Doug Brunk

DENVER – Considerable variation exists in emergency department use of computed tomography or ultrasound for children with abdominal pain and appendicitis, results from a large national study demonstrated.

"Despite the greater diagnostic accuracy of CT, use of CT is decreasing for these conditions, while ultrasound use has been increasing," Michael C. Monuteaux, Sc.D., said at the annual meeting of the Pediatric Academic Societies.

Increasing use of either imaging modality was associated with negative appendectomy rates, said Dr. Monuteaux, a senior biostatistician at Children’s Hospital Boston. "As the hospital-level imaging increased, the hospital-level negative appendectomy [rate] decreased."

The findings come from an analysis of the Pediatric Health Information System, a database maintained by 40 U.S. pediatric hospitals. The researchers studied 8,959,155 visits that patients under the age of 19 years made to emergency departments between 2005 and 2009 with a primary diagnosis of appendicitis, abdominal pain, or common, nontraumatic, acute disease mimickers of appendicitis.

Of these patients, 564,595 (6%) had abdominal pain and 55,238 (0.6%) had appendicitis.

The use of CT in patients with a diagnosis of appendicitis ranged from 21% to 49%, for a median of 34%, while the use of CT for other diagnoses ranged from 5% to 9%, for a median of 6%, Dr. Monuteaux reported.

Use of ultrasound in patients with a diagnosis of appendicitis ranged from 2% to 26%, for a median of 7%, while use of ultrasound for other diagnoses ranged from 2% to 8%, for a median of 6%.

Among patients diagnosed with appendicitis, CT rates decreased from a peak of 35% in 2007 to 29% in 2009, while ultrasound rates increased from 17% in 2005 to 25% in 2009.

Among patients with other diagnoses, CT rates decreased from a peak of 35% in 2007 to 29% in 2009, while ultrasound rates increased from 17% in 2005 to 25% in 2009.

The researchers observed no correlations between rates of either imaging modality and rates of perforated appendicitis. Increasing use of either CT or ultrasound was associated with decreasing negative appendectomy rates. In fact, for every 10% decrease in imaging, there was a 6.4% decrease in negative appendectomy rates.

Dr. Monuteaux acknowledged certain limitations of the study, including the fact that the cohort was drawn from an administrative database, "so it’s difficult to infer clinical management and outcome. We [also] could not adjust for any imaging that may have been done outside of the hospital prior to transfer. We also could not control or account for external factors such as [emergency department] crowding, the surrounding primary care network, or access to care that could possibly influence imaging."

He also noted that the association between type of imaging and patient-level perforation may be related to institutional clinical practice when perforation is suspected.

Dr. Monuteaux said that he had no relevant financial conflicts to disclose.

DENVER – Considerable variation exists in emergency department use of computed tomography or ultrasound for children with abdominal pain and appendicitis, results from a large national study demonstrated.

"Despite the greater diagnostic accuracy of CT, use of CT is decreasing for these conditions, while ultrasound use has been increasing," Michael C. Monuteaux, Sc.D., said at the annual meeting of the Pediatric Academic Societies.

Increasing use of either imaging modality was associated with negative appendectomy rates, said Dr. Monuteaux, a senior biostatistician at Children’s Hospital Boston. "As the hospital-level imaging increased, the hospital-level negative appendectomy [rate] decreased."

The findings come from an analysis of the Pediatric Health Information System, a database maintained by 40 U.S. pediatric hospitals. The researchers studied 8,959,155 visits that patients under the age of 19 years made to emergency departments between 2005 and 2009 with a primary diagnosis of appendicitis, abdominal pain, or common, nontraumatic, acute disease mimickers of appendicitis.

Of these patients, 564,595 (6%) had abdominal pain and 55,238 (0.6%) had appendicitis.

The use of CT in patients with a diagnosis of appendicitis ranged from 21% to 49%, for a median of 34%, while the use of CT for other diagnoses ranged from 5% to 9%, for a median of 6%, Dr. Monuteaux reported.

Use of ultrasound in patients with a diagnosis of appendicitis ranged from 2% to 26%, for a median of 7%, while use of ultrasound for other diagnoses ranged from 2% to 8%, for a median of 6%.

Among patients diagnosed with appendicitis, CT rates decreased from a peak of 35% in 2007 to 29% in 2009, while ultrasound rates increased from 17% in 2005 to 25% in 2009.

Among patients with other diagnoses, CT rates decreased from a peak of 35% in 2007 to 29% in 2009, while ultrasound rates increased from 17% in 2005 to 25% in 2009.

The researchers observed no correlations between rates of either imaging modality and rates of perforated appendicitis. Increasing use of either CT or ultrasound was associated with decreasing negative appendectomy rates. In fact, for every 10% decrease in imaging, there was a 6.4% decrease in negative appendectomy rates.

Dr. Monuteaux acknowledged certain limitations of the study, including the fact that the cohort was drawn from an administrative database, "so it’s difficult to infer clinical management and outcome. We [also] could not adjust for any imaging that may have been done outside of the hospital prior to transfer. We also could not control or account for external factors such as [emergency department] crowding, the surrounding primary care network, or access to care that could possibly influence imaging."

He also noted that the association between type of imaging and patient-level perforation may be related to institutional clinical practice when perforation is suspected.

Dr. Monuteaux said that he had no relevant financial conflicts to disclose.

DENVER – Considerable variation exists in emergency department use of computed tomography or ultrasound for children with abdominal pain and appendicitis, results from a large national study demonstrated.

"Despite the greater diagnostic accuracy of CT, use of CT is decreasing for these conditions, while ultrasound use has been increasing," Michael C. Monuteaux, Sc.D., said at the annual meeting of the Pediatric Academic Societies.

Increasing use of either imaging modality was associated with negative appendectomy rates, said Dr. Monuteaux, a senior biostatistician at Children’s Hospital Boston. "As the hospital-level imaging increased, the hospital-level negative appendectomy [rate] decreased."

The findings come from an analysis of the Pediatric Health Information System, a database maintained by 40 U.S. pediatric hospitals. The researchers studied 8,959,155 visits that patients under the age of 19 years made to emergency departments between 2005 and 2009 with a primary diagnosis of appendicitis, abdominal pain, or common, nontraumatic, acute disease mimickers of appendicitis.

Of these patients, 564,595 (6%) had abdominal pain and 55,238 (0.6%) had appendicitis.

The use of CT in patients with a diagnosis of appendicitis ranged from 21% to 49%, for a median of 34%, while the use of CT for other diagnoses ranged from 5% to 9%, for a median of 6%, Dr. Monuteaux reported.

Use of ultrasound in patients with a diagnosis of appendicitis ranged from 2% to 26%, for a median of 7%, while use of ultrasound for other diagnoses ranged from 2% to 8%, for a median of 6%.

Among patients diagnosed with appendicitis, CT rates decreased from a peak of 35% in 2007 to 29% in 2009, while ultrasound rates increased from 17% in 2005 to 25% in 2009.

Among patients with other diagnoses, CT rates decreased from a peak of 35% in 2007 to 29% in 2009, while ultrasound rates increased from 17% in 2005 to 25% in 2009.

The researchers observed no correlations between rates of either imaging modality and rates of perforated appendicitis. Increasing use of either CT or ultrasound was associated with decreasing negative appendectomy rates. In fact, for every 10% decrease in imaging, there was a 6.4% decrease in negative appendectomy rates.

Dr. Monuteaux acknowledged certain limitations of the study, including the fact that the cohort was drawn from an administrative database, "so it’s difficult to infer clinical management and outcome. We [also] could not adjust for any imaging that may have been done outside of the hospital prior to transfer. We also could not control or account for external factors such as [emergency department] crowding, the surrounding primary care network, or access to care that could possibly influence imaging."

He also noted that the association between type of imaging and patient-level perforation may be related to institutional clinical practice when perforation is suspected.

Dr. Monuteaux said that he had no relevant financial conflicts to disclose.

DENVER – Considerable variation exists in emergency department use of computed tomography or ultrasound for children with abdominal pain and appendicitis, results from a large national study demonstrated.

"Despite the greater diagnostic accuracy of CT, use of CT is decreasing for these conditions, while ultrasound use has been increasing," Michael C. Monuteaux, Sc.D., said at the annual meeting of the Pediatric Academic Societies.

Increasing use of either imaging modality was associated with negative appendectomy rates, said Dr. Monuteaux, a senior biostatistician at Children’s Hospital Boston. "As the hospital-level imaging increased, the hospital-level negative appendectomy [rate] decreased."

The findings come from an analysis of the Pediatric Health Information System, a database maintained by 40 U.S. pediatric hospitals. The researchers studied 8,959,155 visits that patients under the age of 19 years made to emergency departments between 2005 and 2009 with a primary diagnosis of appendicitis, abdominal pain, or common, nontraumatic, acute disease mimickers of appendicitis.

Of these patients, 564,595 (6%) had abdominal pain and 55,238 (0.6%) had appendicitis.

The use of CT in patients with a diagnosis of appendicitis ranged from 21% to 49%, for a median of 34%, while the use of CT for other diagnoses ranged from 5% to 9%, for a median of 6%, Dr. Monuteaux reported.

Use of ultrasound in patients with a diagnosis of appendicitis ranged from 2% to 26%, for a median of 7%, while use of ultrasound for other diagnoses ranged from 2% to 8%, for a median of 6%.

