Sahithi Pemmasani

Objective: To examine 14-year temporal patterns and demographic differences in analgesic prescribing and imaging use among children with appendicitis in a tertiary pediatric emergency department (ED). Methods: We conducted a retrospective cross-sectional study of children <18 years presenting with acute appendicitis (ICD-9/10 codes) to a large urban pediatric ED from 2010 to 2023. Analgesic categories included ketorolac, ibuprofen, acetaminophen, opioids, combination therapy, or no analgesia. Imaging modalities included ultrasound (US), computed tomography (CT), both, or none. Primary outcomes were calendar-year trends in analgesic prescribing and imaging modality use. Secondary analyses evaluated demographic/clinical factors associated with analgesic and imaging patterns using multivariable logistics regression. Results: Among 2275 children (mean [SD] age, 11.0 [3.6] years; 59.7% male; 70.4% White). Overall, 62.9% received analgesics; 43.6% single agents, 19.3% combinations. Opioid-only prescribing declined (32.3% in 2010 to 8.4% in 2023), while combination analgesics (9.2% to 24.2%), acetaminophen only (6.9% to 21.4%), and ketorolac (0% to 9.8%) increased. CT-only imaging decreased sharply (53.1% to 5.1%), while US-only imaging increased (5.4% to 41.9%). In regression analyses, older age was associated with greater odds of ketorolac (AOR 1.17; 95% CI: 1.08-1.26) and opioid use (AOR 1.15; 95% CI: 1.09-1.21). Male sex was associated with higher odds of no analgesia (AOR 1.33; 95% CI: 1.10-1.62). Black children had greater odds of combination analgesics versus White peers (AOR 1.54; 95% CI: 1.06-2.26). Perforation was strongly associated with combination analgesics (AOR 1.84; 95% CI: 1.27-2.65). Conclusions: In a single-center study, pediatric appendicitis care shifted toward reduced opioid and CT use and increased nonopioid multimodal analgesia and US-based imaging over 14 years.

Background and Purpose—: Amidst legalization of therapeutic and recreational use of marijuana/cannabis in the United States, cerebrovascular effects of marijuana use remain largely unknown, especially among young adults. We aimed to examine the association between marijuana use (18–44 years) among young adults and stroke events. Methods—: The study analyzed pooled data from the Behavioral Risk Factor Surveillance System (2016–2017)—a nationally representative cross-sectional survey collected by the Centers for Disease Control and Prevention. Weighted logistic regression models were used to examine an association of recent marijuana use (within the last 30 days) and stroke in young adults (18–44 years) adjusting for patient demographics, risk behavior, and relevant comorbidities. Results—: Overall, 13.6% of participants (n=43 860; weighted 35.5 million; 49.9% men) reported using marijuana recently (in the last month), with 63.3% of them being men. Compared with nonusers, marijuana users were often younger (18–34 years; 73.8% versus 61%), non-Hispanic white or black, and with some college education. Marijuana users were often physically active (81.8% versus 77.5%), heavy drinkers (16.8% versus 4.9%), current combustible cigarette users (37.9% versus 15%) and had lower prevalence of hypertension, diabetes mellitus, and hyperlipidemia as compared with nonusers ( P 10 days/month). Compared with nonusers, stroke odds were even higher among frequent marijuana users with concomitant combustible cigarette use (adjusted odds ratio, 3.12 [95% CI, 1.40–6.97]) and e-cigarette use (adjusted odds ratio, 2.63 [95% CI, 1.07–6.46]), respectively. Conclusions—: There may be a significantly higher odds of stroke in young marijuana users (18–44 years) as compared with nonusers with even greater odds among frequent users (>10 days/month).