Loma Linda University

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Besh Rhyl Barcega, MD
Assistant Professor, Emergency Medicine
School of Medicine
Assistant Professor, Basic Sciences
School of Medicine
Assistant Professor, Pediatrics
School of Medicine
Publications    Scholarly Journals--Published
  • Vargas EJ, Mody AP, Kim TY, Denmark TK, Moynihan JA, Barcega BB, Khan A, Clark RT, Brown LA. "The removal of coins from the upper esophageal tract of children by emergency physicians: A pilot study." Can J of Emerg Medicine 6.6 (2004): 434-440. ( 11/2004 )
  • Schroeder A R, Mansbach J M, Stevenson M, Macias C G, Fisher E S, . . . Camargo C A. (2013). Apnea in Children Hospitalized With Bronchiolitis. Pediatrics, 132(5), E1194-E1201. ( 11/2013 - Present ) Link...
    OBJECTIVE: To identify risk factors for inpatient apnea among children hospitalized with bronchiolitis. METHODS: We enrolled 2207 children, aged <2 years, hospitalized with bronchiolitis at 16 sites during the winters of 2007 to 2010. Nasopharyngeal aspirates (NPAs) were obtained on all subjects, and real-time polymerase chain reaction was used to test NPA samples for 16 viruses. Inpatient apnea was ascertained by daily chart review, with outcome data in 2156 children (98%). Age was corrected for birth <37 weeks. Multivariable logistic regression was performed to identify independent risk factors for inpatient apnea. RESULTS: Inpatient apnea was identified in 108 children (5%, 95% confidence interval [CI] 4%-6%). Statistically significant, independent predictors of inpatient apnea included: corrected ages of <2 weeks (odds ratio [OR] 9.67) and 2 to 8 weeks (OR 4.72), compared with age >= 6 months; birth weight <2.3 kg (5 pounds; OR 2.15), compared with >= 3.2 kg (7 pounds); caretaker report of previous apnea during this bronchiolitis episode (OR 3.63); preadmission respiratory rates of <30 (OR 4.05), 30 to 39 (OR 2.35) and >70 (OR 2.26), compared with 40 to 49; and having a preadmission room air oxygen saturation <90% (OR 1.60). Apnea risk was similar across the major viral pathogens. CONCLUSIONS: In this prospective, multicenter study of children hospitalized with bronchiolitis, inpatient apnea was associated with younger corrected age, lower birth weight, history of apnea, and preadmission clinical factors including low or high respiratory rates and low room air oxygen saturation. Several bronchiolitis pathogens were associated with apnea, with similar apnea risk across the major viral pathogens.
  • Bansil N H, Kim T Y, Tieu L, & Barcega B. (2013). Incidence of Serious Bacterial Infections in Febrile Children With Sickle Cell Disease. Clin Pediatr (Phila), 52(7), 661-666. ( 7/2013 - Present ) Link...
    Objective. To determine the incidence of serious bacterial infections in febrile children with sickle cell disease and to describe the outcomes of children discharged from the pediatric emergency department. Methods. We conducted a retrospective chart review of 188 febrile patients with sickle cell disease presenting to our pediatric emergency department over a 10-year period. Serious bacterial infection was defined as bacteremia, meningitis, urinary tract infection, osteomyelitis, or pneumonia. Results. Our overall incidence rate for serious bacterial infections was 16.0% (95% confidence interval [CI] = 10.8% to 21.2%). Pneumonia had the highest incidence rate of 13.8% (95% CI = 8.8% to 18.8%). This was followed by bacteremia and urinary tract infections, both with incidence rates of 1.1% (95% CI = 0.0% to 2.5%). We had no cases of meningitis or osteomyelitis in our study group. Conclusion. We had an incidence of 16.0% for serious bacterial infections in febrile children with sickle cell disease, with the majority of patients diagnosed with pneumonia.
  • Luu J L, Wendtland C L, Gross M F, Mirza F, Zouros A, . . . Abd-Allah S A. (2011). Three Percent Saline Administration During Pediatric Critical Care Transport. Pediatric Emergency Care, 27(12), 1113-1117. ( 12/2011 - Present ) Link...
