Chaitanya Pant

Case Western Reserve University School of Medicine, Cleveland, Ohio, United States

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Publications (65)243.01 Total impact

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    ABSTRACT: We investigated acute recurrent pancreatitis (ARP) in children using a national healthcare database. From 2002 to 2014, 26,435 children had a diagnosis of acute pancreatitis (AP); 10,648 discharges were index hospitalizations. 6,159 children had a single hospitalization for AP, while 4,489 (42%) children underwent 15,787 re-hospitalizations. Children experienced a median of 2 ARP-related hospitalizations with a median time between admissions of 86 days. Younger patients with a more severe index episode of AP were at a higher risk of ARP. ARP-related hospitalizations had an increased requirement for intensive care unit care compared to an index episode of AP.
    No preview · Article · Dec 2015 · Journal of Pediatric Gastroenterology and Nutrition
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    ABSTRACT: Background: The incidence of Clostridium difficile infection (CDI) is increasing in the pediatric population. Pediatric recipients of solid organ transplantation (SOT) may be at a higher risk for CDI in part due to chemotherapy and prolonged hospitalization. Methods: We utilized data from the Healthcare Cost and Utilization Project Kids' Inpatient Database to study the incidence and outcomes related to CDI as a complicating factor in pediatric recipients of SOT. Results: Our results demonstrate that hospitalized children with SOT have increased rates of infection, with the greatest risk for younger children with additional comorbidities and severe illness. The type of transplanted organ affects the risk for CDI, with the lowest incidence observed in renal transplant patients. Conclusion: The occurrence of CDI in the pediatric SOT population contributes to a greater length of stay and higher hospital charges. However CDI is not an independent predictor of increased in hospital mortality in these patients. This article is protected by copyright. All rights reserved.
    No preview · Article · Nov 2015 · Transplant Infectious Disease
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    ABSTRACT: Background: There is a lack of large database research relating to the epidemiology and health resource utilization associated with short bowel syndrome (SBS) in the United States. Methods: We analyzed the Kids' Inpatient Database for the year 2012 and utilized International Classification of Diseases, Ninth Revision, and Clinical Modification (ICD-9-CM) diagnosis codes to identify patients 0-3 years of age with SBS, who were matched by age and sex to children without SBS. The study variables included patient and hospital demographics, All Patient Refined Diagnosis Related Groups, in-hospital mortality, hospital length of stay, and hospitalization costs. We also determined the most frequent ICD-9-CM diagnostic and procedural codes associated with SBS. Results: Children with SBS demonstrated a higher rate of mortality than that of children without SBS (1.6% vs 0.7%; P < .001). Children with SBS also experienced a longer length of stay (median days [interquartile range]: 8 [15] vs 2 [3]; P < .001) and higher hospital costs ($17,000 [$34,000] vs $3000 [$5000]; P < .001). The most frequent medical diagnoses associated with SBS were infection (62%), anemia (29%), and liver disease (17%). Children with SBS also demonstrated more severe illness as assessed by an All Patient Refined Diagnosis Related Group score of 3 or 4 (94.30% vs 16.20%; P < .001). Conclusions: Children hospitalized with SBS have a high severity of illness and experience complicated inpatient courses related to their disease. Our study represents the first use of national U.S. data to study the epidemiology and health resource utilization associated with SBS.
    No preview · Article · Oct 2015 · Journal of Parenteral and Enteral Nutrition
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    ABSTRACT: Using a national database, we report an increasing trend in Clostridium difficile incidence among hospitalized children in the United States from 2003 to 2012. The incidence rate of CDI increased from 24.0 to 58.0 per 10,000 discharges per year ( P <0.001) across all age groups, with the greatest increase in children 15 years and older. Infect. Control Hosp. Epidemiol. 2015;00(0):1–3
    No preview · Article · Oct 2015 · Infection Control and Hospital Epidemiology
  • Chaitanya Pant · Thomas J Sferra
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    ABSTRACT: We analyzed two national databases to assess the utilization of healthcare resources by children with chronic pancreatitis (CP). In 2012, the hospital discharge rate for pediatric CP was 2.73 per 100,000 children. Patients with CP were sicker with a greater burden of illness than age- and gender-matched counterparts. Acute pancreatitis occurred frequently in hospitalized children with CP. Abdominal pain and nausea and vomiting were the most common gastrointestinal symptoms associated with emergency department visits in children with CP. A significant proportion of these visits resulted in a hospitalization. These findings add to our understanding of the epidemiology of CP in the U.S.
    No preview · Article · Jun 2015 · Journal of pediatric gastroenterology and nutrition
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    ABSTRACT: Esophageal variceal bleeding (EVB) is a frequent complication in cirrhotic patients resulting in considerable mortality and morbidity. The aim of this study was to investigate the occurrence, impact, and trends of EVB in hospitalized cirrhotic patients on a nationwide level in the United States. We interrogated data from the Nationwide Inpatient Sample from 2002 to 2012. Utilizing International Classification of Diseases, Ninth Revision, Clinical Modification codes, we analyzed hospital discharges for cirrhosis and related EVB in adult patients. EVB in cirrhotic patients was independently associated with overall worse outcomes with respect to in-hospital mortality (10% vs 5%; P < 0.01) and hospital charges (median $41,000 vs $26,000; P < 0.01). In the period from 2002 to 2012, the number of cirrhosis-related hospitalizations increased from 337,956 to 570,220 (P < 0.01). Concurrently, the incidence of EVB in hospitalized cirrhotic patients declined from 8.60% to 5.78%, with an overall decreased trend (P < 0.01). The decline in the rate of EVB in hospitalized cirrhotic patients from 2002 to 2012 likely reflects the effectiveness of primary and secondary prophylaxis. Journal of Hospital Medicine 2015. © 2015 Society of Hospital Medicine. © 2015 Society of Hospital Medicine.
    No preview · Article · May 2015 · Journal of Hospital Medicine
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    ABSTRACT: We analyzed a national U.S. database to study the presentation of children with inflammatory bowel disease (IBD) to the emergency department (ED). Our results indicate that from 2006 - 2010 there was a significant increase in the number of ED visits related to children with IBD accompanied by a contemporaneous decline in the rate of hospitalization that followed these ED visits. Earlier published results have highlighted an increased overall rate of hospitalizations in the U.S. related to children with IBD. In this context, our results support the evidence for an increased prevalence of pediatric IBD in the U.S. in recent years.
    No preview · Article · Apr 2015 · Journal of pediatric gastroenterology and nutrition

