academic officer and chair of Pediatrics. In this role, Dr. Kuppermann oversees research, education and innovation for the Children’s National Research Institute as well as academic and administrative leadership in the Department of Pediatrics at George Washington University School of Medicine & Health Services.
(2 min. read)

11. First global clinical trial achieves promising results for hypochondroplasia

Researchers from Children’s National Hospital presented findings from the first clinical trial of the medication vosoritide for children with hypochondroplasia – a rare genetic growth disorder. During the phase 2 trial, researchers found vosoritide increased the growth rate in children with hypochondroplasia, allowing them to grow on average an extra 1.8 cm per year.
(2 min. read)

12. Pioneering research center aims to revolutionize prenatal and neonatal health

Since its establishment in July 2023, the Center for Prenatal, Neonatal & Maternal Health Research at Children’s National Hospital has gained recognition through high-impact scientific publications, featuring noteworthy studies exploring the early phases of human development.
(3 min. read)

American Pediatric Society logo with APS initials and text American Pediatric Society, since 1888.

Children’s National expands 2025 American Pediatric Society class with new inductees

American Pediatric Society logo with APS initials and text American Pediatric Society, since 1888.Children’s National Hospital has expanded its class of American Pediatric Society (APS) members with three new inductees for 2025. The newest APS members include Ioannis Koutroulis, MD, PhD, MBA, research director and emergency medicine physician, Beth Tarini, MD, MPH, MBA, co-director of the Center for Translational Research, and Pavan Zaveri, MD, MEd, emergency medicine physician.

Dr. Tarini will also receive the 2025 Norman J. Siegel New Member Outstanding Science Award for her considerable contributions to pediatric science during the APS Presidential Plenary at the Pediatric Academic Societies 2025 Meeting in Honolulu, Hawaii, April 24 – April 28.

“I am deeply honored to receive the Norman J. Siegel New Member Outstanding Science Award from the American Pediatric Society,” said Dr. Tarini. “This recognition is a testament to the steadfast encouragement and support I have received from my mentors, colleagues, and family throughout my journey. I consider the opportunity to conduct research that optimizes health services for children and their families a privilege and a joy.”

APS members are recognized child health leaders of extraordinary achievement who work together to shape the future of academic pediatrics. Current members nominate new members by recognizing individuals who have distinguished themselves as child health leaders, teachers, scholars, policymakers and clinicians.

“I am deeply honored to be selected as a member of the American Pediatric Society,” said Dr. Zaveri. “I look forward to the opportunity to engage with esteemed leaders in pediatrics across various disciplines as we work together to advance the society’s mission and contribute to the growth of pediatrics through research and mentorship.”

Benefits of APS membership include:

  • Recognition and acknowledgment as a leader in pediatrics: APS members include individuals who have distinguished themselves as academic leaders, teachers and researchers whose contributions to academic pediatrics have garnered national and international recognition.
  • A network of child health professionals: Membership in APS is dedicated to the advancement of child health through the promotion of pediatric research, recognition of achievement and cultivation of excellence through advocacy, scholarship, education and leadership development.
  • Advocacy for child health: In order to speak with one voice on behalf of child health, APS provides representation in Washington, D.C., through the Pediatric Policy Council which combines the advocacy efforts of the APS, the Society for Pediatric Research, the Association of Medical School Pediatric Department Chairs and the Academic Pediatric Association.

“I am grateful to accept this honor from the APS,” said Dr. Koutroulis. “As both a physician and a researcher, I look forward to collaborating with distinguished experts within this network to help advance the development of pediatric care.”

Emergency department nurse with patient

Investment in pediatric emergency care could save over 2,100 lives annually

Emergency department nurse with patient

By becoming highly “pediatric ready,” emergency departments could prevent the deaths of 2,143 children each year with an annual cost between $0 and $12 per child resident, depending on the state.

In emergencies, children have distinct needs. Yet 83% of emergency departments (EDs) nationwide are not fully prepared to meet them. A new study has found that bridging that gap, known as becoming highly “pediatric ready,” could prevent the deaths of 2,143 children each year with an annual cost between $0 and $12 per child resident, depending on the state.

“Our country can afford it, and we owe it to our children to do it,” says the study’s senior author Nathan Kuppermann, M.D., chair of Pediatrics and chief academic officer at Children’s National Hospital.

The research team – led by Oregon Health & Science University and Children’s National – analyzed data from 4,840 EDs, focusing on 669,019 children at risk for death upon seeking care. Using predictive models, they assessed how every ED achieving high pediatric readiness – defined as scoring at least 88 out of 100 on the National Pediatric Readiness Project assessment – could impact mortality rates.

“The National Pediatric Readiness Project outlines essential pediatric capabilities for EDs, such as the availability of essential pediatric equipment and pediatric-specific training,” says Dr. Kuppermann, an emergency medicine physician. “While a perfect score of 100 is ideal, past research shows a score of 88 or higher can reduce mortality risk by up to 76% for ill children and 60% for injured children.”

Why it matters

In Maryland, an additional cost of $1.10 per child could save 17 pediatric lives annually, adjusted for population size. In Virginia, $2.42 per child could save 29 lives annually, and $1.59 per child in the District of Columbia could save 16 lives annually. The research team said strategies for implementing the findings would require regulation, incentives and policy-based initiatives.

“This study builds on a growing body of research demonstrating that every hospital can and must be ready for children’s emergencies,” says lead author Craig Newgard, M.D., M.P.H., an emergency physician at Oregon Health & Science University. “For the first time, we have comprehensive national and state-by-state data that emphasizes both the urgency and feasibility of this work.”

The patient benefit

Headshot of Nathan Kuppermann, MD, MPH

“Our country can afford it, and we owe it to our children to do it,” says the study’s senior author Nathan Kuppermann, M.D., chair of Pediatrics and chief academic officer at Children’s National Hospital.

By applying the potential reduction in mortality associated with high readiness to the number of children at risk of death, the researchers identified the number of lives that could be saved each year. State-specific estimates, adjusted for population size, ranged from 0 preventable deaths in Delaware to 69 in South Dakota.

“Achieving high readiness levels can be challenging for small emergency departments with fewer resources, typically in more rural areas. The result is significant inequity and large healthcare deserts in pediatric emergency care across the United States,” Dr. Kuppermann says. “Yet we found the cost of elevating care to the highest quartile of pediatric readiness is not very high.”

What’s next

The study authors estimate achieving universal high pediatric readiness across the United States would cost approximately $207 million annually. Per-child costs by state to raise ED readiness from current levels ranged from $0 to $12 per year.

“This research emphasizes the urgent need for widespread investment in pediatric readiness,” says Kate Remick, M.D., co-author and emergency physician with the Dell School of Medicine at the University of Texas at Austin. “The National Pediatric Readiness Project has provided a roadmap for improvement. But we need the full engagement of clinicians, healthcare administrators, policymakers and families to make universal pediatric readiness a reality.”

The study outlines several strategies to improve pediatric emergency care, such as integrating high pediatric readiness into hospital accreditation requirements and incentivizing readiness through performance-based reimbursement models.

This study was funded by a Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) Emergency Medical Services for Children Targeted Issue grant (H34MC33243-01-01) and an HHS National Institutes of Health (NIH) Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) grant (R24 HD085927). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HHS, HRSA, NIH, or the U.S. Government.

Headshot of Monika Goyal, M.D., M.S.C.E.

National Academy of Medicine elects gun violence, health equity expert

Headshot of Monika Goyal, M.D., M.S.C.E.

“It is an absolute honor and privilege to be elected to the National Academy of Medicine,” Dr. Goyal said. “I am committed to NAM’s mission of using science to inform policy for the achievement of health equity.”

