{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T19:35:01Z","timestamp":1783020901724,"version":"3.54.6"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To describe the characteristics and selected quality improvement (QI) measures of pediatric emergency department (ED) encounters within Epic Cosmos.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed a retrospective study within Cosmos of all pediatric (&lt;18\u00a0years) US-based ED encounters between January 1, 2020, and June 30, 2025. We summarized demographics, visit characteristics, and diagnoses. We evaluated QI metrics for key conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We included 41,735,030 ED encounters from 18,757,872 distinct patients. The median encounter age was 6 years (IQR 2 to 12) and 52.0% were male. Most patients were White (58.7%), non-Hispanic (67.4%), publicly insured (58.5%), urban-dwelling (85.7%), and nearly half resided in the South (47.6%). The most common chief complaints were fever (16.6%), cough (11.7%), vomiting (8.2%), and abdominal pain (7.4%). Most patients were triaged as Emergency Severity Index (ESI) 4 (45.4%) or ESI 3 (35.7%), and 88.3% were discharged from the ED. QI metric analysis demonstrated corticosteroid use for asthma in 86.3% of encounters, chest radiography among children with asthma in 42.8%, brain CT for head injury in 18.6%, antibiotic use for viral illness in 4.8%, corticosteroid use for croup in 91.7%, intravenous fluid use for dehydration in 10.7%, and topical anesthesia use for lacerations in 56.4%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>We characterized pediatric ED encounters within the Epic Cosmos platform, which is consistent with national patterns of pediatric ED care. These findings highlight the utility of Cosmos for assessing care quality and variability in pediatric emergency medicine, although findings should be interpreted cautiously given variability in coding, data mapping, and institutional representation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/pec.0000000000003595","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T11:00:13Z","timestamp":1774522813000},"page":"556-562","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating Pediatric Emergency Care Within Epic Cosmos"],"prefix":"10.1097","volume":"42","author":[{"given":"Sriram","family":"Ramgopal","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, IL"},{"name":"Stanley Manne Children\u2019s Research Institute, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph J.","family":"Zorc","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Perelman School of Medicine, Children\u2019s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Gray","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Vadasz","sequence":"additional","affiliation":[{"name":"Department of Pathology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark I.","family":"Neuman","sequence":"additional","affiliation":[{"name":"Stanley Manne Children\u2019s Research Institute, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill M.","family":"Laeyendecker","sequence":"additional","affiliation":[{"name":"Stanley Manne Children\u2019s Research Institute, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan","family":"Wu","sequence":"additional","affiliation":[{"name":"Stanley Manne Children\u2019s Research Institute, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, IL"},{"name":"Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick S.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"R1-20260702","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1542\/peds.2014-1382","article-title":"Variation in care of the febrile young infant <90 days in US pediatric emergency departments","volume":"134","author":"Aronson","year":"2014","journal-title":"Pediatrics"},{"key":"R2-20260702","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.ajem.2022.07.058","article-title":"Variability in emergency department management of hypothermic infants\u2264 90 days of age","volume":"16960","author":"Lo","year":"2022","journal-title":"Am J Emerg Med"},{"key":"R3-20260702","doi-asserted-by":"crossref","first-page":"e20182201","DOI":"10.1542\/peds.2018-2201","article-title":"Reducing variability in the infant sepsis evaluation (REVISE): A National Quality Initiative","volume":"144","author":"Biondi","year":"2019","journal-title":"Pediatrics"},{"key":"R4-20260702","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.jpeds.2019.07.034","article-title":"Variation in hospitalization rates following emergency department visits in children with medical complexity","volume":"214","author":"Coller","year":"2019","journal-title":"J Pediatr"},{"key":"R5-20260702","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/j.jpeds.2014.05.057","article-title":"Variation in the management of infants hospitalized for bronchiolitis persists after the 2006 American Academy of Pediatrics bronchiolitis guidelines","volume":"165","author":"Florin","year":"2014","journal-title":"J Pediatr"},{"key":"R6-20260702","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1542\/peds.2013-0179","article-title":"Variation