Charles R Woods

University of Louisville, Louisville, Kentucky, United States

Are you Charles R Woods?

Claim your profile

Publications (78)160.38 Total impact

  • Brian J Holland, John A Myers, Charles R Woods
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine if prenatal diagnosis improves the chance that a newborn with critical congenital heart disease will survive to undergo planned cardiac surgery. A systematic review of the medical literature identified eight studies which met the following criteria: compared outcomes between groups of newborns with prenatal and postnatal diagnosis of critical congenital heart disease, contained the same anatomic diagnosis in each group, provided detailed information on cardiac anatomy, and included detailed information on the preoperative cause of death. A meta-analysis was performed to assess differences in preoperative mortality rates between newborns with a prenatal diagnosis versus postnatal diagnosis. Patients with established risk factors for increased mortality and those whose families chose comfort care were excluded. In patients with comparable anatomy, standard risk, a parental desire to treat, and optimal care, newborns with a prenatal diagnosis of critical congenital heart disease were significantly less likely to die prior to planned cardiac surgery compared to newborns with a comparable postnatal diagnosis (pooled OR=0.26, 95% CI 0.08-0.84). For newborns most likely to benefit from treatment for their critical congenital heart disease, whose families pursue treatment, and who do not have additional risk factors, prenatal diagnosis reduced the risk of death prior to planned cardiac surgery compared to patients with a comparable postnatal diagnosis. Further study and efforts to improve prenatal diagnosis of congenital heart disease should therefore be considered. This article is protected by copyright. All rights reserved.
    Ultrasound in Obstetrics and Gynecology 04/2015; 45(6). DOI:10.1002/uog.14882 · 3.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hospitals vary widely in the services they offer to care for pediatric burn patients. When a hospital does not have the ability or capacity to handle a pediatric burn, the decision often is made to transfer the patient to another short-term hospital. Transfers may be based on available specialty coverage for children; which adult and non-teaching hospitals may not have available. The effect these transfers have on costs and length of stay (LOS) has on pediatric burn patients is not well established and is warranted given the prominent view that pediatric hospitals are inefficient or more costly. The authors examined inpatient admissions for pediatric burn patients in 2003, 2006, and 2009 using the Kids' Inpatient Database, which is part of the Healthcare Cost and Utilization Project. ICD-9-CM codes 940 to 947 were used to define burn injury. The authors tested if transfer status was associated with LOS and total charges for pediatric burn patients, while adjusting for traditional risk factors (eg, age, TBSA, insurance status, type of hospital [pediatric vs adult; teaching vs nonteaching]) by using generalized linear mixed-effects modeling. A total of n = 28,777 children had a burn injury. Transfer status (P < .001) and TBSA (P < .001) was independently associated with LOS, while age, insurance status, and type of hospital were not associated with LOS. Similarly, transfer status (P < .001) and TBSA (P < .001) was independently associated with total charges, while age, insurance status, and type of hospital were not associated with total charges. In addition, the data suggest that the more severe pediatric burn patients are being transferred from adult and non-teaching hospitals to pediatric and teaching hospitals, which may explain the increased costs and LOS seen at pediatric hospitals. Larger more severe burns are being transferred to pediatric hospitals with the ability or capacity to handle these conditions in the pediatric population, which has a dramatic impact on costs and LOS. As a result, unadjusted, pediatric hospitals are seen as being inefficient in treating pediatric burns. However, since pediatric hospitals see more severe cases, after adjustment, type of hospital did not influence costs and LOS. TBSA and transfer status were the predictors studied that independently affect costs and LOS.
    Journal of burn care & research: official publication of the American Burn Association 12/2014; 36(1). DOI:10.1097/BCR.0000000000000206 · 1.55 Impact Factor
  • Charles R Woods, V Faye Jones
    Pediatrics 11/2014; 134(6). DOI:10.1542/peds.2014-3056 · 5.30 Impact Factor
  • Claudia Espinosa, Charles R Woods, Gary S Marshall