The National Academy of Medicine (NAM) has elected Monika Goyal, M.D., M.S.C.E., to its international body of 2,400 leaders in medical sciences, healthcare and public health. One of the highest honors for physicians, the achievement is reserved for individuals who have demonstrated outstanding professional commitment and service.

Dr. Goyal, emergency medicine physician and co-director of the Center for Translational Research at Children’s National Hospital, was recognized for her national leadership in research focused on pediatric firearm injury prevention. She has spotlighted the burden of firearm violence on child health and advanced pediatric equity science. Her research has led to the development of interventions to address healthcare inequities.

“It is an absolute honor and privilege to be elected to the National Academy of Medicine,” Dr. Goyal said. “I am committed to NAM’s mission of using science to inform policy for the achievement of health equity.”

The big picture

The National Academy of Sciences established NAM in 1970 as the Institute of Medicine. The diverse organization requires that at least one-quarter of its membership be selected from fields outside the health professions, including law, engineering, social sciences and the humanities. NAM elected 90 regular and 10 international members during its recent annual meeting.

NAM works with the National Academy of Sciences and National Academy of Engineering. Upon election, NAM members commit to volunteering their services for National Academies activities.

Why we’re excited

“I am thrilled that Dr. Goyal is joining me in this incredible body that works to provide independent, objective analysis on complex scientific problems and public policy decisions,” said NAM member Nathan Kuppermann, M.D., M.P.H., chief academic officer and chair of Pediatrics at Children’s National. “Dr. Goyal’s contributions to pediatric health will be an incredible asset to the organization.”

2024-25 US News Badges

Children’s National again ranked among the best in the nation by U.S. News & World Report

U.S. News and World Report Best Children's Hospitals badges for 2024-2025: Honor Roll and Ranked in 11 Specialties.Children’s National Hospital in Washington, D.C., was ranked as a top hospital in the nation by the U.S. News & World Report 2024-25 Best Children’s Hospitals annual rankings. This marks the eighth 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.

This year, U.S. News ended ordinal rankings on its Honor Roll. Instead of assigning a numerical rank from 1 to 10, all hospitals on the Honor Roll will be recognized as having attained the highest standards of care in the nation.

In addition, Children’s National tied for #1 pediatric hospital in the Mid-Atlantic region, which includes New York, New Jersey, Delaware, Pennsylvania, the District of Columbia, West Virginia and Virginia. It’s also best in the Mid-Atlantic in Neonatology.

For the fourteenth straight year, Children’s National ranked in 10 specialty services. New this year, U.S. News included behavioral health as a service line in the rankings. Since it’s the first year, there are no ordinal rankings for behavioral health, but the Children’s National program was named one of the top 50 programs in the country.

“In my first year here, I witnessed what makes Children’s National so special — our commitment to collaboration, empowering one another, and charting a bold path forward for pediatric care,” said Michelle Riley-Brown, MHA, FACHE, president and chief executive officer of Children’s National. “I’m proud U.S. News again recognized Children’s National as one of the top in the nation and the highest-ranked pediatric hospital in D.C., Maryland and Virginia. Together, we’ll continue to push the boundaries of care, research and innovation to make a difference for those who matter most — the kids.”

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 nearly two decades, U.S. News has published Best Children’s Hospitals to empower the parents and caregivers of children with complex medical needs,” said Ben Harder, chief of health analysis and managing editor at U.S. News. “Children’s hospitals appearing on the U.S. News Honor Roll have a track record of delivering unparalleled 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 Children’s National specialty services that U.S. News ranked in the top 10 nationally are:

The other four specialties ranked among the top 50 are Behavioral Health, Cardiology and Heart Surgery, Pulmonology and Lung Surgery, and Urology.

AAP 2024 Conference logo

Children’s National Hospital the 2024 American Academy of Pediatrics meeting

Children’s National Hospital-affiliated participants will attend this year’s American Academy of Pediatrics National Conference and Exhibition. The meeting will take place in Orlando, Florida from September 27 to October 1. You will find a mini schedule of sessions below.

DateTimePresenterTitle
9/27/20248:00:00 AMBriony Varda, M.D.H1016: Section on Surgery Program: Day 1
9/27/20248:00:00 AMBriony Varda, M.D.H1017: Section on Urology Program: Day 1
9/27/20248:00:00 AMLowell Frank, M.D., FAAPH1014: Section on Cardiology and Cardiac Surgery Program: Day 1
Through the Looking Glass: Using Past Decisions to Inform Current and Future Clinical and Professional Practice
9/27/20242:30:00 PMBrian K. Reilly, M.D., FAAPS1208: Sounding the Alarm on Noise: Prevention Is Key
9/27/20244:00:00 PMBrandon Kappy, M.D., MPPS1312: Using Lessons From the East Palestine Train Derailment to Prepare for Environmental Disasters
9/28/20248:00:00 AMAlicia M. Tucker, M.D.H2013: Section on Obesity Program
9/28/20248:00:00 AMAnnie L. Andrews, M.D., MSCRH2011: Section on Emergency Medicine Program: Day 2
EmergiQuiz, State of the Section & SOEM Awards Presentations and 2024 PEMPix & Hot Topics in Pediatric Emergency Medicine
9/28/202412:00:00 PMMonika Goyal, M.D., M.S.C.E.
Prevalence of Period Poverty in a Pediatric Emergency Department
9/28/20243:30:00 PMAllison Markowsky, M.D., MSHS, FAAPS2412: What’s Trending in the Newborn Nursery: Controversies and Evidence
9/28/20245:00:00 PMBernhard L. “Bud” Wiedermann, M.D., M.A., FAAPS2507: Should I Change My Clinical Practice Based on a Hot New Article? Reading Journals With a Critical Eye
9/29/20248:30:00 AMDennis Ren, M.D.H3022: Section on Emergency Medicine Program: Day 3
Inaugural “Babble Royale” Competition & More Hot Topics in PEM; PediSonoFest
9/29/20249:00:00 AMNatasha Shur, M.D.S3208: Genetic Testing Boot Camp
9/29/20241:00:00 PMLamia Soghier, M.D., M.Ed., M.B.A., FAAPH3037: Section on International Medical Graduates Program
Opportunities and Paths for Career Development in Academic Pediatrics
9/29/20244:00:00 PMMargaret Rush, M.D., MSHSI3304: Emergencies in the Technology-Dependent Medically Complex Children: What Every Pediatrician Should Know
9/29/20245:00:00 PMAnjna Melwani, M.D.S3501: Emergencies in the Technology-Dependent Medically Complex Children: What Every Pediatrician Should Know
9/30/20242:00:00 PMRana F. Hamdy, M.D., M.P.H., MSCES4302: Diagnosis and Treatment of Community-Acquired Pneumonia
10/1/20249:00:00 AMNathaniel S. Beers, M.D., M.P.A., FAAPS5207: Eliminating Suspension, Expulsion, and Other Harsh Discipline Practices in Schools and Early Education

 

boy on cot in emergency shelter

New federally supported hub to advance solutions for pediatric health emergencies

boy on cot in emergency shelterClinicians caring for children are often left to rely on off-label devices and medications approved for adults, especially during public health crises, national disasters and other emergencies. To address this critical gap, Children’s National Hospital is launching a 10-year partnership with the federal Biomedical Advanced Research and Development Authority (BARDA) — valued at $1.5 million per year, with the possibility of an additional funding boost of up to $515 million.

This new pediatric-focused hub will be known as the SPARK Hub — or the Hub for Special Populations Acceleration, Research and Knowledge for Innovations in Pediatrics. It will join a network of four existing BARDA hubs to develop various tools for national health emergencies, including infectious disease outbreaks or chemical, biological, radiological and nuclear attacks. The new opportunity for Children’s National positions the organization as a leader among those working to ensure clinicians and their patients have the resources they need in crises, approved for kids and ready for clinical use.