    Objectives: The purpose of this study was to describe the administration of 3% saline (3%S) during pediatric critical care transport. Methods: A retrospective study was performed on pediatric patients who underwent critical transport to Loma Linda University Children's Hospital from January 1, 2003, to June 30, 2007, and were given 3%S. Patients' demographics, admission diagnosis, route and amount of 3%S administration, serum electrolytes, vital signs, radiographic data, and Glasgow Coma Scale scores were collected and analyzed. Results: A total of 101 children who received 3% S infusions during pediatric critical care transport were identified. Mean patient age was 5.9 years, and mean patient weight was 27.6 kg. The main indications for infusing 3% S were suspected cerebral edema (41%), intracranial bleed with edema (51%), and symptomatic hyponatremia (6%). The amount of 3% S bolus ranged from 1.2 to 24 mL/kg, with a mean of 5.4 mL/kg. Serum electrolytes before and after 3% S infusion demonstrated significant increases in sodium, chloride, and bicarbonate levels (P < 0.05). A significant reduction was also seen in serum urea nitrogen levels and anion gap. Radiographic imaging performed before 3% S infusion demonstrated findings consistent with concerns of increased intracranial pressure such as intracranial bleed and cerebral edema. The route of initial 3%S infusions was mainly through peripheral intravenous lines (96%). No complications related to the 3%S delivery such as local reactions, renal abnormalities, or central pontine myelinolysis were observed. Conclusions: It seems 3%S may be administered safely during pediatric critical transport and administration routes can include peripheral lines. With the importance of initiating therapy early to improve patient outcomes, the use of 3%S may benefit transported children with brain injury and suspected intracranial hypertension.
  • Mansbach J M, Clark S, Barcega B R B, Haddad H, & Camargo C A. (2009). Factors Associated With Longer Emergency Department Length of Stay for Children With Bronchiolitis A Prospective Multicenter Study. Pediatric Emergency Care, 25(10), 636-641. ( 10/2009 - Present )
    Objectives: Emergency department (ED) length of stay (LOS) is a quality of care measure and, when prolonged, contributes to ED crowding. Bronchiolitis, a common seasonal illness of infants, provides an opportunity to examine factors affecting ED LOS. Methods: We analyzed data from a 30-center prospective cohort study of ED patients younger than 2 years with an attending physician diagnosis of bronchiolitis to determine what factors affect LOS. Researchers conducted a structured interview and chart review. Results: Among 1459 children enrolled, ED LOS was available for 1416 children (97%). The median ED LOS was 3.3 hours (interquartile range, 2.3-4.8 hours). Multivariate analysis demonstrated that factors significantly (P < 0.05) associated with ED LOS were larger annual ED visit volume (reference, lowest tertile [<44,134 visits], 44,134-62,420 [b = 0.74], and >= 62,421 [beta = 0.63]), Hispanic race/ethnicity (reference, white race, beta = 1.43), lack of primary care provider (beta = 1.28), duration of symptoms of 4 to 7 days (reference, <1 day; beta = 0.58), presentation of midnight to 7 AM (reference, 4:00-11:59 PM; beta = 1.07), decreasing lowest oxygen saturation in ED (beta = 0.07), fewer number of beta-agonists during the first hour (beta = 0.74), unknown oral intake (reference, adequate; beta = 0.69), performance of chest x-ray (beta = 0.62), and hospital admission (beta = 1.11). Conclusions: In this prospective multicenter study of children younger than 2 years with bronchiolitis, multiple factors were associated with longer ED LOS. These factors suggest the following steps to help shorten ED LOS: optimizing translation services, improving primary care provider rates, enhancing overnight patient flow, forgoing chest x-rays, and developing evidence-based admission criteria.
  Books and Chapters
  • Barcega B, Minasyan L. Lower Extremity Injuries. Pediatric Emergency Medicine: Elsevier Mosby, 2006. ( 1/2006 )