OBJECTIVE:To describe the epidemiology of pediatric trauma and its association with neighborhood opportunity in a large, urban metropolitan area. STUDY DESIGN:This was a multicenter, retrospective, cross-sectional study of pediatric trauma activations in Los Angeles (LA) County between 2010 and 2021. Children under 18 years old with a home zip code in LA County were eligible. Our main exposure was the categorical Child Opportunity Index 2.0 (COI) score for a child's home zip code. The primary outcome was trauma activations per 100,000 children. Our secondary outcomes were variation in injury mechanism, severity and disposition by COI. RESULTS:The final sample was comprised of 28,034 patients. The median age was 13.0 years (IQR 7.0, 16.0). Mortality was 1.8% (n = 493). Overall, geographic areas with lower COI overlapped with areas of higher trauma incidence. Falls and sports-related injuries were more common in higher COI areas (all p < 0.001). Conversely, being a pedestrian or bicyclist struck, firearm injuries and assaults/stabbings were more common in lower COI areas (all p < 0.001). CONCLUSION:The incidence of pediatric trauma varies based on the COI of a child's home zip code. Our findings can help inform resource allocation for injury prevention programs targeted to specific neighborhoods at greatest risk.

Anesthesiology has a longstanding commitment to patient safety, characterized by innovative research, quality improvement, multidisciplinary collaboration, and engineering-based approaches to care systems. The field has been instrumental in advancing technological developments across the perioperative continuum, contributing to the ongoing mission of harm reduction and risk mitigation. However, modern challenges in health care, including increasingly complex patient conditions, workforce shortages, burnout, and the overwhelming volume of health data generated, have created a more urgent and multifaceted landscape for patient safety efforts. Furthermore, with the expanding perioperative continuum, from prehabilitation to postoperative acute care at home, anesthesiology teams must now adapt to a broader role in patient care. To continue enhancing patient safety, anesthesiology must integrate emerging technologies into clinical workflows, scaling their presence and effectiveness. The 2023 Anesthesia Patient Safety Foundation Stoelting Conference highlighted the necessity for anesthesiology to embrace these innovations while recognizing the challenges they pose. Three key technological domains were emphasized: wearables and the Internet of Medical Things; big data and artificial intelligence; and clinical decision support systems coupled with advanced alarm systems. These technologies offer opportunities to improve patient safety but require careful integration into clinical practice. This report explores the potential of these technologies to reshape anesthesiology and perioperative care while focusing on their application across 4 key phases: the preanesthesia phase at home; the intraoperative phase within health systems; postanesthesia recovery; and recovery at home. By leveraging these technologies, anesthesiology can enhance decision-making, improve outcomes, and continue advancing the mission of patient safety in a rapidly evolving health care landscape.

AimThis study aims to identify demographic factors, area-based social determinants of health (SDOH), and clinical features associated with medical decision-making after pediatric out-of-hospital cardiac arrest (OHCA).MethodsThis is a retrospective, exploratory, descriptive analysis of patients < 18 years old admitted to the pediatric intensive care unit (ICU) after OHCA from 2011 to 2022 (n=217) at an urban tertiary care, free-standing children’s hospital. Outcomes of interest included: (1) whether a new advance care plan (ACP) (defined as a written advance directive including do not resuscitate and/or do not intubate) was ordered during hospitalization, and (2) whether the patient was discharged with new medical technology (defined as tracheostomy and/or feeding tube). Logistic regression models identified features associated with these outcomes.ResultsOf the 217 patients, 78 patients (36%) had a new ACP placed during their admission. Of the survivors, 26% (27/102) were discharged home with new medical technology. Factors associated with ACP were greater change in Pediatric Cerebral Performance Category (PCPC) score (aOR=1.49, 95% CI [1.28-1.73], p-value <0.001) and palliative care consultation (aOR = 2.39, 95% CI [1.16-4.89], p-value 0.018). Factors associated with new medical technology were lower change in PCPC score (aOR=0.76, 95% C.I. [0.61-0.95], p-value=0.015) and palliative care consultation (aOR = 7.07, 95% CI [3.01-16.60], p-value <0.001). There were no associations between area-based SDOH and outcomes.ConclusionsUnderstanding factors associated with decision-making related to ACP after OHCA is critical to optimize counseling for families. Multi-institutional studies are warranted to identify whether these findings are generalizable.

