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ABSTRACTBackgroundThe clinical utility of diagnostic neuroimaging for pediatric patients presenting to the emergency department (ED) for psychosis remains unclear. We sought to estimate the prevalence of and characteristics associated with clinically significant neuroimaging findings among pediatric patients presenting to the ED with symptoms of psychosis who had neuroimaging performed.MethodsThis retrospective cross‐sectional study included visits by patients 5 to < 18 years old presenting with symptoms of psychosis to 28 EDs affiliated with the Pediatric Emergency Medicine Collaborative Research Committee from 2016 to 2019 and had neuroimaging performed. We estimated the rate of clinically significant neuroimaging findings, defined as those resulting in further testing, treatment, or medical admission, overall and by imaging modality. Multivariable logistic regression models examined presenting features associated with clinically significant findings.ResultsClinically significant neuroimaging findings were identified in 5.4% (95% CI 4.2%, 6.9%) of 1118 ED visits (54% male, median [IQR] 14 [11–16] years old). Clinically significant findings occurred in 4.9% (34/699) of head computed tomography scans and 7.5% (45/604) of brain magnetic resonance imaging studies (p = 0.07). In a model that imputed missing data, no presenting features were associated with clinically significant neuroimaging findings. In a model that treated missing documentation as absence of the clinical feature, the adjusted odds of clinically significant neuroimaging findings were lower among ED visits by patients with suspected alcohol or substance use (aOR 0.38, 95% CI 0.16, 0.87).ConclusionAmong pediatric patients presenting to the ED with symptoms of psychosis who had neuroimaging obtained, approximately 1 in 20 had clinically significant findings. Suspected alcohol or substance use was associated with lower odds of clinically significant neuroimaging findings, although this finding was not consistent across modeling approaches. Prospective studies are needed to definitively evaluate the utility of neuroimaging among children and adolescents presenting to the ED with symptoms of psychosis.

Introduction: Acute pancreatitis is a significant complication of endoscopic retrograde cholangiopancreatography (ERCP) with no established prevention strategy. Recent studies suggest that rectal indomethacin may reduce the incidence of post-ERCP pancreatitis (PEP), but its effectiveness varies with patient risk levels and the concurrent use of pancreatic stenting. This updated meta-analysis evaluates the efficacy of rectal indomethacin in preventing PEP. Methods: A systematic search of PubMed, Embase, and Scopus up to April 2025 identified randomized controlled trials (RCTs) comparing rectal indomethacin with placebo for PEP prevention. Random-effects meta-analysis, meta-regression, and subgroup analysis were conducted using the R Meta package v8.0–2. Cochrane’s ROB2 and Egger’s regression test are used to assess the risk of bias. Results: The analysis included 15 RCTs representing a total of 4,962 patients. Rectal indomethacin significantly reduced the incidence of PEP compared to placebo (risk ratio [RR]: 0.58; 95% confidence interval [CI], 0.45–0.73; p < 0.01) with no increased risk for bleeding complications (RR: 0.95, 95% CI: 0.64–1.41, p = 0.76). Subgroup analysis showed that indomethacin was effective, especially when given concurrently with a pancreatic stent (RR: 0.4539, 95% CI: 0.26–0.79). However, a high risk of bias was observed in nearly 25% of the overall assessment; there was evidence of a small-study effect, as suggested by Egger’s regression test (p < 0.01). Conclusion: Prophylactic rectal indomethacin appears to be effective in preventing PEP, with no increased risk for bleeding. Future studies should focus on combining other prophylactic options to achieve better prevention of PEP.

