Category Archives: Pediatrics

Pediatrics

How to Treat Coughs in Kids – Health Matters

What is a cough? A cough is usually a reflex response to an irritant from a virus, to pollen, to cigarette smoke. Coughs are a way for the body to protect itself. They prevent irritants from getting deep into the lungs and help open our airways to exchange oxygen and carbon dioxide. For example, if you swallow water the wrong way, youre going to cough it up.

How do you diagnose whats causing the cough? First, we ask some basic questions. How long has the cough been happening and how often? What triggers it? Does the cough last just a couple of seconds or does it take minutes to recover? What makes it better? All of the information gives us hints to determine the cause of the cough.

With technology available, I also encourage parents to record the cough. Bringing a recording to your physician or the emergency department is very helpful, so we can observe any concerning signs of respiratory distress based on what were seeing on the video or hear on an audio recording.

Then we do a physical exam with a stethoscope to listen for sounds in the chest wall, neck, or the nose. This helps differentiate the cough between an upper respiratory cause versus a lower respiratory condition.

Some causes of cough can be detected with specific tests. Certain conditions like COVID, the flu, RSV, or strep can be checked in the office or emergency room if there is a high likelihood of these illnesses. Other conditions, like asthma, may require special exams like a pulmonary function tests.

How long do coughs usually last? It depends on whats causing of the cough. Most colds take three to five days to peak, but the symptoms can last up to two weeks so coughing for 10 to 14 days for a common cold is not unusual, especially in pediatrics.

With other conditions, like pneumonia, the cough may last a month after the main part of the illness is over. If the cough is lasting beyond the expected time, your provider may ask the child to come in more often to be monitored.

How long is a child contagious? It depends on the virus. In most cases, the first five to seven days of a cold is when your child is contagious. Fever can be an indicator of the contagious period. The likelihood of spreading the virus decreases after a week. Your doctor can give specific advice based on the virus.

When should children see a doctor about a cough? We always think about whether the cough interferes with daily activity. So for children, daily activity means going to school, sleeping, playing, or eating. If it interferes with any of those, that is a reason to see a physician. If the child has a cough and a fever that lasts more than five days, then those are signs to see a doctor too.

Another concern is respiratory distress. If the cough causes your child to breath faster than normal, or parents are noticing the breathing is visible underneath the rib cage or in the neck bone, or the nostrils are flaring to breathe those are signs that the body is working too hard. Many children can breathe 30 breaths per minute. For an adult, that would be way too fast. The older you are, the slower your normal breathing rate is. So if a child is breathing faster than normal, that would be reason to seek medical attention.

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How to Treat Coughs in Kids - Health Matters

Pediatrics

COVID-19 vaccination during pregnancy and offspring neurodevelopment – Contemporary Pediatrics

COVID-19 vaccination during pregnancy and offspring neurodevelopment | Image Credit: adipurnatama - adipurnatama - stock.adobe.com.

The increase in COVID-19 vaccination in pregnant people has brought on safety concerns for the unborn child and questions of neurodevelopment. Results of a prospective cohort study published in JAMA Pediatrics suggest that in utero vaccination was safe for the infant regarding neurodevelopment up to 18 months of age.

Pregnant individuals were excluded from early, large-scale clinical trials of COVID-19 vaccines, leaving questions about the impact from vaccine exposure that the offspring could face.

Ranging genetic and environmental factors could underline neurodevelopmental disorders, with fetal exposure to maternal inflammation presenting a potential source for risk.

For example, the authors wrote. In utero exposures to other infections including influenza and rubella have been linked to subsequent increases in lifelong neurodevelopmental and psychiatric impairments including autism spectrum disorder, intellectual disability, schizophrenia, anxiety, and depression."

To determine if in utero exposure to maternal COVID-19 vaccination was associated with risk for neurodevelopmental impairment in 12- and 18-month-old infants, investigators designed the prospective cohort Assessing the Safety of Pregnancy During the Coronavirus Pandemic (ASPIRE) study.

