About

Ron Keren, MD, MPH, is a Professor of Pediatrics (General Pediatrics) at the Children's Hospital of Philadelphia. He holds a medical degree from New York University School of Medicine and a Master of Public Health in Clinical Effectiveness from Harvard School of Public Health. His educational background also includes a Bachelor of Arts in Philosophy from Princeton University. His professional focus involves pediatric healthcare, with a particular emphasis on clinical effectiveness and health outcomes. His research contributions include studies on the impact of antiviral treatments on hospitalized children with influenza, the association between body mass index and urolithiasis in children, and the quality of care for children hospitalized with acute gastroenteritis. He has also investigated disparities in the evaluation and diagnosis of abuse among infants with traumatic brain injury, as well as the effects of corticosteroids in treating Henoch-Schönlein purpura. His work often involves federating clinical data from multiple pediatric hospitals to improve pediatric care and outcomes.

Research topics

• Medicine
• Pediatrics
• Family medicine
• Internal medicine
• Emergency medicine

Selected publications

• Promoting Clinical Expertise in the Age of AI

  JAMA · 2026-05-07

  article1st authorCorresponding

  This Viewpoint discusses how overreliance on artificial intelligence (AI) can lead to deskilling and mis-skilling among clinicians still in training and the importance of thoughtful design and implementation into the clinical learning environment.

  PublisherDOI

• Promoting Child Health by Protecting the Patient-Clinician Relationship From Politics

  JAMA Pediatrics · 2024-08-12 · 7 citations

  letter

  Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Pediatrics HomeNew OnlineCurrent IssueFor Authors Podcast Journals JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2024 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Pediatrics journal

  PublisherDOI

• Importance of risk adjusting central line-associated bloodstream infection rates in children

  Infection Control and Hospital Epidemiology · 2024-10-07 · 1 citations

  articleOpen accessSenior author

  OBJECTIVE: Central line-associated bloodstream infection (CLABSI) is one of the most prevalent pediatric healthcare-associated infections and is used to benchmark hospital performance. Pediatric patients have increased in acuity and complexity over time. Existing approaches to risk adjustment do not control for individual patient characteristics, which are strong predictors of CLABSI risk and vary over time. Our objective was to develop a risk adjustment model for CLABSI in hospitalized children and compare observed to expected rates over time. DESIGN AND SETTING: We conducted a prospective cohort study using electronic health record data at a quaternary Children's Hospital. PATIENTS: We included hospitalized children with central catheters. METHODS: Risk factors identified from published literature were considered for inclusion in multivariable modeling based on association with CLABSI risk in bivariable analysis and expert input. We calculated observed and expected (risk model-adjusted) annual CLABSI rates. RESULTS: Among 16,411 patients with 520,209 line days, 633 patients experienced 796 CLABSIs. The final model included age, behavioral health condition, non-English speaking, oncology service, port catheter type, catheter dwell time, lymphatic condition, total parenteral nutrition, and number of organ systems requiring ICU level care. For every organ system receiving ICU level care the odds ratio for CLABSI was 1.24 (95% CI 1.12-1.37). Although not statistically different, observed rates were lower than expected rates for later years. CONCLUSIONS: Failure to adjust for patient factors, particularly acuity and complexity of disease, may miss clinically significant differences in CLABSI rates, and may lead to inaccurate interpretation of the impact of quality improvement efforts.

  PublisherOA PDFDOI

• Identifying Conditions With High Prevalence, Cost, and Variation in Cost in US Children’s Hospitals