Abstract The Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996 with the intent of expanding the number of Americans with health insurance and making the delivery of healthcare more efficient. It contains three main provisions: portability, tax, and administrative simplification. Portability was designed to prevent individuals from losing healthcare coverage due to a preexisting condition when changing to a new health plan. The tax provision was designed to make health insurance more affordable through tax breaks and incentives. Administrative simplification was designed to simplify and standardize the process and use of electronic health information. The privacy component is known as the Privacy Rule and applies to individuals and organizations transmitting health information during normal healthcare practice. The Privacy Rule designates all personally identifiable health information as protected, otherwise known as protected health information (PHI). Eighteen identifiers constitute private health information, or PHI. The privacy rule extends to cover research activities as well. In general, public health needs are exempt from HIPAA regulations. Breaches in patient privacy and PHI are serious and costly events with legal and financial ramifications for individuals, health systems, and other entities covered by the rule.

BACKGROUND:Current knowledge of the impact of socioeconomic factors on the risk of admission to the pediatric intensive care unit (PICU) for asthma is limited. Using composite measures of social vulnerability-Social Vulnerability Index (SVI) and Child Opportunity Index (COI) 2.0-we compared patients admitted for status asthmaticus to the PICU and pediatric ward at Children's Hospital Los Angeles (CHLA). We hypothesized patients with a high SVI and low COI are at higher risk for PICU admission. METHODS:Patients were identified using ICD-10 codes for asthma. Primary outcome was admission to PICU versus ward for status asthmaticus. Patient-registered residential street addresses were geocoded and spatially joined to SVI and COI 2.0 data at the census tract level. Univariate and regression analyses using the patient's SVI, COI 2.0, and admission location were conducted. RESULTS:From January 2017 to March 2022, there were 2458 admissions matched to addresses from 1983 distinct patients. The overall median SVI for all patients was 0.86 (IQR 0.6, 0.9). Overall median COI was 25.0 (IQR 10, 50). There was no difference in SVI or COI for admission to the PICU versus the ward. However, children requiring multiple hospital admissions for asthma were associated with higher SVI and lower COI. CONCLUSIONS:Children admitted to CHLA for asthma had an elevated SVI and low COI. There was no difference between admission locations based on SVI or COI scores. This indicates we care for children at increased socioeconomic risk, but this did not increase PICU use for asthma.

The role of informatics in public health has increased over the past few decades, and the coronavirus disease 2019 (COVID-19) pandemic has underscored the critical importance of aggregated, multicenter, high-quality, near-real-time data to inform decision-making by physicians, hospital systems, and governments. Given the impact of the pandemic on perioperative and critical care services (eg, elective procedure delays; information sharing related to interventions in critically ill patients; regional bed-management under crisis conditions), anesthesiologists must recognize and advocate for improved informatic frameworks in their local environments. Most anesthesiologists receive little formal training in public health informatics (PHI) during clinical residency or through continuing medical education. The COVID-19 pandemic demonstrated that this knowledge gap represents a missed opportunity for our specialty to participate in informatics-related, public health-oriented clinical care and policy decision-making. This article briefly outlines the background of PHI, its relevance to perioperative care, and conceives intersections with PHI that could evolve over the next quarter century.

Social media has rapidly developed in the past decade to become a powerful and influential force for patients, physicians, health systems, and the academic community. While the use of social media in health care has produced many positive changes, such as rapid dissemination of information, crowd-sourced sharing of knowledge, learning, and social interaction, social media in health care has also negative effects. Recent examples of negative impacts of social media include rapid and unchecked information dissemination leading to patient misinformation and inadvertent reputational harm for health care professionals due to engaging in controversial topics on public platforms. Members of the anesthesiology community, like other medical specialties, have rapidly adopted social media at many different levels. However, most anesthesiologists, health systems, and academic communities have little education, preparation, and guidelines on optimizing the use of social media technology while minimizing the risks of social media. Anesthesiology has been and will continue to be impacted by the forces of technology and the cultural influences of social media for the foreseeable future. The purpose of this article was to examine the recent history of social media adoption in anesthesiology and perioperative medicine, understand the current impact of social media across our specialty, and consider how the future development of technology and evolving social and cultural dynamic influences of social media will have on anesthesiology over the next quarter century.