From May 2020 to August 2021, the study enrolled pregnant people aged 18 years and older at 10 weeks gestation or less. Completing study activities remotely, participants were followed up through pregnancy and for up to 2 years postpartum.

Completion of the baseline demographics questionnaire, the Ages and Stages Questionnaire (3rd edition [ASQ-3]) at 12 and 18 months postpartum, and of the vaccine history questionnaire (monthly) were inclusion criteria.

An abnormal screen on the ASQ-3, which would indicate risk for developmental delay, was the primary outcome of the study. The investigators established that, An abnormal screen was defined as falling below the established threshold score (<2 SDs below the normative data average) on any of 5 subdomains: communication, gross motor, fine motor, problem solving, and social skills.

The ASQ-3 featured 30 questions to indicate the frequency in which their child performed expected milestones, as scores ranged from 0 to 60 (worst to best, respectively). According to authors, the screener is valid, reliable, and ubiquitous in clinical and research settings, with sensitivity of 86%, specificity 85%,and positive and negative predictive values of 54% and 78%, respectively.

Vaccination for COVID-19 during pregnancy was the primary exposure, which was indicated by self-report and confirmed by investigators using dates of vaccinations compared to estimated dates of conception and delivery. Any dose of a vaccine series qualified as exposure, with the majority being messenger RNA vaccines.

In all, 2487 pregnant individuals were enrolled at less than 10 weeks gestation. With completed research activities, a total of 2261 aged 12 months and 1940 aged 18 months with neurodevelopmental assessments were included.

At 12 months, the prevalence of abnormal screens for developmental delay (ASQ-3 scores below established cutoff on at least 1 domain) was 30.6% among exposed. The prevalence of abnormal screens for unexposed at 12 months was 23.2% (2= 2.35;P=.13).

No differences were observed in risk of abnormal screen on the ASQ-3 after in utero exposure to vaccination at 12 or 18 months after adjusting for baseline race, ethnicity, maternal age, education, household income, depression, and anxiety (12 months: aRR, 1.14; 95% CI, 0.97-1.33; 18 months: aRR, 0.88; 95% CI, 0.72-1.07).

Without regard to exposure status, investigators observed more abnormal screens for developmental delay among male infants at 12 and 18 months of age compared to female infants, respectively (12 months: 325 of 980 [33.2%] vs 278 of 984 [28.3%]; 2= 5.57;P=.02; 18 months: 210 of 872 [24.1%] vs 161 of 836 [19.3%]; 2= 5.84;P=.02).

For female infants, a divergent pattern was demonstrated, as at 12 months, there was no difference in risk of abnormal ASQ-3 screen among exposed vs unexposed (aRR, 1.02; 95% CI, 0.81-1.30), though a reduction of risk was observed for exposed female infants at age 18 months (aRR, 0.69; 95% CI, 0.51-0.93).

Findings from the cohort study suggest that, maternal vaccination against COVID-19 during pregnancy was safe from the perspective of offspring neurodevelopment through 18 months of age, the study authors concluded.

Reference:

Jaswa EG,Cedars MI,Lindquist KJ, et al. In utero exposure to maternal COVID-19 vaccination and offspring neurodevelopment at 12 and 18 months.JAMA Pediatr.Published online January 22, 2024. doi:10.1001/jamapediatrics.2023.5743

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COVID-19 vaccination during pregnancy and offspring neurodevelopment - Contemporary Pediatrics

Pediatrics

Discontinuing contact precautions for pediatric patients with methicillin-resistant Staphylococcus aureus – Contemporary Pediatrics

Discontinuing contact precautions for pediatric patients with methicillin-resistant Staphylococcus aureus | Image Credit: John Doe - John Doe - stock.adobe.com.

A recent study, published in the Journal of the Pediatric Infectious Diseases Society, analyzed a pediatric health system's experience discontinuing contact precautions (CP) for methicillin-resistant Staphylococcus aureus (MRSA), spanning 4 years.

