Pamela Carol Garcia-Filion

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Journals/Publications

• Hallus, S., Salek, S., & Garcia, P. C. (2023). Identifying Demographic Trends in Telehealth Utilization by Medicaid Beneficiaries Before and During the COVID-19 pandemic: A Retrospective Cohort Study. Telemedicine and e-Health.
• Situ, B. A., Borchert, M. S., Brown, B., & Garcia-Filion, P. (2023). Association of prepregnancy body mass index and gestational weight gain on severity of optic nerve hypoplasia. Birth defects research, 115(7), 753-763.
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  Optic nerve hypoplasia (ONH) is a birth defect of unknown etiology and a leading cause of visual impairment in developed countries. Recent studies suggest that factors of deprivation and exposures of poor nutritional status, such as lower gestational weight gain (GWG), may be associated with increased risk of ONH. The present study describes the prenatal features of mothers of ONH cases, including prepregnancy BMI and GWG, and the associations with clinical features of disease severity.
• Situ, B., Borchert, M., Brown, B., & Garcia, P. C. (2023). Association of pre-pregnancy BMI and gestational weight gain on severity of optic nerve hypoplasia. Birth Defects Research, 1.
• Bailly, D. K., Reeder, R. W., Muszynski, J. A., Meert, K. L., Ankola, A. A., Alexander, P. M., Pollack, M. M., Moler, F. W., Berg, R. A., Carcillo, J., Newth, C., Berger, J., Bell, M. J., Dean, J. M., Nicholson, C., Garcia-Filion, P., Wessel, D., Heidemann, S., Doctor, A., , Harrison, R., et al. (2022). Anticoagulation practices associated with bleeding and thrombosis in pediatric extracorporeal membrane oxygenation; a multi-center secondary analysis. Perfusion, 2676591211056562.
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  To determine associations between anticoagulation practices and bleeding and thrombosis during pediatric extracorporeal membrane oxygenation (ECMO), we performed a secondary analysis of prospectively collected data which included 481 children (80 ml/kg on any day, pulmonary hemorrhage, or intracranial bleeding, Thrombotic events included pulmonary emboli, intracranial clot, limb ischemia, cardiac clot, and arterial cannula or entire circuit change. Bleeding occurred in 42% of patients. Five percent of subjects thrombosed, of which 89% also bled. Daily bleeding odds were independently associated with day prior activated clotting time (ACT) (OR 1.03, 95% CI= 1.00, 1.05, =0.047) and fibrinogen levels (OR 0.90, 95% CI 0.84, 0.96,
• Dalton, H., Martin, M., Garcia-Filion, P., Shavelle, D., Huang, P. H., Clark, J., Beinart, S., Israel, A., & Korpi-Steiner, N. (2022). Activated clotting time in inpatient diagnostic and interventional settings. Journal of thrombosis and thrombolysis, 54(4), 660-668.
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  Monitoring for the anticoagulant effect of unfractionated (UFH) at the point of care using activated clotting time in real time is vital where risk of thrombosis is high. Although monitoring UFH effect is a routine and important task, changing from one ACT instrument type or technology to another must be preceded by a clinical and statistical evaluation to determine the suitability and repeatability and establish normal and treatable ranges of this newer instrument. In this multi-center prospective evaluation we tested 1236 paired ACT+ samples, and 463 paired ACT-LR samples (1699 total) from enrolled study subjects. Clinical settings included CVOR cardiopulmonary bypass, at the beside in extracorporeal life support (ELS), the Cardiac Catheterization Lab (CCL) during diagnostic studies and percutaneous coronary interventions (PCI), interventional radiology procedures and EP interventions. This study found more consistent clinical performance from the GEM Hemochron 100 as compared to the current clinical model, the Hemochron Signature Elite. The bias of GEM Hemochron 100 for ACT+ and ACT-LR was greatest in the setting of the CVOR where ACT levels were high. ACT-LR measurements by the GEM Hemochron 100 were comparable to the SE when performed in settings of CCL, ECM, EP and ICU. Results obtained for both ACT-LR and ACT+ in all clinical settings in this study using the GEM Hemochron 100 are as accurate and more repeatable as those with the current clinically available Signature Elite.
• Garcia, P. C., Barraza, L. F., Peace-Tuskey, K., Jehn, M., Cordova, F. M., Pogreba Brown, K. M., Carr, D. L., Dykinga, M., Dawodu, O., Mantina, N. M., & Nuno, V. L. (2022). Consequences of COVID-19 on adolescents in Arizona: A longitudinal study protocol. . Frontiers in Public Health.
• Khan, S. M., Farland, L. V., Catalfamo, C. J., Austhof, E., Bell, M. L., Chen, Z., Cordova-Marks, F., Ernst, K. C., Garcia-Filion, P., Heslin, K. M., Hoskinson, J., Jehn, M. L., Joseph, E. C., Kelley, C. P., Klimentidis, Y., Russo Carroll, S., Kohler, L. N., Pogreba-Brown, K., & Jacobs, E. T. (2022). Elucidating symptoms of COVID-19 illness in the Arizona CoVHORT: a longitudinal cohort study. BMJ open, 12(1), e053403.
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  To elucidate the symptoms of laboratory-confirmed COVID-19 cases as compared with laboratory-confirmed negative individuals and to the untested general population among all participants who reported symptoms within a large prospective cohort study.
• Leybas Nuño, V., Mantina, N. M., Dawodu, O., Dykinga, M., Carr, D. L., Pogreba-Brown, K., Cordova-Marks, F., Jehn, M., Peace-Tuskey, K., Barraza, L., & Garcia-Filion, P. (2022). Consequences of COVID-19 on adolescents in Arizona: A longitudinal study protocol. Frontiers in public health, 10, 945089.
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  The long-term impact of COVID-19 is unknown. We developed a 5-year prospective cohort study designed to generate actionable community-informed research about the consequences of COVID-19 on adolescents ages 12-17 years in Arizona.
• Wang, J., Patel, V., Salek, S., Abbaszadegan, H., Rehman, S., & Garcia-Filion, P. (2022). Impact of Expanding Telephonic Codes in a State Medicaid Program During COVID-19. Telemedicine journal and e-health : the official journal of the American Telemedicine Association.
• Whitfill, J. T., Kalpas, E., & Garcia-Filion, P. (2022). Reuniting Long Lost Cousins: a Novel Curriculum in Imaging Informatics for Clinical Informatics Fellows. Journal of digital imaging, 35(4), 876-880.
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  We developed a curriculum of imaging informatics for clinical informatics fellows. While imaging informatics and clinical informatics are related fields, they have distinct bodies of knowledge. The aim of this curriculum is to prepare clinical informatics fellows for questions regarding imaging informatics on the clinical informatics board certification examination, prepare fellows to handle issues and requests involving imaging informatics in their future roles as clinical informaticists, and develop sufficient knowledge and skills in order to interface with imaging and radiology domain experts. We mapped ACGME core competencies for clinical informatics and the clinical informatics skills and attributes to topics covered in this curriculum. Topics covered included orders vs. encounter-based workflow, understanding imaging informatics operations and the differences between an IT department leading digital image management and the radiology department, clinical decision support for radiology, procuring and integrating new modalities into a PACS system, troubleshooting slow application performance in a PACS environment, imaging sharing, artificial intelligence (AI) in imaging including AI bias, validation of models within home institution and regulatory issues, and structured reporting vs. Natural Language Processing to mine radiology report data. These topics were covered in interactive didactic sessions as well as a journal club. Future work will expand to include hands-on learning and a formal evaluation of this curriculum with current fellows and recent graduates.
• Catalfamo, C. J., Heslin, K. M., Shilen, A., Khan, S. M., Hunsaker, J. R., Austhof, E., Barraza, L., Cordova-Marks, F. M., Farland, L. V., Garcia-Filion, P., Hoskinson, J., Jehn, M., Kohler, L. N., Lutrick, K., Harris, R. B., Chen, Z., Klimentidis, Y. C., Bell, M. L., Ernst, K. C., , Jacobs, E. T., et al. (2021). Design of the Arizona CoVHORT: A Population-Based COVID-19 Cohort. Frontiers in public health, 9, 620060.