BACKGROUND:The Affordable Care Act expanded Medicaid eligibility and increased public insurance coverage for children across the United States. As only a subset of states adopted expansion of coverage, disparities in insurance coverage between expansion and nonexpansion states emerged. We examined the association between Medicaid expansion and cardiac surgery outcomes to understand the impact of Medicaid expansion in a medically complex pediatric population. We hypothesized that expansion of Medicaid eligibility would be associated with greater improvement in surgical outcomes. METHODS:The Society of Thoracic Surgeons Congenital Heart Surgery Database was used to evaluate perioperative outcomes for children 0 to 18 years undergoing cardiac surgery between January 2010 and December 2019. We used a difference-in-differences (DiD) design to estimate the impact of Medicaid expansion on surgical outcomes by comparing changes in outcomes between individuals in expansion states and those in nonexpansion states, both before and after the expansion. Outcomes included operative mortality, major complications and postoperative length of stay (PLOS). RESULTS:The interaction between Medicaid expansion and time period post- vs preexpansion was not significant for any of the outcome variables. The odds ratio (OR) for mortality related to the Medicaid expansion was 1.12 (confidence interval [CI], 0.95-1.32, P = .161). For major complications, the OR was 0.99 (CI, 0.90-1.09, P = .770). For PLOS, the incidence rate ratio was 1.02 (CI, 0.99-1.05, P = .141). CONCLUSIONS:There was an overall decline in congenital heart surgery mortality over time; however, states that expanded Medicaid eligibility did not experience a greater improvement in mortality relative to states that did not expand eligibility. Similarly, there was no significant difference in major complications or PLOS related to Medicaid expansion. Further studies are needed to examine long-term outcomes and the larger spectrum of accessibility to congenital cardiac care which may benefit from insurance coverage.

socioeconomic status, and religion.We all have biases.It is important to be aware of these biases and intervene through education and training.This is vital to avoid stigmatizing patients, which can lead to inappropriate care for vulnerable populations.There are free tests online for implicit bias evaluation (i.e., Implicit Association Test) that can allow us to better identify these biases. 8 Anesthesiologists and members of the health care team also need to meet patients where they are.Equal care will not reduce disparities in patient safety; instead, we need to provide equitable care.Optimizing patient communication is paramount.For example, interpreters should be provided for patients not proficient in English.Preoperative instructions and discharge information should be culturally appropriate, available in multiple languages, and at a reading-level suitable for the patient.Poor communication between patients and their health care providers can result in errors and is a threat to patient safety.Community outreach is another opportunity for anesthesiologists to advance health equity and to follow the American Medical Association (AMA) Declaration of Professional Responsibility.

Introduction: Racial and socioeconomic disparities in pediatric asthma prevalence, severity, and use of primary and emergency care have been well studied. However, understanding of the impact of these disparities on risk of hospitalization in the pediatric intensive care unit (PICU) is limited. We used composite measures of socioeconomic risk factors through the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI), and the Child Opportunity Index (COI) 2.0 to compare patients admitted for status asthmaticus to the PICU or pediatric ward at Children’s Hospital Los Angeles (CHLA). We hypothesized patients with a high SVI and low COI are at higher risk for PICU level care. Methods: Following IRB approval, patients were identified using ICD-10 codes for asthma. The outcome of interest was need for PICU versus ward care. Patients were included as requiring PICU level of care if admitted to the PICU during their stay. Patient registered street address was geocoded and linked to US Census-American Community Survey 2019 Data (5-Year) at the census tract level. Bivariate analysis with the patient’s SVI, COI, hospital length of stay (LOS), and PICU admission were conducted. Statistical analysis used SAS, STATA, and ArcGIS Pro. Results: From [October 2015 – May 2022], there were 4,766 admissions matched to addresses from 3,617 distinct patients of which 626 (13.1%) required PICU admission. Overall median SVI for all patients was 0.86 with no difference between groups for SVI: median (1,3 IQR) PICU 0.86 (0.67, 0.93) Ward 0.86 (0.69, 0.93) p=0.56; or for COI: PICU 27 (9, 50) Ward 24 (10, 50) p=0.82. Hospital LOS was significantly longer for those requiring PICU admission: PICU 3 (3, 5) Ward 2 (2, 3) (days) p< 0.001. Conclusions: We found that children admitted to CHLA for asthma had an elevated SVI overall reflecting a patient population among the lowest socioeconomic status in the United States. The median 0.86 SVI score indicates a population that is more socially vulnerable than all but 14% of the US population. Similarly, the COI score demonstrated a population at risk. Yet, there was no difference between groups for the SVI or COI scores indicating we care for children at increased socioeconomic risk, but this did not increase PICU use for asthma admissions.