The findings, indicating sustained infection control success, support the potential extension of this approach to other pediatric facilities.

Key factors include strong adherence to horizontal infection prevention measures and early engagement with stakeholders.

To learn more about the study and its findings, our sister publication Infection Control Today interviewed study authors Michael Sebert, MD, medical director, infection prevention and control, Children's Health Dallas; Zachary Most, MD, assistant professor, Department ofPediatrics, UT Southwestern Medical Center; associate medical director of infection prevention and control, Childrens Health Dallas and serves on the COVID-19 Modeling Group and the Optum Database Research Group at UT Southwestern; and Bethany Phillips, MPH, CIC, MLS (ASCP)CM, director, infection prevention & control at Children's Health, Childrens Health System of Texas, Childrens Medical Center, Dallas, Texas.

Question:

Can you provide an overview of the study's methodology and the specific measures taken when discontinuing contact precautions (CP) for pediatric patients with methicillin-resistantStaphylococcus aureus(MRSA)?

Michael Sebert, MD; Zachary Most, MD; and Bethany Phillips, MPH, CIC, MLS (ASCP)CM:The study was a quasi-experimental retrospective analysis of MRSA infection and colonization rates before and after discontinuation of the requirement for contact precautions for patients with MRSA at our facilities. This change was implemented in September 2019, and outcomes were tracked for 4 years afterwards through August 2023. MRSA infections were measured using the National Healthcare Safety Networks LabID definition. Statistical analyses were conducted using interrupted time series (ITS) and aggregate rate ratios.

Our infection prevention department conducted an evidence-based practice project as part of preparing to discontinue CP for MRSA. This project included a review of local baseline data on health care-associated MRSA infection and colonization, an evaluation of our current and planned horizontal infection prevention measures, and a review of reported experiences from other facilities following the discontinuation of CP for MRSA. We met in advance with physician and nursing leaders from key areas, including pediatric and neonatal intensive care units (PICU and NICU) and hematology/oncology, to discuss the rationale for the change and plans for implementation. Education on the practice change along with proper use of standard precautions was provided to all staff before the change.

Discussion with the NICU led to the decision that CP for MRSA would be selectively continued in that unit due to concerns about the potential for importation of multidrug-resistant organisms from other NICUs in the region that transfer patients into our unit. The open-bay architecture of our NICUthe only area in our hospitals where not all inpatients have single-patient roomsalso contributed to this decision.

Because our electronic health record (EHR) utilized infection control flags to identify patients with a history of MRSA as requiring CP. These flags persisted between encounters, and therefore assistance from our Informatics team was crucial to implement an automated procedure to remove the MRSA flags from the charts of all patients except those in the NICU. For patients who were currently admitted on the date of the change, the infection preventionists worked with the inpatient units to make sure that CP were removed when appropriate but retained if there was another indication for CP such as a resistant gram-negative pathogen or a respiratory viral infection requiring CP.

Question:

What were the key findings of the study regarding the incidence density rate of LabID health care facility-onset MRSA infections after the discontinuation of CP for MRSA in the pediatric health care system?

Sebert, Most, and Phillips:ITS analysis showed no change in the incidence density rate of LabID health care facility-onset MRSA infections associated with the discontinuation of CP for MRSA. Likewise, there was no change in the aggregate incidence density rate of these infections (rate ratio = 0.98, 95% confidence interval 0.74 to 1.28). This provides long-term data for the safety of this approach using a broad measure of MRSA infections, which had previously been lacking in pediatric health care settings.

Question:

The study mentions a decrease in the prevalence rate of contact isolation days. How did the health care system ensure good adherence to horizontal infection prevention measures after discontinuing CP, and what impact did it have on infection rates?

Sebert, Most, and Phillips:

After providing house-wide education about standard precautions, our infection preventionists solicited and trained health care personnel (HCP) volunteers to perform observations of personal protective equipment (PPE) usage by other HCP starting in May 2019.