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  This study is a prospective, population-based cohort of individuals with a history of SARS-CoV-2 infection and those without past infection through multiple recruitment sources. The main study goal is to track health status over time, within the diverse populations of Arizona and to identify the long-term consequences of COVID-19 on health and well-being. A total of 2,881 study participants (16.2% with a confirmed SARS-CoV-2 infection) have been enrolled as of December 22, 2020, with a target enrollment of 10,000 participants and a planned follow-up of at least 2 years. This manuscript describes a scalable study design that utilizes a wide range of recruitment sources, leveraging electronic data collection to capture and link longitudinal participant data on the current and emerging issues associated with the COVID-19 pandemic. The cohort is built within a collaborative infrastructure that includes new and established partnerships with multiple stakeholders, including the state's public universities, local health departments, tribes, and tribal organizations. Challenges remain for ensuring recruitment of diverse participants and participant retention, although the electronic data management system and timing of participant contact can help to mitigate these problems.
• McCulloch, D. L., Garcia-Filion, P., Matar, M., Stewart, C., & Borchert, M. S. (2021). Repeated measurements of ERGs and VEPs using chloral hydrate sedation and propofol anesthesia in young children. Documenta ophthalmologica. Advances in ophthalmology, 143(2), 141-153.
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  Sedation with chloral hydrate or anesthesia using propofol allow ocular examination and testing in young children, but these drugs may affect electrophysiologic recordings. We compared the flash and pattern ERGs and VEPs recorded with each drug in a cohort of young children enrolled in a prospective study of optic nerve hypoplasia (ONH) syndrome.
• Bromberg, C. E., Condon, A. M., Ridgway, S. W., Krishna, G., Garcia-Filion, P. C., Adelson, P. D., Rowe, R. K., & Thomas, T. C. (2020). Sex-Dependent Pathology in the HPA Axis at a Sub-acute Period After Experimental Traumatic Brain Injury. Frontiers in neurology, 11, 946.
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  Over 2.8 million traumatic brain injuries (TBIs) are reported in the United States annually, of which, over 75% are mild TBIs with diffuse axonal injury (DAI) as the primary pathology. TBI instigates a stress response that stimulates the hypothalamic-pituitary-adrenal (HPA) axis concurrently with DAI in brain regions responsible for feedback regulation. While the incidence of affective symptoms is high in both men and women, presentation is more prevalent and severe in women. Few studies have longitudinally evaluated the etiology underlying late-onset affective symptoms after mild TBI and even fewer have included females in the experimental design. In the experimental TBI model employed in this study, evidence of chronic HPA dysregulation has been reported at 2 months post-injury in male rats, with peak neuropathology in other regions of the brain at 7 days post-injury (DPI). We predicted that mechanisms leading to dysregulation of the HPA axis in male and female rats would be most evident at 7 DPI, the sub-acute time point. Young adult age-matched male and naturally cycling female Sprague Dawley rats were subjected to midline fluid percussion injury (mFPI) or sham surgery. Corticotropin releasing hormone, gliosis, and glucocorticoid receptor (GR) levels were evaluated in the hypothalamus and hippocampus, along with baseline plasma adrenocorticotropic hormone (ACTH) and adrenal gland weights. Microglial response in the paraventricular nucleus of the hypothalamus indicated mild neuroinflammation in males compared to sex-matched shams, but not females. Evidence of microglia activation in the dentate gyrus of the hippocampus was robust in both sexes compared with uninjured shams and there was evidence of a significant interaction between sex and injury regarding microglial cell count. GFAP intensity and astrocyte numbers increased as a function of injury, indicative of astrocytosis. GR protein levels were elevated 30% in the hippocampus of females in comparison to sex-matched shams. These data indicate sex-differences in sub-acute pathophysiology following DAI that precede late-onset HPA axis dysregulation. Further understanding of the etiology leading up to late-onset HPA axis dysregulation following DAI could identify targets to stabilize feedback, attenuate symptoms, and improve efficacy of rehabilitation and overall recovery.
• Kruglyakova, J., Garcia-Filion, P., Nelson, M., & Borchert, M. (2020). Orbital MRI versus fundus photography in the diagnosis of optic nerve hypoplasia and prediction of vision. The British journal of ophthalmology, 104(10), 1458-1461.
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  In patients with optic nerve hypoplasia (ONH), the visualisation of the optic disc can be challenging and the definitive diagnosis difficult to ascertain without fundus photography. The use of MRI for diagnosis has been reported as a diagnostic alternative with conflicting results. We retrospectively analysed a disease registry to determine the reliability of orbital MRI measurements of the optic nerve diameter to diagnose ONH, and the correlation with vision outcomes.
• Mcculloch, D. L., Garcia-filion, P., Flotildes, K., Cytros, A., Contractor, D., & Borchert, M. (2020). A direct comparison of sevoflurane and propofol anesthesia for paediatric electroretinograms and visual evoked potentials. Investigative Ophthalmology & Visual Science, 61(7), 764-764.
• Bailly, D. K., Reeder, R. W., Winder, M., Barbaro, R. P., Pollack, M. M., Moler, F. W., Meert, K. L., Berg, R. A., Carcillo, J., Zuppa, A. F., Newth, C., Berger, J., Bell, M. J., Dean, M. J., Nicholson, C., Garcia-Filion, P., Wessel, D., Heidemann, S., Doctor, A., , Harrison, R., et al. (2019). Development of the Pediatric Extracorporeal Membrane Oxygenation Prediction Model for Risk-Adjusting Mortality. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 20(5), 426-434.
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  To develop a prognostic model for predicting mortality at time of extracorporeal membrane oxygenation initiation for children which is important for determining center-specific risk-adjusted outcomes.
• Garcia, P. C., Kruglyakova, J., Borchert, M., & Marvin, N. (2019). Orbital MRI vs fundus photography in the diagnosis of optic nerve hypoplasia and prediction of vision. British Journal of Ophthalmology.
• Schwedt, T. J., Peplinski, J., Garcia-Filion, P., & Berisha, V. (2019). Altered speech with migraine attacks: A prospective, longitudinal study of episodic migraine without aura. Cephalalgia : an international journal of headache, 39(6), 722-731.
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  Some individuals with migraine report the presence of speech changes during their migraine attacks. The goal of this study was to compare objective features of speech during the migraine pre-attack, the migraine attack, and during the interictal period.
• Shahid, M., Shaibi, G. Q., Baines, H., Garcia-Filion, P., Gonzalez-Garcia, Z., & Olson, M. (2018). Risk of hypoglycemia in youth with type 2 diabetes on insulin. Journal of pediatric endocrinology & metabolism : JPEM, 31(6), 625-630.
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  The objective of this study was to ascertain the risk of hypoglycemia among youth with type 2 diabetes (T2D) on insulin therapy.
• Balasuriya, L., Vyles, D., Bakerman, P., Holton, V., Vaidya, V., Garcia-Filion, P., Westdorp, J., Sanchez, C., & Kurz, R. (2017). Computerized Dose Range Checking Using Hard and Soft Stop Alerts Reduces Prescribing Errors in a Pediatric Intensive Care Unit. Journal of patient safety, 13(3), 144-148.
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  An enhanced dose range checking (DRC) system was developed to evaluate prescription error rates in the pediatric intensive care unit and the pediatric cardiovascular intensive care unit.
• Berisha, V., Wang, S., LaCross, A., Liss, J., & Garcia-Filion, P. (2017). Longitudinal changes in linguistic complexity among professional football players. Brain and language, 169, 57-63.
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  Reductions in spoken language complexity have been associated with the onset of various neurological disorders. The objective of this study is to analyze whether similar trends are found in professional football players who are at risk for chronic traumatic encephalopathy. We compare changes in linguistic complexity (as indexed by the type-to-token ratio and lexical density) measured from the interview transcripts of players in the National Football League (NFL) to those measured from interview transcripts of coaches and/or front-office NFL executives who have never played professional football. A multilevel mixed model analysis reveals that exposure to the high-impact sport (vs no exposure) was associated with an overall decline in language complexity scores over time. This trend persists even after controlling for age as a potential confound. The results set the stage for a prospective study to test the hypothesis that language complexity decline is a harbinger of chronic traumatic encephalopathy.
• Cook, A., Osler, T., Hosmer, D., Glance, L., Rogers, F., Gross, B., Garcia-Filion, P., & Malhotra, A. (2017). Gunshot wounds resulting in hospitalization in the United States: 2004-2013. INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 48(3), 621-627.