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Intravenous (IV) antibiotics had been the mainstay of therapy for children with complicated para-pneumonic effusion (PPE) and pleural empyema (PE). Whereas oral antibiotics have been used to complete a prescribed course of therapy, when to switch and how long to treat are more a matter of style than a matter of evidence or official guidelines. There is also controversy regarding the use of video-assisted thoracoscopic surgery (VATS) versus chest tube insertion with fibrinolysis when drainage is indicated. Substantial practice variation exists. Methods: Retrospective chart review and descriptive analysis of children managed by the pediatric infectious diseases service at Kosair Children Hospital between 2008 and 2012. Results: A total of 59 children met inclusion criteria. All patients received IV antibiotics at admission. Sixty-seven percent of children had a surgical procedure on the day of admission or the following day; all of these were VATS, except for 2 children who had a chest tube placed and later underwent VATS. The mean time to VATS was 1.4 days [95% CI 1.08, 1.80]. In 70% of the cases that underwent drainage, no organism was identified by culture of the pleural fluid. All patients received IV antibiotics at admission and all were discharged on oral antibiotics; the mean time to switch was 7.9 days [95% CI 6.76, 9.12] and the mean duration of oral antibiotic therapy was 16.98 days [15.3, 18.64]. There were no deaths; 6 patients required repeat surgical intervention, but this was not related to use of oral antibiotic therapy. Conclusion: Children with complicated PPE and PE can be managed effectively with early VATS and early switch from IV to oral antibiotic therapy.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Acute respiratory conditions are a leading cause of childhood morbidity and mortality. Corticosteroids are effective and established treatments in some acute respiratory infections (e.g. croup) and asthma exacerbations; however, their role is controversial in other conditions owing to inconsistent effectiveness or safety concerns (e.g. bronchiolitis, acute wheeze).
    Evidence-Based Child Health A Cochrane Review Journal 09/2014; 9(3):733-47. DOI:10.1002/ebch.1980
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To better understand factors that may impact infant mortality rates (IMR), we evaluated the consistency across birth hospitals in the classification of a birth event as either a fetal death or an early neonatal (infant) death using natality data from North Carolina for the years 1995-2000. A database consisting of fetal deaths and infant deaths occurring within the first 24 hours after birth was constructed. Bivariate, followed by multivariable regression, analyses were used to control for relevant maternal and infant factors. Based upon hospital variances, adjustments were made to evaluate the impact of the classification on statewide infant mortality rate. After controlling for multiple maternal and infant factors, birth hospital remained a factor related to the classification of early neonatal versus fetal death. Reporting of early neonatal deaths versus fetal deaths consistent with the lowest or highest hospital strata would have resulted in an adjusted IMR varying from 7.5 to 10.64 compared with the actual rate of 8.95. Valid comparisons of IMR among geographic regions within and between countries require consistent classification of perinatal deaths. This study demonstrates that local variation in categorization of death events as fetal death versus neonatal death within the first 24 hours after delivery may impact a state-level IMR in a meaningful magnitude. The potential impact of this issue on IMRs should be examined in other state and national populations.
    BMC Pediatrics 04/2014; 14(1):108. DOI:10.1186/1471-2431-14-108 · 1.92 Impact Factor
  • Charles R Woods
    [Show abstract] [Hide abstract]
    ABSTRACT: CME EDUCATIONAL OBJECTIVES 1. Review the current epidemiology of meningococcal disease in children. 2. Discuss the history of meningococcal vaccine development and the unique challenges posed by developing a vaccine against this microbe. 3. Determine vaccine recommendations as well as potential roadblocks to routine vaccination of young children. The spectrum of disease caused by Neisseria meningitidis includes bacteremia, fulminant sepsis (meningococcemia), meningitis, and pneumonia. The incidence of meningococcal infection has long been higher in infancy than adolescents or adults older than 65 years (a third group with an increased risk based on age). Five meningococcal serogroups (A, B, C, Y, and W135) cause the great majority of human disease. Serogroup B strains cause about two-thirds of disease in children younger than 6 years. For this reason, new meningococcal vaccine formulations have been developed and evaluated in children younger than 2 years. Of four meningococcal vaccines currently licensed in the United States, two conjugate products, (MenACWY-D [Menactra], Sanofi Pasteur; HibMenCY-TT [MenHibrix], GlaxoSmithKline), are recommended for infants and toddlers younger than 2 years who have an increased risk for invasive meningococcal disease. High-risk conditions are complement deficiencies, community outbreaks, functional or anatomic asplenia, and travel to high-risk areas in which serogroup A infection is prevalent. Recommendations vary by age, dosing, and indication between these two products. Both licensed products are immunogenic and have side-effect profiles that are considered safe for use. In most cases, concomitant use with other recommended childhood vaccines does not interfere with responses to these vaccines. As of yet, there has not been universal adoption of this immunization in the infant population by parents or providers. Factors that weigh against the implementation of a national routine infant program include the prevention of only 40 to 50 meningococcal cases, two to four deaths per year, and a relatively low case fatality among infants. Some argue that costs should not be considered a barrier because infant deaths and morbidity would be prevented. The availability of a serogroup B vaccine would improve impact and cost-effectiveness of a routine infant meningococcal vaccine program. Debate over the implementation of routine infant meningococcal vaccination in the United States is ongoing. This review focuses on vaccines for the prevention of N. meningitidis infection in infants and young toddlers in the first 2 years of life.