in emergency department diagnostic testing and disposition outcomes in pneumonia","volume":"132","author":"Florin","year":"2013","journal-title":"Pediatrics"},{"key":"R7-20260702","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1007\/s11606-012-2255-6","article-title":"Variation in length of stay and outcomes among hospitalized patients attributable to hospitals and hospitalists","volume":"28","author":"Goodwin","year":"2013","journal-title":"J Gen Intern Med"},{"key":"R8-20260702","doi-asserted-by":"crossref","first-page":"e2024070153","DOI":"10.1542\/peds.2024-070153","article-title":"Adoption of dexamethasone for asthma exacerbations","volume":"156","author":"Ramgopal","year":"2025","journal-title":"Pediatrics"},{"key":"R9-20260702","doi-asserted-by":"crossref","first-page":"e250160","DOI":"10.1001\/jamanetworkopen.2025.0160","article-title":"Trends in respiratory pathogen testing at US children\u2019s hospitals","volume":"8","author":"Molloy","year":"2025","journal-title":"JAMA Netw open"},{"key":"R10-20260702","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1542\/hpeds.2021-005966","article-title":"Trends in ED resource use for infants 0 to 60 days evaluated for serious bacterial infection","volume":"11","author":"Hernandez","year":"2021","journal-title":"Hosp Pediatr"},{"key":"R11-20260702","doi-asserted-by":"crossref","first-page":"2048","DOI":"10.1001\/jama.299.17.2048","article-title":"Corticosteroids and mortality in children with bacterial meningitis","volume":"299","author":"Mongelluzzo","year":"2008","journal-title":"JAMA"},{"key":"R12-20260702","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1055\/s-0038-1651496","article-title":"The pediatric emergency care applied research network registry: a multicenter electronic health record registry of pediatric emergency care","volume":"9","author":"Deakyne Davies","year":"2018","journal-title":"Appl Clin Inform"},{"key":"R13-20260702","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jpeds.2017.03.035","article-title":"Complexity and Severity of Pediatric Patients Treated at United States Emergency Departments","volume":"186","author":"Hudgins","year":"2017","journal-title":"J Pediatr"},{"key":"R15-20260702","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.1055\/s-0041-1731004","article-title":"The Cosmos collaborative: a vendor-facilitated electronic health record data aggregation platform","volume":"5","author":"Tarabichi","year":"2021","journal-title":"ACI Open"},{"key":"R16-20260702","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/j.ajt.2024.11.008","article-title":"Generalizability of kidney transplant data in electronic health records\u2014The Epic Cosmos database vs the Scientific Registry of Transplant Recipients","volume":"25","author":"Mankowski","year":"2025","journal-title":"Am J Transplant"},{"key":"R18-20260702","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s12873-023-00851-5","article-title":"Systemic review of age brackets in pediatric emergency medicine literature and the development of a universal age classification for pediatric emergency patients-the Munich Age Classification System (MACS)","volume":"23","author":"Althammer","year":"2023","journal-title":"BMC Emerg Med"},{"key":"R21-20260702","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1097\/PEC.0000000000002692","article-title":"Updated diagnosis grouping system for pediatric emergency department visits","volume":"39","author":"Fant","year":"2023","journal-title":"Pediatr Emerg Care"},{"key":"R22-20260702","doi-asserted-by":"crossref","first-page":"e2420579","DOI":"10.1001\/jamanetworkopen.2024.20579","article-title":"Pediatric complex chronic condition system version 3","volume":"7","author":"Feinstein","year":"2024","journal-title":"JAMA Netw Open"},{"key":"R23-20260702","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1111\/acem.13489","article-title":"Use of a National Database to Assess Pediatric Emergency Care Across United States Emergency Departments","volume":"25","author":"Michelson","year":"2018","journal-title":"Acad Emerg Med"},{"key":"R24-20260702","doi-asserted-by":"crossref","first-page":"e31140","DOI":"10.1002\/pbc.31140","article-title":"Direct oral anticoagulant use in hospitalized pediatric patients: insights from nationwide data","volume":"71","author":"Buxton","year":"2024","journal-title":"Pediatr Blood Cancer"},{"key":"R25-20260702","doi-asserted-by":"crossref","first-page":"e2021053498","DOI":"10.1542\/peds.2021-053498","article-title":"Birth hospital length of stay and rehospitalization during COVID-19","volume":"149","author":"Handley","year":"2022","journal-title":"Pediatrics"},{"key":"R26-20260702","article-title":"Epidemiologic trends in pediatric urinary tract infections among United States Emergency Departments from 2016-2023","author":"Gottlieb","year":"2025","journal-title":"Clin Exp Emerg Med"},{"key":"R27-20260702","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.jaacop.2025.10.002","article-title":"A United States National Assessment of Pediatric Emergency and Inpatient Encounters Before, During, and