Among patients diagnosed with appendicitis, CT rates decreased from a peak of 35% in 2007 to 29% in 2009, while ultrasound rates increased from 17% in 2005 to 25% in 2009.

Among patients with other diagnoses, CT rates decreased from a peak of 35% in 2007 to 29% in 2009, while ultrasound rates increased from 17% in 2005 to 25% in 2009.

The researchers observed no correlations between rates of either imaging modality and rates of perforated appendicitis. Increasing use of either CT or ultrasound was associated with decreasing negative appendectomy rates. In fact, for every 10% decrease in imaging, there was a 6.4% decrease in negative appendectomy rates.

Dr. Monuteaux acknowledged certain limitations of the study, including the fact that the cohort was drawn from an administrative database, "so it’s difficult to infer clinical management and outcome. We [also] could not adjust for any imaging that may have been done outside of the hospital prior to transfer. We also could not control or account for external factors such as [emergency department] crowding, the surrounding primary care network, or access to care that could possibly influence imaging."

He also noted that the association between type of imaging and patient-level perforation may be related to institutional clinical practice when perforation is suspected.

Dr. Monuteaux said that he had no relevant financial conflicts to disclose.

DENVER – Considerable variation exists in emergency department use of computed tomography or ultrasound for children with abdominal pain and appendicitis, results from a large national study demonstrated.

"Despite the greater diagnostic accuracy of CT, use of CT is decreasing for these conditions, while ultrasound use has been increasing," Michael C. Monuteaux, Sc.D., said at the annual meeting of the Pediatric Academic Societies.

Increasing use of either imaging modality was associated with negative appendectomy rates, said Dr. Monuteaux, a senior biostatistician at Children’s Hospital Boston. "As the hospital-level imaging increased, the hospital-level negative appendectomy [rate] decreased."

The findings come from an analysis of the Pediatric Health Information System, a database maintained by 40 U.S. pediatric hospitals. The researchers studied 8,959,155 visits that patients under the age of 19 years made to emergency departments between 2005 and 2009 with a primary diagnosis of appendicitis, abdominal pain, or common, nontraumatic, acute disease mimickers of appendicitis.

Of these patients, 564,595 (6%) had abdominal pain and 55,238 (0.6%) had appendicitis.

The use of CT in patients with a diagnosis of appendicitis ranged from 21% to 49%, for a median of 34%, while the use of CT for other diagnoses ranged from 5% to 9%, for a median of 6%, Dr. Monuteaux reported.

Use of ultrasound in patients with a diagnosis of appendicitis ranged from 2% to 26%, for a median of 7%, while use of ultrasound for other diagnoses ranged from 2% to 8%, for a median of 6%.

Among patients diagnosed with appendicitis, CT rates decreased from a peak of 35% in 2007 to 29% in 2009, while ultrasound rates increased from 17% in 2005 to 25% in 2009.

Among patients with other diagnoses, CT rates decreased from a peak of 35% in 2007 to 29% in 2009, while ultrasound rates increased from 17% in 2005 to 25% in 2009.

The researchers observed no correlations between rates of either imaging modality and rates of perforated appendicitis. Increasing use of either CT or ultrasound was associated with decreasing negative appendectomy rates. In fact, for every 10% decrease in imaging, there was a 6.4% decrease in negative appendectomy rates.

Dr. Monuteaux acknowledged certain limitations of the study, including the fact that the cohort was drawn from an administrative database, "so it’s difficult to infer clinical management and outcome. We [also] could not adjust for any imaging that may have been done outside of the hospital prior to transfer. We also could not control or account for external factors such as [emergency department] crowding, the surrounding primary care network, or access to care that could possibly influence imaging."

He also noted that the association between type of imaging and patient-level perforation may be related to institutional clinical practice when perforation is suspected.

Dr. Monuteaux said that he had no relevant financial conflicts to disclose.

DENVER – Considerable variation exists in emergency department use of computed tomography or ultrasound for children with abdominal pain and appendicitis, results from a large national study demonstrated.

"Despite the greater diagnostic accuracy of CT, use of CT is decreasing for these conditions, while ultrasound use has been increasing," Michael C. Monuteaux, Sc.D., said at the annual meeting of the Pediatric Academic Societies.

Increasing use of either imaging modality was associated with negative appendectomy rates, said Dr. Monuteaux, a senior biostatistician at Children’s Hospital Boston. "As the hospital-level imaging increased, the hospital-level negative appendectomy [rate] decreased."

The findings come from an analysis of the Pediatric Health Information System, a database maintained by 40 U.S. pediatric hospitals. The researchers studied 8,959,155 visits that patients under the age of 19 years made to emergency departments between 2005 and 2009 with a primary diagnosis of appendicitis, abdominal pain, or common, nontraumatic, acute disease mimickers of appendicitis.

Of these patients, 564,595 (6%) had abdominal pain and 55,238 (0.6%) had appendicitis.

The use of CT in patients with a diagnosis of appendicitis ranged from 21% to 49%, for a median of 34%, while the use of CT for other diagnoses ranged from 5% to 9%, for a median of 6%, Dr. Monuteaux reported.

Use of ultrasound in patients with a diagnosis of appendicitis ranged from 2% to 26%, for a median of 7%, while use of ultrasound for other diagnoses ranged from 2% to 8%, for a median of 6%.

Among patients diagnosed with appendicitis, CT rates decreased from a peak of 35% in 2007 to 29% in 2009, while ultrasound rates increased from 17% in 2005 to 25% in 2009.

Among patients with other diagnoses, CT rates decreased from a peak of 35% in 2007 to 29% in 2009, while ultrasound rates increased from 17% in 2005 to 25% in 2009.

The researchers observed no correlations between rates of either imaging modality and rates of perforated appendicitis. Increasing use of either CT or ultrasound was associated with decreasing negative appendectomy rates. In fact, for every 10% decrease in imaging, there was a 6.4% decrease in negative appendectomy rates.

Dr. Monuteaux acknowledged certain limitations of the study, including the fact that the cohort was drawn from an administrative database, "so it’s difficult to infer clinical management and outcome. We [also] could not adjust for any imaging that may have been done outside of the hospital prior to transfer. We also could not control or account for external factors such as [emergency department] crowding, the surrounding primary care network, or access to care that could possibly influence imaging."

He also noted that the association between type of imaging and patient-level perforation may be related to institutional clinical practice when perforation is suspected.

Dr. Monuteaux said that he had no relevant financial conflicts to disclose.

DENVER – Children exposed to secondhand tobacco smoke who are admitted to the hospital for influenza are more likely to require admission to the intensive care unit and have a longer hospital stay than their peers who are not exposed to secondhand smoke.

These effects are even greater for children with chronic illnesses who are exposed to secondhand smoke, Dr. Karen M. Wilson reported at the annual meeting of the Pediatric Academic Societies.

An estimated 18% of children aged 3-11 years are regularly exposed to secondhand tobacco smoke inside the home, said Dr. Wilson, assistant professor of pediatrics at the University of Rochester (N.Y.).

Although secondhand smoke exposure is associated with worse outcomes for children’s illnesses, including respiratory syncytial virus and asthma, "the effect of secondhand smoke exposure on influenza severity in children is unclear," she noted. "More than 40% of preschool children experience influenza at some point. In adults, tobacco smoke increases the risk of influenza infection and the risk of complications."

To determine if children hospitalized with influenza who are exposed to secondhand smoke have more severe illness, Dr. Wilson and her associates conducted a review of 169 medical charts at Golisano Children’s Hospital in Rochester. They generated a list of patients aged 0-15 years with a discharge diagnosis of influenza between 2002 and 2009. The influenza diagnosis was verified by laboratory review.

Measures of severity included intensive care unit admission, defined as admission or transfer to the ICU at any time during the stay; need for mechanical ventilation, defined as any documentation of endotracheal intubation during the stay; and length of stay.

Exposure to secondhand smoke was assessed by any documentation of presence or absence of secondhand smoke exposure by any provider. "Any documentation of exposure was considered exposed; documentation of no exposure was considered not exposed," Dr. Wilson said.

She reported findings from 113 children who were included in the final analysis. Of these, 46 (41%) were exposed to secondhand smoke and 67 (59%) were not. The average age of the 113 children was 4 years, and 50% were male. Of the 113 children, 58% were white, 22% were black, 8% were Hispanic, and 3.5% were Asian; race/ethnicity was unknown in the remaining 8.5%. Fewer than half of the children (44%) had public health insurance.

More than three-quarters of the children (78%) had influenza A. In addition, 25% had asthma, 25% had an underlying chronic condition, 14% had documentation of prematurity, 19% required ICU care, and 6% required mechanical ventilation.

None of the potential covariates – including asthma, prematurity, and chronic conditions – were significantly associated with secondhand smoke exposure. However, children exposed to secondhand smoke were significantly more likely to require ICU admission (31% vs. 10% for children with no exposure) and mechanical ventilation (13% vs. 2%, respectively).

The mean length of stay was 2.1 days for children who had no chronic condition or exposure to secondhand smoke, 2.5 days for children who had no chronic condition but had exposure to secondhand smoke, 3.5 days for children who had a chronic condition but no exposure to secondhand smoke, and 11 days for children who had a chronic condition and were exposed to secondhand smoke.