    Pediatric Annals 08/2013; 42(8):164-71. DOI:10.3928/00904481-20130723-11 · 0.29 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: The perineal and gluteal regions are the most frequent areas of skin and soft tissue infection (SSTI) in diapered children. No studies have investigated the relationship between perineal and general hygiene practices and SSTIs in this population. This study was conducted to evaluate this relationship. METHODS: A cross-sectional observational study was conducted in an urban pediatric emergency department. Subjects were recruited into 3 study groups as follows: gluteal/perineal SSTIs (SSTI), diaper dermatitis (DD), or healthy normal skin (NS). Survey responses were analyzed for significance followed by a clinically oriented staged regression to model predictors of SSTI compared with the NS and DD groups. RESULTS: There were 100 subjects in the SSTI, 206 in the NS, and 151 in the DD groups. Race was the only demographic characteristic that differed between the groups. After adjustment for race, no day care attendance, history of SSTI, household contact with SSTI history, and higher propensity for diaper rash were associated with SSTI compared with NS. Regression results comparing SSTI to DD revealed no day care attendance, history of SSTI, household contact with SSTI history, less sensitive skin, and less diaper cream use to be predictors of SSTI. CONCLUSIONS: Perineal and general hygiene practices were not significantly different between children with SSTI compared with children with NS or DD. Based on the results of this study, further prospective studies should evaluate diaper hygiene practices that prevent DD and subsequent SSTIs, the preventative role of day care attendance, and effective interventions that minimize the risk of recurrent SSTIs.
    Pediatric emergency care 04/2013; DOI:10.1097/PEC.0b013e31828e9b7f · 0.92 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective An influenza pandemic may demand that a large number of influenza immunizations be rapidly given with limited resources. This study tested the utility and practicality of self-immunization with live attenuated influenza intranasal vaccine in a mass vaccination event.Methods The self-immunization clinic model was evaluated in a three-tiered fashion using student, first responder, and open community events.Results A single nurse was easily able to direct 89 people through the process of self-administration of the vaccine in a three-hour first-responder event and 122 people in a three-hour open community event. 96% of participants believed that they had performed the self-administration correctly, and the same percentage reported that they would like to receive influenza immunization by self-vaccination in the future.Conclusions The self-immunization clinic is a practical and potentially useful model in an influenza pandemic setting.
    Disaster Medicine and Public Health Preparedness 04/2013; 7(02). DOI:10.1017/dmp.2013.25 · 1.14 Impact Factor
  • Charles R Woods
    [Show abstract] [Hide abstract]
    ABSTRACT: Rocky Mountain spotted fever is typically undifferentiated from many other infections in the first few days of illness. Treatment should not be delayed pending confirmation of infection when Rocky Mountain spotted fever is suspected. Doxycycline is the drug of choice even for infants and children less than 8 years old.
    Pediatric Clinics of North America 04/2013; 60(2):455-470. DOI:10.1016/j.pcl.2012.12.001 · 2.20 Impact Factor
  • Charles R Woods
    PEDIATRICS 03/2013; 131(4). DOI:10.1542/peds.2013-0125 · 5.30 Impact Factor
  • C. R. Woods
    02/2013; 2(1):87-90. DOI:10.1093/jpids/pis133
  • Charles R Woods, Kristina A Bryant
    [Show abstract] [Hide abstract]
    ABSTRACT: Viral pathogens are commonly isolated from children with community-acquired pneumonia (CAP). Viruses like respiratory syncytial virus, human rhinovirus, human metapneumovirus, parainfluenza viruses, and influenza may act as sole pathogens or may predispose to bacterial pneumonia by a variety of mechanisms. New, emerging, or reemerging viral pathogens occasionally cause outbreaks of severe respiratory tract infection in children. The 2009-2010 H1N1 influenza virus pandemic resulted in increased rates of influenza-related hospitalizations and deaths in children. Rapid viral diagnostic tests based on antigen detection or nucleic acid amplification are increasingly available for clinical use and confirm the importance of viral infection in children hospitalized with CAP. Recently published guidelines for the management of CAP in children note that positive viral test results can modify clinical decision making in children with suspected pneumonia by allowing antibacterial therapy to be withheld in the absence of clinical, laboratory, or radiographic findings that suggest bacterial coinfection.