  JAMA Network Open · 2021-07-26 · 66 citations

  articleOpen access

  Importance: Identifying high priority pediatric conditions is important for setting a research agenda in hospital pediatrics that will benefit families, clinicians, and the health care system. However, the last such prioritization study was conducted more than a decade ago and used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Objectives: To identify conditions that should be prioritized for comparative effectiveness research based on prevalence, cost, and variation in cost of hospitalizations using contemporary data at US children's hospitals. Design, Setting, and Participants: This retrospective cohort study of children with hospital encounters used data from the Pediatric Health Information System database. Children younger than 18 years with inpatient hospital encounters at 45 tertiary care US children's hospitals between January 1, 2016, and December 31, 2019, were included. Data were analyzed from March 2020 to April 2021. Main Outcomes and Measures: The condition-specific prevalence and total standardized cost, the corresponding prevalence and cost ranks, and the variation in standardized cost per encounter across hospitals were analyzed. The variation in cost was assessed using the number of outlier hospitals and intraclass correlation coefficient. Results: There were 2 882 490 inpatient hospital encounters (median [interquartile range] age, 4 [1-12] years; 1 554 024 [53.9%] boys) included. Among the 50 most prevalent and 50 most costly conditions (total, 74 conditions), 49 (66.2%) were medical, 15 (20.3%) were surgical, and 10 (13.5%) were medical/surgical. The top 10 conditions by cost accounted for $12.4 billion of $33.4 billion total costs (37.4%) and 592 815 encounters (33.8% of all encounters). Of 74 conditions, 4 conditions had an intraclass correlation coefficient (ICC) of 0.30 or higher (ie, major depressive disorder: ICC, 0.49; type 1 diabetes with complications: ICC, 0.36; diabetic ketoacidosis: ICC, 0.33; acute appendicitis without peritonitis: ICC, 0.30), and 9 conditions had an ICC higher than 0.20 (scoliosis: ICC, 0.27; hypertrophy of tonsils and adenoids: ICC, 0.26; supracondylar fracture of humerus: ICC, 0.25; cleft lip and palate: ICC, 0.24; acute appendicitis with peritonitis: ICC, 0.21). Examples of conditions high in prevalence, cost, and variation in cost included major depressive disorder (cost rank, 19; prevalence rank, 10; ICC, 0.49), scoliosis (cost rank, 6; prevalence rank, 38; ICC, 0.27), acute appendicitis with peritonitis (cost rank, 13; prevalence rank, 11; ICC, 0.21), asthma (cost rank, 10; prevalence rank, 2; ICC, 0.17), and dehydration (cost rank, 24; prevalence rank, 8; ICC, 0.18). Conclusions and Relevance: This cohort study found that major depressive disorder, scoliosis, acute appendicitis with peritonitis, asthma, and dehydration were high in prevalence, costs, and variation in cost. These results could help identify where future comparative effectiveness research in hospital pediatrics should be targeted to improve the care and outcomes of hospitalized children.

  PublisherOA PDFDOI

• Variation in tonsillectomy cost and revisit rates: analysis of administrative and billing data from US children’s hospitals

  BMJ Quality & Safety · 2020-06-30 · 10 citations

  article

  Background Tonsillectomy is one of the most common and cumulatively expensive surgical procedures in children. We determined if substantial variation in resource use, as measured by standardised costs, exists across hospitals for performing tonsillectomy and if higher resource use is associated with better quality of care, as measured by revisits to hospital. Methods We conducted a retrospective analysis of children undergoing routine outpatient tonsillectomy between 2011 to 2017 across US children's hospitals using an administrative and billing data source. The primary outcome measures were the hospital tonsillectomy standardised cost and the 30-day revisit rate to hospital. We analysed the interhospital variation in standardised cost by determining the number of outlier hospitals in standardised cost and the intraclass correlation coefficient. Results 131 814 children (median age 6 years, IQR: 4,9; female sex 52.5%) underwent tonsillectomy for airway obstruction (62.9%) and infection (23.9%) across 28 hospitals. The median adjusted hospital standardised cost for tonsillectomy was $2392 (IQR: $1827, $2793; range: $1166 to $4222). There was substantial interhospital variation in costs as 11 (40%) hospitals were cost outliers, and the intraclass correlation coefficient was 0.62, suggesting that 62% of the variation in cost was attributable to variation between hospitals. The median hospital revisit rate was 9.5% (IQR: 7.8, 12.1) and higher hospital costs did not correlate with lower revisit rates ( r s =0.03, 95% CI −0.36 to 0.41; p=0.87). Conclusions There is substantial variation in hospital resource use and standardised costs for routine outpatient tonsillectomy across US children’s hospitals. Higher resource use is not associated with lower revisit rates. Further study is needed to understand the practices of lower resource use hospitals who deliver high quality of care.

  PublisherDOI

• Antimicrobial Resistance and Urinary Tract Infection Recurrence

  UNC Libraries · 2020-04-21

  articleOpen access

  The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial found that recurrent urinary tract infections (rUTI) with resistant organisms were more common in the trimethoprim-sulfamethoxazole prophylaxis (TSP) arm. We describe factors associated with trimethoprim-sulfamethoxazole (TMP-SMX) resistance of rUTIs in RIVUR.