These observations and feedback focused on appropriate use as indicated by exposure risks as well as when required by transmission-based precautions. Findings were generally favorable and supported the decision to discontinue CP for MRSA later that fall. These observations continued through the beginning of 2022 to ensure that practice did not drift.

Horizontal infection prevention processes at our hospitals that may not be standard everywhere include high-touch surface cleaning by nursing staff of inpatient rooms twice per shift. This process focuses on surfaces such as bedrails and IV pumps that are frequently contacted by patients and/or HCP. Completion of high-touch surface cleaning must be documented, and adherence is reported to unit leadership.

This cleaning is a supplemental measure above and beyond daily cleaning by the environmental services (EVS) department. To monitor the effectiveness of routine cleaning, our infection prevention team has also partnered with EVS to use fluorescent markers as an objective measure of cleaning and to provide feedback to EVS staff.

Other ways that adherence to horizontal infection prevention measures is monitored include hand hygiene observations and audits of prevention bundles for health care-associated infections (HAIs), including central line-associated bloodstream infections and catheter-associated urinary tract infections. Although these measures are subject to bias from the observation process itself (Hawthorne effect), adherence appeared to be high and contributed to our confidence in ending CP for MRSA.

Our observational study cannot address the specific impact of these horizontal infection prevention measures on MRSA infection rates after stopping CP.

The published experiences with successful discontinuation of CP for MRSA at other facilities, however, consistently emphasize the importance of these horizontal measures. Our experience was similar and cannot be extrapolated to facilities where adherence to horizontal infection prevention measures may not be high.

Question:

Were there any unexpected challenges or outcomes observed during the 4-year period after discontinuing CP for MRSA in the pediatric health care settings?

Sebert, Most, and Phillips:The most surprising part of the entire process of discontinuing CP for MRSA was how uneventful it was. Acceptance of the change was high among staff and patient families. Utilizing an evidence-based practice project model for implementing this sort of large-scale change may have assisted in the positive reception from staff. They were engaged throughout the project via questionnaires soliciting feedback on our current practice, participating in the creation of the education, serving as PPE auditors, and, most importantly, they were able to review the rationale behind the practice change. Health care-associated MRSA infection rates were monitored and reported to the hospitals infection control committees on a quarterly basis without concerning trends being identified.

Question:

The study suggests that the experience supports considering the discontinuation of CP for MRSA in similar pediatric health care settings. What factors, in your opinion, contributed to the success of this approach, and what considerations should other pediatric facilities keep in mind when making such decisions?

Sebert, Most, and Phillips:As mentioned above, we believe that strong adherence to horizontal infection prevention measures such as hand hygiene, standard precautions, environmental cleaning, and HAI prevention bundle elements were collectively key to the success of this approach. A review of baseline data before implementing the change showed no recent outbreaks or clusters of health care-associated MRSA infections. Other institutions considering a similar discontinuation of CP for MRSA should conduct a risk assessment, evaluate horizontal infection prevention measures, and review surveillance data to ensure that there have not been unrecognized clusters of health care-associated MRSA infections.

In addition to strong adherence to infection prevention measures, engaging key stakeholders early in the process contributed to the successful implementation of the practice change. Employing our infection preventionists together with our medical director as a physician advocate when initiating discussions with the clinical teams allowed our IP team to ensure that we were able to gain the confidence of medical providers while also providing an approachable forum for the frontline staff to provide their valuable input.

Question:

Given the positive outcomes observed in the pediatric health care system, do you believe the findings could be extrapolated to other pediatric facilities, and what implications might this have for the broader approach to managing MRSA in pediatric health care settings?

Sebert, Most, and Phillips::We are optimistic that our success with discontinuing CP for MRSA might be extended to other pediatric facilities in the setting of good adherence to horizontal infection prevention measures. The strength of our study, however, is qualified in that was a retrospective observational analysis at a single institution. The data supporting this approach in pediatric health care settings remain more limited than what has been published from facilities caring for adults. As more pediatric facilities consider discontinuation of CP for MRSA, multicenter studiesincluding control sites where CP have been maintainedwould shed more light on this still controversial topic.