BARDA is part of the Administration for Strategic Preparedness and Response within the U.S. Department of Health and Human Services (HHS), which leads the nation’s medical and public health preparedness, response and recovery efforts during disasters and public health emergencies. The new SPARK Hub led by Children’s National seeks to accelerate innovations that can detect, prevent or respond to the medical consequences of a health security threat for children. SPARK’s scope includes drugs, biologics, devices, diagnostics and digital health solutions that improve prevention, readiness and response.

Kolaleh Eskandanian, Ph.D., M.B.A., P.M.P., vice president and chief innovation officer at Children’s National and principal investigator of SPARK Innovations in Pediatrics, said the hospital was honored to take on this role, which “underscores our commitment to advancing the health and safety of children during public health emergencies.”

“To tackle the complex challenges in developing pediatric medical countermeasures, we have assembled an exceptional team of pediatrician-scientists,” Dr. Eskandanian said. “Their expertise will be instrumental as we partner with BARDA on this vital mission, ensuring that our most vulnerable populations receive the care and protection they deserve.”

Children’s National will lead the hub with its SPARK partners: BioHealth Innovation, Consortia for Improving Medicine with Innovation and Technology (CIMIT) at Mass General Brigham, and University Hospitals Rainbow Babies and Children’s. Johnson & Johnson Innovation JLABS and BLUE KNIGHT™ join the team as strategic industry partners.

The BARDA Accelerator Network aims to provide comprehensive support to health security innovators, startups and BARDA portfolio companies. Dr. Eskandanian said that innovators have ideas for devices, but they often could benefit from wrap-around support to accelerate their development through technical guidance, business and commercialization expertise, and resources. The network will facilitate the rapid development, evaluation, validation and commercialization of medical countermeasures.

“One of the critical challenges we face in safeguarding our children during public health emergencies is the limited medical countermeasures specifically approved for pediatric use,” Dr. Eskandanian said. “This creates significant ethical, legal and operational dilemmas when considering whether to use untested or off-label options for our youngest and most vulnerable populations.”

Children’s National has in-depth experience leading nonprofit accelerator programs to spur innovation in healthcare. It is currently serving its 11th year as leader of one of five pediatric consortia funded by the U.S. Food and Drug Administration, the Alliance for Pediatric Device Innovation, which focuses on bringing patients medical devices specifically evaluated and labeled for use in pediatrics.

Children’s National is also one of two leading hospital sites for the Pediatric Pandemic Network (PPN), which aims to empower healthcare systems and communities to provide high-quality, equitable care to children every day and in crises. The Health Resources and Services Administration, a part of HHS, funds the PPN.

Nathan Kuppermann

Q&A with Dr. Kuppermann: Collaboration is critical for scientific success

Nathan Kuppermann, M.D., M.P.H., is taking on a pivotal role at Children’s National Hospital as executive vice president, the new chief academic officer (CAO) and chair of Pediatrics to continue growing the institution’s reputation as a world-class research hospital. He brings more than 30 years of clinical experience in pediatric emergency medicine and research to the leadership role, where he will oversee nearly 2,000 active research projects at the Children’s National Research Institute.

Dr. Kuppermann knows that science drives cures and improved outcomes. Early in his career, he received enhanced research training at the Harvard School of Public Health, where he laid the groundwork to become a globally recognized clinical researcher. He has studied when to order CT scans for children with head, abdominal and neck trauma to minimize radiation exposure, how to best manage children with diabetic ketoacidosis, infants with febrile illnesses and other complex questions in pediatric emergency medicine that require a multidisciplinary research approach to improve clinical care.

Dr. Kupperman is thrilled to join the scientific community in the nation’s capital, which he sees as a global city where he can authentically share his culturally rich background. He is the son of Brazilian immigrants — a chemical physicist and an organic chemist — and he married a pediatric endocrinologist whose parents are from Mexico and Germany. They have three daughters, and their youngest was adopted from Guatemala. As a family, they travel extensively, and he cares deeply about global health, having served as associate dean for Global Health at UC Davis.

A high school point guard who still plays basketball, Dr. Kuppermann runs his team’s offense on the court, choreographing the flow of each game to optimize his team’s strengths. The position requires peripheral vision to get the ball to the right player and make everyone look good. He sees parallels with his new role as CAO.

Q: What is your approach to research in pediatric healthcare?

A: Fundamentally, my philosophy around research is that we all need to collaborate. When I started doing my own research, I realized over time that to have big, impactful studies, two things had to happen: First, you need to work with people who have expertise beyond your own. I’m a big believer in team science and bench-to-bedside research, collaborating with people with complementary research skills.

Second, I realized that in pediatric research, you must collaborate in research networks to ensure your sample size has enough patients and patients from diverse populations to have definitive results and generalizable data.

Q: What values will you bring to the new role?

A: Three key elements come to mind. First, I’m a big believer in transparent communication, which is the root of everything good in life, whether it’s with your science, your friendships or your family.

I’m a big believer in team science. We all have certain areas of expertise, but if we want to combine our expertise to impact children and improve their health, we need to work together in teams, bringing together basic science researchers, clinicians, information technology specialists, knowledge-translation specialists and disseminators.

Finally, I am a cheerleader for science. As you develop your own science, you also are responsible for leading the next generation of scientists.  I’ve spent as much time being a scientific mentor as I have working to discover new knowledge through scientific inquiry.

Q: You talk extensively about your family’s international roots and how it drives your work. What is the role of diversity in medicine and how does that guide you?

A: Diversity is fundamental to healthcare. We in the medical community recognize the disparities in the care we deliver, which I’ve studied in my research. Diversity must not only be a research focus, but our teams must be diverse to better investigate — and work to resolve — these inequities of care.

Children’s National is both a hospital that is mindful of its immediate community and an institution that greatly values the diversity of its patients and its staff. It’s also highly ranked in research and cares deeply about global health, all of which are drivers in my work.

When I considered the potential of coming to Children’s National, I thought I might be able to help this already great institution further its mission by serving its immediate community, growing and developing its global health programs, and taking research here from its already great bones and accomplishments to the next level.

Q: What approach do you bring to clinical care?

A:  When I do a research study and enroll patients into a clinical trial, I think about the patient and others the research can impact. I frequently think of a quote by the late Paul Brodeur, a scientific writer who wrote a lot about asbestos, which is very powerful and meaningful to me: “Statistics are humans with the tears wiped away.”

And what it means to me is that we must be mindful as researchers that we’re talking about humans with our research. We’re not just talking about numbers, and we’re not just talking about getting grants and papers. We’re talking about how we can elevate the evidence and translate it to the bedside to improve the lives of humans.

Drs. Donnelly and Goyal

Inspired to make a change

Drs. Donnelly and Goyal

Drs. Donnelly and Goyal lead our efforts to support survivors of violence with a focus on prevention.

Children’s National Hospital created the Youth Violence Intervention Program in 2022 to build connections with patients and prevent future violence through follow-up support for them and their families.

The team works under the leadership of Katie Donnelly, M.D., M.P.H., the program’s medical director who is an emergency medicine physician. They care for children who are survivors of community violence, including gunshot wounds, stabbings or assaults. The program has cared for about 250 youth to date.

Dr. Donnelly and Monika Goyal, M.D., MSCE, associate division chief of Emergency Medicine and Trauma Services, lead our efforts to support survivors of violence with a focus on prevention. Dr. Goyal leads the Safer through Advocacy, Firearm Education and Research (SAFER) group. It works on a local and national level to reduce firearm injuries and deaths among children.