In a logistic regression model controlling for age, gender, race, and type of insurance, exposure to secondhand smoke was significantly associated with ICU admission but chronic conditions were not.

In a logistic regression model limited to exposure to secondhand smoke and chronic conditions, chronic conditions were associated with the need for mechanical ventilation but exposure to secondhand smoke was not.

In a negative binomial regression model using the log-transformed length of stay, controlling for age, gender, race, insurance type, and chronic conditions, exposure to secondhand smoke was associated with an increased length of hospital stay, with an incident rate ratio of 1.9.

Dr. Wilson acknowledged certain limitations of the study, including its single-center design "and the potential for errors in documentation and abstraction," she said. "The exposure measure was reliant on provider documentation ... but provider documentation is more likely to underestimate secondhand smoke exposure in children, so we probably misclassified some children as being non–smoke exposed."

In addition, "there may be other covariates that we were not able to measure because we don’t have documentation in the chart," she said.

Despite such limitations, Dr. Wilson said that the findings support the notion of considering secondhand smoke exposure in risk stratification for children admitted with influenza. "Greater efforts are needed to help parents eliminate their children’s exposure to secondhand smoke," she said. "Parents of children with chronic illness should be aware of the risk of secondhand smoke exposure, and children exposed to secondhand smoke should be a priority group for influenza immunization."

Dr. Wilson disclosed that she is on the speakers bureau for the American Academy of Pediatrics Julius B. Richmond Center of Excellence, with funding from the Flight Attendant Medical Research Institute, National Research Service Award T32, Strong Children’s Research Center Summer Research Program, and the Child Health Corporation of America through a grant to the Pediatric Research in Inpatient Settings Network.

DENVER – Children exposed to secondhand tobacco smoke who are admitted to the hospital for influenza are more likely to require admission to the intensive care unit and have a longer hospital stay than their peers who are not exposed to secondhand smoke.

These effects are even greater for children with chronic illnesses who are exposed to secondhand smoke, Dr. Karen M. Wilson reported at the annual meeting of the Pediatric Academic Societies.

An estimated 18% of children aged 3-11 years are regularly exposed to secondhand tobacco smoke inside the home, said Dr. Wilson, assistant professor of pediatrics at the University of Rochester (N.Y.).

Although secondhand smoke exposure is associated with worse outcomes for children’s illnesses, including respiratory syncytial virus and asthma, "the effect of secondhand smoke exposure on influenza severity in children is unclear," she noted. "More than 40% of preschool children experience influenza at some point. In adults, tobacco smoke increases the risk of influenza infection and the risk of complications."

To determine if children hospitalized with influenza who are exposed to secondhand smoke have more severe illness, Dr. Wilson and her associates conducted a review of 169 medical charts at Golisano Children’s Hospital in Rochester. They generated a list of patients aged 0-15 years with a discharge diagnosis of influenza between 2002 and 2009. The influenza diagnosis was verified by laboratory review.

Measures of severity included intensive care unit admission, defined as admission or transfer to the ICU at any time during the stay; need for mechanical ventilation, defined as any documentation of endotracheal intubation during the stay; and length of stay.

Exposure to secondhand smoke was assessed by any documentation of presence or absence of secondhand smoke exposure by any provider. "Any documentation of exposure was considered exposed; documentation of no exposure was considered not exposed," Dr. Wilson said.

She reported findings from 113 children who were included in the final analysis. Of these, 46 (41%) were exposed to secondhand smoke and 67 (59%) were not. The average age of the 113 children was 4 years, and 50% were male. Of the 113 children, 58% were white, 22% were black, 8% were Hispanic, and 3.5% were Asian; race/ethnicity was unknown in the remaining 8.5%. Fewer than half of the children (44%) had public health insurance.

More than three-quarters of the children (78%) had influenza A. In addition, 25% had asthma, 25% had an underlying chronic condition, 14% had documentation of prematurity, 19% required ICU care, and 6% required mechanical ventilation.

None of the potential covariates – including asthma, prematurity, and chronic conditions – were significantly associated with secondhand smoke exposure. However, children exposed to secondhand smoke were significantly more likely to require ICU admission (31% vs. 10% for children with no exposure) and mechanical ventilation (13% vs. 2%, respectively).

The mean length of stay was 2.1 days for children who had no chronic condition or exposure to secondhand smoke, 2.5 days for children who had no chronic condition but had exposure to secondhand smoke, 3.5 days for children who had a chronic condition but no exposure to secondhand smoke, and 11 days for children who had a chronic condition and were exposed to secondhand smoke.

In a logistic regression model controlling for age, gender, race, and type of insurance, exposure to secondhand smoke was significantly associated with ICU admission but chronic conditions were not.

In a logistic regression model limited to exposure to secondhand smoke and chronic conditions, chronic conditions were associated with the need for mechanical ventilation but exposure to secondhand smoke was not.

In a negative binomial regression model using the log-transformed length of stay, controlling for age, gender, race, insurance type, and chronic conditions, exposure to secondhand smoke was associated with an increased length of hospital stay, with an incident rate ratio of 1.9.

Dr. Wilson acknowledged certain limitations of the study, including its single-center design "and the potential for errors in documentation and abstraction," she said. "The exposure measure was reliant on provider documentation ... but provider documentation is more likely to underestimate secondhand smoke exposure in children, so we probably misclassified some children as being non–smoke exposed."

In addition, "there may be other covariates that we were not able to measure because we don’t have documentation in the chart," she said.

Despite such limitations, Dr. Wilson said that the findings support the notion of considering secondhand smoke exposure in risk stratification for children admitted with influenza. "Greater efforts are needed to help parents eliminate their children’s exposure to secondhand smoke," she said. "Parents of children with chronic illness should be aware of the risk of secondhand smoke exposure, and children exposed to secondhand smoke should be a priority group for influenza immunization."

Dr. Wilson disclosed that she is on the speakers bureau for the American Academy of Pediatrics Julius B. Richmond Center of Excellence, with funding from the Flight Attendant Medical Research Institute, National Research Service Award T32, Strong Children’s Research Center Summer Research Program, and the Child Health Corporation of America through a grant to the Pediatric Research in Inpatient Settings Network.

DENVER – Children exposed to secondhand tobacco smoke who are admitted to the hospital for influenza are more likely to require admission to the intensive care unit and have a longer hospital stay than their peers who are not exposed to secondhand smoke.

These effects are even greater for children with chronic illnesses who are exposed to secondhand smoke, Dr. Karen M. Wilson reported at the annual meeting of the Pediatric Academic Societies.

An estimated 18% of children aged 3-11 years are regularly exposed to secondhand tobacco smoke inside the home, said Dr. Wilson, assistant professor of pediatrics at the University of Rochester (N.Y.).

Although secondhand smoke exposure is associated with worse outcomes for children’s illnesses, including respiratory syncytial virus and asthma, "the effect of secondhand smoke exposure on influenza severity in children is unclear," she noted. "More than 40% of preschool children experience influenza at some point. In adults, tobacco smoke increases the risk of influenza infection and the risk of complications."

To determine if children hospitalized with influenza who are exposed to secondhand smoke have more severe illness, Dr. Wilson and her associates conducted a review of 169 medical charts at Golisano Children’s Hospital in Rochester. They generated a list of patients aged 0-15 years with a discharge diagnosis of influenza between 2002 and 2009. The influenza diagnosis was verified by laboratory review.

Measures of severity included intensive care unit admission, defined as admission or transfer to the ICU at any time during the stay; need for mechanical ventilation, defined as any documentation of endotracheal intubation during the stay; and length of stay.

Exposure to secondhand smoke was assessed by any documentation of presence or absence of secondhand smoke exposure by any provider. "Any documentation of exposure was considered exposed; documentation of no exposure was considered not exposed," Dr. Wilson said.

She reported findings from 113 children who were included in the final analysis. Of these, 46 (41%) were exposed to secondhand smoke and 67 (59%) were not. The average age of the 113 children was 4 years, and 50% were male. Of the 113 children, 58% were white, 22% were black, 8% were Hispanic, and 3.5% were Asian; race/ethnicity was unknown in the remaining 8.5%. Fewer than half of the children (44%) had public health insurance.

More than three-quarters of the children (78%) had influenza A. In addition, 25% had asthma, 25% had an underlying chronic condition, 14% had documentation of prematurity, 19% required ICU care, and 6% required mechanical ventilation.

None of the potential covariates – including asthma, prematurity, and chronic conditions – were significantly associated with secondhand smoke exposure. However, children exposed to secondhand smoke were significantly more likely to require ICU admission (31% vs. 10% for children with no exposure) and mechanical ventilation (13% vs. 2%, respectively).

The mean length of stay was 2.1 days for children who had no chronic condition or exposure to secondhand smoke, 2.5 days for children who had no chronic condition but had exposure to secondhand smoke, 3.5 days for children who had a chronic condition but no exposure to secondhand smoke, and 11 days for children who had a chronic condition and were exposed to secondhand smoke.

In a logistic regression model controlling for age, gender, race, and type of insurance, exposure to secondhand smoke was significantly associated with ICU admission but chronic conditions were not.

In a logistic regression model limited to exposure to secondhand smoke and chronic conditions, chronic conditions were associated with the need for mechanical ventilation but exposure to secondhand smoke was not.