The issue addressed in our study about the requirement for CP in patients with MRSA is only one aspect of the overall care of these patients.

Timely recognition, diagnosis, and treatment of infection remain critical whether or not an institution has continued CP for MRSA. Unsettled questions also remain regarding whether active surveillance for MRSA in health care settings may provide benefits and about the role for decolonization strategies in patients identified to have MRSA infection or colonization.

Thestudyis titled Discontinuation of Contact Precautions for Methicillin-resistantStaphylococcus aureusin a Pediatric Healthcare System.

This interview was initially published by our sister publication, Infection Control Today.

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Discontinuing contact precautions for pediatric patients with methicillin-resistant Staphylococcus aureus - Contemporary Pediatrics

Pediatrics

Recent reports of measles in multiple states – Contemporary Pediatrics

Recent reports of measles in multiple states | Image Credit: weerapat1003 - weerapat1003- stock.adobe.com.

In the recent days and weeks, cases of measles have been reported in Delaware, New Jersey, Georgia, Pennsylvania, Virginia, and Washington State, according to an American Academy of Pediatrics (AAP) News report.1

Transmitted through contact of droplets or airborne spread via breathing, coughing, or sneezing from an infected individual, measles can remain in the air for up to 2 hours.1

[These reports are] not really surprising given the decrease in vaccination rates that have been occurring since the pandemic, said Tina Tan, MD, FAAP, FIDSA, FPIDS, editor in chief,Contemporary Pediatrics; professor of pediatrics, Feinberg School of Medicine, Northwestern University; pediatric infectious diseases attending, Ann & Robert H. Lurie Children's Hospital of Chicago.

This is not new and demonstrates what is known, in that if vaccination rates do not stay at a level that is protective, outbreaks of vaccine preventable diseases will occur, said Tan.

The acute viral respiratory illness can be characterized by fever as high as 105 degrees Fahrenheit and malaise, coryza, cough, and conjunctivitis, a pathognomonic enanthema followed by a maculopapular rash, according to the Centers for Disease Control and Prevention (CDC).2

The CDC states that up to 9 out of 10 susceptible persons with close contact to an infected measles patient will develop the infectious disease. Infants and children aged younger than 5 years are at high-risk for severe illness and further complications from measles.2

Routine childhood immunization for the measles-mumps-rubella (MMR) vaccine is recommended at 12 to 15 months of age for the first dose, with the second coming at ages 4 through 6 years, or at least 28 days after first dose.2

The MMR-varicella (MMRV) vaccine is available to children 12 months through 12 years of age, with 3 months being the minimal interval between doses.2

Clinicians need to understand that the United Statesand multiple other countries around the worldare currently in an environment where vaccination rates have fallen below protective levels given the significant increase in vaccine hesitancy and major decrease in vaccination rates, Tan told Contemporary Pediatrics. Measles and other vaccine preventable diseases need to be on the differential diagnoses of children presenting with signs and symptoms that may be associated with these diseases.

According to the CDC, evidence of immunity for measles includes at least 1 of the following:2

The AAP News report states a CDC study recently revealed that 93% of kindergartners were fully vaccinated against measles in the 2022 to 2023 school year, marking it the third consecutive year that vaccination rates were below the Healthy People 2030 target of 95%.1

There has been a decrease in vaccination rates here in Chicago and other areas of the United States due to an increase in vaccine hesitancy, added Tan. There has also been an increase in parents seeking notes of medical and philosophical exemption so that they do not have to vaccinate their children.