We spoke Drs. Donnelly and Goyal about their goals and the impact of this work.

The interview is edited for brevity.

What inspired you to launch the youth violence intervention program and SAFER?

Dr. Donnelly: Injury is a part of life, and it is something I can never fully protect any child from. But for me, the toughest cases are those caused by violence, particularly gun violence. We are seeing more kids come in with their second or third injury. Violence is a chronic disease that runs much deeper than a single injury. I wanted to do more to break the cycle and address its root causes, such as disconnection from school, unaddressed emotional trauma and poverty. I researched other hospital-based violence intervention programs and learned about the D.C. Office of Victim Services and Justice Grants. We established the program with funding from that entity.

Dr. Goyal: As we started to hear more about gun violence impacting youth, I felt like I needed to do something. Every time I care for a child in our trauma bay who suffered a gunshot wound, it just takes a piece of me. I co-founded SAFER in 2016 to make our communities safer for children so they can live healthy and fulfilling lives. It began with four physicians and has grown into a multidisciplinary team of more than 40 Children’s National experts who volunteer their time in addition to their regular duties.

What keeps you going when challenges feel insurmountable?

Dr. Donnelly: I try to focus on the kids’ successes. Last year we had several teens in the program enroll in D.C.’s Mayor Marion S. Barry Summer Youth Employment Program. They were so proud to show off the debit cards they received to process their earnings. I also think about the kids that our team has helped get back into school who are doing well. These successes are things you can’t always measure with graphs or reports. But I hold them close to my heart, and they are all inspiring.

Dr. Goyal: Gun violence has a ripple effect. Even if a child has not personally experienced gun violence, it may still touch their lives. They may have family members, neighbors or friends who are victims. Their neighborhoods may have experienced gun violence, so it impacts a child’s ability to feel safe. It is devastating. Our work through SAFER keeps me going. We are doing this by sharing evidence-based interventions, advocating for policies that protect kids, and educating families about safe firearm storage and use, among other efforts.

What do these efforts mean to you?

Dr. Donnelly: The work we do gets us a seat at the table to impact larger change, and that is gratifying. Children’s National has become the expert on pediatric firearm injuries in the D.C. region, and we work with local governments on gun violence prevention legislation. I also appreciate opportunities to share our knowledge with the community. I recently spoke at a Teach for America conference about how young teachers can talk about gun violence and safety in their classrooms.

Dr. Goyal: There have been so many feelings of helplessness, and we know we can’t make a difference in every child’s or family’s life. But we are committed to tackling this crisis and trying to prevent tragedies from happening again. It is humbling to be part of this work.

How can philanthropy support these programs?

Dr. Donnelly: External support is essential to sustaining the Youth Violence Intervention Program. We are thankful for the government funding to keep this work going, but D.C. has faced budget cuts, so it’s not always guaranteed. Also, most of the critical psychosocial support we provide is not reimbursed by insurance. This includes things like food and housing resources and transportation costs for kids to get to school or medical appointments safely. Philanthropic support would ensure that we can continue this work and expand the program. We need more Violence Intervention specialists and a trauma-focused mental healthcare provider so our patients don’t have to wait for services. There is much more we can do to ensure that families have what they need to thrive.

Dr. Goyal: I agree, there are so many opportunities for growth. We were grateful to receive a generous gift from the Honorable Ann Brown (former commissioner of the U.S. Consumer Product Safety Commission) to support some of our prevention efforts. These include expanding screenings in the E.D., developing trainings to help youth de-escalate conflict and advancing research to increase awareness of gun safety. Additional support would allow us to scale and grow our programs so we can make an even bigger impact.

Read more stories like this one in the latest issue of Believe magazine.

Monika K. Goyal, M.D., M.S.C.E., and Beth A. Tarini, M.D., M.S., M.B.A.

Drs. Goyal and Tarini to lead Center for Translational Research

Monika K. Goyal, M.D., M.S.C.E., and Beth A. Tarini, M.D., M.S., M.B.A.

As CTR co-directors, Drs. Goyal and Tarini will lead the hospital’s mission to advance translational science, clinical research and community health.

Children’s National Hospital has appointed two nationally regarded leaders in pediatric research – Monika K. Goyal, M.D., M.S.C.E., and Beth A. Tarini, M.D., M.S., M.B.A. – to head its Center for Translational Research (CTR), a hub of high-impact scientific investigation that touches nearly every pediatric specialty.

As CTR co-directors, Drs. Goyal and Tarini will lead the hospital’s mission to advance translational science, clinical research and community health. They will begin their new roles on July 1.

Moving the field forward

“It is truly an honor to lead the CTR at such a pivotal moment in pediatric health,” said Dr. Goyal, an emergency medicine specialist and health services researcher. “I look forward to helping Children’s National lead the science on advancing health equity for the patients, families and communities we serve, both locally and nationally.”

As the largest of the six centers within the Children’s National Research Institute, CTR is pivotal in finding groundbreaking ways to improve health across pediatric medicine. Using a “bench to bedside” approach, the CTR faculty strives to seamlessly translate science from the laboratory bench to the patient’s bedside, moving pediatric medicine forward as expeditiously as possible to bring advances into the community.

“CTR is uniquely positioned to solve the biggest healthcare issues facing our pediatric patients,” said Dr. Tarini, a pediatrician and national leader in newborn screening research and policy. “I look forward to leading our diverse faculty of physicians and researchers as they leverage their front-line experience and innovative research to improve child health.”

Why we’re excited

Dr. Tarini joined Children’s National in 2018 and is currently the associate director for CTR. She was recently promoted to tenured professor of Pediatrics at George Washington University and has extensively studied policies to optimize the delivery of genetic services to families of newborns. In January, Dr. Tarini was appointed to a National Academies of Sciences, Engineering and Medicine Committee to examine the current landscape of newborn screening systems, processes and research in the United States. Dr. Tarini has obtained $10 million in federal and foundation funding, and she has served as president of the Society for Pediatric Research.

Dr. Goyal joined Children’s National in 2012. She is the inaugural endowed chair for Women in Science and Health and has served as the associate division chief for Academic Affairs and Research within the Emergency Department since 2018. She was recently promoted to tenured professor of Pediatrics and Emergency Medicine at George Washington University. Dr. Goyal is a nationally renowned equity science scholar and has published over 130 peer-reviewed manuscripts. She has secured more than $25 million in federal and foundation funding to address disparities in adolescent sexual health, pain management and firearm violence.

Children’s National leads the way

Catherine Bollard, M.D., M.B.Ch.B., interim chief academic officer, said she looks forward to seeing the advances in pediatric health guided by these two outstanding researchers. “By harnessing the immense talent within Children’s National for our search, we found two exceptional leaders in Drs. Goyal and Tarini,” Dr. Bollard said. “Their work promoting research that accelerates discovery across the continuum of bench, bedside and community has already made a significant impact.”

person using a ChatBot

Study finds difficulty distinguishing between human and AI-written abstracts

person using a ChatBotA new study published in JAMA Pediatrics suggests healthcare professionals struggle to identify research abstracts written by artificial intelligence (AI) compared to those written by humans.

The study, led by Dennis Ren, M.D., emergency medicine provider at Children’s National Hospital, highlights the lack of established standards for the use of AI in scientific writing and publishing.

The big picture

The researchers presented 102 healthcare professionals with four research abstracts: two written by human researchers from the Pediatric Academic Societies Meeting in 2020, and two generated by ChatGPT 3.5 (OpenAI). The participants were asked to identify the abstracts’ origin and state how they made their determination.