• Cook, A., Osler, T., Hosmer, D., Glance, L., Rogers, F., Gross, B., Garcia-Filion, P., & Malhotra, A. (2017). Gunshot wounds resulting in hospitalization in the United States: 2004-2013. Injury, 48(3), 621-627.
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  The United States (US) leads all high income countries in gunshot wound (GSW) deaths. However, as a result of two decades of reduced federal support, study of GSW has been largely neglected. In this paper we describe the current state of GSW hospitalizations in the US using population-based data.
• Dalton, H. J., Reeder, R., Garcia-Filion, P., Holubkov, R., Berg, R. A., Zuppa, A., Moler, F. W., Shanley, T., Pollack, M. M., Newth, C., Berger, J., Wessel, D., Carcillo, J., Bell, M., Heidemann, S., Meert, K. L., Harrison, R., Doctor, A., Tamburro, R. F., , Dean, J. M., et al. (2017). Factors Associated with Bleeding and Thrombosis in Children Receiving Extracorporeal Membrane Oxygenation. American journal of respiratory and critical care medicine, 196(6), 762-771.
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  Extracorporeal membrane oxygenation (ECMO) is used for respiratory and cardiac failure in children but is complicated by bleeding and thrombosis.
• Garcia-Filion, P., Almarzouki, H., Fink, C., Geffner, M., Nelson, M., & Borchert, M. (2017). Brain Malformations Do Not Predict Hypopituitarism in Young Children with Optic Nerve Hypoplasia. Hormone research in paediatrics, 88(3-4), 251-257.
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  Optic nerve hypoplasia (ONH), a leading cause of pediatric blindness, is associated with brain malformations and hypopituitarism in the constellation known as septo-optic dysplasia. Neuroimaging is used to anticipate hypopituitarism, but with unconfirmed reliability. We report prospective findings on the association of hypopituitarism with brain malformations.
• Hammond, B. G., Garcia-Filion, P., Kang, P., Rao, M. Y., Willis, B. C., & Dalton, H. J. (2017). Identifying an Oxygenation Index Threshold for Increased Mortality in Acute Respiratory Failure. Respiratory care, 62(10), 1249-1254.
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  The objective of this work was to examine current oxygenation index (OI) data and outcomes using electronic medical record data to identify a specific OI value associated with mortality.
• McCulloch, D., Garcia-Filion, P., Fink, C., Fisher, A. C., Eleuteri, A., & Borchert, M. S. (2017). Predictive value of N95 waveforms of pattern electroretinograms (PERGs) in children with optic nerve hypoplasia (ONH). Documenta ophthalmologica. Advances in ophthalmology, 135(2), 97-106.
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  As part of a long-term, prospective study of prenatal and clinical risk factors for optic nerve hypoplasia (ONH) at Children's Hospital Los Angeles, pattern ERGs (PERGs) were evaluated for prognostic value using an automated objective and robust analytical method.
• Magoteaux, S., Gilbert, M., Langlais, C. S., Garcia-Filion, P., & Notrica, D. M. (2016). Should Children with Suspected Nonaccidental Injury Be Admitted to a Surgical Service?. Journal of the American College of Surgeons, 222(5), 838-43.
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  In many hospitals, children with suspected nonaccidental trauma (sNAT) are admitted to nonsurgical services (NSS). Although the surgical service (SS) initially admitted sNAT patients at our American College of Surgeons (ACS)-verified level 1 pediatric trauma center (vPTC), a change in hospital policy allowed admission to NSS. The objective of this study was to determine if the rate of care-related indicators (CRIs) varies by admission to an SS vs an NSS in the sNAT patient population.
• Moosavi, M., Seguin, J., Li, Q., Polychronakos, C., Atabek, M. E., Dulac, Y., Tauber, M., Jouret, B., Ekbom, K., Kalman, S., Jakobsson, J. G., Suzuki, S., Koga, M., Takahashi, H., Matsuo, K., Turanlahti, M., Kajosaari, M., Makitie, O., Taskinen, M., , Abduljabbar, M. A., et al. (2016). Brain Malformations do not predict hypopituitarism in young children with optic nerve hypoplasia. Hormone Research in Paediatrics, 82(2), X-X. doi:10.1159/000341125
• Stewart, C., Garcia-Filion, P., Fink, C., Ryabets-Lienhard, A., Geffner, M. E., & Borchert, M. (2016). Efficacy of growth hormone replacement on anthropometric outcomes, obesity, and lipids in children with optic nerve hypoplasia and growth hormone deficiency. International journal of pediatric endocrinology, 2016, 5.
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  Hypopituitarism and obesity are causes of major lifelong morbidity in patients with optic nerve hypoplasia (ONH). Growth hormone deficiency (GHD) affects the majority of children with ONH, though the degree of deficiency and variability of early growth patterns range from early severe retardation to normal initial growth. The utility of early GH replacement for improving anthropometric, body composition, and lipid outcomes in patients with ONH and GHD, especially those with normal initial height velocity, is unknown. This study examines the effects of GH replacement in a cohort of children with ONH and GHD.
• Buttram, S. D., Garcia-Filion, P., Miller, J., Youssfi, M., Brown, S. D., Dalton, H. J., & Adelson, P. D. (2015). Computed tomography vs magnetic resonance imaging for identifying acute lesions in pediatric traumatic brain injury. Hospital pediatrics, 5(2), 79-84.
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  Pediatric traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. Computed tomography (CT) is the modality of choice to screen for brain injuries. MRI may provide more clinically relevant information. The purpose of this study was to compare lesion detection between CT and MRI after TBI.
• Dalton, H. J., Garcia-Filion, P., Holubkov, R., Moler, F. W., Shanley, T., Heidemann, S., Meert, K., Berg, R. A., Berger, J., Carcillo, J., Newth, C., Harrison, R., Doctor, A., Rycus, P., Dean, J. M., Jenkins, T., Nicholson, C., & , E. K. (2015). Association of bleeding and thrombosis with outcome in extracorporeal life support. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 16(2), 167-74.
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  Changes in technology and increased reports of successful extracorporeal life support use in patient populations, such as influenza, cardiac arrest, and adults, are leading to expansion of extracorporeal life support. Major limitations to extracorporeal life support expansion remain bleeding and thrombosis. These complications are the most frequent causes of death and morbidity. As a pilot project to provide baseline data for a detailed evaluation of bleeding and thrombosis in the current era, extracorporeal life support patients were analyzed from eight centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network.
• Fisher, A. C., McCulloch, D. L., Borchert, M. S., Garcia-Filion, P., Fink, C., Eleuteri, A., & Simpson, D. M. (2015). Comparison of human expert and computer-automated systems using magnitude-squared coherence (MSC) and bootstrap distribution statistics for the interpretation of pattern electroretinograms (PERGs) in infants with optic nerve hypoplasia (ONH). Documenta ophthalmologica. Advances in ophthalmology, 131(1), 25-34.
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  Pattern electroretinograms (PERGs) have inherently low signal-to-noise ratios and can be difficult to detect when degraded by pathology or noise. We compare an objective system for automated PERG analysis with expert human interpretation in children with optic nerve hypoplasia (ONH) with PERGs ranging from clear to undetectable.
• Mcculloch, D. L., Borchert, M., Garcia-filion, P., Hamilton, R., Matar, M., & Stewart, C. (2015). Repeated measures comparison of chloral hydrate and propofol effects on flash electroretinograms (ERGs) and pattern ERGs (PERGs). Investigative Ophthalmology & Visual Science, 56(7), 482-482.
• Notrica, D. M., Eubanks, J. W., Tuggle, D. W., Maxson, R. T., Letton, R. W., Garcia, N. M., Alder, A. C., Lawson, K. A., St Peter, S. D., Megison, S., & Garcia-Filion, P. (2015). Nonoperative management of blunt liver and spleen injury in children: Evaluation of the ATOMAC guideline using GRADE. The journal of trauma and acute care surgery, 79(4), 683-93.
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  Nonoperative management of liver and spleen injury should be achievable for more than 95% of children. Large national studies continue to show that some regions fail to meet these benchmarks. Simultaneously, current guidelines recommend hospitalization for injury grade + 2 (in days). A new treatment algorithm, the ATOMAC guideline, is in clinical use at many centers but has not been prospectively validated.