In a negative binomial regression model using the log-transformed length of stay, controlling for age, gender, race, insurance type, and chronic conditions, exposure to secondhand smoke was associated with an increased length of hospital stay, with an incident rate ratio of 1.9.

Dr. Wilson acknowledged certain limitations of the study, including its single-center design "and the potential for errors in documentation and abstraction," she said. "The exposure measure was reliant on provider documentation ... but provider documentation is more likely to underestimate secondhand smoke exposure in children, so we probably misclassified some children as being non–smoke exposed."

In addition, "there may be other covariates that we were not able to measure because we don’t have documentation in the chart," she said.

Despite such limitations, Dr. Wilson said that the findings support the notion of considering secondhand smoke exposure in risk stratification for children admitted with influenza. "Greater efforts are needed to help parents eliminate their children’s exposure to secondhand smoke," she said. "Parents of children with chronic illness should be aware of the risk of secondhand smoke exposure, and children exposed to secondhand smoke should be a priority group for influenza immunization."

Dr. Wilson disclosed that she is on the speakers bureau for the American Academy of Pediatrics Julius B. Richmond Center of Excellence, with funding from the Flight Attendant Medical Research Institute, National Research Service Award T32, Strong Children’s Research Center Summer Research Program, and the Child Health Corporation of America through a grant to the Pediatric Research in Inpatient Settings Network.

DENVER – Children exposed to secondhand tobacco smoke who are admitted to the hospital for influenza are more likely to require admission to the intensive care unit and have a longer hospital stay than their peers who are not exposed to secondhand smoke.

These effects are even greater for children with chronic illnesses who are exposed to secondhand smoke, Dr. Karen M. Wilson reported at the annual meeting of the Pediatric Academic Societies.

An estimated 18% of children aged 3-11 years are regularly exposed to secondhand tobacco smoke inside the home, said Dr. Wilson, assistant professor of pediatrics at the University of Rochester (N.Y.).

Although secondhand smoke exposure is associated with worse outcomes for children’s illnesses, including respiratory syncytial virus and asthma, "the effect of secondhand smoke exposure on influenza severity in children is unclear," she noted. "More than 40% of preschool children experience influenza at some point. In adults, tobacco smoke increases the risk of influenza infection and the risk of complications."

To determine if children hospitalized with influenza who are exposed to secondhand smoke have more severe illness, Dr. Wilson and her associates conducted a review of 169 medical charts at Golisano Children’s Hospital in Rochester. They generated a list of patients aged 0-15 years with a discharge diagnosis of influenza between 2002 and 2009. The influenza diagnosis was verified by laboratory review.

Measures of severity included intensive care unit admission, defined as admission or transfer to the ICU at any time during the stay; need for mechanical ventilation, defined as any documentation of endotracheal intubation during the stay; and length of stay.

Exposure to secondhand smoke was assessed by any documentation of presence or absence of secondhand smoke exposure by any provider. "Any documentation of exposure was considered exposed; documentation of no exposure was considered not exposed," Dr. Wilson said.

She reported findings from 113 children who were included in the final analysis. Of these, 46 (41%) were exposed to secondhand smoke and 67 (59%) were not. The average age of the 113 children was 4 years, and 50% were male. Of the 113 children, 58% were white, 22% were black, 8% were Hispanic, and 3.5% were Asian; race/ethnicity was unknown in the remaining 8.5%. Fewer than half of the children (44%) had public health insurance.

More than three-quarters of the children (78%) had influenza A. In addition, 25% had asthma, 25% had an underlying chronic condition, 14% had documentation of prematurity, 19% required ICU care, and 6% required mechanical ventilation.

None of the potential covariates – including asthma, prematurity, and chronic conditions – were significantly associated with secondhand smoke exposure. However, children exposed to secondhand smoke were significantly more likely to require ICU admission (31% vs. 10% for children with no exposure) and mechanical ventilation (13% vs. 2%, respectively).

The mean length of stay was 2.1 days for children who had no chronic condition or exposure to secondhand smoke, 2.5 days for children who had no chronic condition but had exposure to secondhand smoke, 3.5 days for children who had a chronic condition but no exposure to secondhand smoke, and 11 days for children who had a chronic condition and were exposed to secondhand smoke.

In a logistic regression model controlling for age, gender, race, and type of insurance, exposure to secondhand smoke was significantly associated with ICU admission but chronic conditions were not.

In a logistic regression model limited to exposure to secondhand smoke and chronic conditions, chronic conditions were associated with the need for mechanical ventilation but exposure to secondhand smoke was not.

In a negative binomial regression model using the log-transformed length of stay, controlling for age, gender, race, insurance type, and chronic conditions, exposure to secondhand smoke was associated with an increased length of hospital stay, with an incident rate ratio of 1.9.

Dr. Wilson acknowledged certain limitations of the study, including its single-center design "and the potential for errors in documentation and abstraction," she said. "The exposure measure was reliant on provider documentation ... but provider documentation is more likely to underestimate secondhand smoke exposure in children, so we probably misclassified some children as being non–smoke exposed."

In addition, "there may be other covariates that we were not able to measure because we don’t have documentation in the chart," she said.

Despite such limitations, Dr. Wilson said that the findings support the notion of considering secondhand smoke exposure in risk stratification for children admitted with influenza. "Greater efforts are needed to help parents eliminate their children’s exposure to secondhand smoke," she said. "Parents of children with chronic illness should be aware of the risk of secondhand smoke exposure, and children exposed to secondhand smoke should be a priority group for influenza immunization."

Dr. Wilson disclosed that she is on the speakers bureau for the American Academy of Pediatrics Julius B. Richmond Center of Excellence, with funding from the Flight Attendant Medical Research Institute, National Research Service Award T32, Strong Children’s Research Center Summer Research Program, and the Child Health Corporation of America through a grant to the Pediatric Research in Inpatient Settings Network.

DENVER – Children exposed to secondhand tobacco smoke who are admitted to the hospital for influenza are more likely to require admission to the intensive care unit and have a longer hospital stay than their peers who are not exposed to secondhand smoke.

These effects are even greater for children with chronic illnesses who are exposed to secondhand smoke, Dr. Karen M. Wilson reported at the annual meeting of the Pediatric Academic Societies.

An estimated 18% of children aged 3-11 years are regularly exposed to secondhand tobacco smoke inside the home, said Dr. Wilson, assistant professor of pediatrics at the University of Rochester (N.Y.).

Although secondhand smoke exposure is associated with worse outcomes for children’s illnesses, including respiratory syncytial virus and asthma, "the effect of secondhand smoke exposure on influenza severity in children is unclear," she noted. "More than 40% of preschool children experience influenza at some point. In adults, tobacco smoke increases the risk of influenza infection and the risk of complications."

To determine if children hospitalized with influenza who are exposed to secondhand smoke have more severe illness, Dr. Wilson and her associates conducted a review of 169 medical charts at Golisano Children’s Hospital in Rochester. They generated a list of patients aged 0-15 years with a discharge diagnosis of influenza between 2002 and 2009. The influenza diagnosis was verified by laboratory review.

Measures of severity included intensive care unit admission, defined as admission or transfer to the ICU at any time during the stay; need for mechanical ventilation, defined as any documentation of endotracheal intubation during the stay; and length of stay.

Exposure to secondhand smoke was assessed by any documentation of presence or absence of secondhand smoke exposure by any provider. "Any documentation of exposure was considered exposed; documentation of no exposure was considered not exposed," Dr. Wilson said.

She reported findings from 113 children who were included in the final analysis. Of these, 46 (41%) were exposed to secondhand smoke and 67 (59%) were not. The average age of the 113 children was 4 years, and 50% were male. Of the 113 children, 58% were white, 22% were black, 8% were Hispanic, and 3.5% were Asian; race/ethnicity was unknown in the remaining 8.5%. Fewer than half of the children (44%) had public health insurance.

More than three-quarters of the children (78%) had influenza A. In addition, 25% had asthma, 25% had an underlying chronic condition, 14% had documentation of prematurity, 19% required ICU care, and 6% required mechanical ventilation.

None of the potential covariates – including asthma, prematurity, and chronic conditions – were significantly associated with secondhand smoke exposure. However, children exposed to secondhand smoke were significantly more likely to require ICU admission (31% vs. 10% for children with no exposure) and mechanical ventilation (13% vs. 2%, respectively).

The mean length of stay was 2.1 days for children who had no chronic condition or exposure to secondhand smoke, 2.5 days for children who had no chronic condition but had exposure to secondhand smoke, 3.5 days for children who had a chronic condition but no exposure to secondhand smoke, and 11 days for children who had a chronic condition and were exposed to secondhand smoke.

In a logistic regression model controlling for age, gender, race, and type of insurance, exposure to secondhand smoke was significantly associated with ICU admission but chronic conditions were not.

In a logistic regression model limited to exposure to secondhand smoke and chronic conditions, chronic conditions were associated with the need for mechanical ventilation but exposure to secondhand smoke was not.

In a negative binomial regression model using the log-transformed length of stay, controlling for age, gender, race, insurance type, and chronic conditions, exposure to secondhand smoke was associated with an increased length of hospital stay, with an incident rate ratio of 1.9.