  • No preview · Article · Apr 2015 · Gastroenterology

  • No preview · Article · Apr 2015 · Gastroenterology

  • No preview · Article · Apr 2015 · Gastroenterology
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    Full-text · Conference Paper · Apr 2015
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    ABSTRACT: Nucleic acid amplification tests including real-time polymerase chain reaction and loop-mediated isothermal DNA amplification (LAMP) are currently used as standalone diagnostic tests of C. difficile infection (CDI) in the United States. These assays are reported to have similar sensitivity and specificity to toxigenic culture. We assessed the diagnostic accuracy and clinical value of LAMP for the diagnosis of CDI. We searched PubMed and 4 other databases to identify diagnostic accuracy studies that compared LAMP with culture cytotoxicity neutralization assay (CCNA) or anaerobic toxigenic culture (TC) of C. difficile from database inception to 2014. We used the random-effects model to calculate pooled sensitivities, specificities, likelihood ratios, diagnostic odds ratios and their 95% CIs. Hierarchical summary receiver operating characteristic curves were constructed. A search of the databases yielded 16 studies (6,979 samples) that met the inclusion criteria. When TC was used as the gold standard (6,572 samples), bivariate analysis yielded a mean sensitivity of 0.95 (95% CI, 0.93-0.97; I2 = 67.4) and a mean specificity of 0.99 (95% CI, 0.96-1.00; I2 = 97.0). With CCNA as a gold standard (407 samples), the mean sensitivity was 0.93 (95% CI, 0.85-0.97; I2 = 68.6) and mean specificity, 0.91 (95% CI, 0.87-0.94; I2 = 90.7). The studies had substantial heterogeneity. None of the subgroups investigated could account for the heterogeneity. LAMP is a useful diagnostic tool with high sensitivity and specificity for detecting CDI. The results should however be interpreted only in the presence of clinical suspicion and symptomatic diarrhoea. Keywords: Loop-mediated isothermal amplification, meta-analysis, C. difficile, specificity, sensitivity
    Full-text · Article · Feb 2015 · Diagnostic Microbiology and Infectious Disease
  • Chaitanya Pant · Thomas J Sferra