• Oatman, O. J., McClellan, D. R., Olson, M. L., & Garcia-Filion, P. (2015). Endocrine and pubertal disturbances in optic nerve hypoplasia, from infancy to adolescence. International journal of pediatric endocrinology, 2015(1), 8.
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  Endocrinologic abnormalities are a common co-morbidity in patients with optic nerve hypoplasia (ONH), however the impact on puberty is unknown. The purpose of this study was to examine rates of endocrine dysfunction and pubertal disturbances in a pediatric population of ONH.
• Borchert, M., Garcia-Filion, P., Fink, C., Geffner, M., & Nelson, M. (2014). Re: Ramakrishnaiah et al.: Reliability of magnetic resonance imaging for the detection of hypopituitarism in children with optic nerve hypoplasia (Ophthalmology 2014;121:387-91). Ophthalmology, 121(5), e26-7.
• Buttram, S. D., Garcia-filion, P., Schmidt, A., Valasek, C., & Dalton, H. J. (2014). ABSTRACT 510: CASE-CONTROL STUDY OF ANTICOAGULATION REGIMEN EFFECTS ON BLEEDING COMPLICATIONS AND BLOOD PRODUCT ADMINISTRATION DURING EXTRACORPOREAL LIFE SUPPORT. Pediatric Critical Care Medicine, 15, 116. doi:10.1097/01.pcc.0000449236.10544.18
• Esque, J. L., Garcia-filion, P., Brown, S. D., Franken, A. S., Condie, J., Liu, L., Dalton, H. J., & Buttram, S. D. (2014). ABSTRACT 302: IMPLEMENTATION OF A PEDIATRIC STROKE TEAM. Pediatric Critical Care Medicine, 15, 71. doi:10.1097/01.pcc.0000449028.89803.fa
• Johnson, J. J., Tuggle, D. W., Garcia, N. M., Eubanks, J. W., Notrica, D. M., Brahmamdam, P., Megison, S., Maxson, R. T., Piper, K., Lawson, K. A., Garcia-Filion, P., & Recicar, J. (2014). The use of a computer-based internal education program for pediatric trauma centers: a multicenter ATOMAC study. The American surgeon, 80(4), 419-21.
• Johnson, K. N., Harte, M., Garcia-Filion, P., & Notrica, D. M. (2014). Fate of the combined adult and pediatric trauma centers: impact of increased pediatric trauma requirements. The American surgeon, 80(12), 1280-2.
• Johnson, K. N., Raetz, A., Harte, M., McMahon, L. E., Grandsoult, V., Garcia-Filion, P., & Notrica, D. M. (2014). Pediatric trauma patient alcohol screening: a 3 year review of screening at a Level I pediatric trauma center using the CRAFFT tool. Journal of pediatric surgery, 49(2), 330-2.
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  Alcohol use is a risk factor for adult trauma. Alcohol may significantly influence pediatric trauma risk, but literature is sparse. The aim of this study was to examine the impact of alcohol use screening in pediatric trauma patients.
• Lettieri, C. K., Garcia-Filion, P., & Hingorani, P. (2014). Incidence and outcomes of desmoplastic small round cell tumor: results from the surveillance, epidemiology, and end results database. Journal of cancer epidemiology, 2014, 680126.
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  Desmoplastic small round cell tumor (DSRCT) is a rare but highly fatal malignancy. Due to the rarity of this neoplasm, no large population based studies exist. Procedure. This is a retrospective cohort analysis. Incidence rates were calculated based on sex and ethnicity and compared statistically. Gender-, ethnicity-, and treatment- based survival were calculated using the Kaplan-Meier method. Results. A total of 192 cases of DSRCT were identified. Peak incidence age was between 20 and 24 years. Age-adjusted incidence rate for blacks was 0.5 cases/million and for whites was 0.2 cases/million (P = 0.037). There was no statistically significant difference in survival based on gender or ethnicity. When adjusted for age, there was no statistically significant difference in survival amongst patients who received radiation therapy compared to those who did not (HRadj = 0.73; 95% CI 0.49, 1.11). There was a statistically significant survival advantage for patients who received radiation after surgery compared to those who did not (HR 0.49; 95% CI 0.30, 0.79). Conclusion. DSRCT is more common in males and in people of African-American descent. Although overall survival remains poor, radiation therapy following surgery seems to improve outcome in these patients.
• Sutedja, J., Garcia-Filion, P., Fink, C., & Borchert, M. (2014). Absence of age-related optic disk changes in young children with optic nerve hypoplasia. Eye (London, England), 28(5), 562-6.
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  To determine whether the ratio of optic disk diameter to disk-to-macula distance (DD/DM) in children with optic nerve hypoplasia (ONH) changes over time.
• Azarakhsh, N., Grimes, S., Notrica, D. M., Raines, A., Garcia, N. M., Tuggle, D. W., Maxson, R. T., Alder, A. C., Recicar, J., Garcia-Filion, P., Greenwell, C., Lawson, K. A., Wan, J. Y., & Eubanks, J. W. (2013). Blunt cerebrovascular injury in children: underreported or underrecognized?: A multicenter ATOMAC study. The journal of trauma and acute care surgery, 75(6), 1006-11; discussion 1011-2.
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  Blunt cerebrovascular injury (BCVI) has been well described in the adult trauma literature. The risk factors, proper screening, and treatment options are well known. In pediatric trauma, there has been very little research performed regarding this injury. We hypothesize that the incidence of BCVI in children is lower than the 1% reported incidence in adult studies and that many children at risk are not being screened properly.
• Fink, C., Garcia-Filion, P., & Borchert, M. (2013). Failure of stem cell therapy to improve visual acuity in children with optic nerve hypoplasia. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 17(5), 490-3.
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  To evaluate the effectiveness of stem cell therapy in improving visual acuity or optic nerve function in children with optic nerve hypoplasia (ONH).
• Garcia-filion, P., & Borchert, M. (2013). Optic nerve hypoplasia syndrome: a review of the epidemiology and clinical associations.. Current treatment options in neurology, 15(1), 78-89. doi:10.1007/s11940-012-0209-2
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  Optic nerve hypoplasia (ONH) has developed into a leading cause of congenital blindness. The frequently associated features of hypopituitarism and absent septum pellucidum were felt to have embryonic linkage as "septo-optic dysplasia" or "de Morsier's syndrome." More recent studies have suggested these associations are independent of one another. This review provides an assessment of the historical and recent evidence linking neuroradiologic, endocrinologic and developmental morbidity in patients with ONH. The prenatal risk factors, heritability, and genetic mutations associated with ONH are described..Recognition of the critical association of ONH with hypopituitarism should be attributed to William Hoyt, not Georges de Morsier. De Morsier never described a case of ONH or recognized its association with hypopituitarism or missing septum pellucidum. Hypopituitarism is caused by hypothalamic dysfunction. This, and other more recently identified associations with ONH, such as developmental delay and autism, are independent of septum pellucidum development. Other common neuroradiographic associations such as corpus callosum hypoplasia, gyrus dysplasia, and cortical heterotopia may have prognostic significance. The predominant prenatal risk factors for ONH are primiparity and young maternal age. Presumed risk factors such as prenatal exposure to drugs and alcohol are not supported by scrutiny of the literature. Heritability and identified gene mutations in cases of ONH are rare..Children with ONH require monitoring for many systemic, developmental, and even life-threatening problems independent of the severity of ONH and presence of brain malformations including abnormalities of the septum pellucidum. "Septo-optic dysplasia" and "de Morsier's syndrome" are historically inaccurate and clinically misleading terms.
