Prashant Mahajan

Prashant Mahajan
University of Michigan | U-M · Department of Emergency Medicine

Doctor of Medicine

About

211
Publications
19,691
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5,974
Citations
Citations since 2017
100 Research Items
3941 Citations
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Introduction
I am a pediatric health services and outcomes researcher. My main area of research interest is optimizing clinician decision making in the emergency department to enhance patient and health systems outcomes and improve healthcare safety and quality. My research focuses on infections (evaluation and management of febrile infants), developing clinically meaningful decision rules in the evaluation of febrile infants and inflammation (asthma, sepsis), and clinical decision making.

Publications

Publications (211)
Article
Full-text available
Background The COVID-19 pandemic affected the volume and epidemiology of pediatric emergency department (ED) visits. We aimed to determine the rate of associated complications for 16 high-risk conditions in a Michigan statewide network of academic and community EDs during the pandemic. Methods We conducted a cross-sectional study of pediatric ED v...
Article
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Introduction: The Emergency Medicine Education and Research by Global Experts (EMERGE) network was formed to generate and translate evidence to improve global emergency care. We share the challenges faced and lessons learned in establishing a global research network. Methods: We describe the challenges encountered when EMERGE proposed the develo...
Article
This is a revision of the previous American Academy of Pediatrics policy statement titled “Patient Safety in the Emergency Care Setting,” and is the first joint policy statement by the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association to address pediatric patient safety in the emergen...
Article
Full-text available
Patient safety is the foundation of high-quality health care and remains a critical priority for all clinicians caring for children. There are numerous aspects of pediatric care that increase the risk of patient harm, including but not limited to risk from medication errors attributable to weight-dependent dosing and need for appropriate equipment...
Article
This is a revision of the previous American Academy of Pediatrics policy statement titled “Patient Safety in the Emergency Care Setting” and is the first joint policy statement by the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association to address pediatric patient safety in the emergenc...
Article
OBJECTIVE To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results. METHODS Secondary analysis of a prospective observational study of noncritical febrile infants ≤60 days between 2011 and 2019 conducted in the Pediatric Emergency Care Applied Research Network em...
Article
Objectives: While most acute gastroenteritis (AGE) episodes in children rapidly self-resolve, some children go on to experience more significant and prolonged illness. We sought to develop a prognostic score to identify children at risk of experiencing moderate-to-severe disease after an index Emergency Department (ED) visit. Methods: Data were...
Article
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Background: Early screening and accurately identifying Acute Appendicitis (AA) among patients with undifferentiated symptoms associated with appendicitis during their emergency visit will improve patient safety and health care quality. The aim of the study was to compare models that predict AA among patients with undifferentiated symptoms at emerg...
Article
Critical care settings are unpredictable, dynamic environments where clinicians face high decision density in suboptimal conditions (stress, time constraints, competing priorities). Experts have described two systems of human decision making: one fast and intuitive; the other slow and methodical. Heuristics, or mental shortcuts, a key feature of in...
Article
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The coronavirus disease 2019 crisis has forced the world to integrate telemedicine into health delivery systems in an unprecedented way. To deliver essential care, lawmakers, physicians, patients, payers, and health systems have all adopted telemedicine and redesigned delivery processes with accelerated speed and coordination in a fragmented way wi...
Article
Background: It is unknown if probiotics exert pathogen-specific effects in children with diarrhea secondary to acute gastroenteritis. Methods: Analysis of patient-level data from two multi-center randomized, placebo controlled, trials conducted in pediatric emergency departments in Canada and the U.S.. Participants were 3-48 months with >3 diarr...
Article
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Introduction Diagnostic processes in the emergency department (ED) involve multiple interactions among individuals who interface with information systems to access and record information. A better understanding of diagnostic processes is needed to mitigate errors. This paper describes a study protocol to map diagnostic processes in the ED as a foun...