  PublisherDOI

• Recurrent Urinary Tract Infections in Children With Bladder and Bowel Dysfunction

  UNC Libraries · 2020-04-21

  articleOpen access

  Little generalizable information is available on the outcomes of children diagnosed with bladder and bowel dysfunction (BBD) after a urinary tract infection (UTI). Our objectives were to describe the clinical characteristics of children with BBD and to examine the effects of BBD on patient outcomes in children with and without vesicoureteral reflux (VUR).

  PublisherDOI

• Predictors of Antimicrobial Resistance among Pathogens Causing Urinary Tract Infection in Children

  UNC Libraries · 2020-04-22

  articleOpen access

  To determine which children with urinary tract infection (UTI) are likely to have pathogens resistant to narrow-spectrum antimicrobials.

  PublisherDOI

• Early Antibiotic Treatment for Pediatric Febrile Urinary Tract Infection and Renal Scarring

  UNC Libraries · 2020-04-18

  articleOpen access

  Existing data regarding the association between delayed initiation of antimicrobial therapy and the development of renal scarring are inconsistent. To determine whether delay in the initiation of antimicrobial therapy for febrile urinary tract infections (UTIs) is associated with the occurrence and severity of renal scarring. Retrospective cohort study that combined data from 2 previously conducted longitudinal studies (the Randomized Intervention for Children With Vesicoureteral Reflux trial and the Careful Urinary Tract Infection Evaluation Study). Children younger than 6 years with a first or second UTI were followed up for 2 years. Duration of the child's fever prior to initiation of antimicrobial therapy for the index UTI. New renal scarring defined as the presence of photopenia plus contour change on a late dimercaptosuccinic acid renal scan (obtained at study exit) that was not present on the baseline scan. Of the 482 children included in the analysis, 434 were female (90%), 375 were white (78%), and 375 had vesicoureteral reflux (78%). The median age was 11 months. A total of 35 children (7.2%) developed new renal scarring. Delay in the initiation of antimicrobial therapy was associated with renal scarring; the median (25th, 75th percentiles) duration of fever prior to initiation of antibiotic therapy in those with and without renal scarring was 72 (30, 120) and 48 (24, 72) hours, respectively (P = .003). Older age (OR, 1.03; 95% CI, 1.01-1.05), Hispanic ethnicity (OR, 5.24; 95% CI, 2.15-12.77), recurrent urinary tract infections (OR, 0.97; 95% CI, 0.27-3.45), and bladder and bowel dysfunction (OR, 6.44; 95% CI, 2.89-14.38) were also associated with new renal scarring. Delay in the initiation of antimicrobial therapy remained significantly associated with renal scarring even after adjusting for these variables. Delay in treatment of febrile UTIs and permanent renal scarring are associated. In febrile children, clinicians should not delay testing for UTI.

  PublisherDOI

• Predictors Of Non-Escherichia Coli Urinary Tract Infection

  UNC Libraries · 2020-04-22

  articleOpen access

  We aimed to determine which children are prone to non-Escherichia coli coli UTIs. We included 769 children with UTI. We found that circumcised males, Hispanic children, children without fever, and children with Grade 3–4 VUR were more likely to have a UTI caused by organisms other than E. coli. This information may guide clinicians in their choice of antimicrobial therapy.

  PublisherDOI

Recent grants

• NIH Grant R01HS019862

  NIH · $8.7M · 2015

• NIH Grant K23HD043179

  NIH · $801k · 2009

• NIH Grant R01DK078045

  NIH · $2.9M · 2015

• NIH Grant U01DK074064

  NIH · $2.8M · 2015

Frequent coauthors

• Dimitri Christakis

  University of Washington

  404 shared

• Aaron E. Carroll

  Providence College

  404 shared

• James Madara

  St. Louis County Missouri

  404 shared

• Michael Berkwits

  404 shared

• Monica Smith

  Dell Children's Medical Center of Central Texas

  404 shared

• Annette Flanagin

  404 shared

• Michael Mcgraw

  Perspectives Charter School

  403 shared

• Gretchen Linder

  Washington University in St. Louis

  403 shared

Education

• MPH, Clinical Effectiveness

  Harvard School of Public Health

  2001

• MD

  New York University School of Medicine

  1994

• BA, Philosophy

  Princeton University

  1989