The participants were able to identify the abstracts’ origins correctly 43% of the time, but accuracy ranged from 20% to 57%. This suggests that healthcare professionals cannot reliably distinguish between research abstracts written by humans and those written by AI. Interestingly, 72.5% of participants believed using AI for research abstracts was ethical.

Why it matters

AI tools are becoming more widely used in scientific research, including writing and editing scientific content. However, there are no set standards for what constitutes the appropriate use of AI in scientific writing and publishing. This study asks the critical question: can healthcare professionals even tell the difference between AI and human generated content?

In conclusion, the authors state that they have no reservations about using AI to generate abstracts or even full articles as long as the final product can be reviewed and edited.

“AI may help with knowledge dissemination, but it can also be a source of misinformation and disinformation,” says Dr. Ren. “We need to teach skills of critical thinking and critical appraisal to everyone.”

What’s next

The team is currently exploring other potential applications of AI, such as whether it may be useful in emergency department triage.

Read the full study, Identification of Human-Generated vs AI-Generated Research Abstracts by Health Care Professionals, in JAMA Pediatrics.

2024 Pediatric Academic Societies meeting logo

Children’s National Hospital at the 2024 Pediatric Academic Societies meeting

Children’s National Hospital-affiliated participants will present at this year’s Pediatric Academic Societies meeting. The meeting will take place in Toronto, from May 2-6, 2024. For information on the presentations, please refer to the chart below.

DayTimePresenter(s)Title
5/3/20249:00 AMStacey Stokes, M.D., M.P.H.APA QI: Informatics for Improvers: Leveraging Clinical Decision Support to Propel Data-Driven and Reliable Continuous Improvement
5/3/202412:00 PMRana F. Hamdy, M.D., M.P.H., MSCEA Career in Antimicrobial Stewardship… so Much More to Explore
5/3/202412:00 PMAshima Gulati, M.D., Ph.D., FASNCase Studies in Pediatric Kidney Diseases: Who, When and How to Order Genetic Testing?
5/3/20243:45 PMPriti Bhansali, M.D., ME.d.iSPOT an Improvement: Taking Peer Observation and Feedback to the Next Level
5/3/20243:45 PMJosepheen De Asis-Cruz, M.D., Ph.D.Maternal psychopathology and SSRI use during pregnancy are associated with altered fetal hippocampal connectivity in utero
5/4/20248:00 AMAndrea J. Boudreaux, Psy.D., M.P.H., M.H.A., F.A.C.H.E.A Doctor in the School Nurse’s Office? Bringing a Virtual School Based Program into Practice
5/4/20248:00 AMJessica Hippolyte, M.D., M.P.H.A Practical Approach to a Thorny Issue: Evaluating the Role of Race, Ethnicity, and Ancestry in Clinical Decision-Making
5/4/20248:00 AMAshraf S. Harahsheh, M.D., F.A.A.P., F.A.C.C.Cardiology 1
5/4/20248:00 AMDewesh Agrawal, M.D.Emergency Medicine 1: Quality and Safety
5/4/20248:00 AMLenore Jarvis, M.D., ME.d.
Amanda Stewart, M.D., M.P.H.		From Bedside to State House: Daily Advocacy
5/4/20248:00 AMAisha Barber, M.D., ME.d.Unionization in Pediatrics: A Pro-Con Debate
5/4/20248:45 AMJillian E. Nickerson, M.D., M.S.Implementation of tele-psychiatry in an urban pediatric satellite emergency department
5/4/20249:00 AMJessica Weisz, M.D.“TEACH”ing: Evaluation of a 3-Year Multimodal Child Poverty Curriculum
5/4/20249:00 AMTameka T. Watson, M.D.Timing of Growth Failure in Very Premature Infants and Implications for Brain Development
5/4/202410:00 AMNeha H. Shah, M.D., M.P.H.Subspecialty Networking Breakout: Pediatric Hospital Medicine
5/4/202411:00 AMLee S. Beers, M.D.AAP Presidential Plenary: Emerging Research on the Intersections of Mental Health, Impact of the Pandemic, and Equity, Diversity, and Inclusion
5/4/202411:00 AMDenver Brown, M.D.Implications of SDOH on glomerular disease, hypertension and CKD
5/4/202411:15 AMJosepheen De Asis-Cruz, M.D., Ph.D.Associations Between Antenatal Opioid Exposure and Newborn Functional Brain Connectivity
5/4/20242:00 PMIan Chua, M.D., M.H.P.E.Addressing Misinformation & Building Competency for Gender Diverse Patient Care
5/5/20248:00 AMTamara Gayle, M.D., ME.d., M.P.H.APA SIG: Pediatric Hospital Medicine – Creating an Inclusive and Sustainable Workplace
5/5/20248:00 AMSuma B. Hoffman, M.D., M.S.
Simranjeet S. Sran, M.E., ME.d., C.H.S.E., F.A.A.P.		Hands on Workshop: Complex Resuscitations in Neonates and Infants – Managing High Acuity, Low Occurrence (HALO) Events
5/5/20248:15 AMJaytoya Manget, D.N.P., M.S.P.H., F.N.P.Connecting the Dots to Improve Health and Education Equity: Results of A Pilot Program Integrating School Attendance Data into a Pediatric Primary Care
5/5/20248:55 AMAisha Barber, M.D., ME.d.APA Pediatric Hospital Medicine SIG – Creating an Inclusive and Sustainable Workplace
5/5/202411:00 AMNicola Brodie, M.D.
Julie Heier, Ph.D.
Courtney Horton, M.D.
Darcel Jackson, C.P.X.P., L.S.S.G.B.
Emma Whitmyre, Ph.D.		Challenge Accepted: Integrating Behavioral Health in Primary Care for Children with Medical Complexity and Their Families
5/5/202411:00 AMIan Chua, M.D., M.H.P.E.
Margarita Ramos, M.D., M.S.
Neha H. Shah, M.D., M.P.H.		Embracing Failure: The Key To Success In Academic Medicine
5/5/202411:00 AMCaleb E. Ward, M.B., B.Chir., M.P.H.Emergency Medicine 4
5/5/202411:00 AMDewesh Agrawal, M.D.
Terry Kind, M.D., M.P.H.		Launching and Landing a Career in Medical Education: From Passion to Profession
5/5/202411:00 AMNathaniel S. Beers, M.D., M.P.A.
Andrea J. Boudreaux, Psy.D., M.P.H., M.H.A., F.A.C.H.E.
Bianca Johnson, M.S.W.
Jaytoya Manget, D.N.P., M.S.P.H., F.N.P.
Jessica Weisz, M.D.		School Attendance as a Vital Sign: Integrating school attendance into practice to advance health and educational equity
5/5/202411:05 AMSudeepta Basu, M.D.SPR 2023 Bridging to Success Award: GABA-editing spectroscopy for understanding the developing brain in preterm infants.
5/5/20242:00 PMAllison M. Jackson, M.D., M.P.H.Child Protective Services Referrals in the Context of Intimate Partner Violence: Clinical Practice, Research, & Advocacy
5/5/20242:00 PMJosepheen De Asis-Cruz, M.D., Ph.D.In utero SSRI exposure alters fetal cerebral cortical development and structural brain connectivity
5/5/20242:00 PMJeremy Kern, M.D.
Lydia Lissanu, M.D.
Elana Neshkes, M.D.
Laura A. Nicholson, M.S.N., R.N., C.P.N., C.H.S.E.
Grace Quinn, M.D.
Ariella M. Weinstock, M.D., M.S. Ed		STRIVE for a restorative de-escalation: Strategies for a TRauma-Informed approach using Verbal and Environmental Skills
5/5/20242:45 PMKristen Sgambat, Ph.D., RDArterial stiffness, body composition, and perception of racism in pediatric kidney transplant recipients
5/5/20242:45 PMSudeepta Basu, M.D.Cerebellar GABA and Glutamate Concentrations at Term-equivalent age Predicts 18-month Cognitive Deficits in Preterm Infants
5/6/20248:00 AMIan Chua, M.D., M.H.P.E.
Gabrina Dixon, M.D., ME.d.
Tamara Gayle, M.D., ME.d., M.P.H.
Margarita Ramos, M.D., M.S.		Amplify Your Voice: Media Strategies Beyond Conventional Academic Dissemination
5/6/20248:00 AMStacey Stokes, M.D., M.P.H.
Padma Swamy, M.D., M.P.H.		APA SIG: Health Informatics and Serving the Underserved Combined – Moving the Needle on Social Needs: From Screening to Data Management and Response
5/6/20248:00 AMDeena Berkowitz, M.D., M.P.H.APA Urgent Care SIG: You’re Not Too Busy To Think About Promotion: Leveraging Your Current Scholarly Activities For Academic Advancement
5/6/20248:30 AMPadma Swamy, M.D., M.P.H.Screening, data sharing, and resource allocation considerations when developing social needs interventions
5/6/20241:00 PMChristina Lindgren, M.D.APA Simulation-based Medical Education (SBME) SIG
5/6/20241:00 PMGabrina Dixon, M.D., ME.d.Creating and Optimizing a Visiting Elective at your Institution for Underrepresented in Medicine (URiM) Students
5/6/20241:00 PMJunghoon Kim, Ph.D.Improved prediction of fetal neurobiological features by censoring high-motion frames in fetal functional MRI
5/6/20241:05 PMChristina Lindgren, M.D.Introduction to Conceptual Frameworks for Simulation Based Medical Education
5/6/20241:10 PMSuma B. Hoffman, M.D., M.S.Small Group Activity: Name That Conceptual Framework
5/6/20242:15 PMMargaret Rush, M.D., M.S.H.S.Racial disparities in hospital length of stay for bacterial tracheostomy associated infections