Article
Objectives: To identify independent predictors of and derive a risk score for invasive herpes simplex virus (HSV) infection. Methods: In this 23-center nested case-control study, we matched 149 infants with HSV to 1340 controls; all were ≤60 days old and had cerebrospinal fluid obtained within 24 hours of presentation or had HSV detected. The pr...
Article
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Introduction: Emergency departments (ED) globally are addressing the coronavirus disease 2019 (COVID-19) pandemic with varying degrees of success. We leveraged the 17-country, Emergency Medicine Education & Research by Global Experts (EMERGE) network and non-EMERGE ED contacts to understand ED emergency preparedness and practices globally when com...
Article
Study objective: This study aimed to explore oral ondansetron usage and impact on outcomes in clinical practice. Methods: This observational study was a planned secondary analysis of 2 trials conducted in 10 US and 6 Canadian institutions between 2014 and 2017. Children 3 to 48 months old with gastroenteritis and ≥3 episodes of vomiting in the 2...
Article
Objective To determine if low household income is associated with disease severity following emergency department (ED) discharge in children with acute gastroenteritis (AGE). Methods We conducted a secondary analysis employing data collected in ten US-based tertiary-care, pediatric EDs between 2014 and 2017. Participants were aged 3–48 months and...
Article
Background: Between-country variation in health care resource use and its impact on outcomes in acute care settings have been challenging to disentangle from illness severity by using administrative data. Methods: We conducted a preplanned analysis employing patient-level emergency department (ED) data from children enrolled in 2 previously cond...
Article
Introduction: It is unclear whether the alleged efficacy of probiotics in childhood acute gastroenteritis depends on the duration and severity of symptoms before treatment. Methods: Preplanned secondary analysis of 2 randomized placebo-controlled trials in children 3-48 months of age was conducted in 16 emergency departments in North America eva...
Article
Full-text available
Importance Despite guidelines endorsing oral rehydration therapy, intravenous fluids are commonly administered to children with acute gastroenteritis in high-income countries. Objective To identify factors associated with intravenous fluid administration and hospitalization in children with acute gastroenteritis. Design, Setting, and Participants...
Article
Fever is one of the most common presenting complaints among infants brought to pediatric emergency. Although most of the infants have benign, self-limiting viral infections, approximately 10% of all may have serious bacterial infection. Clinical examination alone is insufficient to detect serious bacterial infection in well appearing infants, and a...
Article
Objective To create definitions for complications for 16 serious pediatric conditions using the International Classification of Diseases, 10th Revision, Clinical Modification or Procedure Coding System (ICD‐10‐CM/PCS), and to assess whether complication rates are similar to those measured with ICD‐9‐CM/PCS. Data Sources The Healthcare Cost and Uti...
Article
Background Gastroenteritis is a common and impactful disease in childhood. Probiotics are often used to treat acute gastroenteritis (AGE); however, in a large multicenter randomized controlled trial (RCT) in 971 children, Lactobacillus rhamnosus GG (LGG) was no better than placebo in improving patient outcomes. Objectives We sought to determine wh...
Article
Objectives The diagnostic process is a vital component of safe and effective emergency department (ED) care. There are no standardized methods for identifying or reliably monitoring diagnostic errors in the ED, impeding efforts to enhance diagnostic safety. We sought to identify trigger concepts to screen ED records for diagnostic errors and descri...
Article
Full-text available
Background Diagnostic decision making, especially in emergency departments, is a highly complex cognitive process that involves uncertainty and susceptibility to errors. A combination of factors, including patient factors (eg, history, behaviors, complexity, and comorbidity), provider-care team factors (eg, cognitive load and information gathering...
Article
Objectives: To determine the time to positivity for bacterial pathogens and contaminants in blood and cerebrospinal fluid (CSF) cultures in a cohort of febrile infants ≤60 days of age. Methods: This was a secondary analysis of prospective observational multicenter study of noncritically ill infants ≤60 days of age with temperatures ≥38°C and blo...
Article
Non-adherence in clinical trials affects safety and efficacy determinations. Predictors of non-adherence in pediatric acute illness trials are unknown. We sought to examine predictors of non-adherence in a multicenter randomized trial of 971 children with acute gastroenteritis receiving a 5-day oral course of Lactobacillus rhamnosus GG or placebo....
