Clinical Focus


  • Pediatrics
  • Pediatric Hospital Medicine
  • Sedation
  • Emergency Management
  • Pediatric Surgical Co-Management/Consultation

Academic Appointments


  • Clinical Associate Professor, Pediatrics

Administrative Appointments


  • Assistant Medical Director, Office of Emergency Management, Stanford Children's Health and Stanford Healthcare (2015 - Present)

Professional Education


  • Board Certification: American Board of Pediatrics, Pediatric Hospital Medicine (2019)
  • Residency: University of Arizona Pediatric Residency (2005) AZ
  • Medical Education: University of Wisconsin School of Medicine Registrar (2002) WI
  • Board Certification: American Board of Pediatrics, Pediatrics (2005)

All Publications


  • Characteristics and Outcomes of Critically Ill Children With Multisystem Inflammatory Syndrome. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Snooks, K., Scanlon, M. C., Remy, K. E., Shein, S. L., Klein, M. J., Zee-Cheng, J., Rogerson, C. M., Rotta, A. T., Lin, A., McCluskey, C. K., Carroll, C. L. 2022

    Abstract

    OBJECTIVES: To characterize the prevalence of pediatric critical illness from multisystem inflammatory syndrome in children (MIS-C) and to assess the influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain on outcomes.DESIGN: Retrospective cohort study.SETTING: Database evaluation using the Virtual Pediatric Systems Database.PATIENTS: All children with MIS-C admitted to the PICU in 115 contributing hospitals between January 1, 2020, and June 30, 2021.MEASUREMENTS AND MAIN RESULTS: Of the 145,580 children admitted to the PICU during the study period, 1,338 children (0.9%) were admitted with MIS-C with the largest numbers of children admitted in quarter 1 (Q1) of 2021 (n = 626). The original SARS-CoV-2 viral strain and the D614G Strain were the predominant strains through 2020, with Alpha B.1.1.7 predominating in Q1 and quarter 2 (Q2) of 2021. Overall, the median PICU length of stay (LOS) was 2.7 days (25-75% interquartile range [IQR], 1.6-4.7 d) with a median hospital LOS of 6.6 days (25-75% IQR, 4.7-9.3 d); 15.2% received mechanical ventilation with a median duration of mechanical ventilation of 3.1 days (25-75% IQR, 1.9-5.8 d), and there were 11 hospital deaths. During the study period, there was a significant decrease in the median PICU and hospital LOS and a decrease in the frequency of mechanical ventilation, with the most significant decrease occurring between quarter 3 and quarter 4 (Q4) of 2020. Children admitted to a PICU from the general care floor or from another ICU/step-down unit had longer PICU LOS than those admitted directly from an emergency department.CONCLUSIONS: Overall mortality from MIS-C was low, but the disease burden was high. There was a peak in MIS-C cases during Q1 of 2021, following a shift in viral strains in Q1 of 2021. However, an improvement in MIS-C outcomes starting in Q4 of 2020 suggests that viral strain was not the driving factor for outcomes in this population.

    View details for DOI 10.1097/PCC.0000000000003054

    View details for PubMedID 35994614

  • Epidemiology and Outcomes of SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome in Children vs Influenza Among Critically Ill Children. JAMA network open Shein, S. L., Carroll, C. L., Remy, K. E., Rogerson, C. M., McCluskey, C. K., Lin, A., Rotta, A. T. 2022; 5 (6): e2217217

    View details for DOI 10.1001/jamanetworkopen.2022.17217

    View details for PubMedID 35704321

  • School Closures in the United States and Severe Respiratory Illnesses in Children: A Normalized Nationwide Sample. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Rogerson, C. M., Lin, A., Klein, M. J., Zee-Cheng, J., McCluskey, C. K., Scanlon, M. C., Rotta, A. T., Remy, K. E., Shein, S. L., Carroll, C. L. 2022

    Abstract

    OBJECTIVES: To determine the association between nationwide school closures and prevalence of common admission diagnoses in the pediatric critical care unit.DESIGN: Retrospective cohort study.SETTING: National database evaluation using the Virtual Pediatric Systems LLC database.PATIENTS: All patients admitted to the PICU in 81 contributing hospitals in the United States.MEASUREMENTS AND MAIN RESULTS: Diagnosis categories were determined for all 110,418 patients admitted during the 20-week study period in each year (2018, 2019, and 2020). Admission data were normalized relative to statewide school closure dates for each patient using geographic data. The "before school closure" epoch was defined as 8 weeks prior to school closure, and the "after school closure" epoch was defined as 12 weeks following school closure. For each diagnosis, admission ratios for each study day were calculated by dividing 2020 admissions by 2018-2019 admissions. The 10 most common diagnosis categories were examined. Significant changes in admission ratios were identified for bronchiolitis, pneumonia, and asthma. These changes occurred at 2, 8, and 35 days following school closure, respectively. PICU admissions decreased by 82% for bronchiolitis, 76% for pneumonia, and 76% for asthma. Nonrespiratory diseases such as diabetic ketoacidosis, status epilepticus, traumatic injury, and poisoning/ingestion did not show significant changes following school closure.CONCLUSIONS: School closures are associated with a dramatic reduction in the prevalence of severe respiratory disease requiring PICU admission. School closure may be an effective tool to mitigate future pandemics but should be balanced with potential academic, economic, mental health, and social consequences.

