Objectives: The goals of this study are to assess primary care provider (PCP) knowledge of and attitudes toward pediatric obstructive sleep apnea (OSA), and to identify variations in practice patterns. Design: A cross-sectional survey including the Obstructive Sleep Apnea Knowledge and Attitudes in Children (OSAKA-KIDS) questionnaire was administered to PCPs from August to December 2021. Univariable analyses and multivariable linear regressions were performed to analyze associations between demographics and knowledge, attitudes, and screening frequency. Results: There were 82 PCPs who completed the survey (age 43.4 ±9.6 years, 69.6% female, 90.2% non-Hispanic White). Specialties included Pediatrics (65.9%) and Family Medicine (32.9%). Respondents answered a mean 84.9 ±10.7% questions correctly on the knowledge portion. Years in practice, provider training background, and academic affiliation were not associated with knowledge scores. Less than half (45.1%) of respondents screened for OSA ‘most of the time’ (32.9%) or ‘always’ (12.2%). Higher screening frequency was associated with clinics with higher Medicaid beneficiaries (P=0.002) and a lower proportion of Black patients (P=0.033). Providers who felt more confident in managing OSA were more likely to screen ‘most of the time’ (B=0.532, 95%CI [0.120 – 0.926], P=0.012), or ‘always’ (B=0.708, 95%CI [0.129 – 1.29], P=0.017). Conclusion: These results suggest guideline-recommended screening for OSA is low among PCPs despite high knowledge scores. Higher confidence in OSA management was associated with higher screening rates for obstructive sleep-disordered breathing. Further studies on interventions aimed to increase screening and confidence may improve equitable care.

Background: Splenic dysfunction in children with sickle cell disease (SCD) increases the risk of serious bacterial infections; therefore, families are instructed to seek medical care in the presence of fever. Recurrent hospital admissions of patients with SCD cause financial and resource burdens on caregivers and the healthcare system, contributing to a lower quality of life in this patient population. Recent studies have documented a reduction of the incidence of bacterial infections among these patients managed on an outpatient basis with no association of increased morbidity and mortality. We decided to establish a partnership between our pediatric hematology/oncology division and pediatric emergency medicine division to initiate an algorithm to identify low risk patients eligible for outpatient management. Procedure: We conducted a retrospective review of patients with SCD less than 18 years of age, followed at the Comprehensive Care Sickle Cell Center at the Medical University of South Carolina (MUSC), who presented to our Pediatric Emergency Department (ED) with a temperature ≥ 101°F from July 1st 2018 to June 30th 2020. Results: Mean length of stay and age at admission were nearly equal between pre- and post-implementation of the algorithm. The admission rates from the study for were 55.2% and 43.6% pre- and post-implementation, respectively. Patients revisited the ED within 72 hours in 6.7% of patients in pre-implementation and 5.9% of patients in post-implementation. There were no patient deaths. Conclusions: Our pathway helps to standardize the treatment of febrile pediatric patients with SCD and safely decreases hospital admissions.