Dr. Wilson acknowledged certain limitations of the study, including its single-center design "and the potential for errors in documentation and abstraction," she said. "The exposure measure was reliant on provider documentation ... but provider documentation is more likely to underestimate secondhand smoke exposure in children, so we probably misclassified some children as being non–smoke exposed."

In addition, "there may be other covariates that we were not able to measure because we don’t have documentation in the chart," she said.

Despite such limitations, Dr. Wilson said that the findings support the notion of considering secondhand smoke exposure in risk stratification for children admitted with influenza. "Greater efforts are needed to help parents eliminate their children’s exposure to secondhand smoke," she said. "Parents of children with chronic illness should be aware of the risk of secondhand smoke exposure, and children exposed to secondhand smoke should be a priority group for influenza immunization."

Dr. Wilson disclosed that she is on the speakers bureau for the American Academy of Pediatrics Julius B. Richmond Center of Excellence, with funding from the Flight Attendant Medical Research Institute, National Research Service Award T32, Strong Children’s Research Center Summer Research Program, and the Child Health Corporation of America through a grant to the Pediatric Research in Inpatient Settings Network.

DENVER – Children exposed to secondhand tobacco smoke who are admitted to the hospital for influenza are more likely to require admission to the intensive care unit and have a longer hospital stay than their peers who are not exposed to secondhand smoke.

These effects are even greater for children with chronic illnesses who are exposed to secondhand smoke, Dr. Karen M. Wilson reported at the annual meeting of the Pediatric Academic Societies.

An estimated 18% of children aged 3-11 years are regularly exposed to secondhand tobacco smoke inside the home, said Dr. Wilson, assistant professor of pediatrics at the University of Rochester (N.Y.).

Although secondhand smoke exposure is associated with worse outcomes for children’s illnesses, including respiratory syncytial virus and asthma, "the effect of secondhand smoke exposure on influenza severity in children is unclear," she noted. "More than 40% of preschool children experience influenza at some point. In adults, tobacco smoke increases the risk of influenza infection and the risk of complications."

To determine if children hospitalized with influenza who are exposed to secondhand smoke have more severe illness, Dr. Wilson and her associates conducted a review of 169 medical charts at Golisano Children’s Hospital in Rochester. They generated a list of patients aged 0-15 years with a discharge diagnosis of influenza between 2002 and 2009. The influenza diagnosis was verified by laboratory review.

Measures of severity included intensive care unit admission, defined as admission or transfer to the ICU at any time during the stay; need for mechanical ventilation, defined as any documentation of endotracheal intubation during the stay; and length of stay.

Exposure to secondhand smoke was assessed by any documentation of presence or absence of secondhand smoke exposure by any provider. "Any documentation of exposure was considered exposed; documentation of no exposure was considered not exposed," Dr. Wilson said.

She reported findings from 113 children who were included in the final analysis. Of these, 46 (41%) were exposed to secondhand smoke and 67 (59%) were not. The average age of the 113 children was 4 years, and 50% were male. Of the 113 children, 58% were white, 22% were black, 8% were Hispanic, and 3.5% were Asian; race/ethnicity was unknown in the remaining 8.5%. Fewer than half of the children (44%) had public health insurance.

More than three-quarters of the children (78%) had influenza A. In addition, 25% had asthma, 25% had an underlying chronic condition, 14% had documentation of prematurity, 19% required ICU care, and 6% required mechanical ventilation.

None of the potential covariates – including asthma, prematurity, and chronic conditions – were significantly associated with secondhand smoke exposure. However, children exposed to secondhand smoke were significantly more likely to require ICU admission (31% vs. 10% for children with no exposure) and mechanical ventilation (13% vs. 2%, respectively).

The mean length of stay was 2.1 days for children who had no chronic condition or exposure to secondhand smoke, 2.5 days for children who had no chronic condition but had exposure to secondhand smoke, 3.5 days for children who had a chronic condition but no exposure to secondhand smoke, and 11 days for children who had a chronic condition and were exposed to secondhand smoke.

In a logistic regression model controlling for age, gender, race, and type of insurance, exposure to secondhand smoke was significantly associated with ICU admission but chronic conditions were not.

In a logistic regression model limited to exposure to secondhand smoke and chronic conditions, chronic conditions were associated with the need for mechanical ventilation but exposure to secondhand smoke was not.

In a negative binomial regression model using the log-transformed length of stay, controlling for age, gender, race, insurance type, and chronic conditions, exposure to secondhand smoke was associated with an increased length of hospital stay, with an incident rate ratio of 1.9.

Dr. Wilson acknowledged certain limitations of the study, including its single-center design "and the potential for errors in documentation and abstraction," she said. "The exposure measure was reliant on provider documentation ... but provider documentation is more likely to underestimate secondhand smoke exposure in children, so we probably misclassified some children as being non–smoke exposed."

In addition, "there may be other covariates that we were not able to measure because we don’t have documentation in the chart," she said.

Despite such limitations, Dr. Wilson said that the findings support the notion of considering secondhand smoke exposure in risk stratification for children admitted with influenza. "Greater efforts are needed to help parents eliminate their children’s exposure to secondhand smoke," she said. "Parents of children with chronic illness should be aware of the risk of secondhand smoke exposure, and children exposed to secondhand smoke should be a priority group for influenza immunization."

Dr. Wilson disclosed that she is on the speakers bureau for the American Academy of Pediatrics Julius B. Richmond Center of Excellence, with funding from the Flight Attendant Medical Research Institute, National Research Service Award T32, Strong Children’s Research Center Summer Research Program, and the Child Health Corporation of America through a grant to the Pediatric Research in Inpatient Settings Network.

SAN FRANCISCO – Compared with placebo, a single dose of montelukast attenuated exercise-induced bronchoconstriction in children within 2 hours and lasted through 24 hours post dose, results from a small study found.

Although this treatment effect of montelukast has been observed in previously published studies of adults with exercise-induced bronchoconstriction, this is the first analysis of its kind in children with the condition.

“The ability to take a single tablet and have it last for 24 hours is probably more meaningful for children than for adults, because children often engage in unplanned physical activities more than adults do,” Dr. George Philip said in an interview during a poster session at the meeting.

In a multicenter study, Dr. Philip, senior director of clinical research at Merck Research Laboratories, North Wales, Pa., and his associates enrolled 66 children aged 6-14 years with preexercise forced expiratory volume in 1 second (FEV₁) of 70% predicted or greater and a maximum fall in FEV₁ of 20% or greater at two screening exercise challenges performed on a treadmill. Study participants were randomized to receive single-dose montelukast (4 or 5 mg) or placebo before the exercise challenges were performed at 2 and 24 hours post dose.

The primary end point was maximum percent fall in FEV₁ after exercise challenge 2 hours post dose. Secondary end points included maximum percent fall in FEV₁ after the 24-hour postdose challenge and each of the following end points at 2 and 24 hours post dose: maximum percent fall in FEV₁ categorized as less than 10%, 10%-20%, and greater than 20%; area under the curve during the 60 minutes post challenge; and time to recovery to within 5% of preexercise baseline.

The mean age of patients was 11 years, and 56% were male. About three-quarters (74.2%) were white, 16.7% were black, and 9.1% were from other ethnic groups.

Dr. Philip reported that the mean percent fall in FEV₁ was significantly better after the 2-hour postdose exercise challenge in the montelukast treatment group than in the placebo group (15.3% vs. 20%, respectively). Patients in the montelukast group also fared significantly better, compared with their counterparts in the placebo group, in maximum percent fall in FEV₁ after the 24-hour postdose exercise challenge (12.92% vs. 17.25%, respectively); the categorized maximum percent fall at 2 hours (P = .034) though not at 24 hours (P = .061); and area under the curve at 2 hours (P = .022) and 24 hours (P = .013).

There were few clinical adverse events and no serious drug-related adverse events.

SAN FRANCISCO – Compared with placebo, a single dose of montelukast attenuated exercise-induced bronchoconstriction in children within 2 hours and lasted through 24 hours post dose, results from a small study found.

Although this treatment effect of montelukast has been observed in previously published studies of adults with exercise-induced bronchoconstriction, this is the first analysis of its kind in children with the condition.

“The ability to take a single tablet and have it last for 24 hours is probably more meaningful for children than for adults, because children often engage in unplanned physical activities more than adults do,” Dr. George Philip said in an interview during a poster session at the meeting.

In a multicenter study, Dr. Philip, senior director of clinical research at Merck Research Laboratories, North Wales, Pa., and his associates enrolled 66 children aged 6-14 years with preexercise forced expiratory volume in 1 second (FEV₁) of 70% predicted or greater and a maximum fall in FEV₁ of 20% or greater at two screening exercise challenges performed on a treadmill. Study participants were randomized to receive single-dose montelukast (4 or 5 mg) or placebo before the exercise challenges were performed at 2 and 24 hours post dose.

The primary end point was maximum percent fall in FEV₁ after exercise challenge 2 hours post dose. Secondary end points included maximum percent fall in FEV₁ after the 24-hour postdose challenge and each of the following end points at 2 and 24 hours post dose: maximum percent fall in FEV₁ categorized as less than 10%, 10%-20%, and greater than 20%; area under the curve during the 60 minutes post challenge; and time to recovery to within 5% of preexercise baseline.