References:

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Recent reports of measles in multiple states - Contemporary Pediatrics

Pediatrics

Expert shares advice for parents navigating pediatric influenza, COVID-19, and RSV this winter – Newswise

Newswise Coping with the challenges of parenting can be particularly stressful for those concerned about the flu, COVID-19, or RSV. With an increase in cases this season, parents are seeking effective preventive measures and safety guidelines for their kids. Dr. Christopher Pierce, the interim chair of pediatrics at the Virginia Tech Carilion School of Medicine, offers insights on managing these three illnesses.

This year, doctors are currently seeing high numbers of flu and this started a bit earlier than historically, says Dr. Pierce. Yearly flu vaccines are needed to give our immune systems a "reminder" of how to fight the flu, there is some added immunity that repeat exposure plays as well.

The prevalence of influenza among children has decreased early pandemic but increased over the past two years, which Dr. Pierce attributes to the heightened exposure to COVID-19 during that period. There was minimal influenza activity from spring 2020 through early summer 2022, which was a direct result of masking and social distancing.

He also says RSV is still prominent, but has begun a decline. RSV is more difficult to track as it is not reportable as are Flu and COVID, which means there is not a good way to keep track of these numbers.

Dr. Pierce says it is important to look for key indicators to assess the severity of your childs illness. Parents should look for rapid breathing, using accessory muscles such as "tummy breathing or "head bobbing, and if older children are complaining of not breathing well, would warrant an emergent evaluation. He says to also watch their level of alertness and fluid intake. Nonetheless, he stresses that reaching out to the primary care provider is the safest way to evaluate a childs level of illness and get the best care.

To differentiate between the three, Dr. Pierce recommends getting tested. Influenza, COVID-19, and RSV can mimic one another, so knowing which symptoms align with which illness can help parents. Overall, COVID-19 symptoms tend to be milder in children and the flu is more of the fever/aches/malaise. RSV is different for premature and younger infants as it can trigger lower respiratory symptoms known as bronchiolitis (not bronchitis) which can lead to respiratory distress which requires hospitalization to manage.

His biggest piece of advice - get the flu vaccine. It is the safest and most effective way to prevent the risk of hospitalization and death from influenza.

- Written by Sarah Hern

Dr. Christopher Pierce is the interim chair of pediatrics with the Virginia Tech Carilion School of Medicine (VTCSOM) and an associate professor of pediatrics. He is also the Chief of General Pediatrics at Carilion Childrens. His leadership has been instrumental in establishing Carilion Childrens Tanglewood Center, which opened in 2021, as the anchor for pediatric care for the region. Dr. Pierce joined Carilion in 2001 as a general pediatrician.

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Expert shares advice for parents navigating pediatric influenza, COVID-19, and RSV this winter - Newswise

Pediatrics

Global Group of Researchers Release New Criteria for Diagnosing Pediatric Sepsis and Septic Shock – AboutLawsuits.com

The Society of Critical Care Medicine convened a task force of 35 pediatric experts in critical care, emergency medicine, infectious diseases, general pediatrics, nursing, public health, and neonatology from six continents to recommend a new set of guidelines on how to treat children under 18 years old with suspected sepsis and a higher risk of death.

The team, led by researchers at the University of Colorado School of Medicine, conducted a systematic review and analysis of more than 3 million pediatric health care encounters from 10 medical sites across four continents.

The task force recommended defining sepsis in children as infections identified by two points using the Phoenix Sepsis Score, which includes identifying dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems.

The review indicates children with at least two points on the sepsis score had a 7% increased risk of death in the hospital if they were treated in higher resource settings and a 29% increased risk if they were treated in lower resource hospitals. This risk of death was eight times higher than among children with suspected infections who do not meet the new sepsis criteria.

Children with septic shock had an 11% increased risk of death in higher resource hospitals and a 34% increased risk of death if they were treated in lower-resource hospitals.

Death rates were also higher among children with organ dysfunction in the respiratory, cardiovascular, coagulation, or neurological organ systems.

Prior to the new criteria, most doctors defined sepsis as an infection with life-threatening organ dysfunction that can lead to death.

With the new criteria, septic shock is defined as children with sepsis who had cardiovascular dysfunction with at least one cardiovascular point on the Phoenix Sepsis Score.

