Clinical Focus

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

Academic Appointments

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

  • Understanding Pediatric Surge in the United States. Pediatric clinics of North America Lin, A., Chung, S. 2024; 71 (3): 395-411


    The concepts of pediatric surge in the United States continue to evolve from a theoretic framework to practical implementation. As disasters become more frequent, ranging from natural to human-caused, children remain a vulnerable population. The coronavirus disease 2019 pandemic and the 2022 to 2023 tripledemic respiratory surge revealed advances and continued challenges in our ability to care for a large influx of pediatric patients. Understanding pediatric surge through the framework of the 4 S's (space, staff, stuff, and systems/structures) can identify gaps at multiple levels.

    View details for DOI 10.1016/j.pcl.2024.01.013

    View details for PubMedID 38754932

  • Pediatric Medical Countermeasures: Antidotes and Cytokines for Radiological and Nuclear Incidents and Terrorism. Disaster medicine and public health preparedness Maciulewicz, T. S., Kazzi, Z., Navis, I. L., Nelsen, G. J., Cieslak, T. J., Newton, C., Lin, A., West, D. J., Walter, F. G. 2024; 18: e76


    The war in Ukraine raises concerns for potential hazards of radiological and nuclear incidents. Children are particularly vulnerable in these incidents and may need pharmaceutical countermeasures, including antidotes and cytokines. Searches found no published study comparing pediatric indications and dosing among standard references detailing pediatric medications for these incidents. This study addresses this gap by collecting, tabulating, and disseminating this information to healthcare professionals caring for children. Expert consensus chose the following references to compare their pediatric indications and dosing of medical countermeasures for radiation exposure and internal contamination with radioactive materials: Advanced Hazmat Life Support (AHLS) for Radiological Incidents and Terrorism, DailyMed, Internal Contamination Clinical Reference, Medical Aspects of Radiation Incidents, and Medical Management of Radiological Casualties, as well as Micromedex, POISINDEX, and Radiation Emergency Medical Management (REMM). This is the first study comparing pediatric indications and dosing for medical countermeasures among commonly used references for radiological and nuclear incidents.

    View details for DOI 10.1017/dmp.2024.35

    View details for PubMedID 38651400

  • Suicide and Self-Harm in Adolescents During the COVID-19 Pandemic: A U.S. Virtual Pediatric Systems, LLC, Database Study of PICU Admissions, 2016-2021. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies McCluskey, C. K., Black, T. R., Zee-Cheng, J., Klein, M. J., Lin, A., Rogerson, C. M., Carroll, C. L., Remy, K. E., Scanlon, M. C., Shein, S. L., Wright, M., Rotta, A. T. 2023


    To characterize the epidemiology of suicide and self-harm among adolescents admitted to PICUs during the first 2 years of the COVID-19 pandemic in the United States.Descriptive analysis of a large, multicenter, quality-controlled database (Virtual Pediatric Systems [VPS]), and of a national public health dataset (U.S. Centers for Disease Control and Prevention web-based Wide-ranging ONline Data for Epidemiology Research [CDC WONDER]).The 69 PICUs participating in the VPS database that contributed data for the entire the study period, January 1, 2016, to December 31, 2021.Adolescents older than 12 years to younger than 18 years old admitted to a participating PICU during the study period with a diagnosis involving self-harm or a suicide attempt (VPS sample), or adolescent suicide deaths over the same period (CDC WONDER sample).None.We identified 10,239 suicide deaths and 7,692 PICU admissions for self-harm, including 5,414 admissions in the pre-pandemic period (Q1-2016 to Q1-2020) and 2,278 in the pandemic period (Q2-2020 to Q4-2021). Compared with the pre-pandemic period, there was no increase in the median (interquartile range) number of suicide deaths per quarter (429 [399-453] vs. 416 [390-482]) or PICU admissions for self-harm per quarter (315 [289-353] vs. 310 [286-387]) during the pandemic period, respectively. There was an increase in the ratio of self-harm PICU admissions to all-cause PICU admissions per quarter during the pandemic (1.98 [1.43-2.12]) compared with the pre-pandemic period per quarter (1.59 [1.46-1.74]). We also observed a significant decrease in all-cause PICU admissions per quarter early in the pandemic compared with the pre-pandemic period (16,026 [13,721-16,297] vs. 19,607 [18,371-20,581]).The number of suicide deaths and PICU admissions per quarter for self-harm remained relatively constant during the pandemic, while the number of all-cause PICU admissions per quarter decreased compared with the pre-pandemic period. The resultant higher ratio of self-harm admissions to all-cause PICU admissions may have contributed to the perception that more adolescents required critical care for mental health-related conditions early in the pandemic.

    View details for DOI 10.1097/PCC.0000000000003381

    View details for PubMedID 37812055

  • Importance of inclusive leadership in the pandemic response: the critical role of the physician BMJ LEADER Destino, L., Lin, A., Mathew, R., Lee, T., Aziz, N., Claura, R., Kim, J., Lee, G. 2023
  • 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


    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


    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


    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
  • 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