The mean age of patients was 11 years, and 56% were male. About three-quarters (74.2%) were white, 16.7% were black, and 9.1% were from other ethnic groups.

Dr. Philip reported that the mean percent fall in FEV₁ was significantly better after the 2-hour postdose exercise challenge in the montelukast treatment group than in the placebo group (15.3% vs. 20%, respectively). Patients in the montelukast group also fared significantly better, compared with their counterparts in the placebo group, in maximum percent fall in FEV₁ after the 24-hour postdose exercise challenge (12.92% vs. 17.25%, respectively); the categorized maximum percent fall at 2 hours (P = .034) though not at 24 hours (P = .061); and area under the curve at 2 hours (P = .022) and 24 hours (P = .013).

There were few clinical adverse events and no serious drug-related adverse events.

SAN FRANCISCO – Compared with placebo, a single dose of montelukast attenuated exercise-induced bronchoconstriction in children within 2 hours and lasted through 24 hours post dose, results from a small study found.

Although this treatment effect of montelukast has been observed in previously published studies of adults with exercise-induced bronchoconstriction, this is the first analysis of its kind in children with the condition.

“The ability to take a single tablet and have it last for 24 hours is probably more meaningful for children than for adults, because children often engage in unplanned physical activities more than adults do,” Dr. George Philip said in an interview during a poster session at the meeting.

In a multicenter study, Dr. Philip, senior director of clinical research at Merck Research Laboratories, North Wales, Pa., and his associates enrolled 66 children aged 6-14 years with preexercise forced expiratory volume in 1 second (FEV₁) of 70% predicted or greater and a maximum fall in FEV₁ of 20% or greater at two screening exercise challenges performed on a treadmill. Study participants were randomized to receive single-dose montelukast (4 or 5 mg) or placebo before the exercise challenges were performed at 2 and 24 hours post dose.

The primary end point was maximum percent fall in FEV₁ after exercise challenge 2 hours post dose. Secondary end points included maximum percent fall in FEV₁ after the 24-hour postdose challenge and each of the following end points at 2 and 24 hours post dose: maximum percent fall in FEV₁ categorized as less than 10%, 10%-20%, and greater than 20%; area under the curve during the 60 minutes post challenge; and time to recovery to within 5% of preexercise baseline.

The mean age of patients was 11 years, and 56% were male. About three-quarters (74.2%) were white, 16.7% were black, and 9.1% were from other ethnic groups.

Dr. Philip reported that the mean percent fall in FEV₁ was significantly better after the 2-hour postdose exercise challenge in the montelukast treatment group than in the placebo group (15.3% vs. 20%, respectively). Patients in the montelukast group also fared significantly better, compared with their counterparts in the placebo group, in maximum percent fall in FEV₁ after the 24-hour postdose exercise challenge (12.92% vs. 17.25%, respectively); the categorized maximum percent fall at 2 hours (P = .034) though not at 24 hours (P = .061); and area under the curve at 2 hours (P = .022) and 24 hours (P = .013).

There were few clinical adverse events and no serious drug-related adverse events.

DENVER – Although new adolescent vaccine recommendations disseminated between 2005 and early 2007 for meningococcal, tetanus-diphtheria-pertussis, and human papillomavirus vaccines were anticipated to increase the proportion of adolescents with an annual preventive visit, no such impact has occurred, results from a large national survey demonstrated.

However, the rates of vaccination-only visits did increase, researchers led by Christina S. Albertin, reported during a poster session at the meeting.

The findings suggest that patterns of primary care delivery did not appear to change as a result of the new recommendations for this population.

“Additional methods, such as reminder recall interventions for annual well care visits, may be needed to bring additional adolescents in for recommended preventive care,” the researchers wrote.

Ms. Albertin and her associates from the division of general pediatrics at the University of Rochester (N.Y.) analyzed Medical Expenditure Panel Surv ey data for any medical visits, well-care visits, and vaccine-only visits made by adolescents, aged 11-21 years, during two time periods: 2004-2005 (before the vaccine recommendations) and 2007-2008 (after the recommendations).

They compared visit rates overall and by age group (11-13 years, 14-17 years, and 18-21 years), sex, race/ethnic group, insurance status, and household income. They used chi square analysis to compare rates between the two time periods, controlling for the complex sample design.

Ms. Albertin presented findings from 2,693 adolescents studied in 2004-2005 and 1,988 adolescents studied in 2007-2008.

Between the two time periods, no significant changes in the percentage of adolescents with any medical visit overall were observed (73% vs. 72%, respectively), nor were any changes seen among any of the subgroups following the recommendations, the researchers reported.

In addition, the percentage of well-child visits did not change significantly overall (they remained at 41% for both time periods), or among any of the subgroups.

The average number of visits with a vaccination overall increased significantly from 0.08% in 2004-2005 to 0.14% in 2007-2008.

Likewise, the percentage of adolescents who reported a visit with a vaccination increased from 8% to 11%.

The subgroups with significant increases included adolescents aged 14-17 years, females, whites, those who were privately insured, and those from families with the highest income level.

“The data seem to show that in the initial 21 months or so following the recommendations, pediatricians focused on fitting vaccinations into existing visits, not expanding the number of [patient] visits,” Ms. Albertin said in an interview.

“I'm surprised by the results given that there are Tdap vaccine requirements in many states,” the investigator commented.

She went on to explain that through 2008, only 16 states had school requirements for the Tdap vaccine.

“Now, projected through 2011 it looks like that's going to more than double,” she said.

“As a result, I think that we will slowly see an increase in both immunization-only and preventive visits,” Ms. Albertin noted.

Ms. Albertin said she had no relevant financial conflicts to disclose.

DENVER – Although new adolescent vaccine recommendations disseminated between 2005 and early 2007 for meningococcal, tetanus-diphtheria-pertussis, and human papillomavirus vaccines were anticipated to increase the proportion of adolescents with an annual preventive visit, no such impact has occurred, results from a large national survey demonstrated.

However, the rates of vaccination-only visits did increase, researchers led by Christina S. Albertin, reported during a poster session at the meeting.

The findings suggest that patterns of primary care delivery did not appear to change as a result of the new recommendations for this population.

“Additional methods, such as reminder recall interventions for annual well care visits, may be needed to bring additional adolescents in for recommended preventive care,” the researchers wrote.

Ms. Albertin and her associates from the division of general pediatrics at the University of Rochester (N.Y.) analyzed Medical Expenditure Panel Surv ey data for any medical visits, well-care visits, and vaccine-only visits made by adolescents, aged 11-21 years, during two time periods: 2004-2005 (before the vaccine recommendations) and 2007-2008 (after the recommendations).

They compared visit rates overall and by age group (11-13 years, 14-17 years, and 18-21 years), sex, race/ethnic group, insurance status, and household income. They used chi square analysis to compare rates between the two time periods, controlling for the complex sample design.

Ms. Albertin presented findings from 2,693 adolescents studied in 2004-2005 and 1,988 adolescents studied in 2007-2008.

Between the two time periods, no significant changes in the percentage of adolescents with any medical visit overall were observed (73% vs. 72%, respectively), nor were any changes seen among any of the subgroups following the recommendations, the researchers reported.

In addition, the percentage of well-child visits did not change significantly overall (they remained at 41% for both time periods), or among any of the subgroups.

The average number of visits with a vaccination overall increased significantly from 0.08% in 2004-2005 to 0.14% in 2007-2008.

Likewise, the percentage of adolescents who reported a visit with a vaccination increased from 8% to 11%.

The subgroups with significant increases included adolescents aged 14-17 years, females, whites, those who were privately insured, and those from families with the highest income level.

“The data seem to show that in the initial 21 months or so following the recommendations, pediatricians focused on fitting vaccinations into existing visits, not expanding the number of [patient] visits,” Ms. Albertin said in an interview.

“I'm surprised by the results given that there are Tdap vaccine requirements in many states,” the investigator commented.

She went on to explain that through 2008, only 16 states had school requirements for the Tdap vaccine.

“Now, projected through 2011 it looks like that's going to more than double,” she said.

“As a result, I think that we will slowly see an increase in both immunization-only and preventive visits,” Ms. Albertin noted.

Ms. Albertin said she had no relevant financial conflicts to disclose.

DENVER – Although new adolescent vaccine recommendations disseminated between 2005 and early 2007 for meningococcal, tetanus-diphtheria-pertussis, and human papillomavirus vaccines were anticipated to increase the proportion of adolescents with an annual preventive visit, no such impact has occurred, results from a large national survey demonstrated.

However, the rates of vaccination-only visits did increase, researchers led by Christina S. Albertin, reported during a poster session at the meeting.

The findings suggest that patterns of primary care delivery did not appear to change as a result of the new recommendations for this population.

“Additional methods, such as reminder recall interventions for annual well care visits, may be needed to bring additional adolescents in for recommended preventive care,” the researchers wrote.

Ms. Albertin and her associates from the division of general pediatrics at the University of Rochester (N.Y.) analyzed Medical Expenditure Panel Surv ey data for any medical visits, well-care visits, and vaccine-only visits made by adolescents, aged 11-21 years, during two time periods: 2004-2005 (before the vaccine recommendations) and 2007-2008 (after the recommendations).