    View details for DOI 10.1097/PCC.0000000000002967

    View details for PubMedID 35447632

  • Universal Level Designations for Hospitalized Pediatric Patients in Evacuation. Hospital pediatrics Lin, A., King, M. A., McCarthy, D. C., Eriksson, C. O., Newton, C. R., Cohen, R. S. 2022

    Abstract

    Children comprise approximately 22% of the population in the United States.1 In a widespread disaster such as a hurricane, pandemic, wildfire or major earthquake, children are at least proportionately affected to their share of the population, if not more so. They also have unique vulnerabilities including physical, mental, and developmental differences from adults, which make them more prone to adverse health effects of disasters.2-4 There are about 5000 pediatric critical care beds and 23 000 neonatal intensive care beds out of 900 000 total hospital beds in the United States.5 While no mechanism exists to consistently track pediatric acute care beds nationally (especially in real time), a previous study6 showed a 7% decline in pediatric medical-surgical beds between 2002 and 2011. This study also estimated there are about 30 000 acute care pediatric beds nationally. Finding appropriate hospital resources for the provision of care for pediatric disaster victims is an important concern for those charged with triaging patients in a major event.

    View details for DOI 10.1542/hpeds.2021-006356

    View details for PubMedID 35137099

  • Triage by Resource Allocation for INpatients: A Novel Disaster Triage Tool for Hospitalized Pediatric Patients DISASTER MEDICINE AND PUBLIC HEALTH PREPAREDNESS Lin, A., Taylor, K., Cohen, R. S. 2018; 12 (6): 692–96
  • Triage by Resource Allocation for INpatients: A Novel Disaster Triage Tool for Hospitalized Pediatric Patients. Disaster medicine and public health preparedness Lin, A., Taylor, K., Cohen, R. S. 2018: 1–5

    Abstract

    OBJECTIVE: To develop a disaster triage tool for the evacuation of hospitalized neonatal and pediatric populations.METHODS: We expanded an existing neonatal disaster triage tool for the evacuation of a children's hospital. We assessed inpatients using bedside visual assessments and chart review to categorize patients transport level based on local emergency medical services protocols and expert opinion. The tool was refined by using multiple Plan Do Study Act cycles. Primary outcome was the number of each level of transport required for hospital evacuation. Secondary outcome was improved efficiency of obtaining information about specific transport needs for evacuation.RESULTS: We evaluated 1382 patients both visually and through electronic chart review over 10 random days. Accordance between visual assessment and electronic chart review reached 96.3%. During a 2 hour statewide disaster drill, no hospital units completed self-assessed transport needs for their patients; a single nurse used Triage by Resource Allocation in INpatients to determine transportation needs in less than 1 hour. (Disaster Med Public Health Preparedness. 2018;page 1 of 5).

    View details for PubMedID 29382399

  • Integrating the home management plan of care for children with asthma into an electronic medical record. Joint Commission journal on quality and patient safety / Joint Commission Resources Patel, S. J., Longhurst, C. A., Lin, A., Garrett, L., Gillette-Arroyo, J., Mark, J. D., Wood, M. S., Sharek, P. J. 2012; 38 (8): 359-365

    Abstract

    Asthma exacerbation is one of the most common causes for pediatric hospitalization. One of the three Joint Commission quality measures--which has proven the most challenging--addresses the provision of a home management plan of care (HMPC) for discharge of pediatric inpatients with a primary diagnosis of asthma. A user-friendly electronic medical record (EMR)-generated HMPC was developed and implemented at Lucile Packard Children's Hospital (LPCH) Palo Alto, California, an HPMC needed to be completed before entry of an inpatient discharge order.A cohort study using historical controls was conducted in 2010-2011. Patients were eligible to receive an HMPC if they were between the ages of 2 and 17 years old at discharge, had a length of stay < 120 days, were not enrolled in clinical trials, and had the primary discharge diagnosis of asthma. These patients were identified by the EMR if this diagnosis was listed in the diagnosis list or problem list or if the asthma admit/discharge order set was initiated.Compliance with the HMPC increased from 65.3% for the 39 months (April 1, 2007-June 30, 2010) before integration of the HMPC into EMR to 93.7% for the 18 months after integration (July 1, 2010, through December 31, 2011); p < .0001. Users of the EMR-integrated HMPC found it to be significantly easier to complete, less time-consuming, and less prone to potential errors or omission.Lessons learned at LPCH included the need for a continuous surveillance and improvement model, which resulted in several iterations of the HMPC; the importance of soliciting user input, which resulted in improvements in work flow; and consistent support from the quality management and information technology departments, which are crucial to eliminating barriers and facilitating improvement.

    View details for PubMedID 22946253

  • Integrating the Home Management Plan of Care for Children with Asthma into an Electronic Medical Record JOINT COMMISSION JOURNAL ON QUALITY AND PATIENT SAFETY Patel, S. J., Longhurst, C. A., Lin, A., Garrett, L., Gillette-Arroyo, J., Mark, J. D., Wood, M. S., Sharek, P. J. 2012; 38 (8): 359–65