 

healthcare professional putting on PPE

Prioritizing equity in pediatric care strategies following the pandemic

healthcare professional putting on PPE

Societal inequities can affect differential health outcomes among various populations.

The emergence of the COVID-19 pandemic prompted an examination and acknowledgment of the societal inequities affecting differential health outcomes among various populations. There’s been a heightened focus on identifying and confronting the longstanding factors contributing to health disparities, particularly among historically marginalized and minoritized groups, which expose them to greater vulnerabilities during emergencies like a pandemic.

The hold-up in the field

In a recent study published in Pediatric Clinics of North America, the authors introduce a focus on health equity and the social determinants of health as applied to an overarching framework of pandemic preparedness.

“There is little shared about the role of pediatricians in planning for disasters — like in the aftermath of the pandemic — with a focus on health equity,” says Joelle Simpson, M.D., M.P.H., chief of Emergency Medicine at Children’s National Hospital and co-author of the paper.

Moving the field forward

The authors discuss recommendations for pediatricians in planning for disasters with a focus on health equity and social determinants of health. In their observations, they consider:

  • The COVID-19 pandemic amplified health inequities and placed tremendous strain on society, economy, education systems and healthcare infrastructure.
  • Building on pediatric readiness frameworks is a recommended approach to creating a pediatric pandemic plan.
  • Health equity considerations need to be built into all policies, processes and systems at the outset.
  • The evolving national discourse on racism and inequities across communities including social injustices faced by minoritized groups is important framing for pandemic planning across all phases of disaster including preparedness, response and recovery.

The patient benefit

“Community engagement and serving as a trusted messenger and committed partner in health is critical in the process of recovery,” the authors write.

They emphasize the importance of integrating health equity viewpoints into communication planning and formulating strategies for community involvement. Fortunately, there has been a rise in opportunities to collaborate and gain insights from established networks dedicated to children’s pandemic or disaster readiness. These networks include the Emergency Medical Services for Children state programs, Pediatric Disaster Centers of Excellence and the Regional Pediatric Pandemic Network.

Children’s National Hospital leads the way

Children’s National, a lead hub for the Pediatric Pandemic Network (PPN), elevates the importance of planning for disasters as it pertains to children. Through the PPN, children’s hospitals in the country coordinate, prepare and enable high-quality, equitable, research-based pediatric care in emergencies, disasters and pandemics. The network prioritizes addressing the distinctive requirements and obstacles faced by children amid pandemics and disasters, emphasizing the importance of integrating health equity into emergency planning efforts.

Pensive woman looking out the window

The role of healthcare providers in adolescent relationship abuse

Pensive woman looking out the window

Healthcare providers can play an important role in adolescent relationship abuse.

Adolescent relationship abuse (ARA) or “teen dating violence” is a significant public health concern that affects millions of adolescents in the United States and globally. Providers who care for adolescents must be prepared to promote healthy relationships and support ARA survivors given that adolescents experiencing this are at increased risk for negative health and psychosocial outcomes.

What this means

In a new article published in the journal Pediatric Clinics of North America, the authors comment on the opportunity healthcare providers have for ARA prevention using a universal education approach that provides information on healthy and unhealthy relationship behaviors and ARA resources. A shared decision-making approach when responding to ARA disclosure may facilitate patient-provider trust, safety, resource utilization and adolescent autonomy.

“It is important to consider several concepts that apply broadly across work with adolescents: adolescent development, healing-centered engagement, intersectionality, co-occurring forms of violence and ARA prevention,” said Lenore Jarvis, M.D., director of Advocacy and Health Policy for the Division of Emergency Medicine at Children’s National Hospital and the article’s author. “Linkage to resources that are not disclosure dependent may increase connection to resources, youth empowerment and autonomy.”

Why it matters

The study equips healthcare providers with concrete ways to address ARA within the healthcare setting. Providers can use the steps outlined to learn more about examples of abusive relationship behaviors, ARA indicators, healing-centered engagement approaches, universal education and screening recommendations, and ARA resources.

“Recommended language and scripts are also provided to further illustrate limits to confidentiality, universal education, indicator-based assessment, response to disclosure (victimization and perpetration), when mandatory reporting is indicated and safety planning,” Dr. Jarvis added.

Moving the field forward

A universal education approach that provides all youth with information on healthy relationships and resources for ARA provides opportunity for youth to access resources regardless of disclosure. A survivor-centered response to ARA disclosure includes validation and shared decision-making with the adolescent about resources and support, including a warm hand-off to victim services resources and connection to a trusted adult. Providers should address both immediate and long-term health needs and ongoing support after ARA disclosure.

“I find the development of healing-centered engagement approaches with adolescents to be exciting. Healing-centered engagement emphasizes both trauma and resilience as universal experiences, recognizes that trauma and healing occur within relationships and empowers adolescents to actively participate in their healing process,” Dr. Jarvis explained. “General practices that may facilitate healing-centered engagement in healthcare settings include ensuring awareness of limits to patient provider confidentiality, opportunity for resource connection that is not disclosure dependent, and a shared decision-making approach when ARA is disclosed. These practices can foster patient-provider trust, empower adolescents and minimize risk for potential unintended harm related to healthcare provision.”

The article also incorporates some of the lessons learned from Dr. Jarvis’ Centers for Disease Control and Prevention K01 grant award on “Addressing Relationship Abuse in a Pediatric Emergency Department.” Further, the co-authors work together in a national ARA and intimate partner violence workgroup to discuss evidence-based recommendations to provide the best care possible for patients and families with regards to interpersonal violence. Dr. Jarvis recently did a podcast on the subject of ARA for “Pediatric Meltdown.”

Headshot of Monika Goyal, M.D., M.S.C.E.