    No preview · Article · Feb 2015 · Journal of Pediatrics
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    ABSTRACT: The objective of this study was to describe the epidemiology and trends in pediatric acute pancreatitis (AP)-associated emergency department (ED) visits in the United States. Estimates of AP-associated ED visits were calculated in children from birth to 19 years of age using the Nationwide Emergency Department Sample. From 2006 to 2011, there were an estimated total of 78,787 ED visits associated with the diagnosis of AP. The greatest number of ED visits occurred in children 15 to 19 years of age (67.0%). A majority of patients were subsequently admitted to the hospital for further care (74.1%). Risk factors independently associated with an increased rate of hospital admission included 3 or more comorbid conditions (adjusted odds ratio [aOR] 12.81; 95% confidence interval [CI], 11.29-14.56), children younger than 5 years (aOR, 1.73; 95% CI, 1.58-1.89), presentation to a teaching hospital (aOR, 1.68; 95% CI, 1.62-1.74) or a hospital in the Western region of the United States (aOR, 1.48; 95% 1.42-1.54), and health coverage with Medicaid (aOR, 1.23; 95% CI, 1.17-1.29). Acute pancreatitis-associated ED visits increased from 14.5 per 100,000 children in 2006 to 16.1 per 100,000 children in 2011 (11.42% increase; P < 0.01). There has been an increasing incidence of AP-associated ED visits in children from 2006 to 2011.
    No preview · Article · Feb 2015 · Gastroenterology
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    ABSTRACT: Objective: An estimated 20-30% of patients with primary Clostridium difficile infection (CDI) develop recurrent CDI (rCDI) within 2 weeks of completion of therapy. While the actual mechanism of recurrence remains unknown, a variety of risk factors have been suggested and studied. The aim of this systematic review and meta-analysis was to evaluate current evidence on the risk factors for rCDI. Design: We searched MEDLINE and 5 other databases for subject headings and text related to rCDI. All studies investigating risk factors of rCDI in a multivariate model were eligible. Information on study design, patient population, and assessed risk factors were collected. Data were combined using a random-effects model and pooled relative risk ratios (RRs) were calculated. Results: A total of 33 studies (n=18,530) met the inclusion criteria. The most frequent independent risk factors associated with rCDI were age≥65 years (risk ratio [RR], 1.63; 95% confidence interval [CI], 1.24-2.14; P=.0005), additional antibiotics during follow-up (RR, 1.76; 95% CI, 1.52-2.05; P<.00001), use of proton-pump inhibitors (PPIs) (RR, 1.58; 95% CI, 1.13-2.21; P=.008), and renal insufficiency (RR, 1.59; 95% CI, 1.14-2.23; P=.007). The risk was also greater in patients previously on fluoroquinolones (RR, 1.42; 95% CI, 1.28-1.57; P<.00001). Conclusions: Multiple risk factors are associated with the development of rCDI. Identification of modifiable risk factors and judicious use of antibiotics and PPI can play an important role in the prevention of rCDI.
    Full-text · Article · Jan 2015 · Infection Control and Hospital Epidemiology
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    ABSTRACT: There is scant literature about cirrhosis and its associated complications in a non-hospitalized population. To study the epidemiology of cirrhosis-associated Emergency Department visits in the US. Estimates were calculated in patients’ ≥18 years using the Nationwide Emergency Department Sample. The number of visits associated with an International Classification of Diseases-9 diagnosis code of cirrhosis increased non-significantly from 23.81/10,000 population (2006) to 23.9/10,000 population (2011; P = 0.05). A majority of these patients (75.30%) underwent hospital admission, the greatest risk factor for this was the presence of ≥3 comorbidities (adjusted odds ratio 30.8; 95% Confidence Interval 30.4–31.2). Infection was the most frequent concurrent complicating diagnosis associated with cirrhosis (20.1%). There was a decreased incidence in most of the complicating conditions except for hepatorenal syndrome and spontaneous bacterial peritonitis. Our results indicate a stable trend for cirrhosis-associated Emergency Department visits from 2006 to 2011. Further studies are required to investigate the increased incidence of spontaneous bacterial peritonitis and hepatorenal renal syndrome in the cirrhotic population.