• Garcia-filion, P., & Borchert, M. (2013). Prenatal determinants of optic nerve hypoplasia: review of suggested correlates and future focus.. Survey of ophthalmology, 58(6), 610-9. doi:10.1016/j.survophthal.2013.02.004
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  Optic nerve hypoplasia (ONH), a congenital malformation characterized by an underdeveloped optic nerve, is a seemingly epidemic cause of childhood blindness and visual impairment with associated lifelong morbidity. Although the prenatal determinants of ONH are unknown, early case reports have led to a longstanding speculation that risky health behaviors (e.g., prenatal use of recreational drugs, alcohol) are a likely culprit. There has yet to be a systematic review of the epidemiology of ONH to assess the common prenatal features that may help focus research efforts in the identification of likely prenatal correlates. A review of the past 50 years of epidemiologic research was conducted to examine the prenatal features linked with ONH and provide direction for future research. There are select prominent prenatal features associated with ONH: young maternal age and primiparity. Commonly implicated prenatal exposures (recreational or pharmaceutical drugs, viral infection, etc.) were rare or uncommon in large cohort studies of ONH and therefore unlikely to be major contributors to ONH. Familial cases and gene mutations are rare. The preponderance of young mothers and primiparity among cases of ONH is striking, although the significance is unclear. Recent research suggests a potential role for prenatal nutrition, weight gain, and factors of deprivation. With the rapidly increasing prevalence of ONH, future research should focus on investigating the relevance of young maternal age and primiparity and exploring the recently suggested etiologic correlates in epidemic clusters of ONH.
• Hingorani, P., Garcia-filion, P., White-collins, A., Kolb, E. A., Azorsa, D. O., & Dickman, P. S. (2013). BIRC5 expression is a poor prognostic marker in Ewing sarcoma.. Pediatric blood & cancer, 60(1), 35-40. doi:10.1002/pbc.24290
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  BIRC5 (Survivin), an inhibitor of apoptosis protein (IAP), is over-expressed in several human cancers and increased expression is associated with poor prognosis. The goal of the current study was to evaluate the role of BIRC5 in Ewing sarcoma (ES), the second most common pediatric bone sarcoma..BIRC5 protein expression was determined in ES cell lines using Western Blot analysis. Functional role of survivin on growth and viability of ES cells was assessed by siRNA knockdown of BIRC5 and by using a small molecule inhibitor YM155. Immunohistochemical analysis for BIRC5 protein was performed on patient tumor samples using an anti-survivin antibody. The degree of BIRC5 protein expression was correlated with clinical parameters and patient outcome..BIRC5 is over-expressed in a panel of ES cell lines. Gene silencing of BIRC5 in the ES cell line TC-71 decreases cell growth by more than 50% for each BIRC5 siRNA construct compared to non-silencing siRNA control constructs. YM155 also reduces ES cell growth and viability with an EC(50) ranging from 2.8 to 6.2 nM. BIRC5 protein is expressed in majority of the ES tumor samples with minimal expression in normal tissue (P < 0.005). Tumors with more than 50% expression are associated with worse overall survival than tumors with less than 50% expression (Hazard Ratio: 6.05; CI: 1.7-21.4; P = 0.04)..BIRC5 is over-expressed in ES cell lines and tumor samples. Further, it plays an important role in cell growth and viability in vitro. Higher degree of expression in patients is an independent poor prognostic factor.
• Hizon, C. K., Garcia-filion, P., Shaibi, G. Q., Mcclellan, P. G., Mcclellan, D., Kapadia, C., & Hizon, M. C. (2013). Is A1C Less Concordant with OGTT in Children as Compared in Adults? Data from a Hispanic Community in Arizona. Journal of diabetes & metabolism, 2013(07), 1-3. doi:10.4172/2155-6156.1000290
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  Early efforts to identify hyperglycemia and those at risk for developing type 2 diabetes (T2DM) are warranted. For decades, the diagnosis of T2DM has been based on plasma glucose (PG) criteria but recent recommendations include the use of A1C for identifying hyperglycemia. These recommendations are based upon adult studies and data suggests that A1C may be less concordant in children, as compared to adults. The purpose of our study was to compare A1C, fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) between adolescents and adults in Hispanic population at disproportionate risk for developing T2DM. Methods: Data from self-identified as Latino, 91 overweight adolescents, and 406 overweight adults were assessed after an overnight fast for A1C, FPG and OGTT results. Receiver Operator Characteristics Curves for A1C vs. any hyperglycemia (prediabetes or diabetes) were then developed. Result: 26 (28.6%) of the adolescents and 209 (51.5%) of adults exhibited hyperglycemia according to FPG and/OGTT. The prevalence of hyperglycemia as defined by an A1C>5.7% was 30.8% in adolescents and 55.6% in adults. Of the 26 adolescents, hyperglycemic on FPG and /or OGTT only 9 had A1C>5.7% for a sensitivity of 34.6%. This in contrast to adults, where the sensitivity of A1C>5.7% was 74.2%. Positive predictive value (PPV) for the A1C threshold of 5.7% was 32.1% in adolescents vs. 73.7% in adults. Conclusion: Concordance of A1C with other measures of hyperglycemia is lower in overweight Hispanic adolescents, as compared to overweight Hispanic adults.
• Sowrey, L., Lawson, K. A., Garcia-filion, P., Notrica, D., Eubanks, J. W., Maxson, R. T., Recicar, J., Megison, S. M., Garcia, N. M., & Tuggle, D. W. (2013). Duodenal injuries in the very young: child abuse?. The journal of trauma and acute care surgery, 74(1), 136-41; discussion 141-2. doi:10.1097/ta.0b013e3182788cb2
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  Duodenal injuries in children are uncommon but have been specifically linked with child abuse in case reports. Owing to the rarity of the diagnosis, few studies to date have looked at the association between duodenal injuries and mechanism in younger child. We hypothesize that duodenal injuries in the very young are significantly associated with child abuse..This investigation is a retrospective cohort study of patients admitted with duodenal injuries at one of six Level I pediatric trauma centers. All institutions had institutional review board approval. The trauma registries were used to identify children aged 0 year to 5 years from 1991 to 2011. Multiple variables were collected and included age, mechanism of injury, type of duodenal injury, additional injuries, mortality, and results of abuse investigation if available. Relationships were analyzed using Fischer's exact test..We identified 32 patients with duodenal injuries with a mean age of 3 years. Duodenal injuries included duodenal hematomas (44%) and perforations/transections (56%). Of all duodenal injuries, 53% resulted in operation, 53% had additional injuries, and 12.5% resulted in death. Of the 32 children presenting with duodenal injuries, 20 were child abuse patients (62.5%). All duodenal injuries in children younger than 2 years were caused by child abuse (6 of 6, p = 0.06) and more than half of the duodenal injuries in children older than 2 years were caused by child abuse (14 of 26). Child abuse-related duodenal injuries were associated with delayed presentation (p = 0.004). There was a significant increase in child abuse-related duodenal injuries during the time frame of the study (p = 0.002)..Duodenal injuries are extremely rare in the pediatric population. This multi-institutional investigation found that child abuse consistently associated with duodenal injuries in children younger than 2 years. The evidence supports a child abuse investigation on children younger than 2 years with duodenal injury..Epidemiological study, level III.
• Almarzouki, H. S., Fink, C., Garcia-filion, P., & Borchert, M. (2012). Neuroradiographic findings in children with optic nerve hypoplasia. Journal of Aapos, 16(1), e10. doi:10.1016/j.jaapos.2011.12.040
• Beers, S. R., Wisniewski, S. R., Garcia-filion, P., Tian, Y., Hahner, T., Berger, R. P., Bell, M. J., & Adelson, P. D. (2012). Validity of a pediatric version of the Glasgow Outcome Scale-Extended.. Journal of neurotrauma, 29(6), 1126-39. doi:10.1089/neu.2011.2272
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  The Glasgow Outcome Scale (GOS) and its most recent revision, the GOS-Extended (GOS-E), provide the gold standard for measuring traumatic brain injury (TBI) outcome. The GOS-E exhibits validity when used with adults and some adolescents, but validity with younger children is not established. Because the GOS-E lacks the developmental specificity necessary to evaluate children, toddlers, and infants, we modified the original version to create the GOS-E Pediatric Revision (GOS-E Peds), a developmentally appropriate structured interview, to classify younger patients. The criterion, predictive, and discriminant validity of the GOS-E Peds was measured in 159 subjects following TBI (mild: 36%; moderate: 12%; severe: 50%) at 3 and 6 months after injury. Participants were included from two studies completed at the Pediatric Neurotrauma Center at Children's Hospital of Pittsburgh. We assessed the relationship among GOS-E Peds, the GOS, and the Vineland Adaptive Behavior Scales as well as other standardized measures of functional, behavioral, intellectual, and neuropsychological outcome. Premorbid function was assessed 24-36 h after injury. The GOS-E Peds showed a strong correlation with the GOS at 3 and 6 month time points. Criterion-related validity was also indicated by GOS-E Peds' association with most measures at both time points and at injury severity levels. The 3 month GOS-E Peds was associated with the 6 month GOS-E Peds, everyday function, behavior, and most cognitive abilities. Discriminant validity is suggested by weak correlations between both 3 and 6 month GOS-E Peds and premorbid measures. The GOS-E Peds is sensitive to severity of injury and is associated with changes in TBI sequelae over time. This pediatric revision provides a valid outcome measure in infants, toddlers, children, and adolescents through age 16. Findings support using the GOS-E Peds as the primary outcome variable in pediatric clinical trials.
