{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T04:14:08Z","timestamp":1741666448768,"version":"3.38.0"},"reference-count":23,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1 TR002014"],"award-info":[{"award-number":["UL1 TR002014"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p> Rocky Mountain spotted fever (RMSF) is a bacterial disease associated with morbidity and mortality when untreated. The primary study objectives are to describe clinician diagnostic and treatment practices in a nonendemic area after the occurrence of an unrecognized severe pediatric presumed RMSF case (index case). We hypothesized that inpatient diagnostic testing frequency and initiation of empiric treatment will increase after the index case. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> We performed a retrospective chart review of patients aged less than 18 y evaluated for RMSF at Penn State Hershey Children\u2019s Hospital between 2010 and 2019. We divided the study population into 2 groups (preindex and postindex) and evaluated patient characteristics, RMSF testing completion, and timing of doxycycline administration. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Fifty-four patients (14 [26%] preindex and 40 [74%] postindex) were included. Age (median [25<jats:sup>th<\/jats:sup> percentile, 75<jats:sup>th<\/jats:sup> percentile]) decreased from 14.5 y (8.6, 16) preindex to 8.3 y (3.6, 14) postindex. Twelve (86%) preindex and 31 (78%) postindex patients received empiric doxycycline ( P=0.70). Four years after the index case, a decrease in empiric and urgent initiation of doxycycline administration was noted. One case of severe RMSF was diagnosed 4 y after the index case. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p> Our study found that inpatient RMSF testing increased after the index case, but not all patients received empiric treatment. This may represent an underappreciation of RMSF severity even after a recent devastating case. We suggest that when severe rare but possibly reversible diseases, such as RMSF occur, all clinicians are educated on the diagnostic and treatment approach to reduce the morbidity and mortality risk. <\/jats:p><\/jats:sec>","DOI":"10.1016\/j.wem.2021.05.005","type":"journal-article","created":{"date-parts":[[2021,8,12]],"date-time":"2021-08-12T08:48:11Z","timestamp":1628758091000},"page":"427-432","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of a Severe Rocky Mountain Spotted Fever Case on Treatment Practices at an Academic Institution Within a Nonendemic Area"],"prefix":"10.1177","volume":"32","author":[{"given":"Conrad","family":"Krawiec","sequence":"first","affiliation":[{"name":"Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children\u2019s Hospital, Hershey, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary D.","family":"Ceneviva","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children\u2019s Hospital, Hershey, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shouhao","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neal J.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children\u2019s Hospital, Hershey, Pennsylvania"},{"name":"Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,12,1]]},"reference":[{"doi-asserted-by":"publisher","key":"bibr1-j.wem.2021.05.005","DOI":"10.1016\/j.jemermed.2018.02.043"},{"doi-asserted-by":"publisher","key":"bibr2-j.wem.2021.05.005","DOI":"10.1093\/cid\/civ116"},{"doi-asserted-by":"publisher","key":"bibr3-j.wem.2021.05.005","DOI":"10.1016\/j.jpeds.2006.11.023"},{"doi-asserted-by":"publisher","key":"bibr4-j.wem.2021.05.005","DOI":"10.1016\/j.pcl.2012.12.001"},{"issue":"2","key":"bibr5-j.wem.2021.05.005","first-page":"142","volume":"6","author":"Allen H.C.","year":"2017","journal-title":"J\u00a0Pediatr Intensive Care"},{"doi-asserted-by":"publisher","key":"bibr6-j.wem.2021.05.005","DOI":"10.1371\/journal.pntd.0007469"},{"doi-asserted-by":"publisher","key":"bibr7-j.wem.2021.05.005","DOI":"10.1093\/clinids\/20.5.1118"},{"doi-asserted-by":"publisher","key":"bibr8-j.wem.2021.05.005","DOI":"10.1111\/j.1749-6632.2003.tb07379.x"},{"doi-asserted-by":"publisher","key":"bibr9-j.wem.2021.05.005","DOI":"10.1111\/pde.13053"},{"doi-asserted-by":"publisher","key":"bibr10-j.wem.2021.05.005","DOI":"10.1371\/journal.pntd.0000338"},{"doi-asserted-by":"publisher","key":"bibr11-j.wem.2021.05.005","DOI":"10.3389\/fcimb.2018.00090"},{"doi-asserted-by":"publisher","key":"bibr12-j.wem.2021.05.005","DOI":"10.3389\/fpubh.2015.00055"},{"doi-asserted-by":"publisher","key":"bibr13-j.wem.2021.05.005","DOI":"10.1177\/0141076815620614"},{"doi-asserted-by":"publisher","key":"bibr14-j.wem.2021.05.005","DOI":"10.1097\/01.HMR.0000296790.39128.20"},{"doi-asserted-by":"publisher","key":"bibr15-j.wem.2021.05.005","DOI":"10.1097\/PCC.0000000000002198"},{"doi-asserted-by":"publisher","key":"bibr16-j.wem.2021.05.005","DOI":"10.14745\/ccdr.v45i04a02"},{"doi-asserted-by":"publisher","key":"bibr17-j.wem.2021.05.005","DOI":"10.1093\/ofid\/ofz066"},{"doi-asserted-by":"publisher","key":"bibr18-j.wem.2021.05.005","DOI":"10.1016\/j.jpeds.2015.02.015"},{"doi-asserted-by":"publisher","key":"bibr19-j.wem.2021.05.005","DOI":"10.1016\/j.jpeds.2013.10.008"},{"doi-asserted-by":"publisher","key":"bibr20-j.wem.2021.05.005","DOI":"10.4269\/ajtmh.2012.12-0126"},{"issue":"5","key":"bibr21-j.wem.2021.05.005","first-page":"209","volume":"102","author":"Hayden A.M.","year":"2004","journal-title":"J\u00a0Ky Med Assoc"},{"doi-asserted-by":"publisher","key":"bibr22-j.wem.2021.05.005","DOI":"10.1016\/j.ttbdis.2015.10.005"},{"doi-asserted-by":"publisher","key":"bibr23-j.wem.2021.05.005","DOI":"10.1097\/PHH.0b013e3182368c74"}],"container-title":["Wilderness &amp; 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