    Full-text · Article · Jan 2015 · Medicine
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    ABSTRACT: Objective: To describe the epidemiology and trends in pediatric gastrointestinal (GI) bleeding associated emergency department (ED) visits in the US. Methods: Estimates of GI bleeding associated ED visits were calculated in children from birth to 19 years of age using the Nationwide Emergency Department Sample (NEDS). Results: From 2006 to 2011, there were an estimated total of 437,283 ED visits associated with diagnosis of GI bleeding. Specifically, there were 88,675 cases of upper GI bleeding, 132,102 cases of lower GI bleeding and 217,008 cases of unspecified GI bleeding. GI bleeding associated ED visits increased from 82.2/100,000 children in 2006 to 93.9/100,000 children in 2011 (14.3% increase; P < 0.01). The rate of increase was chiefly noted for lower GI bleeding (31.3%) followed by unspecified GI bleeding (10.4%) with a relatively minor increase in upper GI bleeding (1.1%). The greatest number of visits occurred in children 15-19 years of age (39.2%). A majority of patients underwent routine discharge (80.8%). Risk factors independently associated with an increased rate of hospital admission included ≥3 comorbid conditions (adjusted odds ratio [aOR] 112.2; 95% CI 103.4-121.7), presentation to a teaching hospital (aOR 3.2; 95% CI 3.1-3.2), the presence of upper GI bleeding (aOR 3.1; 95% 3.0-3.2), health coverage with private insurance (aOR 1.6; 95% CI 1.6-1.7) and children <5 years of age (aOR 1.3; 95% CI 1.2-1.3). Conclusion: Our results indicate that there has been an increasing incidence of GI bleeding associated ED visits in children from 2006 to 2011 with cases of lower GI bleeding accounting for the largest increase. Only a small number of children merited admission to the hospital, suggesting that a majority of visits involved non-life-threatening bleeds. These data represent important complementary information to the overall study of pediatric GI bleeding in the US.
    No preview · Article · Dec 2014 · Current Medical Research and Opinion
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    ABSTRACT: Objectives The objective was to estimate emergency department (ED) visits for Clostridium difficile infection in the United States for the years 2006 through 2010.Methods Estimates of ED visits for C. difficile infection were calculated in patients 18 years and older using the Nationwide Emergency Department Sample.ResultsDuring the calendar years 2006 through 2010, there were an estimated total of 491,406,018 ED visits. Of these, 462,160 ED visits were associated with a primary International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of C. difficile. The C. difficile infection ED visit rate (visits/100,000 census population) increased from 34.1 in 2006 to 42.3 in 2010, an increase of 24% (p < 0.01). There was also a significant overall increased trend in the number of ED visits for C. difficile from 2006 through 2010 (p < 0.01). The highest ED visit rate for C. difficile was observed for patients 65 years and older (163.18 per 100,000), while the lowest visit rate was for patients aged 18 to 24 years (5.10 per 100,000). The greatest increase in C. difficile infection visits occurred in the age group 18 to 24 years.Conclusions These results indicate an increased trend of ED visits for C. difficile in the period 2006 through 2010 with an overall population-adjusted increase of 24%. This represents important complementary data to previous studies reporting an increase in the rate of C. difficile infections in the U.S. hospitalized population.
    No preview · Article · Dec 2014 · Academic Emergency Medicine