• Buttram, S., Garcia-filion, P., Condie, J., Franken, A., Liu, P. I., Dalton, H. J., & Adelson, P. D. (2012). 373: DEVELOPMENT AND IMPLEMENTATION OF A PEDIATRIC STROKE TEAM AT A FREE STANDING PEDIATRIC HOSPITAL. Critical Care Medicine, 40, 1-328. doi:10.1097/01.ccm.0000424591.86941.31
• Fink, C., Vedin, A. M., Garcia-filion, P., Ma, N. S., Geffner, M. E., & Borchert, M. (2012). Newborn thyroid-stimulating hormone in children with optic nerve hypoplasia: associations with hypothyroidism and vision.. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 16(5), 418-23. doi:10.1016/j.jaapos.2012.05.012
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  To assess in children with optic nerve hypoplasia (ONH) whether newborn screening (NBS) thyroid-stimulating hormone (TSH) measurements can detect central hypothyroidism and whether newborn TSH or subsequent thyroidal status is associated with visual function..From a registry of children with ONH at Children's Hospital Los Angeles, post-natal thyroidal status was retrospectively compared with NBS TSH levels in the subset of subjects born in California. The subset of subjects with outcome data at age 5 years was assessed for relationship of vision to NBS TSH levels and ultimate thyroidal status..A total of 135 subjects from the ONH registry were included in this study. Approximately 50% of subjects in each analysis were hypothyroid. Those diagnosed with hypothyroidism had lower median NBS TSH levels than did euthyroid subjects (3.2 vs 4.5 μIU/mL; P = 0.006) and significantly worse quantitative vision outcomes (median visual acuity, logMAR 3.0 vs 1.0; P = 0.039). Receiver operating characteristic analysis suggested an optimal NBS TSH cut-point of 3.3 μIU/mL. Serum TSH levels greater than this (30/43) were associated with relatively better vision outcomes (median visual acuity, logMAR 1.2 vs 3.3; P = 0.04)..Children with ONH and lower NBS TSH levels are more likely to have central hypothyroidism and less likely to experience good vision than those with greater NBS TSH levels.
• Garcia-filion, P., Coimbra, R., Vinces, F. Y., Velmahos, G. C., Stevens, L. R., Sherck, J. P., Phelan, H. A., Petersen, S. R., Pembaur, K., Notrica, D. M., Norwood, S. H., Moore, F. O., Matthews, M. R., Lottenberg, L., Karmy-jones, R. C., Hu, C. K., Hoff, W. S., Hill, J., Haan, J. M., , Goslar, P. W., et al. (2012). Management of pediatric occult pneumothorax in blunt trauma: a subgroup analysis of the American Association for the Surgery of Trauma multicenter prospective observational study.. Journal of pediatric surgery, 47(3), 467-72. doi:10.1016/j.jpedsurg.2011.09.037
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  Occult pneumothorax (OPTX) represents air within the pleural space not visible on conventional chest radiographs. Increased use of computed tomography has led to a rise in the detection of OPTX. Optimal management remains undefined..A pediatric subgroup analysis (age
• Notrica, D. M., Garcia-filion, P., Kuroiwa, E., Clarke, D., Harte, M., Hill, J., Moffat, S., & Weiss, J. P. (2012). Pediatric trauma centers: correlation of ACS-verified trauma centers with CDC statewide pediatric mortality rates.. The journal of trauma and acute care surgery, 73(3), 566-70; discussion 570-2. doi:10.1097/ta.0b013e318265ca6f
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  Research on the impact of pediatric trauma centers (PTCs) on mortality has been conflicting, most likely owing to differing methodologies. Using a population-based approach, we assessed whether American College of Surgeons (ACS)-verified trauma centers are associated with reduced overall state pediatric injury mortality rates..A population-based study of state pediatric injury mortality rates (per 100,000 children ≤ 18 years) using data for 2008 from Centers for Disease Control and Prevention-National Center for Injury Prevention and Control. The availability of verified PTCs (vPTCs) and ACS-verified adult trauma centers in each state was determined and compared with mortality rates using regression, adjusting for injury mortality covariates. Correlation of mortality with type of trauma centers available was determined. The mortality versus number of PTCs per pediatric population was also examined..vPTCs were present in 36% of states, including 24% of states with Level I vPTCs. The mean (SD) pediatric injury mortality for the 32 states without a vPTC was 20.6 (6.6) per 100,000 children 18 years or younger. Presence and higher verification level of vPTC within a state correlated with decreasing pediatric injury mortality (p(unadjusted)= 0.005; p(adjusted) = 0.004). Mortality was 37% lower among states with only Level I vPTCs (12.9 [2.2]). Mortality was inversely correlated with the number of Level I vPTCs (p(unadjusted) = 0.006; p(adjusted) = 0.06) and lowest for states with two Level I vPTCs (11.8 [1.7]). Higher ratios of Level I vPTCs per population correlated with lower mortality rates (β = -3.53, p = 0.003)..The findings highlight a correlation between state pediatric injury mortality rates and presence of ACS-verified Level I PTCs..Prognostic study, level IV.
• Vedin, A. M., Garcia-filion, P., Fink, C., Borchert, M., & Geffner, M. E. (2012). Serum prolactin concentrations in relation to hypopituitarism and obesity in children with optic nerve hypoplasia.. Hormone research in paediatrics, 77(5), 277-80. doi:10.1159/000338330
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  The majority of children with optic nerve hypoplasia (ONH) develop hypopituitarism and many also become obese. These associated conditions are a major cause of morbidity and are possibly due to hypothalamic dysfunction. Because mild hyperprolactinemia often occurs in subjects with disorders of the hypothalamus, we examined whether hyperprolactinemia was present in children with ONH during the first 3 years of life and whether it was a marker for hypopituitarism and/or obesity..Data were retrospectively analyzed from a registry study of children with ONH. The initial serum prolactin was obtained prior to age 36 months (n = 125) and compared with pituitary function and body mass index at age 5..72% of subjects had an elevated initial serum prolactin and 60% had hypopituitarism. An elevated initial prolactin was associated with hypopituitarism (OR 2.58; 95% CI 1.16, 5.73), specifically with growth hormone deficiency (OR 2.77; 95% CI 1.21, 6.34). 31% of subjects had a body mass index ≥ 85th percentile, but this did not correlate with initial hyperprolactinemia..Early hyperprolactinemia correlates with the presence of hypopituitarism in children with ONH, but it is not a reliable prognosticator of hypopituitarism. Additionally, hyperprolactinemia does not predict future weight excess.
• Balasuriya, L., Fried, O., Tellez, D., Garcia-filion, P., Dalton, H. J., & Bakerman, P. R. (2011). Direct fluorescent-antibody testing followed by culture for diagnosis of 2009 H1N1 influenza A.. Journal of clinical microbiology, 49(10), 3673-4. doi:10.1128/jcm.05255-11
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  During the 2009 H1N1 influenza A outbreak, 773 children were tested for influenza by direct fluorescent-antibody testing with PCR confirmation. Direct fluorescent-antibody testing has a specificity of 99.6% but a sensitivity of only 65.0%. Physicians should recognize diagnostic limitations of direct fluorescent-antibody testing, which missed one-third of infected individuals.