The new criteria updates sepsis definitions first established in 2005 and later defined as a life-threatening infection in 2016. However, those criteria did not include children and left many to suffer untreated sepsis, since there was no agreed consensus as to when to diagnose it and how to treat it, because a childs body responds to sepsis in a different way than adults.

Adults can often have a drop in blood pressure early on, but children maintain blood pressure much longer, but can experience severe symptoms in a different way. Children suffering from sepsis or septic shock can experience damage to the kidneys, lungs, heart, and brain, as well as death, if the condition is not treated quickly and appropriately.

Researchers said the new Phoenix Sepsis Score criteria has the potential to improve clinical care, epidemiological assessment, and research in pediatric sepsis and septic shock around the world.

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Global Group of Researchers Release New Criteria for Diagnosing Pediatric Sepsis and Septic Shock - AboutLawsuits.com

Pediatrics

Recurrent Syncope Unveiling Pulmonary Hypertension Secondary to Pulmonary Artery Thrombi in a Pediatric Patient – Cureus

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Recurrent Syncope Unveiling Pulmonary Hypertension Secondary to Pulmonary Artery Thrombi in a Pediatric Patient - Cureus

Pediatrics

ChatGPT bombs test on diagnosing kids’ medical cases with 83% error rate – Ars Technica

Enlarge / Dr. Greg House has a better rate of accurately diagnosing patients than ChatGPT.

ChatGPT is still no House, MD.

While the chatty AI bot has previously underwhelmed with its attempts to diagnose challenging medical caseswith an accuracy rate of 39 percent in an analysis last yeara study out this week in JAMA Pediatrics suggests the fourth version of the large language model is especially bad with kids. It had an accuracy rate of just 17 percent when diagnosing pediatric medical cases.

The low success rate suggests human pediatricians won't be out of jobs any time soon, in case that was a concern. As the authors put it: "[T]his study underscores the invaluable role that clinical experience holds." But it also identifies the critical weaknesses that led to ChatGPT's high error rate and ways to transform it into a useful tool in clinical care. With so much interest and experimentation with AI chatbots, many pediatricians and other doctors see their integration into clinical care as inevitable.

The medical field has generally been an early adopter of AI-powered technologies, resulting in some notable failures, such as creating algorithmic racial bias, as well as successes, such as automating administrative tasks and helping to interpret chest scans and retinal images. There's also lot in between. But AI's potential for problem-solving has raised considerable interest in developing it into a helpful tool for complex diagnosticsno eccentric, prickly, pill-popping medical genius required.

In the new study conducted by researchers at Cohen Childrens Medical Center in New York, ChatGPT-4 showed it isn't ready for pediatric diagnoses yet. Compared to general cases, pediatric ones require more consideration of the patient's age, the researchers note. And as any parent knows, diagnosing conditions in infants and small children is especially hard when they can't pinpoint or articulate all the symptoms they're experiencing.

For the study, the researchers put the chatbot up against 100 pediatric case challenges published in JAMA Pediatrics and NEJM between 2013 and 2023. These are medical cases published as challenges or quizzes. Physicians reading along are invited to try to come up with the correct diagnosis of a complex or unusual case based on the information that attending doctors had at the time. Sometimes, the publications also explain how attending doctors got to the correct diagnosis.

For ChatGPT's test, the researchers pasted the relevant text of the medical cases into the prompt, and then two qualified physician-researchers scored the AI-generated answers as correct, incorrect, or "did not fully capture the diagnosis." In the latter case, ChatGPT came up with a clinically related condition that was too broad or unspecific to be considered the correct diagnosis. For instance, ChatGPT diagnosed one child's case as caused by a branchial cleft cysta lump in the neck or below the collarbonewhen the correct diagnosis was Branchio-oto-renal syndrome, a genetic condition that causes the abnormal development of tissue in the neck, and malformations in the ears and kidneys. One of the signs of the condition is the formation of branchial cleft cysts.