Article
Full-text available
Objective: Few prospective studies have assessed the occurrence of radiographic pneumonia in young febrile infants. We analyzed factors associated with radiographic pneumonias in febrile infants 60 days or younger evaluated in pediatric emergency departments. Study design: We conducted a planned secondary analysis of a prospective cohort study w...
Article
Objectives Using case review to determine whether a patient experienced a delayed diagnosis is challenging. Measurement would be more accurate if case reviewers had access to multi-expert consensus on grading the likelihood of delayed diagnosis. Our objective was to use expert consensus to create a guide for objectively grading the likelihood of de...
Article
Full-text available
Objectives: Vascular access device decision-making for pediatric patients remains a complex, highly variable process. To date, evidence-based criteria to inform these choices do not exist. The objective of the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC) was to provide guidance on device selection, device char...
Article
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Importance: While the literature documenting health disparities has advanced in recent decades, less is known about the pattern of racial/ethnic disparities in emergency care in the United States. Objective: To describe the trends and differences of health outcomes and resource utilization among racial/ethnic groups in US emergency care for adult p...
Article
Background: The ability of the decades-old Boston and Philadelphia criteria to accurately identify infants at low risk for serious bacterial infections has not been recently reevaluated. Methods: We assembled a multicenter cohort of infants 29 to 60 days of age who had cerebrospinal fluid (CSF) and blood cultures obtained. We report the performa...
Article
Full-text available
Importance Appendicitis may be missed during initial emergency department (ED) presentation. Objective To compare patients with a potentially missed diagnosis of appendicitis (ie, patients with symptoms associated with appendicitis, including abdominal pain, constipation, nausea and/or vomiting, fever, and diarrhea diagnosed within 1-30 days after...
Article
Full-text available
Our study demonstrated that it's feasible to obtain quality microRNAs from nasal epithelium in ED setting. We found that miR-582-5p is overexpressed in severe asthmatics suggesting future potential of this microRNA as a clinical biomarker.
Article
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Background: Acute severe childhood asthma is an infrequent, but potentially life-threatening emergency condition. There is a wide range of different approaches to this condition, with very little supporting evidence, leading to significant variation in practice. To improve knowledge in this area, there must first be consensus on how to conduct cli...
Article
Full-text available
Objective: To examine the association between the medical imaging utilization and information related to patients' socioeconomic, demographic and clinical factors during the patients' ED visits; and to develop predictive models using these associated factors including natural language elements to predict the medical imaging utilization at pediatri...
Article
In 4292 infants aged ≤60 days with cerebrospinal fluid (CSF) pleocytosis, the bacterial meningitis score had excellent sensitivity (121 of 121 [100.0%] [95% confidence interval, 96.5%-100.0%]) but low specificity (66 of 4171 [1.6%] [95% confidence interval, 1.3%-2.0%]) and therefore should not be applied clinically to infants in this age group.
Article
Full-text available
Background: There is an incomplete understanding of disparities in emergency care for children across racial and ethnic groups in the United States. In this project, we sought to investigate patterns in emergency care utilization, disposition, and resource use in children by race and ethnicity after adjusting for demographic, socioeconomic, and cli...
Article
The recruitment setting plays a key role in the evaluation of behavioral interventions. We evaluated a behavioral intervention for urban adolescents with asthma in three randomized trials conducted separately in three different settings over the course of 8 years. We hypothesized that characteristics of trial participants recruited from the ED and...
Preprint
Background. Acute severe childhood asthma is an infrequent, but potentially life-threatening emergency presentation. There is a wide range of different approaches to this condition, with very little supporting evidence, leading to significant variation in practice. To improve knowledge in this area, there must first be consensus on how to conduct c...
Article
Background Delayed diagnoses of serious emergency conditions can lead to morbidity in children, but are challenging to identify and measure. We developed and piloted an automated tool for identifying delayed diagnosis of two serious conditions commonly seen in the ED using administrative data. Methods We identified cases with a final diagnosis of...