  • No preview · Article · Dec 2014 · Infection Control and Hospital Epidemiology
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    ABSTRACT: Background: Patients with cystic fibrosis (CF) are reported to have a high asymptomatic carriage rate of Clostridium difficile (C. difficile). However, most reports are limited to case reports and case series. The objective of this study was to investigate the incidence of C. difficile infection (CDI) in hospitalized patients with CF in the United States. Methods: Data were obtained from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality for the years 2002 to 2010. Data were weighted to generate national-level estimates. Results: For the year 2010, there were a total of 9,706,097 weighted hospital discharges in the 18 – 44 year age group. In this age cohort, 32,541 patients had a diagnosis of CDI and 19,278 patients had a diagnosis of CF. The incidence of CDI in the hospitalized CF population was 1.6% compared to an incidence of 0.3% in the non-CF hospitalized population (P<0.05). After matching to control for demographic factors and comorbidities; patients with CF continued to have a higher risk for CDI than their matched counterparts (OR 3.0 95% CI 2.6-3.5). Patients with CF + CDI had an overall worse outcome than patients with CDI only (P<0.05). Utilizing a multiple variable regression model, patients in the CF + CDI group continued to demonstrate poor outcomes compared to patients in the CDI only group. This was evident as a higher risk of death (adjusted odds ratio (aOR) 3.1 95% CI 1.9-5.1), colectomy (aOR 2.6 95% CI 1.3-5.3) and higher hospital charges (adjusted regression coefficient $42,000 95% CI $22,000- $62,000). The difference in LOS between the two groups was not significant (adjusted regression coefficient 3.3 days 95% CI 0.81-5.8 days). Between the years 2002 – 2010, the incidence of CDI in the hospitalized CF population (ages 18 – 44 years) increased from 0.9% to 1.6% whereas the incidence of CDI in the corresponding non-CF population increased from 0.2% to 0.3%. For both these groups, this represented a significant increasing trend in the incidence of CDI (P<0.05). Conclusion: There was an increasing trend in the incidence of CDI complicating CF in the years 2002 - 2010. CDI had worse outcomes (higher risk of death, colectomy and hospital charges) in the setting of CF.
    No preview · Conference Paper · Oct 2014

Publication Stats

479 Citations
243.01 Total Impact Points

Institutions

  • 2015
    • Case Western Reserve University School of Medicine
      • Department of Medicine
      Cleveland, Ohio, United States
    • University of Kansas Medical Center
      Kansas City, Kansas, United States
  • 2014-2015
    • University of Kansas
      • • Department of Internal Medicine
      • • School of Medicine
      Lawrence, Kansas, United States
    • Kansas City VA Medical Center
      Kansas City, Missouri, United States
    • Kansas City University of Medicine and Biosciences
      Kansas City, Missouri, United States
  • 2011-2014
    • Oklahoma City University
      Oklahoma City, Oklahoma, United States
  • 2012
    • Cleveland Clinic
      Cleveland, Ohio, United States
  • 2010-2012
    • University of Oklahoma Health Sciences Center
      • Department of Pediatrics
      Oklahoma City, OK, United States
  • 2007-2011
    • Louisiana State University Health Sciences Center Shreveport
      • Section of Medicine/Pediatrics
      Shreveport, Louisiana, United States
  • 2009-2010
    • Louisiana State University in Shreveport
      Shreveport, Louisiana, United States