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In This Issue of JAMA Pediatrics
April 2017


JAMA Pediatr. 2017;171(4):313. doi:10.1001/jamapediatrics.2016.3099


Despite the emphasis on prevention, dental caries among children younger than 5 years has been increasing. Using state Medicaid data, Blackburn and colleagues examined the effect of early preventive dental care on reducing the need for subsequent caries-related treatment. They found that children with dentist-delivered vs primary care provider–delivered preventive care more frequently required subsequent caries-related treatment and had more visits and higher costs than a matched control group. In their Editorial, Milgrom and Cunha-Cruz discuss the scarce evidence for preventive care with fluoride varnish and the need for large randomized clinical trials to inform care.


In many hospitals, children with an intracranial injury on imaging are automatically admitted to the intensive care unit, even if they meet other criteria for mild traumatic brain injury. Using data from the Pediatric Emergency Care Applied Research Network study on traumatic brain injury, Greenburg et al developed a clinical decision tool to risk stratify the need for intensive care unit admission. Depressed skull fracture midline shifts, epidural hematomas, and Glasgow Coma Scale scores were associated with the need for neurosurgical intervention, intubation for more than 24 hours, or death. The negative predictive value of having none of these risk factors was 98.8% (95% CI, 97.3%-99.6%).

Adolescents who are sexual minorities face an increased risk of attempting suicide that is potentially related to stigma regarding their sexual orientation. Raifman and colleagues used the state-level Youth Risk Behavior Surveillance System to examine the association between state same-sex marriage policies and self-reported suicide attempts. Such policies were associated with a 7% relative reduction in the proportion of high school students attempting suicide. The Editorial by Hatzenbuehler discusses the importance of laws and policies in reducing the harassment and structural stigma associated with sexual orientation.

Editorial and JAMA Pediatrics Patient Page

Author Audio Interview

Reverse triage, consisting of early discharge, is an important strategy to create surge capacity during a large-scale disaster. Kelen and colleagues modeled the potential surge capacity in a children’s hospital and the patients that could be discharged early. They estimated that the net surge capacity was approximately 50% of beds, with the psychiatry unit having the highest proportion of patients for early discharge and oncology unit the lowest. In his Editorial, Burkle discusses the need for pediatric health care leadership to participate in community disaster planning.