Article
Medical errors are a leading cause of morbidity and mortality in healthcare. Pediatric patients receiving care in the acute or emergency setting may be especially susceptible to medical error and subsequent harm. Here we review the most common types of medical errors in pediatric emergency medicine – those related to medication, laboratory evaluati...
Article
In Reply We thank Burstein and Papenburg, Verd and Moll, and Bonadio for the letters pertaining to our study¹ in which we derived and validated a prediction rule for identifying febrile infants 60 days and younger with serious bacterial infections (SBI). Burstein and Papenburg question the use of the less widely available procalcitonin (PCT) rather...
Preprint
Full-text available
Background. Acute severe childhood asthma is an infrequent, but potentially life-threatening emergency presentation. There is a wide range of different approaches to this condition, with very little supporting evidence, leading to significant variation in practice. To improve knowledge in this area, there must first be consensus on how to conduct c...
Article
Objectives: To define and measure complications across a broad set of acute pediatric conditions in emergency departments using administrative data, and to assess the validity of these definitions by comparing resource utilization between children with and without complications. Study design: Using local consensus, we predefined complications fo...
Article
Background Rh sensitization occurs when women whose red blood cells are Rh(D)-antigen negative develop anti-Rh(D) antibodies either during a previous pregnancy in which the fetus is Rh(D) positive or by exposure to Rh antigens from blood products/transfusion. Neonates born to Rh-sensitized mothers may present with severe jaundice and anemia. Other...
Article
Introduction : Although oral rehydration therapy is recommended for children with acute gastroenteritis (AGE) with none to some dehydration, intravenous (IV) rehydration is still commonly administered to these children in high-income countries. IV rehydration is associated with pain, anxiety, and emergency department (ED) revisits in children with...
Article
Background: Febrile infants commonly present to emergency departments for evaluation. Objective: We describe the variation in diagnostic testing and hospitalization of febrile infants ≤60 days of age presenting to the emergency departments in the Pediatric Emergency Care Applied Research Network. Methods: We enrolled a convenience sample of no...
Article
Full-text available
There is a global variation in policies that define clear indications for pediatric intensive care unit (PICU) admissions. In resource-limited countries where PICU service availability is limited, the admission criteria to PICU are urgently needed to optimize the utilization of available intensive care services and to maximize patient benefit. The...
Article
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Background The epidemiology of emergency care globally is largely unknown, especially in developing countries, because of a lack of common taxonomy, an absence of robust reporting mechanisms, and because emergency medicine is not always recognised as a subspecialty in its own right. Other disease-specific and specialty-specific research networks ha...
Article
Importance: In young febrile infants, serious bacterial infections (SBIs), including urinary tract infections, bacteremia, and meningitis, may lead to dangerous complications. However, lumbar punctures and hospitalizations involve risks and costs. Clinical prediction rules using biomarkers beyond the white blood cell count (WBC) may accurately ide...
Article
Emergency medicine requires diagnosing unfamiliar patients with undifferentiated acute presentations. This requires hypothesis generation and questioning, examination, and testing. Balancing patient load, care across the severity spectrum, and frequent interruptions create time pressures that predispose humans to fast thinking or cognitive shortcut...
Article
Background: Acute gastroenteritis develops in millions of children in the United States every year, and treatment with probiotics is common. However, data to support the use of probiotics in this population are limited. Methods: We conducted a prospective, randomized, double-blind trial involving children 3 months to 4 years of age with acute ga...
Article
Full-text available
Background Pediatric emergency care research networks have evolved substantially over the past 2 decades. Some networks are specialized in specific areas (e.g. sedation, simulation) while others study a variety of medical and traumatic conditions. Given the increased collaboration between pediatric emergency research networks, the logical next step...
Article
The 2006 IOM report, Emergency Care for Children: Growing Pains, uses the word “uneven” to describe the current status of pediatric emergency care in the United States. ⁸Institute of Medicine, Committee of the Future of Emergency Care in the US Health System Emergency Care for Children: Growing Pains. National Academies Press, Washington, DC2006 •...