• Chien, M., Bulloch, B., Garcia-filion, P., Youssfi, M., Shrader, M. W., & Segal, L. S. (2011). Bedside ultrasound in the diagnosis of pediatric clavicle fractures.. Pediatric emergency care, 27(11), 1038-41. doi:10.1097/pec.0b013e318235e965
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  The objective of the study was to determine the diagnostic accuracy of pediatric emergency physicians in diagnosing clavicle fractures by bedside ultrasound (US)..This was a prospective study of pediatric emergency department (ED) patients with suspected clavicle fractures conducted in a tertiary-care, freestanding pediatric hospital. A convenience sample of patients younger than 17 years underwent bedside US for detection of clavicle fracture by pediatric emergency physicians with limited US training. Ultrasound findings were compared with standard radiographs, which were considered the criterion standard. Pain scores using the validated color analog scale (0-10) were determined before and during US. Total length of stay in the ED, time to US, and time to radiograph were recorded..Fifty-eight patients were enrolled, of which 39 (67%) had fracture determined by radiograph. Ultrasound interpretation gave a sensitivity of 89.7% (95% confidence interval [CI], 75.8%-97.1%) and specificity of 89.5% (95% CI, 66.9%-98.7%). Positive and negative predictive values were 94.6% (95% CI, 81.8%-99.3%) and 81.0% (95% CI, 58.1%-94.5%), respectively. Positive and negative likelihood ratios were 8.33 and 0.11, respectively. Pain scores averaged 4.7 before US and 5.2 during US (P = 0.204). There was a statistically significant difference between mean time to US (76 minutes) and mean time to radiograph (107 minutes) (P < 0.001)..Pediatric emergency physicians with minimal formal training can accurately diagnose clavicle fractures by US. In addition, US itself is not associated with an increase in pain and may reduce length of stay in the ED.
• Menoch, M., Zimmerman, S., Garcia-filion, P., & Bulloch, B. (2011). Child abuse education: an objective evaluation of resident and attending physician knowledge.. Pediatric emergency care, 27(10), 937-40. doi:10.1097/pec.0b013e3182307ae5
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  The objective of the study was to evaluate residents' and practicing physicians' medical knowledge of child abuse and maltreatment..In a freestanding pediatric hospital and community hospital, a 30-question survey was administered to pediatric residents, general pediatricians (GPs), and pediatric emergency medicine (PEM) physicians. The institution's child protection team developed the questions, which were pilot tested for validity. Question content covered major concepts in child abuse and neglect. Information on previous training of child abuse was also collected..There were 95 respondents, 64.2% (n = 61) were residents, 19% (n = 18) were GPs, and 16.8% (n = 16) were PEM physicians. Overall, the average score was 63.3% (SD, 13.8%). There was a statistically significant difference in the knowledge of child abuse and neglect across physician categories (P < 0.001). Pediatric emergency medicine physicians scored the highest (76.9 [SD, 9.1]) compared with GPs (66.7 [SD, 12.4]; P = 0.018) and pediatric residents (60.4 [SD, 12.9]; P < 0.001). There was no difference in the level of knowledge across residency training years (P = 0.076)..With a mean score in our study of 63.3%, there appears to be an overall lack of knowledge in child abuse. These findings highlight the need for increased education in child maltreatment.
• Notrica, D. M., Brown, D., & Garcia-filion, P. (2011). Development of a pediatric Level 1 trauma center at a freestanding children's hospital: staff attitudes and perceptions before and after trauma designation.. Journal of pediatric surgery, 46(9), 1764-70. doi:10.1016/j.jpedsurg.2011.04.005
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  Despite research correlating survival or better outcomes with pediatric trauma care at pediatric hospitals, almost 90% of injured children are treated at predominantly adult facilities. Although the reasons are likely multifactorial, attitudes of pediatric hospital staff may play a role in the development of a pediatric trauma center..A survey of hospital staff was conducted to measure the attitude of staff on the effects of becoming a pediatric trauma center. The instrument was administered before and 6 months after trauma center designation. Major topic areas were staffing, organizational impact, education, safety, and financial issues. Attitudes were measured by Likert scale and compared between phases..A total of 404 staff participated before and 447 staff participated 6 months after designation. Nonphysician respondents dominated the survey respondent pool. Areas of concern included staffing, education, patient volume and acuity, and order and flow. Positive attitudes were seen in areas including quality of care, skill development, and recruitment. Overall improvement in attitudes was observed in several areas..Hospital staff consistently agreed on the positive impact on quality of care and overall employee benefit. Concerns were mostly diminished at follow-up. A persistent concern of adequate staffing mismatched actual needs. The findings of this study indicate that the staff perceive many measurable benefits to pediatric trauma center development, which have never previously been described.
• Schneider, W. V., Bulloch, B., Wilkinson, M., Garcia-filion, P., Keahey, L., & Hostetler, M. A. (2011). Utility of portable spirometry in a pediatric emergency department in children with acute exacerbation of asthma.. The Journal of asthma : official journal of the Association for the Care of Asthma, 48(3), 248-52. doi:10.3109/02770903.2011.555036
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  The primary purpose of this study was to determine if portable spirometers can be successfully used in an emergency department (ED) in children with an acute exacerbation of asthma. The secondary purpose of this study was to determine if a validated clinical asthma score (CAS) correlates with the spirometry results in children with an acute exacerbation of asthma..Children between the ages of 6 and 17 years who presented to an urban free-standing children's hospital ED with an acute exacerbation of asthma were enrolled in our study. On arrival, the CAS was recorded and then portable spirometry was performed. Attempts were continued until acceptable and reproducible flow loop measurements were obtained or until the patient was unable to perform further attempts. Outcomes included success at spirometry and correlation of spirometry with the CAS..A total of 101 patients were enrolled in this study. Of those patients, only 35 (35%) were able to successfully perform portable spirometry. Successful spirometry attempts were associated with older age (10.4 vs. 8.9, p = .01), lower respiratory rates (24.8 vs. 30.2, p = .001), lower heart rates (110 vs. 124, p = .004), and lower CASs (8.4 vs. 9.7, p = .001). Increasing asthma severity correlated with a decreased likelihood of successfully obtaining a useful forced expiratory volume in 1 second (FEV(1)) measurement (p = .013). Compared with cases of mild asthma, a patient with moderate asthma is 33% less likely to be able to perform spirometry, and a patient with severe asthma 93% less likely to perform spirometry. The CAS correlated poorly with the more objective measure of FEV(1)% predicted in those with mild asthma..Many children are incapable of using portable spirometry for the evaluation of acute exacerbations of asthma in the ED. The clinical asthma scoring system demonstrated poor correlation with portable spirometry measurements in terms of severity classification.
• Wilkinson, M., Bulloch, B., Garcia-filion, P., & Keahey, L. (2011). Efficacy of racemic albuterol versus levalbuterol used as a continuous nebulization for the treatment of acute asthma exacerbations: a randomized, double-blind, clinical trial.. The Journal of asthma : official journal of the Association for the Care of Asthma, 48(2), 188-93. doi:10.3109/02770903.2011.554939
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  To compare racemic albuterol (RAC) with levalbuterol (LEV) in continuous form for the treatment of acute pediatric asthma exacerbations in the emergency department..Children between the ages of 6 and 17 inclusive were enrolled if they had a history of asthma, presented to the emergency department with an acute asthma exacerbation, and had an initial forced expiratory volume in 1 second (FEV1)
• Borchert, M., Garcia-filion, P., Fink, C., Austin, M. M., Fisher, A. C., & Mcculloch, D. L. (2010). Ganglion Cell Deficits in optic Nerve Hypoplasia (ONH) Are Associated With a Selective Deficit in the N95 Component of the Pattern Electroretinogram (PERG). Investigative Ophthalmology & Visual Science, 51(13), 3269-3269.
• Mcculloch, D. L., Borchert, M., Garcia-filion, P., Fink, C., Austin, M. J., & Fisher, A. C. (2010). Human and Computer-Automated Systems for Measurement of Pattern Electroretinograms (PERGs) in Infants With Optic Nerve Hypoplasia (ONH). Investigative Ophthalmology & Visual Science, 51(13), 3270-3270.
