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Papers by Charles Schubert

Academic Pediatrics, 2017

Objective. This study examined the prevalence of gonorrhea in girls <12 years of age who presente... more Objective. This study examined the prevalence of gonorrhea in girls <12 years of age who presented with vaginitis and in whom sexual abuse was not suspected.

Ann Emerg Med, 1994

ABSTRACT

Pediatric Emergency Care, May 1, 1998

An epidemic of syphilis is present in many parts of the United States. In 1990, the incidence of ... more An epidemic of syphilis is present in many parts of the United States. In 1990, the incidence of syphilis reached its highest rate since 1949, 20.4 cases per 100,000 persons. 1 In our institution, the number of cases of syphilis rose from zero in 1990 to 26 in 1994. With its ...

Pediatrics, Dec 1, 1995

To determine the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginali... more To determine the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, syphilis, and human immunodeficiency virus (HIV) infection in sexually abused children and to develop selective criteria for sexually transmitted disease (STD) testing in these children in our community. Prospective. University-affiliated children's hospital in Ohio. All children evaluated at our hospital for sexual abuse were eligible. Eight hundred fifty-five children were evaluated over a 1-year period. The study included 704 girls and 151 boys. Children ranged in age from 3 weeks to 18 years old. Standard STD testing (American Academy of Pediatrics recommendations) was defined as serum rapid plasma reagin test, examination for Trichomonas, N gonorrhoeae culture of the throat, rectum, and genitalia and C trachomatis culture of the rectum and genitalia. STD testing in this study was recommended in children with 1) a history of genital discharge or contact with the perpetrator's genitalia, 2) examination findings of genital discharge or trauma, and 3) all adolescents. HIV testing was obtained in children with risk factors for HIV infection, those with contact with a perpetrator with HIV risk factors, or if the family was concerned about HIV acquisition. A total of 423 children were tested for N gonorrhoeae, 415 for C trachomatis, 275 for syphilis, 208 for Trichomonas, and 140 for HIV. Twelve children were determined to have N gonorrhoeae infection, 11 had C trachomatis infection, and four had Trichomonas infection. Overall, the prevalence of STDs in prepubertal girls was 3.2% and 14.6% in pubertal girls. The prevalence of N gonorrhoeae in prepubertal girls with vaginal discharge was 11.1% and 0% in prepubertal girls without discharge (P < .001). C trachomatis infection was diagnosed in 0.8% of prepubertal girls compared with 7.0% of pubertal girls (P < .001). None of the children tested positive for syphilis or HIV and no males had a STD. In our community, N gonorrhoeae testing in prepubertal girls can be limited to those with a vaginal discharge on examination unless other risk factors are present. The prevalence C trachomatis and Trichomonas in prepubertal girls is low and may be omitted from routine evaluations. All pubertal girls evaluated for sexual abuse should be tested for STDs because of the high prevalence of asymptomatic infection in this patient population.

Pediatric Emergency Care, 1993

Cultures for sexually transmitted diseases (STDs) are frequently obtained as part of an evaluatio... more Cultures for sexually transmitted diseases (STDs) are frequently obtained as part of an evaluation for alleged sexual abuse, but the prevalence of STDs in abused children is very low. Furthermore, STDs in children may not be identified if the clinician does not maintain a high index of suspicion in the symptomatic child. A retrospective review was done to study the symptoms and presenting complaints of girls under 12 with gonorrhea and chlamydia infections and to examine the prevalence of STDs in asymptomatic girls. The charts of 622 patients were reviewed. All patients were females under 12, Tanner I or II, who were initially seen for evaluation of sexual abuse or who were diagnosed with an STD. During the study period, 28 girls were found to have STDs. Twenty-two of these girls had vaginal gonorrhea; vaginal chlamydia was diagnosed in eight. Twenty-three of the 28 girls (82%) with an STD were initially seen and cultured for a chief complaint of vaginal discharge. Of the 581 patients who were cultured for evaluation of abuse, only five STDs were diagnosed (0.7%). All 22 girls with gonorrhea had a vaginal discharge on examination. Of the eight girls with chlamydia, two also had vaginal gonorrhea. Of the six who had chlamydia without gonorrhea, asymptomatic infection was common; four gave histories of discharge but only one had a discharge on examination. Our review indicates that girls under 12 who present for evaluation of vaginal discharge may have an STD and should be cultured for gonorrhea and chlamydia whether or not sexual abuse is suspected.(ABSTRACT TRUNCATED AT 250 WORDS)

Background: IMGs account for 30% of the pediatric workforce in the US; many work in Health Profes... more Background: IMGs account for 30% of the pediatric workforce in the US; many work in Health Professional Shortage Areas (HPSAs). There are numerous issues regarding their presence in residency training but little is available about their performance, outcomes or reasons to train in the US or return home. The Cincinnati Children's Hospital Pediatric Residency (CCHMC) has intentionally accepted IMGs since 2001. The program's intention is to train competent pediatricians, able to give back both locally and globally. Objective: To assess the CCHMC IMGs for academic standing on admission, motivations to train in the US, contributions to care in their home country during/after residency, career outcomes, and decision making involved in returning to their home countries. Design/Methods: This was an exploratory investigation using a custom designed survey developed by an iterative process of expert review with pretesting to ensure question clarity, ease of completion and corresponden...