Article
Full-text available
Emergency care providers share a compelling interest in developing an effective patient‐centered, outcomes‐based research agenda that can decrease variability in pediatric outcomes. The 2018 Academic Emergency Medicine Consensus Conference, “Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps (AEMCC),” aimed to f...
Article
Despite the fact that emergency care can impact health of populations, the global epidemiology of emergencies in children and adults is unknown and substantial variation exists in emergency infrastructure among different nations, especially among the low and middle income countries. Various research networks which are etiology specific or subspecia...
Article
Objective: To compare the risk of serious bacterial infection between infants aged ≤60 days who are febrile in the emergency department (ED) and those who have only a history of fever and are afebrile on arrival to the ED. Study design: In this secondary analysis of a multicenter prospective study using data collected between December 2008 and M...
Preprint
BACKGROUND Augmented reality (AR) is increasingly being investigated for its applications to medical specialties as well as in medical training. Currently, there is little information about its applicability to training within emergency medicine. OBJECTIVE The objective of this article is to review current literature related to augmented reality a...
Article
Full-text available
Background: Augmented reality is increasingly being investigated for its applications to medical specialties as well as in medical training. Currently, there is little information about its applicability to training and care delivery in the context of emergency medicine. Objective: The objective of this article is to review current literature re...
Article
Objective: To determine the risk of serious bacterial infections (SBIs) in young febrile infants with and without viral infections. Study design: Planned secondary analyses of a prospective observational study of febrile infants 60 days of age or younger evaluated at 1 of 26 emergency departments who did not have clinical sepsis or an identifiab...
Article
Objective: Medical errors threaten patient safety, especially in the pediatric emergency department (ED) where overcrowding, multiple handoffs, and workflow interruptions are common. Errors related to process variance involve situations that are not consistent with standard ED operations or routine patient care. Setting/participants: We performe...
Article
Full-text available
Fever is the most common complaint for a child to visit hospital. Under the aegis of INDO-US Emergency and Trauma Collaborative, Pediatric Emergency Medicine chapter of Academic College of Emergency Experts in India developed evidence-based consensus for evaluation and management of febrile child in emergency department. An extensive literature sea...
Chapter
Children with underlying heart disease often present to the emergency department (ED) with common pediatric illnesses. In addition to the morbidity from the illness itself, these illnesses can further alter the fragile cardiovascular physiology in children with underlying heart disease placing them at a higher risk for complications and mortality....
Article
Objectives: Reports of the test accuracy of the urinalysis for diagnosing urinary tract infections (UTIs) in young febrile infants have been variable. We evaluated the test characteristics of the urinalysis for diagnosing UTIs, with and without associated bacteremia, in young febrile infants. Methods: We performed a planned secondary analysis of...
Article
Full-text available
Background: Although neonatal herpes simplex virus (HSV) is a potentially devastating infection requiring prompt evaluation and treatment, large-scale assessments of the frequency in potentially infected infants have not been performed. Methods: We performed a retrospective cross-sectional study of infants ≤60 days old who had cerebrospinal flui...
Article
Objective Insufficient sleep is common among caregivers and is associated with worse health outcomes; however, the contributors to poor sleep among caregivers are unknown. We investigated the cross-sectional association between socioeconomic status (SES), psychosocial stressors, and sleep among caregivers. Methods Caregivers (n = 98) of teenagers...
Article
Study objective: To describe the current epidemiology of bacteremia in febrile infants 60 days of age and younger in the Pediatric Emergency Care Applied Research Network (PECARN). Methods: We conducted a planned secondary analysis of a prospective observational study of febrile infants 60 days of age and younger presenting to any of 26 PECARN e...
Article
Full-text available
In this diagnostic accuracy study of clinical and biomarker variables in the diagnosis of serious bacterial infections (SBIs), including pneumonia, in febrile children (age <16 y), a diagnostic model was derived by using multinomial logistic regression and internal validity. External validation of a published model was undertaken, followed by model...