Q&A with Dr. Goyal: Trailblazing equity work leads to election to ASCI

Headshot of Monika Goyal, M.D., M.S.C.E.

Monika Goyal, M.D., MSCE, associate division chief of Emergency Medicine and Trauma Services

Monika Goyal, M.D., MSCE, associate division chief of Emergency Medicine and Trauma Services, is joining The American Society for Clinical Investigation (ASCI), one of a small cadre of pediatric emergency medicine physicians elected to the premier medical honor society for physician-scientists. Dr. Goyal considers her new honor a pivotal opportunity to represent pediatric emergency medicine, which is often underrepresented in research.

Interim Chief Academic Officer Catherine Bollard, M.D., M.B.Ch.B., nominated Dr. Goyal to ASCI because of her nationally renowned work as an equity science scholar, having published more than 130 peer-reviewed manuscripts and securing more than $25 million in funding from the National Institutes of Health (NIH). “From the very beginning of her career, Dr. Goyal has been a trailblazer as it relates to her research interests,” said Dr. Bollard, also an ASCI member.

Dr. Goyal serves as the inaugural chair for Women in Science and Medicine and associate division chief for Academic Affairs and Research at Children’s National Hospital. Her academic work has focused on disparities in the emergency setting, where she has studied the impacts of gun violence, pain management, sexual health and more. In 2023, the journal Pediatrics named a Children’s National manuscript on gun violence one of the 12 most significant papers in its 75-year history. Dr. Goyal was the first author and remains tremendously proud of the impact science can make on society.

Q: How did you find yourself investigating the science of gun laws?

A: A half-dozen years ago, three other pediatric emergency medicine physicians and I had been caring for countless numbers of children who had been victims of gun violence and felt motivated to act. I started SAFER at Children’s National – Safer through Advocacy, Firearm, Education and Research – which is now an institution-wide initiative to address gun violence within our community and beyond. More than 50 individuals at Children’s National are now active in our organization.

We’ve been able to publish a lot of research in this area, including our national study looking at the association between the strictness of gun laws with firearm-related deaths in children. We found that children are more likely to die from gun violence in states with less strict gun laws. It’s not surprising, yet the recognition by the American Academy of Pediatrics demonstrates the importance of using science to understand this, and it shows how far we’ve come in the medical community. Until recently, this issue has been under-recognized and under-supported, despite it being a massive public health crisis for our children and our country.

Q: Given the pace of emergency medicine, how did you find your way to research?

A: Early in my career, much of my work focused on adolescent sexual health. I kept finding that there was racial bias in terms of who we considered to be at risk for sexually transmitted infections. This finding then motivated me to investigate and understand whether racial bias impacted other aspects of care delivery across various clinical conditions in the Emergency Department.

I started by looking at whether differences existed in pain management based on a patient’s race. In evaluating data on children nationwide who are diagnosed with appendicitis, we found that Black children are less likely to receive appropriate pain management compared to white children, even after we adjusted for pain score and illness severity. We have found similar themes with respect to pain management among children diagnosed with fractures.

Q: What can be done?

A: We are grateful to have been awarded additional NIH funding to develop and test interventions to mitigate inequities. Currently, we are studying the impact of audit and feedback through the provision of what we are calling ‘equity report cards’ and clinical decision support embedded in the electronic health record to improve racial, ethnic and language equity in pain management.

Hundreds of studies have demonstrated that this is an issue at hospitals across the country. I am proud of Children’s National for having the humility for this self-reflection and the courage to do something about it. Our work here is helping to inform efforts across the country, and I am proud of our institution’s leadership in advancing health equity through community-informed, evidence-based interventions.

Boy lying in a hospital bed, surrounded by medical equipment

Black, Hispanic children at greater risk for complications during hospitalization

Boy lying in a hospital bed, surrounded by medical equipment

The research team found that patients who are Black and Medicaid-insured patients experienced the greatest disparities in postoperative sepsis, a rare complication in which patients suffer from infection that can cause multi-organ failure.

Evaluating more than 5 million pediatric hospital stays nationwide, researchers found children who are Black, Hispanic or insured with Medicaid face a greater risk of health events after surgeries than white patients, according to a new study published in the journal Pediatrics.

“We looked at the data, and we calculated the risks,” said Kavita Parikh, M.D., MSHS, medical director of Quality & Safety Research, research director of the Division of Hospital Medicine and first author on the multi-institute study. “Despite decades of focus on eliminating medical errors, we know that children continue to suffer substantial harms in hospital settings, and our study highlights where children who are Black, Hispanic or insured with Medicaid are at the greatest risk.”

The big picture

The study analyzed data from more than 5.2 million hospitalizations collected by the 2019 Kids’ Inpatient Database, a national repository of data on hospital stays. It includes a 10% sample of newborns and an 80% sample of other pediatric discharges from 4,000 U.S. hospitals. More than 80% of patients were younger than 1 year of age.

The research team found that patients who are Black and Medicaid-insured patients experienced the greatest disparities in postoperative sepsis, a rare complication in which patients suffer from infection that can cause multi-organ failure. Patients who are Hispanic experienced the greatest disparity in postoperative respiratory failure, a complication that can limit breathing and ventilation.

Plausible factors cited include structural racism in the U.S. healthcare system, clinician bias, insufficient cultural responsiveness, communication barriers and limited access to high-quality healthcare.

What’s ahead

The study – “Disparities in Racial, Ethnic, and Payor Groups for Pediatric Safety Events in U.S. Hospitals” – is foundational in understanding what is happening among pediatric patients. Dr. Parikh said that researchers now must conduct further studies into these alarming disparities and qualitative work to understand drivers, with the action-oriented goal of developing interventions to improve patient safety in the hospital for all children.

“We brought together leaders in pediatric medicine, health policy and public health to analyze this data, and we are committed to taking the next steps to improve outcomes for pediatric patients,” Dr. Parikh said. “It will take more patient-centered work and research, resources and multifaceted strategies to resolve these worrying disparities for our pediatric patients nationwide.”

collage of news outlet logos

Children’s National in the News: 2023

collage of news outlet logos
Explore some of the notable medical advancements and stories of bravery that defined 2023, showcasing the steadfast commitment of healthcare professionals at Children’s National Hospital and the resilient spirit of the children they support. Delve into our 2023 news highlights for more.

1. COVID during pregnancy dramatically increases the risk of complications and maternal death, large new study finds

According to a study published in British Medical Journal Global Health, women who get COVID during pregnancy are nearly eight times more likely to die and face a significantly elevated risk of ICU admission and pneumonia. Sarah Mulkey, M.D., prenatal-neonatologist neurologist, discussed findings based on her work with pregnant women and their babies.
(Fortune)

2. Rest isn’t necessarily best for concussion recovery in children, study says

A study led by Christopher Vaughan, Psy.D., pediatric neuropsychologist, suggests that — despite what many people may presume — getting kids back to school quickly is the best way to boost their chance for a rapid recovery after a concussion.
(CNN)

3. Pediatric hospital beds are in high demand for ailing children. Here’s why

David Wessel, M.D., executive vice president, chief medical officer and physician-in-chief, explained that one reason parents were still having trouble getting their children beds in a pediatric hospital or a pediatric unit after the fall 2022 respiratory surge is that pediatric hospitals are paid less by insurance.
(CNN)

4. Anisha Abraham details impact of social media use on children: ‘True mental health crisis’

Anisha Abraham, M.D., M.P.H., chief of the Division of Adolescent and Young Adult Medicine, joined America’s Newsroom to discuss the impact social media access has had on children’s mental health.
(FOX News)

5. Saving Antonio: Can a renowned hospital keep a boy from being shot again?

After 13-year-old Antonio was nearly killed outside his mom’s apartment, Children’s National Hospital went beyond treating his bullet wounds. Read how our Youth Violence Intervention Program team supported him and his family during his recovery.
(The Washington Post)