Background: IMGs account for 30% of the pediatric workforce in the US and many provide medical ca... more Background: IMGs account for 30% of the pediatric workforce in the US and many provide medical care in Health Professional Shortage Areas. Numerous issues are perceived to limit their effectiveness in large academic training programs, but little on their performance beyond USMLE scores and board passing rates is available. The Cincinnati Children's Hospital Pediatric Residency (CCHMC) has intentionally admitted IMGs since 2001. The intention of this program is to recruit top IMGs capable of delivering comparable care to US graduates (USGs). Objective: To assess IMGs academic standing upon admission and to evaluate perceptions by USGs and faculty regarding IMG performance in residency and their overall effect on the program. Design/Methods: This was an exploratory investigation using a custom designed survey developed by an iterative process of expert review followed by pretesting to ensure question clarity, ease of completion & correspondence with stated research objectives. USG...

Pediatrics, Jan 10, 2015

Despite the growing importance of global health (GH) training for pediatric residents, few mechan... more Despite the growing importance of global health (GH) training for pediatric residents, few mechanisms have cataloged GH educational opportunities offered by US pediatric residency programs. We sought to characterize GH education opportunities across pediatric residency programs and identify program characteristics associated with key GH education elements. Data on program and GH training characteristics were sought from program directors or their delegates of all US pediatric residency programs during 2013 to 2014. These data were used to compare programs with and without a GH track as well as across small, medium, and large programs. Program characteristics associated with the presence of key educational elements were identified by using bivariate logistic regression. Data were collected from 198 of 199 active US pediatric residency programs (99.5%). Seven percent of pediatric trainees went abroad during 2013 to 2014. Forty-nine programs (24.7%) reported having a GH track, 66.1% ha...

Clinical Pediatric Emergency Medicine, 2005

PEDIATRICS, 2000

Objective. Rib fractures are uncommon in infancy and, when diagnosed, often raise the suspicion o... more Objective. Rib fractures are uncommon in infancy and, when diagnosed, often raise the suspicion of child abuse. However, the prevalence of other causes of rib fractures has not been well defined. The purpose of this study was to determine the causes and clinical presentations of rib fractures in infants <12 months old.

PEDIATRICS, 1999

PEDIATRICS, 2011

Despite its high prevalence, pain often is poorly managed in the emergency department. We used im... more Despite its high prevalence, pain often is poorly managed in the emergency department. We used improvement science and quality-improvement methods to reduce delays associated with opioid delivery for children presenting to the emergency department with clinically apparent extremity fractures. On the basis of a review of the literature, interviews with key stakeholders, expert consensus, and reviews of isolated examples of patients receiving timely analgesics, a multidisciplinary improvement team identified a set of operational factors, or key drivers, believed to be critical to the performance of appropriate initial pain management for children presenting to the emergency department with acute extremity injury. These key drivers focused the development of an intervention. The intervention, termed the orthopedic evaluation process, addressed all 4 identified key drivers simultaneously by standardizing triage decisions, activating necessary health care providers, aligning the care delivery need with necessary resources, and allowing parallel-task completion between physicians and nursing staff. After implementation of this process, 95% of the patients with long-bone extremity fractures treated with intravenous opioids received a first dose within 45 minutes of arrival, compared with a preintervention baseline average of 20%. By applying quality-improvement and process improvement methodology, we identified key drivers for the rapid delivery of systemic opioids to patients with clinically apparent extremity fractures and significantly improved the timeliness of analgesic delivery for this subgroup of patients.

Pediatric Emergency Care, 1992

An 11-week-old infant experienced toxicity following the intranasal instillation of a four percen... more An 11-week-old infant experienced toxicity following the intranasal instillation of a four percent cocaine solution in preparation for an examination to rule out choanal stenosis. The child recovered fully but required the use of anticonvulsants and admission to the hospital. To our knowledge, this is the first case report where cocaine toxicity was experienced following this routine practice. We present our case and a review of the literature involving other instances where there have been complications with the use of topical cocaine. This report should alert the medical community to the potential complications of using topical cocaine for its anesthetic properties.

Pediatric Emergency Care, 2000