    Current Infectious Disease Reports 02/2013; DOI:10.1007/s11908-013-0324-6
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Encephalitis is a clinical syndrome that can be associated with infectious, post-infectious, and non-infectious causes. Infectious causes include herpes, arboviruses and many others. Specific causes often are not identified. Epidemiology and burden of encephalitis in the U.S. has not been described since 1997. Recent studies have focused on specific pathogens or smaller populations. Methods: Online versions of the Nationwide Inpatient Sample (NIS) database and the Kids' Inpatient Database (KID) from Healthcare Cost and Utilization Project (http://hcupnet.ahrq.gov/) were used to evaluate frequency of hospitalizations with International Classification of Disease, 9th revision (ICD-9) codes for all causes of encephalitis from 1997-2009. Data were stratified by all causes, known causes and unexplained causes of encephalitis based on the title of the ICD-9 code. Census data were used for population estimates. Data are presented for the 5 years for which NIS and KID are both available. Results: Total U.S. hospitalizations and hospitalization incidence with associated ICD-9 codes for encephalitis increased from 18,211 (6.72 per 100,000) in 1997 to 22,439 (7.31 per 100,000) in 2009. Hospitalization with known causes of encephalitis increased from 7,773 (2.87 per 100,000) in 1997 to 12,370 (4.03 per 100,000) in 2009. Hospitalizations with unexplained causes of encephalitis decreased (Figure). Mean hospital length of stay (LOS) remained relatively stable (9.9 d in 1997 and 10.8 d in 2009). Mean hospital charges increased 3-fold ($26,802 in 1997 and $80,555 in 2009). Data for children <17 yrs in KID were highly similar to all ages data shown in the Figure. s Conclusion: Hospitalizations associated with encephalitis diagnoses of all types increased in the U.S. from 1997 to 2009. ICD-9 codes for specific causes of encephalitis also increased over time, likely due to increased availability of molecular diagnostic tests for more microbes, as well as introduction of West Nile Virus into the U.S. during this time. LOS remained stable but hospital charges tripled over time. More detailed analyses are in progress.
    IDWeek 2012 Meeting of the Infectious Diseases Society of America; 10/2012
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Clindamycin is commonly used to treat community-acquired MRSA infections. The impact of this practice on outpatient antibiotic consumption at the national level is unknown. Methods: The National Ambulatory Medical Care Survey (NAMCS) collects data from outpatient visits to primary care offices and the National Hospital Ambulatory Medical Care Survey (NHAMCS) includes visits to hospital outpatient and emergency departments (EDs) in the United States. NAMCS and NHAMCS data from 2000-2009 were used to establish patterns of clindamycin prescription over time. A clinical encounter was defined as being associated with clindamycin if any of the eight recorded medications had a drug code consistent with clindamycin. We compared patterns of prescription between children (aged<19) and adults, outpatient settings (office, hospital clinics and EDs) and across diagnostic categories. All results were weighted to provide nationally representative estimates. Results: 13.3% of the 11 billion outpatient visits during the study period were associated with an antimicrobial prescription. Clindamycin accounted for 1.85% (± 0.08) of these visits. In adults use increased from 1.6% in 2000 to 2.9% in 2009. In children use increased from 0.5% to 2.1%. Three broad groups of diagnoses accounted for nearly 50% of clindamycin usage: skin and soft tissue infections (SSTIs) (21%), dental diagnoses (11%) and respiratory diagnoses (12%). Use of clindamycin increased in SSTIs (0.5 to 7.5%) and dental diagnoses (1.8 to 8.1%), but remained stable for respiratory diagnoses. The increased use of clindamycin for SSTIs was more pronounced in children (0.25 to 12.7%) than in adults (0.6 to 6.1%). The change in prescription for dental diagnoses was only observed in adults (2.5 to 10.2%). There was no significant change in the use of clindamycin for other diagnoses. Most clindamycin prescriptions occurred in the ED setting. This was largely due to increases seen after 2003 in both children and adults. Conclusion: The outpatient use of clindamycin use has increased over the past decade, likely due to the increased prevalence of infections with community-acquired MRSA. This increase was most pronounced in pediatric SSTIs and adult dental diagnoses, and occurred almost exclusively in the ED setting.
    IDWeek 2012 Meeting of the Infectious Diseases Society of America; 10/2012