They compared visit rates overall and by age group (11-13 years, 14-17 years, and 18-21 years), sex, race/ethnic group, insurance status, and household income. They used chi square analysis to compare rates between the two time periods, controlling for the complex sample design.

Ms. Albertin presented findings from 2,693 adolescents studied in 2004-2005 and 1,988 adolescents studied in 2007-2008.

Between the two time periods, no significant changes in the percentage of adolescents with any medical visit overall were observed (73% vs. 72%, respectively), nor were any changes seen among any of the subgroups following the recommendations, the researchers reported.

In addition, the percentage of well-child visits did not change significantly overall (they remained at 41% for both time periods), or among any of the subgroups.

The average number of visits with a vaccination overall increased significantly from 0.08% in 2004-2005 to 0.14% in 2007-2008.

Likewise, the percentage of adolescents who reported a visit with a vaccination increased from 8% to 11%.

The subgroups with significant increases included adolescents aged 14-17 years, females, whites, those who were privately insured, and those from families with the highest income level.

“The data seem to show that in the initial 21 months or so following the recommendations, pediatricians focused on fitting vaccinations into existing visits, not expanding the number of [patient] visits,” Ms. Albertin said in an interview.

“I'm surprised by the results given that there are Tdap vaccine requirements in many states,” the investigator commented.

She went on to explain that through 2008, only 16 states had school requirements for the Tdap vaccine.

“Now, projected through 2011 it looks like that's going to more than double,” she said.

“As a result, I think that we will slowly see an increase in both immunization-only and preventive visits,” Ms. Albertin noted.

Ms. Albertin said she had no relevant financial conflicts to disclose.

SAN FRANCISCO – Compared with placebo, a single dose of montelukast attenuated exercise-induced bronchoconstriction in children within 2 hours and lasted through 24 hours post dose, results from a small study found.

Although this treatment effect of montelukast has been observed in previously published studies of adults with exercise-induced bronchoconstriction, this is the first analysis of its kind in children with the condition.

"The ability to take a single tablet and have it last for 24 hours is probably more meaningful for children than for adults, because children often engage in unplanned physical activities more than adults do," Dr. George Philip said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In a multicenter study, Dr. Philip, senior director of clinical research at Merck Research Laboratories, North Wales, Pa., and his associates enrolled 66 children aged 6-14 years with pre-exercise forced expiratory volume in 1 second (FEV₁) of 70% predicted or greater and a maximum fall in FEV₁ of 20% or greater at two screening exercise challenges performed on a treadmill. Study participants were randomized to receive single-dose montelukast (4 or 5 mg) or placebo before the exercise challenges were performed at 2 and 24 hours post dose.

The primary end point was maximum percent fall in FEV₁ after exercise challenge 2 hours post dose. Secondary end points included maximum percent fall in FEV₁ after the 24-hour postdose challenge and each of the following end points at 2 and 24 hours post dose: maximum percent fall in FEV₁ categorized as less than 10%, 10%-20%, and greater than 20%; area under the curve during the 60 minutes post challenge; and time to recovery to within 5% of pre-exercise baseline.

The mean age of patients was 11 years, and 56% were male. About three-quarters (74.2%) were white, 16.7% were black, and 9.1% were from other ethnic groups.

Dr. Philip reported that the mean percent fall in FEV₁ was significantly better after the 2-hour postdose exercise challenge in the montelukast treatment group, compared with the placebo group (15.3% vs. 20%, respectively). Patients in the montelukast group also fared significantly better, compared with their counterparts in the placebo group, in maximum percent fall in FEV₁ after the 24-hour postdose exercise challenge (12.92% vs. 17.25%, respectively); the categorized maximum percent fall at 2 hours (P = .034) though not at 24 hours (P = .061); and area under the curve at 2 hours (P = .022) and 24 hours (P = .013).

There were few clinical adverse events and no serious drug-related adverse events.

Dr. Philip acknowledged that the controlled laboratory setting in which the exercise challenge took place is a limitation of the study. "Natural exercise may be different from what we did in the laboratory, where all the kids had to run on a treadmill and reach a certain heart rate so we could define a clear and reproducible exercise-induced response," he explained. "Based on that response to challenge, we showed a benefit. But the kind of exercise that’s done in a laboratory may or may not match what’s done in other settings. Also, because the use of a single dose of montelukast to prevent exercise-induced bronchoconstriction in children less than age 15 years is not currently approved by the FDA, this use is considered investigational."

Merck funded the study. Dr. Philip is a full-time employee of the company.

SAN FRANCISCO – Compared with placebo, a single dose of montelukast attenuated exercise-induced bronchoconstriction in children within 2 hours and lasted through 24 hours post dose, results from a small study found.

Although this treatment effect of montelukast has been observed in previously published studies of adults with exercise-induced bronchoconstriction, this is the first analysis of its kind in children with the condition.

"The ability to take a single tablet and have it last for 24 hours is probably more meaningful for children than for adults, because children often engage in unplanned physical activities more than adults do," Dr. George Philip said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In a multicenter study, Dr. Philip, senior director of clinical research at Merck Research Laboratories, North Wales, Pa., and his associates enrolled 66 children aged 6-14 years with pre-exercise forced expiratory volume in 1 second (FEV₁) of 70% predicted or greater and a maximum fall in FEV₁ of 20% or greater at two screening exercise challenges performed on a treadmill. Study participants were randomized to receive single-dose montelukast (4 or 5 mg) or placebo before the exercise challenges were performed at 2 and 24 hours post dose.

The primary end point was maximum percent fall in FEV₁ after exercise challenge 2 hours post dose. Secondary end points included maximum percent fall in FEV₁ after the 24-hour postdose challenge and each of the following end points at 2 and 24 hours post dose: maximum percent fall in FEV₁ categorized as less than 10%, 10%-20%, and greater than 20%; area under the curve during the 60 minutes post challenge; and time to recovery to within 5% of pre-exercise baseline.

The mean age of patients was 11 years, and 56% were male. About three-quarters (74.2%) were white, 16.7% were black, and 9.1% were from other ethnic groups.

Dr. Philip reported that the mean percent fall in FEV₁ was significantly better after the 2-hour postdose exercise challenge in the montelukast treatment group, compared with the placebo group (15.3% vs. 20%, respectively). Patients in the montelukast group also fared significantly better, compared with their counterparts in the placebo group, in maximum percent fall in FEV₁ after the 24-hour postdose exercise challenge (12.92% vs. 17.25%, respectively); the categorized maximum percent fall at 2 hours (P = .034) though not at 24 hours (P = .061); and area under the curve at 2 hours (P = .022) and 24 hours (P = .013).

There were few clinical adverse events and no serious drug-related adverse events.

Dr. Philip acknowledged that the controlled laboratory setting in which the exercise challenge took place is a limitation of the study. "Natural exercise may be different from what we did in the laboratory, where all the kids had to run on a treadmill and reach a certain heart rate so we could define a clear and reproducible exercise-induced response," he explained. "Based on that response to challenge, we showed a benefit. But the kind of exercise that’s done in a laboratory may or may not match what’s done in other settings. Also, because the use of a single dose of montelukast to prevent exercise-induced bronchoconstriction in children less than age 15 years is not currently approved by the FDA, this use is considered investigational."

Merck funded the study. Dr. Philip is a full-time employee of the company.

SAN FRANCISCO – Compared with placebo, a single dose of montelukast attenuated exercise-induced bronchoconstriction in children within 2 hours and lasted through 24 hours post dose, results from a small study found.

Although this treatment effect of montelukast has been observed in previously published studies of adults with exercise-induced bronchoconstriction, this is the first analysis of its kind in children with the condition.

"The ability to take a single tablet and have it last for 24 hours is probably more meaningful for children than for adults, because children often engage in unplanned physical activities more than adults do," Dr. George Philip said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In a multicenter study, Dr. Philip, senior director of clinical research at Merck Research Laboratories, North Wales, Pa., and his associates enrolled 66 children aged 6-14 years with pre-exercise forced expiratory volume in 1 second (FEV₁) of 70% predicted or greater and a maximum fall in FEV₁ of 20% or greater at two screening exercise challenges performed on a treadmill. Study participants were randomized to receive single-dose montelukast (4 or 5 mg) or placebo before the exercise challenges were performed at 2 and 24 hours post dose.

The primary end point was maximum percent fall in FEV₁ after exercise challenge 2 hours post dose. Secondary end points included maximum percent fall in FEV₁ after the 24-hour postdose challenge and each of the following end points at 2 and 24 hours post dose: maximum percent fall in FEV₁ categorized as less than 10%, 10%-20%, and greater than 20%; area under the curve during the 60 minutes post challenge; and time to recovery to within 5% of pre-exercise baseline.

The mean age of patients was 11 years, and 56% were male. About three-quarters (74.2%) were white, 16.7% were black, and 9.1% were from other ethnic groups.

Dr. Philip reported that the mean percent fall in FEV₁ was significantly better after the 2-hour postdose exercise challenge in the montelukast treatment group, compared with the placebo group (15.3% vs. 20%, respectively). Patients in the montelukast group also fared significantly better, compared with their counterparts in the placebo group, in maximum percent fall in FEV₁ after the 24-hour postdose exercise challenge (12.92% vs. 17.25%, respectively); the categorized maximum percent fall at 2 hours (P = .034) though not at 24 hours (P = .061); and area under the curve at 2 hours (P = .022) and 24 hours (P = .013).