Following the COVID-19 Pandemic: Mental and Behavioral Health Diagnoses","volume":"4","author":"Smith","year":"2026","journal-title":"JAACAP Open"},{"key":"R28-20260702","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.ajem.2025.08.012","article-title":"Chief complaint, drug testing, and neuroimaging for cannabis poisoning in the emergency department","volume":"98","author":"Walsh","year":"2025","journal-title":"Am J Emerg Med"},{"key":"R29-20260702","doi-asserted-by":"crossref","first-page":"e2024065881","DOI":"10.1542\/peds.2024-065881","article-title":"Cannabis legalization and resource use for ingestions by young children","volume":"153","author":"Walsh","year":"2024","journal-title":"Pediatrics"},{"key":"R30-20260702","doi-asserted-by":"crossref","first-page":"e1454","DOI":"10.1097\/PEC.0000000000002790","article-title":"Pediatric return visits to the emergency department: the time to return curve","volume":"38","author":"Ramgopal","year":"2022","journal-title":"Pediatr Emerg Care"},{"key":"R31-20260702","doi-asserted-by":"crossref","first-page":"e12950","DOI":"10.1002\/emp2.12950","article-title":"Comparing two definitions of pediatric complexity among children cared for in general and pediatric emergency departments in a statewide sample","volume":"4","author":"Ramgopal","year":"2023","journal-title":"JACEP Open"},{"key":"R32-20260702","doi-asserted-by":"crossref","first-page":"e2020039628","DOI":"10.1542\/peds.2020-039628","article-title":"Pediatric Emergency Department Visits at US Children\u2019s Hospitals During the COVID-19 Pandemic","volume":"147","author":"DeLaroche","year":"2021","journal-title":"Pediatrics"},{"key":"R33-20260702","doi-asserted-by":"crossref","first-page":"e47","DOI":"10.1542\/hpeds.2024-008083","article-title":"Application of the Diagnosis Grouping System to Pediatric Emergency Department Encounters","volume":"15","author":"Ramgopal","year":"2025","journal-title":"Hosp Pediatr"},{"key":"R34-20260702","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1111\/j.1553-2712.2009.00635.x","article-title":"A new diagnosis grouping system for child emergency department visits","volume":"17","author":"Alessandrini","year":"2010","journal-title":"Acad Emerg Med"},{"key":"R35-20260702","doi-asserted-by":"crossref","first-page":"ooaf095","DOI":"10.1093\/jamiaopen\/ooaf095","article-title":"Documentation of social determinants of health for patients with type 2 diabetes in Epic Cosmos","volume":"8","author":"Kukhareva","year":"2025","journal-title":"JAMIA Open"},{"key":"R36-20260702","doi-asserted-by":"crossref","first-page":"e70093","DOI":"10.1111\/cts.70093","article-title":"With big data comes big responsibility: Strategies for utilizing aggregated, standardized, de-identified electronic health record data for research","volume":"18","author":"Olaker","year":"2025","journal-title":"Clin Transl Sci"},{"key":"R37-20260702","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1001\/jama.2011.1385","article-title":"Hospital-level compliance with asthma care quality measures at children\u2019s hospitals and subsequent asthma-related outcomes","volume":"306","author":"Morse","year":"2011","journal-title":"JAMA"},{"key":"R38-20260702","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3109\/02770903.2010.535884","article-title":"Pediatric emergency departments are more likely than general emergency departments to treat asthma exacerbation with systemic corticosteroids","volume":"48","author":"Bekmezian","year":"2011","journal-title":"J Asthma"},{"key":"R39-20260702","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1097\/MPG.0b013e31822ecaac","article-title":"Time-series analysis of ondansetron use in pediatric gastroenteritis","volume":"54","author":"Freedman","year":"2012","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"R40-20260702","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1097\/INF.0000000000002586","article-title":"Antibiotic prescribing for viral respiratory infections in the pediatric emergency department and urgent care","volume":"39","author":"Desai","year":"2020","journal-title":"Pediatr Infect Dis J"},{"key":"R41-20260702","doi-asserted-by":"crossref","first-page":"e20170203","DOI":"10.1542\/peds.2017-0203","article-title":"Racial and ethnic differences in antibiotic use for viral illness in emergency departments","volume":"140","author":"Goyal","year":"2017","journal-title":"Pediatrics"},{"key":"R42-20260702"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000003595","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T18:21:29Z","timestamp":1783016489000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000003595"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,26]]},"references-count":38,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000003595","relation":{},"ISSN":["0749-5161","1535-1815"],"issn-type":[{"value":"0749-5161","type":"print"},{"value":"1535-1815","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,26]]},"assertion":[{"value":"2025-12-18","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-22","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}