PV091 / #536Poster Topic:AS11 - Epidemiology and Public HealthBackground/PurposeThe economic impact of Coronavirus Disease 2019 (COVID-19) in Systemic Lupus Erythematosus (SLE) patients remains incompletely characterized. We aimed to analyze healthcare resource utilization and costs among hospitalized SLE patients with COVID-19 compared to those without, using a nationally representative database.MethodsUsing the 2021 National Inpatient Sample, we identified adult SLE patients (International Classification of Diseases, 10th Revision code M32) and stratified by COVID-19 status. Primary outcomes included length of stay (LOS) and total hospital charges. We employed survey-weighted Poisson regression for LOS analysis and generalized linear models for cost analysis, adjusting for demographics, comorbidities, and clinical factors.ResultsAmong 170,085 hospitalized SLE patients, 12,710 (7.47%) had COVID-19. Mean LOS was significantly longer in SLE patients with COVID-19 vs without (8.48 vs 5.57 days, p &lt; 0.001). After adjustment, COVID-19 was associated with a 53% increase in LOS (incidence rate ratio [IRR] 1.53, 95% CI 1.47-1.60, p &lt; 0.001). Total hospital charges were substantially higher in COVID-19 patients vs non-COVID-19 patients ($103,126 vs $77,628, p &lt; 0.001), with an adjusted cost ratio of 1.34 (95% CI 1.26-1.42, p &lt; 0.001). Stratified analyses revealed higher rates of mechanical ventilation (11.25% vs 2.76%, p &lt; 0.001) and acute kidney injury (29.31% vs 21.38%, p &lt; 0.001) in COVID-19 patients. Among SLE patients with COVID-19, females vs males (88.24% vs 11.76%) showed lower hospital charges (IRR 0.91, 95% CI 0.85-0.98, p = 0.015) and shorter LOS (IRR 0.92, 95% CI 0.88-0.96, p &lt; 0.001). African American vs Caucasian patients (29.50% vs 48.03%) demonstrated higher resource utilization (IRR 1.29, 95% CI 1.23-1.36, p &lt; 0.001). Patients with severe vs mild comorbidity burden (41.03% vs 9.87%) had significantly higher costs (IRR 2.15, 95% CI 2.03-2.28, p &lt; 0.001).ConclusionsCOVID-19 in SLE patients is associated with substantially increased healthcare resource utilization, manifesting as longer hospitalizations and higher costs. The economic burden is particularly pronounced in patients requiring mechanical ventilation or developing acute kidney injury. These findings highlight the significant economic impact of COVID-19 in SLE patients and can inform healthcare resource allocation and policy decisions for this high-risk population.

Infections related to neuromodulation devices such as spinal cord stimulators (SCS) and intrathecal pumps (ITPs) present complex challenges due to potential complications such as localized infections, deep infections, sepsis, and neurological injury. Prompt diagnosis requires patients and providers to be educated on wound management and sepsis symptoms for immediate medical attention. Antibiotic therapy and duration vary based on infection severity, with deep infections often requiring device removal despite recent improvements in salvage rates with aggressive initial intervention. Deep infections necessitate timely diagnosis through imaging modalities such as magnetic resonance imaging (MRI) or computed tomography (CT), followed by device removal and culture-guided antibiotic therapy, often in collaboration with infectious disease specialists and spine surgeons. ITP infections pose similar challenges along with the risk of meningitis and may require careful management of medication withdrawal symptoms during emergent pump removal. Lab monitoring may aid treatment assessment, although negative cultures can occur due to post-antibiotic exposure. Postoperative recommendations stress standardized guidelines, patient education, and vigilant surveillance, with close follow-up crucial for early infection detection and intervention. Managing device-related infections demands a multi-specialty approach to minimize complications and optimize outcomes. This paper outlines best practices for diagnosing, managing, and treating neuromodulation device infections, focusing on guiding clinical decision-making from the onset of infection through treatment and potential reimplantation.

A leadless pacemaker (LLPM) was recommended for a patient with intermittent complete heart block and near-syncope. Delivery of LLPM is through a large sheath that has limited deflection and steerability. This report describes the successful deployment of a ventricular LLPM in a patient with prior surgical correction of AV septal defect with subsequent significant right atrial enlargement. The LLPM could not traverse the tricuspid valve. A snare was advanced to the right atrium and used to create greater tip deflection of the delivery sheath. Importantly, once the delivery sheath crosses the tricuspid valve, the snare is loosened to allow directing the sheath to the right ventricular septum rather than the initial direction that was toward the right ventricular apex. The ventricular LLPM was successfully fixated. In the presence of complex anatomy, deployment of a LLPM delivery sheath can be facilitated with use of a snare to assist with increased deflection then subsequent guidance to the preferred right ventricular location of the septum.

Mycoplasma pneumoniae (MP) has long been recognized as a common cause of community-acquired pneumonia (CAP), typically associated with mild to moderate respiratory illness. However, increasing evidence suggests that MP can also lead to more severe forms of pneumonia, particularly in individuals with underlying risk factors, such as advanced age, chronic diseases, or immunocompromised. Despite its potential for severe illness, MP remains an often overlooked pathogen in the clinical setting. We present two cases involving young adults—one male and one female—who developed severe MP-associated CAP requiring hospitalization. These cases underscore the clinical manifestations, risk factors, and diagnostic challenges associated with MP infection.