There were few clinical adverse events and no serious drug-related adverse events.

Dr. Philip acknowledged that the controlled laboratory setting in which the exercise challenge took place is a limitation of the study. "Natural exercise may be different from what we did in the laboratory, where all the kids had to run on a treadmill and reach a certain heart rate so we could define a clear and reproducible exercise-induced response," he explained. "Based on that response to challenge, we showed a benefit. But the kind of exercise that’s done in a laboratory may or may not match what’s done in other settings. Also, because the use of a single dose of montelukast to prevent exercise-induced bronchoconstriction in children less than age 15 years is not currently approved by the FDA, this use is considered investigational."

Merck funded the study. Dr. Philip is a full-time employee of the company.

SAN FRANCISCO – Compared with placebo, a single dose of montelukast attenuated exercise-induced bronchoconstriction in children within 2 hours and lasted through 24 hours post dose, results from a small study found.

Although this treatment effect of montelukast has been observed in previously published studies of adults with exercise-induced bronchoconstriction, this is the first analysis of its kind in children with the condition.

"The ability to take a single tablet and have it last for 24 hours is probably more meaningful for children than for adults, because children often engage in unplanned physical activities more than adults do," Dr. George Philip said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In a multicenter study, Dr. Philip, senior director of clinical research at Merck Research Laboratories, North Wales, Pa., and his associates enrolled 66 children aged 6-14 years with pre-exercise forced expiratory volume in 1 second (FEV₁) of 70% predicted or greater and a maximum fall in FEV₁ of 20% or greater at two screening exercise challenges performed on a treadmill. Study participants were randomized to receive single-dose montelukast (4 or 5 mg) or placebo before the exercise challenges were performed at 2 and 24 hours post dose.

The primary end point was maximum percent fall in FEV₁ after exercise challenge 2 hours post dose. Secondary end points included maximum percent fall in FEV₁ after the 24-hour postdose challenge and each of the following end points at 2 and 24 hours post dose: maximum percent fall in FEV₁ categorized as less than 10%, 10%-20%, and greater than 20%; area under the curve during the 60 minutes post challenge; and time to recovery to within 5% of pre-exercise baseline.

The mean age of patients was 11 years, and 56% were male. About three-quarters (74.2%) were white, 16.7% were black, and 9.1% were from other ethnic groups.

Dr. Philip reported that the mean percent fall in FEV₁ was significantly better after the 2-hour postdose exercise challenge in the montelukast treatment group, compared with the placebo group (15.3% vs. 20%, respectively). Patients in the montelukast group also fared significantly better, compared with their counterparts in the placebo group, in maximum percent fall in FEV₁ after the 24-hour postdose exercise challenge (12.92% vs. 17.25%, respectively); the categorized maximum percent fall at 2 hours (P = .034) though not at 24 hours (P = .061); and area under the curve at 2 hours (P = .022) and 24 hours (P = .013).

There were few clinical adverse events and no serious drug-related adverse events.

Dr. Philip acknowledged that the controlled laboratory setting in which the exercise challenge took place is a limitation of the study. "Natural exercise may be different from what we did in the laboratory, where all the kids had to run on a treadmill and reach a certain heart rate so we could define a clear and reproducible exercise-induced response," he explained. "Based on that response to challenge, we showed a benefit. But the kind of exercise that’s done in a laboratory may or may not match what’s done in other settings. Also, because the use of a single dose of montelukast to prevent exercise-induced bronchoconstriction in children less than age 15 years is not currently approved by the FDA, this use is considered investigational."

Merck funded the study. Dr. Philip is a full-time employee of the company.

SAN FRANCISCO – Compared with placebo, a single dose of montelukast attenuated exercise-induced bronchoconstriction in children within 2 hours and lasted through 24 hours post dose, results from a small study found.

Although this treatment effect of montelukast has been observed in previously published studies of adults with exercise-induced bronchoconstriction, this is the first analysis of its kind in children with the condition.

"The ability to take a single tablet and have it last for 24 hours is probably more meaningful for children than for adults, because children often engage in unplanned physical activities more than adults do," Dr. George Philip said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In a multicenter study, Dr. Philip, senior director of clinical research at Merck Research Laboratories, North Wales, Pa., and his associates enrolled 66 children aged 6-14 years with pre-exercise forced expiratory volume in 1 second (FEV₁) of 70% predicted or greater and a maximum fall in FEV₁ of 20% or greater at two screening exercise challenges performed on a treadmill. Study participants were randomized to receive single-dose montelukast (4 or 5 mg) or placebo before the exercise challenges were performed at 2 and 24 hours post dose.

The primary end point was maximum percent fall in FEV₁ after exercise challenge 2 hours post dose. Secondary end points included maximum percent fall in FEV₁ after the 24-hour postdose challenge and each of the following end points at 2 and 24 hours post dose: maximum percent fall in FEV₁ categorized as less than 10%, 10%-20%, and greater than 20%; area under the curve during the 60 minutes post challenge; and time to recovery to within 5% of pre-exercise baseline.

The mean age of patients was 11 years, and 56% were male. About three-quarters (74.2%) were white, 16.7% were black, and 9.1% were from other ethnic groups.

Dr. Philip reported that the mean percent fall in FEV₁ was significantly better after the 2-hour postdose exercise challenge in the montelukast treatment group, compared with the placebo group (15.3% vs. 20%, respectively). Patients in the montelukast group also fared significantly better, compared with their counterparts in the placebo group, in maximum percent fall in FEV₁ after the 24-hour postdose exercise challenge (12.92% vs. 17.25%, respectively); the categorized maximum percent fall at 2 hours (P = .034) though not at 24 hours (P = .061); and area under the curve at 2 hours (P = .022) and 24 hours (P = .013).

There were few clinical adverse events and no serious drug-related adverse events.

Dr. Philip acknowledged that the controlled laboratory setting in which the exercise challenge took place is a limitation of the study. "Natural exercise may be different from what we did in the laboratory, where all the kids had to run on a treadmill and reach a certain heart rate so we could define a clear and reproducible exercise-induced response," he explained. "Based on that response to challenge, we showed a benefit. But the kind of exercise that’s done in a laboratory may or may not match what’s done in other settings. Also, because the use of a single dose of montelukast to prevent exercise-induced bronchoconstriction in children less than age 15 years is not currently approved by the FDA, this use is considered investigational."

Merck funded the study. Dr. Philip is a full-time employee of the company.

SAN FRANCISCO – Compared with placebo, a single dose of montelukast attenuated exercise-induced bronchoconstriction in children within 2 hours and lasted through 24 hours post dose, results from a small study found.

Although this treatment effect of montelukast has been observed in previously published studies of adults with exercise-induced bronchoconstriction, this is the first analysis of its kind in children with the condition.

"The ability to take a single tablet and have it last for 24 hours is probably more meaningful for children than for adults, because children often engage in unplanned physical activities more than adults do," Dr. George Philip said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In a multicenter study, Dr. Philip, senior director of clinical research at Merck Research Laboratories, North Wales, Pa., and his associates enrolled 66 children aged 6-14 years with pre-exercise forced expiratory volume in 1 second (FEV₁) of 70% predicted or greater and a maximum fall in FEV₁ of 20% or greater at two screening exercise challenges performed on a treadmill. Study participants were randomized to receive single-dose montelukast (4 or 5 mg) or placebo before the exercise challenges were performed at 2 and 24 hours post dose.

The primary end point was maximum percent fall in FEV₁ after exercise challenge 2 hours post dose. Secondary end points included maximum percent fall in FEV₁ after the 24-hour postdose challenge and each of the following end points at 2 and 24 hours post dose: maximum percent fall in FEV₁ categorized as less than 10%, 10%-20%, and greater than 20%; area under the curve during the 60 minutes post challenge; and time to recovery to within 5% of pre-exercise baseline.

The mean age of patients was 11 years, and 56% were male. About three-quarters (74.2%) were white, 16.7% were black, and 9.1% were from other ethnic groups.

Dr. Philip reported that the mean percent fall in FEV₁ was significantly better after the 2-hour postdose exercise challenge in the montelukast treatment group, compared with the placebo group (15.3% vs. 20%, respectively). Patients in the montelukast group also fared significantly better, compared with their counterparts in the placebo group, in maximum percent fall in FEV₁ after the 24-hour postdose exercise challenge (12.92% vs. 17.25%, respectively); the categorized maximum percent fall at 2 hours (P = .034) though not at 24 hours (P = .061); and area under the curve at 2 hours (P = .022) and 24 hours (P = .013).

There were few clinical adverse events and no serious drug-related adverse events.

Dr. Philip acknowledged that the controlled laboratory setting in which the exercise challenge took place is a limitation of the study. "Natural exercise may be different from what we did in the laboratory, where all the kids had to run on a treadmill and reach a certain heart rate so we could define a clear and reproducible exercise-induced response," he explained. "Based on that response to challenge, we showed a benefit. But the kind of exercise that’s done in a laboratory may or may not match what’s done in other settings. Also, because the use of a single dose of montelukast to prevent exercise-induced bronchoconstriction in children less than age 15 years is not currently approved by the FDA, this use is considered investigational."

Merck funded the study. Dr. Philip is a full-time employee of the company.