Overall, ChatGPT got the right answer in just 17 of the 100 cases. It was plainly wrong in 72 cases, and did not fully capture the diagnosis of the remaining 11 cases. Among the 83 wrong diagnoses, 47 (57 percent) were in the same organ system.

Among the failures, researchers noted that ChatGPT appeared to struggle with spotting known relationships between conditions that an experienced physician would hopefully pick up on. For example, it didn't make the connection between autism and scurvy (Vitamin C deficiency) in one medical case. Neuropsychiatric conditions, such as autism, can lead to restricted diets, and that in turn can lead to vitamin deficiencies. As such, neuropsychiatric conditions are notable risk factors for the development of vitamin deficiencies in kids living in high-income countries, and clinicians should be on the lookout for them. ChatGPT, meanwhile, came up with the diagnosis of a rare autoimmune condition.

Though the chatbot struggled in this test, the researchers suggest it could improve by being specifically and selectively trained on accurate and trustworthy medical literaturenot stuff on the Internet, which can include inaccurate information and misinformation. They also suggest chatbots could improve with more real-time access to medical data, allowing the models to refine their accuracy, described as "tuning."

"This presents an opportunity for researchers to investigate if specific medical data training and tuning can improve the diagnostic accuracy of LLM-based chatbots," the authors conclude.

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ChatGPT bombs test on diagnosing kids' medical cases with 83% error rate - Ars Technica

Pediatrics

ChatGPT is terrible at diagnosing child medical cases, according to new study – Mashable

OpenAI's ChatGPT is no closer to replacing your family physicians, as the increasingly advanced chatbot failed to accurately diagnose the vast majority of hypothetical pediatric cases.

The findings were part of a new study published in JAMA Pediatrics on Jan. 2, conducted by researchers from Cohen Children's Medical Center in New York. The researchers analyzed the bot's responses to requests for medical diagnosis of child illnesses and found that the bot had an 83 percent error rate across tests.

The study used what are known as pediatric case challenges, or medical cases originally posted to groups of physicians as learning opportunities (or diagnostic challenges) involving unusual or limited information. Researchers sampled 100 challenges published on JAMA Pediatrics and NEJM between the years 2013 and 2023.

ChatGPT provided incorrect diagnoses for 72 out of 100 of the experimental cases provided, and generated 11 answers that were deemed "clinically related" to the correct diagnosis but considered too broad to be correct.

The researchers attribute part of this failure to the generative AI's inability to recognize relationships between certain conditions and external or preexisting circumstances, often used to help diagnose patients in a clinical setting. For example, ChatGPT did not connect "neuropsychiatric conditions" (such as autism) to commonly seen cases of vitamin deficiency and other restrictive-diet-based conditions.

The study concludes that ChatGPT needs continued training and involvement of medical professionals that feeds the AI not with an internet-generated well of information, which can often cycle in misinformation, but on vetted medical literature and expertise.

AI-based chatbots relying on Large Language Models (LLMs) have been previously studied for their efficacy in diagnosing medical cases and in accomplishing the daily tasks of physicians. Last year, researchers tested generative AI's ability to pass the three-part United States Medical Licensing Exam It passed.

But while it's still highly criticized for its training limits and potential to exacerbate medical bias, many medical groups, including the American Medical Association, don't view the advancement of AI in the field just as a threat of replacement. Instead, better trained AI's are considered ripe for their administrative and communicative potential, like generating patient-side text, explaining diagnoses in common terms, or in generating instructions. Clinical uses, like diagnostics, remain a controversial, and hard to research, topic.

To that extent, the new report represents the first analysis of a chatbot's diagnostic potential in a purely pediatric setting acknowledging the specialized medical training undertaken by medical professionals. Its current limitations show that even the most advanced chatbot on the public market can't yet compete with the full range of human expertise.

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ChatGPT is terrible at diagnosing child medical cases, according to new study - Mashable