• Mcculloch, D. L., Garcia-filion, P., Fink, C., Chaplin, C. A., & Borchert, M. S. (2010). Clinical electrophysiology and visual outcome in optic nerve hypoplasia.. The British journal of ophthalmology, 94(8), 1017-23. doi:10.1136/bjo.2009.161117
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  In optic nerve hypoplasia (ONH), the extent of functional loss of retinal ganglion cells cannot be determined by ophthalmoscopic examination. The prognostic value of visual electrodiagnostic tests in infants and toddlers with ONH was assessed by comparison with visual outcome..85 participants with ONH had electroretinogram (ERG) and visual-evoked potential (VEP) testing to flash and to pattern-reversal checks and ocular fundus photography prior to 36 months of age. These initial measures were compared with visual acuity outcomes at 5 years of age in the better-seeing eye..Visual outcomes ranged from normal to no light perception. Electrodiagnostic tests with prognostic value were: the amplitude of the flash VEP (Spearman's rank correlations, p
• Borchert, M. S., Fink, C., Garcia-filion, P., Mcculloch, D. L., & Chaplin, C. A. (2009). Light-adapted electroretinograms in optic nerve hypoplasia.. Documenta ophthalmologica. Advances in ophthalmology, 119(2), 123-32. doi:10.1007/s10633-009-9188-3
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  The purpose of the study is to characterise retinal function using light-adapted electroretinograms (ERGs) in a series of young children with ONH, congenital dysplasia of retinal ganglion cells. ERGs were recorded with chloral hydrate sedation in 27 children with ONH (18 with bilateral and 9 with unilateral ONH, age 4-35 months) and an adult reference population (n = 12). Stimuli included ISCEV standard flash, oscillatory potentials (OPs) and standard flicker as well as a light-adapted luminance-response series (photopic hill). The disc diameter to disc macula (DD:DM) ratio was measured from fundus photographs. The results are eyes with ONH, classified by DD:DM, were severe (0.35, n = 9), all had prolonged ERG implicit times and smaller i-waves than those of adults. Eyes with moderate or severe ONH also had smaller amplitudes for OPs and flicker ERGs and required stronger flashes to obtain the peak b-wave amplitude. Abnormalities of the photopic hill were a common but inconsistent feature of ONH and were not indicative of ONH severity. Abnormalities of the photopic hill of the ERG suggest that some cases of ONH may have retinal dysfunction with specific deficits in the ON or OFF pathways of the retina. ONH is a complex and heterogeneous condition that may involve dysfunction distal to the retinal ganglion cells.
• Borchert, M., & Garcia-filion, P. (2008). The syndrome of optic nerve hypoplasia.. Current neurology and neuroscience reports, 8(5), 395-403. doi:10.1007/s11910-008-0061-7
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  The congenital malformation known as optic nerve hypoplasia (ONH) has been recognized in the past 30 years as an epidemic cause of congenital blindness. It was believed to occur either as an isolated anomaly or as a component of the syndrome of septo-optic dysplasia, which has evolved to include midline brain malformations and hypopituitarism. Evidence now suggests that ONH infrequently occurs in isolation. Most afflicted children will have hypothalamic dysfunction and/or neurodevelopmental impairment, regardless of MRI findings or severity of ONH. Adverse outcomes can often be ameliorated with early intervention. Thus, the syndrome of ONH should be suspected in all infants with signs of hypothalamic dysfunction or vision impairment.
• Garcia-filion, P., Epport, K., Azen, C., Geffner, M. E., Fink, C., Borchert, M., & Nelson, M. D. (2008). Neuroradiographic, endocrinologic, and ophthalmic correlates of adverse developmental outcomes in children with optic nerve hypoplasia: a prospective study.. Pediatrics, 121(3), e653-9. doi:10.1542/peds.2007-1825
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  Developmental delay has been reported to occur with optic nerve hypoplasia, a leading cause of pediatric blindness, but has not been systematically examined for its prevalence and correlation with associated pathologies of optic nerve hypoplasia..The purpose of this study was to determine the developmental outcomes of children with optic nerve hypoplasia and the correlation of development with neuroradiographic, endocrinologic, and ophthalmic findings..We conducted a prospective analysis of 73 subjects diagnosed with optic nerve hypoplasia at
• Mcculloch, D. L., Garcia-filion, P., Garcia-fillion, P., Boemel, G. B., & Borchert, M. S. (2007). Retinal function in infants with optic nerve hypoplasia: electroretinograms to large patterns and photopic flash.. Eye (London, England), 21(6), 712-20. doi:10.1038/sj.eye.6702309
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  Optic nerve hypoplasia (ONH), which is defined as a congenital deficiency of retinal ganglion cells, may also involve more distal layers of the retina. We investigated electrophysiological function of the retina in ONH using electroretinograms (ERGs)..ERGs were recorded from 48 subjects (3.5-35 months) with unilateral or bilateral ONH. Pattern reversal (4 degrees checks) was presented under chloral hydrate sedation, using an optical system to correct a cycloplegic refraction. A photopic flash stimulus was also used. Fundus photographs were used to measure the disk diameter/disk macula ratio (DD/DM), and to document other clinical signs. Eyes were classified as moderate (0.15-0.3) or severe (
• Ahmad, T., Garcia-filion, P., Borchert, M., Burkett, L., Kaufman, F. R., & Geffner, M. E. (2006). Endocrinological and auxological abnormalities in young children with optic nerve hypoplasia: a prospective study.. The Journal of pediatrics, 148(1), 78-84. doi:10.1016/j.jpeds.2005.08.050
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  To determine the prevalence of endocrinopathies, neuroradiographical findings, and growth derangements in young children with optic nerve hypoplasia (ONH)..A prospective observational study examined the prevalence of endocrinopathies at study enrollment and growth patterns in children with ONH. Subjects (n = 47, mean +/- SD 15.2 +/- 10.6 months) were followed until 59.0 +/- 6.2 months of age..The prevalence of endocrinopathies was 71.7%: 64.1% of subjects had growth hormone (GH) axis abnormalities, 48.5% hyperprolactinemia, 34.9% hypothyroidism, 17.1% adrenal insufficiency, and 4.3% diabetes insipidus (DI). Endocrinopathies were not associated with ONH laterality, absence of the septum pellucidum, or pituitary abnormalities on neuroimaging. End height standard deviation score (SDS) was similar to start length SDS independent of GH surrogate status. A significant increase in end weight SDS was found for the cohort (p < .001). A body mass index (BMI) >85th percentile was noted in 44.4% of the cohort and in 52.1% of subjects with GH axis abnormalities. Initial hyperprolactinemia was positively associated with increased end BMI SDS (p = .004)..These prospective findings confirm the high prevalence of pituitary endocrinopathies in children with ONH reported in previous retrospective studies. Our data reveal that some of these children maintain normal height velocity despite GH axis abnormalities, and, as a group, they are at high risk for increased BMI.

Presentations

• Bhavaradju, V., Panchanathan, S., Willis, B., & Garcia, P. C. (2022). (Workshop) From Experience to Competence: Mining the Electronic Health Record to Measure Clinical Experiences in Pediatric Trainees. Pediatric Academic Societies.
• Bhavaradju, V., Panchanathan, S., Willis, B., & Garcia, P. C. (2021). (Workshop) From Experience to Competence: Mining the Electronic Health Record to Measure Clinical Experiences in Pediatric Trainees. Conference on Teaching and Learning 2021.
• Garcia, P. C., Panchanathan, S., & Muth, A. (2019, November). Objective measures for medical education from the EHR. AMIA. Washington, DC.

Poster Presentations

• Bhavaradju, V., Panchanathan, S., Willis, B., & Garcia, P. C. (2022). From experience to competence: Mining the electronic health record to measure clinical experiences in trainees. ACGME.
• Garcia, P. C., Kruglyakova, J., & Borchert, M. (2019, May). Diagnosis of optic nerve hypoplasia and vision prognosis with orbital MRI vs fundus photography. ARVO. Vancouver, Canada.
• Garcia, P. C., McCulloch, D., & Borchert, M. (2019, May). Repeated measures comparison of chloral hydrate and propofol effects on full field electroretinograms (ERGs) and pattern ERGs (PERGS). ARVO. Vancouver, Canada.
• Garcia, P. C., Panchanathan, S., Hsiao, S., & Paredes, Y. (2020, April). Exploring Medical Education Learning Analytics from the Use of Electronic Health Record Systems. Learning Analytics. Tempe, Arizona.
• Martinez, G. F., Gallitano-Mendel, A. L., Nelson, L. R., Lucio, F., Hartmark-Hill, J. R., Garcia, P. C., Gulati, M., Mallin, E., Thomas, T., & Herbst-Kralovetz, M. (2019, November). Strategic initiative to create a Women in Medicine and Science (WIMS) program at a recently established and independently accredited College of Medicine. AAMC Learn Serve Lead. Phoenix, AZ: AAMC.