Background

The prevalence of Down syndrome (DS)-affected births has increased during the past 30 years; moreover, children with DS have a higher incidence of congenital heart disease compared with their peers. Whether children with DS have better or worse outcomes after repair of congenital heart disease is unclear. We sought to identify differences in in-hospital mortality after cardiac surgery in pediatric patients with and without DS using a large national database.

Methods and results

Children aged <18 years who underwent surgical intervention for congenital heart disease were identified using the Kids' Inpatient Database (2000, 2003, 2006, and 2009). Patients were stratified using the Risk Adjustment for Congenital Heart Surgery algorithm. A total of 4231 (8.2%) of the 51 309 patients studied had a diagnosis of DS. In-hospital death for patients with DS was significantly lower than that for patients without DS overall (1.9% versus 4.3%; P<0.05) as well as within risk categories 2 (1.0% versus 1.8%; P<0.05) and 3 (2.3% versus 5.1%; P<0.05). Multivariable logistic regression showed a lower odds of death among children with DS (odds ratio=0.60; 95% confidence interval, 0.47-0.76; P<0.05) after adjusting for Risk Adjustment for Congenital Heart Surgery risk category, premature birth, major noncardiac structural anomaly, and age.

Conclusions

In this large national study, children with DS who underwent repair of congenital heart disease were more likely to survive to discharge than children without DS. Future work is needed to better understand the factors underlying these differences.

Objectives

To compare the severity of illness and outcomes among children admitted to a children's hospital PICU from referring emergency departments with and without access to a pediatric critical care telemedicine program.

Design

Retrospective cohort study.

Setting

Tertiary academic children's hospital PICU.

Patients

Pediatric patients admitted directly to the PICU from referring emergency departments between 2010 and 2014.

Interventions

None.

Measurements

Demographic factors, severity of illness, and clinical outcomes among children receiving care in emergency departments with and without access to pediatric telemedicine, as well as a subcohort of children admitted from emergency departments before and after the implementation of telemedicine.

Main results

Five hundred eighty-two patients from 15 emergency departments with telemedicine and 524 patients from 60 emergency departments without telemedicine were transferred and admitted to the PICU. Children admitted from emergency departments using telemedicine were younger (5.6 vs 6.9 yr; p< 0.001) and less sick (Pediatric Risk of Mortality III score, 3.2 vs 4.0; p < 0.05) at admission to the PICU compared with children admitted from emergency departments without telemedicine. Among transfers from emergency departments that established telemedicine programs during the study period, children arrived significantly less sick (mean Pediatric Risk of Mortality III scores, 1.2 units lower; p = 0.03) after the implementation of telemedicine (n = 43) than before the implementation of telemedicine (n = 95). The observed-to-expected mortality ratios of posttelemedicine, pretelemedicine, and no-telemedicine cohorts were 0.81 (95% CI, 0.53-1.09), 1.07 (95% CI, 0.53-1.60), and 1.02 (95% CI, 0.71-1.33), respectively.

Conclusions

The implementation of a telemedicine program designed to assist in the care of seriously ill children receiving care in referring emergency departments was associated with lower illness severity at admission to the PICU. This study contributes to the body of evidence that pediatric critical care telemedicine programs assist referring emergency departments in the care of critically ill children and could result in improved clinical outcomes.

Alcohol-intoxicated suspects’ confessions are admissible in U.S. courts; however, it is unknown how jurors evaluate such confessions. Study 1 assessed potential jurors’ perceptions of intoxication in interrogative contexts. Many respondents were unaware that questioning intoxicated suspects and presenting subsequent confessions in court are legal, and respondents generally reported they would rely less on intoxicated than sober confessions. In Study 2, potential jurors read a case about a defendant who had confessed or not while sober or intoxicated. Participants who read about an intoxicated defendant perceived the interrogation as more inappropriate and the defendant as more cognitively impaired than did participants who read about a sober defendant, and as a result, they were less likely to convict. Furthermore, intoxicated confessions influenced conviction decisions to a lesser extent than did sober confessions. Findings suggest that investigators might consider abstaining from interrogating intoxicated suspects or else risk jurors finding confessions unconvincing in court.