6. Formerly conjoined twins reunite with doctors who separated them

Erin and Jade Buckles underwent a successful separation at Children’s National Hospital. Nearly 20 years later they returned to meet with some of the medical staff who helped make it happen.
(Good Morning America)

7. Asthma mortality rates differ by location, race/ethnicity, age

Shilpa Patel, M.D., M.P.H., medical director of the Children’s National IMPACT DC Asthma Clinic, weighed in on a letter published in Annals of Allergy, Asthma & Immunology, asserting that the disparities in mortality due to asthma in the United States vary based on whether they occurred in a hospital, ethnicity or race and age of the patient.
(Healio)

8. How one Afghan family made the perilous journey across the U.S.-Mexico border

After one family embarked on a perilous journey from Afghanistan through Mexico to the U.S.-Mexico border, they eventually secured entry to the U.S. where Karen Smith, M.D., medical director of Global Services, aided the family’s transition and provided their daughter with necessary immediate medical treatment.
(NPR)

9. When a child is shot, doctors must heal more than just bullet holes

With the number of young people shot by guns on the rise in the U.S., providers and staff at Children’s National Hospital are trying to break the cycle of violence. But it’s not just the physical wounds though that need treating: young victims may also need help getting back on the right track — whether that means enrolling in school, finding a new group of friends or getting a job.
(BBC News)

10. This 6-year-old is a pioneer in the quest to treat a deadly brain tumor

Callie, a 6-year-old diagnosed with diffuse intrinsic pontine glioma, was treated with low-intensity focused ultrasound (LIFU) at Children’s National Hospital and is the second child in the world to receive this treatment for a brain tumor. LIFU is an emerging technology that experts like Hasan Syed, M.D., and Adrianna Fonseca, M.D., are trialing to treat this fatal childhood brain tumor.
(The Washington Post)

11. F.D.A. approves sickle cell treatments, including one that uses CRISPR

The FDA approved a new genetic therapy, giving people with sickle cell disease new opportunities to eliminate their symptoms. David Jacobsohn, M.B.A., M.D., confirmed that Children’s National Hospital is one of the authorized treatment centers and talked about giving priority to the sickest patients if they are on Vertex’s list.
(The New York Times)

12. 6-year-old fulfils wish to dance in the Nutcracker

After the potential need for open-heart surgery threatened Caroline’s Nutcracker performance, Manan Desai, M.D., a cardiac surgeon, figured out a less invasive procedure to help reduce her recovery time so she could perform in time for the holidays.
(Good Morning America)

2023 with a lightbulb

The best of 2023 from Innovation District

2023 with a lightbulbAdvanced MRI visualization techniques to follow blood flow in the hearts of cardiac patients. Gene therapy for pediatric patients with Duchenne muscular dystrophy. 3D-printed casts for treating clubfoot. These were among the most popular articles we published on Innovation District in 2023. Read on for our full list.

1. Advanced MRI hopes to improve outcomes for Fontan cardiac patients

Cardiac imaging specialists and cardiac surgeons at Children’s National Hospital are applying advanced magnetic resonance imaging visualization techniques to understand the intricacies of blood flow within the heart chambers of children with single ventricle heart defects like hypoplastic left heart syndrome. The data allows surgeons to make critical corrections to the atrioventricular valve before a child undergoes the single ventricle procedure known as the Fontan.
(3 min. read)

2. Children’s National gives first commercial dose of new FDA-approved gene therapy for Duchenne muscular dystrophy

Children’s National Hospital became the first pediatric hospital to administer a commercial dose of Elevidys (delandistrogene moxeparvovec-rokl), the first gene therapy for the treatment of pediatric patients with Duchenne muscular dystrophy (DMD). Elevidys is a one-time intravenous gene therapy that aims to delay or halt the progression of DMD by delivering a modified, functional version of dystrophin to muscle cells.
(2 min. read)

3. New model to treat Becker Muscular Dystrophy

Researchers at Children’s National Hospital developed a pre-clinical model to test drugs and therapies for Becker Muscular Dystrophy (BMD), a debilitating neuromuscular disease that is growing in numbers and lacks treatment options. The work provides scientists with a much-needed method to identify, develop and de-risk drugs for patients with BMD.
(2 min. read)

4. First infants in the U.S. with specially modified pacemakers show excellent early outcomes

In 2022, five newborns with life-threatening congenital heart disease affecting their heart rhythms were the first in the United States to receive a novel modified pacemaker generator to stabilize their heart rhythms within days of birth. Two of the five cases were cared for at Children’s National Hospital. In a follow-up article, the team at Children’s National shared that “early post-operative performance of this device has been excellent.”
(2 min. read)

5. AI: The “single greatest tool” for improving access to pediatric healthcare

Experts from the Food and Drug Administration, Pfizer, Oracle Health, NVIDIA, AWS Health and elsewhere came together to discuss how pediatric specialties can use AI to provide medical care to kids more efficiently, more quickly and more effectively at the inaugural symposium on AI in Pediatric Health and Rare Diseases, hosted by Children’s National Hospital and the Fralin Biomedical Research Institute at Virginia Tech.
(3 min. read)

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

The American Academy of Pediatrics (AAP) 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.
(2 min. read)

7. Why a colorectal transition program matters

Children’s National Hospital recently welcomed pediatric and adult colorectal surgeon Erin Teeple, M.D., to the Division of Colorectal and Pelvic Reconstruction. Dr. Teeple is the only person in the United States who is board-certified as both a pediatric surgeon and adult colorectal surgeon, uniquely positioning her to care for people with both acquired and congenital colorectal disease and help them transition from pediatric care to adult caregivers.
(3 min. read)

8. First-of-its-kind holistic program for managing pain in sickle cell disease

The sickle cell team at Children’s National Hospital received a grant from the Founders Auxiliary Board to launch a first-of-its-kind, personalized holistic transformative program for the management of pain in sickle cell disease. The clinic uses an inter-disciplinary approach of hematology, psychology, psychiatry, anesthesiology/pain medicine, acupuncture, mindfulness, relaxation and aromatherapy services.
(3 min read)

9. Recommendations for management of positive monosomy X on cell-free DNA screening

Non-invasive prenatal testing using cell-free DNA (cfDNA) is currently offered to all pregnant women regardless of the fetal risk. In a study published in the American Journal of Obstetrics and Gynecology, researchers from Children’s National Hospital provided context and expert recommendations for maternal and fetal evaluation and management when cfDNA screening is positive for monosomy X or Turner Syndrome.
(2 min. read)

10. Innovation in clubfoot management using 3D anatomical mapping

While clubfoot is relatively common and the treatment is highly successful, the weekly visits required for Ponseti casting can be a significant burden on families. Researchers at Children’s National Hospital are looking for a way to relieve that burden with a new study that could eliminate the weekly visits with a series of 3D-printed casts that families can switch out at home.
(1 min. read)

11. Gender Self-Report seeks to capture the gender spectrum for broad research applications

A new validated self-report tool provides researchers with a way to characterize the gender of research participants beyond their binary designated sex at birth. The multi-dimensional Gender Self-Report, developed using a community-driven approach and then scientifically validated, was outlined in a peer-reviewed article in the American Psychologist, a journal of the American Psychological Association.
(2 min. read)

12. Cardiovascular and bone diseases in chronic kidney disease

In a study published by Advances in Chronic Kidney Disease, a team at Children’s National Hospital reviewed cardiovascular and bone diseases in chronic kidney disease and end-stage kidney disease patients with a focus on pediatric issues and concerns.
(1 min. read)