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Since 2006, the Advisory Committee on Immunization Practices (ACIP) has recommended that all teenagers who are eligible for a tetanus-containing vaccine (TCV) be immunized with Tdap instead of Td. However, some adolescents continue to receive Td. This study explored Tdap uptake among adolescents in the United States and assessed which patient and provider characteristics were associated with receipt of Td instead of Tdap. Methods: Data were obtained from the 2008-2010 National Immunization Survey – Teen, a publicly-available database that contains demographic and immunization information for adolescents aged 13-17 years. Survey weights were used to calculate national estimates of Td and Tdap receipt during the study period. A second set of analyses was performed including only those adolescents who had received a TCV. Bivariate analyses were performed to test for differences in demographic characteristics between teenagers who received Td and those who received Tdap, stratified by year. Multiple logistic regression techniques were then used to determine predictors of Td receipt rather than Tdap. Results: Overall Tdap uptake increased from 40.8% in 2008 to 68.7% in 2010. The proportion of Tdap receipt among TCV recipients increased from 55.1% to 83.8%. Td recipients were more likely to be older (45% receipt among 17-year-olds versus 11% of 13-year-olds, p<0.0001), from the southern region of the U.S. (32% receipt in the South versus 26% in all other regions, p<0.0001), and seen at a public facility (32% receipt at public facilities versus 26% from a mix of facilities, p<0.0001). In multivariable analyses older age (OR=8.206, 95% CI 6.255 – 10.766, p<0.0001) and living in the South (OR=1.597, 95% CI 1.313 – 1.944, p<0.0001) increased the odds a teenager received Td. Having multiple vaccination providers in 2008 (OR=1.254, 95% CI 1.013 – 1.553, p=0.0383) and 2010 (OR=1.434, 95% CI 1.161 – 1.771, p=0.0008) was also associated with Td receipt. Conclusion: Tdap uptake from 2008 to 2010 has increased, suggesting that the Tdap recommendation has been adopted more widely over time. Further education among vaccination providers may still be needed in the Southern region of the United States.
    IDWeek 2012 Meeting of the Infectious Diseases Society of America; 10/2012
  • Charles Woods
    IDWeek 2012 Meeting of the Infectious Diseases Society of America; 10/2012
  • Charles Woods
    IDWeek 2012 Meeting of the Infectious Diseases Society of America; 10/2012
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess the effectiveness of guidelines and education on empirical therapy for community-acquired pneumonia. Administrative records for children with a primary diagnosis of pneumonia from January 2007 to September 2009 were reviewed. Antimicrobial use was measured monthly over 3 periods: (1) before creation of an antimicrobial stewardship task force (ASTF), (2) after ASTF formation but before release of guidelines for antimicrobial use, and (3) after guideline release. Antimicrobial use over time was assessed by using quasi-binomial logistic regression models that incorporated interrupted events, seasonality, and autocorrelation. Allowing calculation of immediate changes due to specific interventions and trends in use over each time period. The primary outcome was use of ampicillin as recommended in the guidelines versus ceftriaxone, the historical standard. Secondary outcomes included other antimicrobial use, length of stay, mortality, and readmission. One thousand two hundred forty-six children met study criteria. Ampicillin use increased from 2% at baseline to 6% after ASTF formation and 44% after guideline release. Ceftriaxone use increased slightly (from 56% to 59%) after ASTF formation but decreased to 28% after guideline release. An immediate change in prescription occurred in the month after guideline publication and remained stable over the following year. Guidelines and education can have an impact on antimicrobial use in the pediatric setting. Although the optimal strategies for pediatric antimicrobial stewardship programs still are being determined, we believe that our approach offers an inexpensive and low-risk step in the right direction.
    PEDIATRICS 04/2012; 129(5):e1326-33. DOI:10.1542/peds.2011-2412 · 5.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study reviewed Kentucky Medicaid claims data for children with autism spectrum disorders to determine psychotropic drug (PTD) use in this population. Children with autism spectrum disorders (ICD-9 code 299.XX) in 3 different age-groups from 2005 to 2008 were identified; PTD use was defined as at least 1 prescription per year. PTD use in all age ranges was higher than in previously reported studies. High PTD use in children between 1 and 5 years is particularly of concern and may reflect perceived inadequacies of comprehensive educational/behavioral services for these children.
    Clinical Pediatrics 04/2012; 51(10):923-7. DOI:10.1177/0009922812440837 · 1.26 Impact Factor

Publication Stats

1k Citations
160.38 Total Impact Points

Institutions

  • 2002–2015
    • University of Louisville
      • • Department of Pediatrics
      • • Division of Infectious Diseases
      Louisville, Kentucky, United States
  • 2008
    • Wake Forest University
      Winston-Salem, North Carolina, United States
  • 2001–2007
    • Wake Forest School of Medicine
      • • Section on Infectious Diseases
      • • Department of Pediatrics
      Winston-Salem, North Carolina, United States
  • 2006
    • Winston-Salem State University
      Winston-Salem, North Carolina, United States
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
    • Duke University
      Durham, North Carolina, United States
  • 2003
    • University of North Carolina at Chapel Hill
      North Carolina, United States