Paediatrics & child health最新文献

Background: Artificial intelligence (AI) encompasses a wide range of technologies that enable computers to mimic human intellect and is playing a significant role in healthcare education.

Objectives: To review the current applications of AI in paediatric postgraduate medical education programs.

Methods: A scoping review was conducted using a comprehensive literature search involving Ovid MEDLINE, Ovid Embase, and ERIC conducted from 1946 to May 27, 2024. Inclusion criteria involved articles that discussed AI in postgraduate paediatric education. Articles that addressed undergraduate education and other health professional education were excluded.

Results: Nine articles met the inclusion criteria. Four studies were conducted in the United States, two in China, and one each in France, Korea, and Canada. The studies discussed the use of AI in general paediatrics, paediatric oncology, developmental paediatrics, and paediatric genetics. AI was used as a clinical decision support tool in postgraduate training in seven studies with mixed results on the accuracy of AI predictions. One study used AI models to assess residents' intubation competency, and another assessed the experiences and general perspectives of AI among paediatric residents and junior faculty.

Conclusions: Amongst included studies, AI was largely used as a clinical decision support tool in paediatric postgraduate education and the accuracy of AI predictions are improved when large amounts of data are used to train and tune the AI model. As such, physicians should be trained in AI use and take an active role in training and tuning AI models on an ongoing basis to ensure appropriate use of AI in healthcare.

Background: The diagnostic value of a single C-reactive protein (CRP) measurement in distinguishing bacterial from non-bacterial infections is limited. CRP velocity (CRPv), a dynamic metric derived from sequential CRP measurements, has shown promise in enhancing diagnostic accuracy in adults.

Aims: To evaluate the association between CRPv in the first 24 hours of presentation and bacterial etiologies in pediatric patients with initial CRP level < 31.9 mg/L on presentation to the pediatric emergency department (PED).

Methods: A retrospective cohort analysis of patients under 18 years of age who presented to our emergency department from 2018 through 2021. Each patient had two CRP measurements within a 24-hour period. CRPv was computed as the difference between the first (CRP1) and second (CRP2) CRP values divided by the time interval between measurements. Bacterial infections were determined based on discharge diagnoses, including positive cultures or clinical/radiological evidence.

Results: Of 307 patients with initial CRP1 ≤ 31.9 mg/L, 103 (33.5%) were diagnosed with bacterial infections. Patients with bacterial infections had significantly higher CRP1, CRP2, and CRPv values. CRPv showed the highest area under the curve (AUC) and was the strongest independent predictor of bacterial infection, with an adjusted odds ratio of 2.8 (95% CI 1.3 to 6.0, P = 0.005).

Conclusions: CRPv provides superior diagnostic accuracy compared to single CRP measurements in identifying bacterial infections in pediatric patients with low initial CRP levels, suggesting its potential for enhancing early detection and guiding treatment. Further prospective studies are needed to confirm its clinical utility.

Off-road vehicles (ORVs) are motorized vehicles engineered specifically for navigating rough terrain. They are often seen in rural, remote, and agricultural settings, but are widely used in Canada, primarily for recreation, and are responsible for a disproportionate number of severe injuries and deaths in the paediatric population. ORVs are becoming heavier and faster, and injuries associated with their use by children and adolescents are similar in severity to those sustained in motor vehicle crashes. However, while the automotive industry is bound by safety legislation, strict enforcement, and engineering and road strategies to prevent harm, there is no comparable regulatory framework for ORVs, leaving a gap in safety advancements. Based on a comprehensive literature search undertaken in February 2024, this statement provides an overview of the effects of ORV use by children and adolescents, factors influencing ORV crashes and resultant injuries, and recommendations for health care providers and governments to reduce preventable harms associated with ORVs in the paediatric population.

Acute head trauma (AHT) leading to traumatic brain injury is an important cause of paediatric morbidity and mortality. Injury severity depends on the mechanism of trauma and age of the child. The vast majority of childhood AHT cases are mild, require no therapy, and leave no long-term sequelae. However, it is important to identify individuals at risk for significant injury and those who require specific evaluation and intervention. This statement replaces a 2013 document from the Canadian Paediatric Society on this topic. It describes issues related to AHT in infants, children, and youth, including clinical manifestations, initial management priorities, guidelines for observation, imaging, and subsequent follow-up and treatment. The evaluation of patients with AHT at the time of initial assessment is also addressed.

Objectives: Pediatric gallstone disease is increasing in incidence, possibly due to rising rates of childhood obesity. There are concerns about delayed presentations and the need for surgery and endoscopic management. The aim of this project is to assess rates of cholecystectomy in pediatrics, distribution of pathology, impact of body mass index (BMI), and need for endoscopic retrograde cholangiopancreatography (ERCP).

Methods: We performed a retrospective cohort study of pediatric patients undergoing cholecystectomy and compared baseline characteristics and outcomes between different pathologies and between overweight (BMI ≥ 85^th percentile) and normal weight cohorts.

Results: A total of 210 patients were included with 108 (51.4%) undergoing elective gallbladder surgery, 35 (16.7%) undergoing emergent gallbladder surgery, and 67 (32.0%) requiring surgery for bile duct disease. Most were female (77.3%), overweight (69.9%), and adolescents (mean age 14.0 ± 2.9). Metabolic syndrome-associated steatotic liver disease was present in 5.3%, hereditary spherocytosis in 7.7%, and sickle cell disease in 1.4%. Thirty-eight required ERCP (18.1%). Patients presenting emergently had much longer lengths of stay than did those with elective admissions (median 3.0 ± 3.0 versus 0.0 ± 1.0 days, P < 0.001). Overweight patients more frequently experienced complications than the normal weight cohort (16% versus 7%, P = 0.044). Furthermore, length of stay (LOS) was also higher in the normal weight cohort than in the overweight group in elective biliary colic patients and emergent gallbladder patients (P = 0.007 and 0.042, respectively).

Conclusions: Gallstone disease in pediatrics often presents emergently. This is associated with worse outcomes such as prolonged LOS when compared with non-urgent cases. A significant proportion of patients present with common bile duct disease and require ERCP. Early diagnosis leading to surgical referral for patients with gallstone disease and multimodal strategies to decrease risk factors and expedite weight loss may help prevent complicated gallstone disease.

Importance: Bacteremia in children can lead to septic shock, meningitis or death. Knowledge of common pathogens and predictors is crucial for appropriate lifesaving management.

Objective: We aimed to identify pathogens and associated variables in children with bacteremia presenting to the emergency department (ED).

Methods: This retrospective cohort study was conducted in a tertiary pediatric hospital in Montreal, Canada (2018-2024). The full cohort included all children with a positive blood culture drawn in the ED while this study focused on cases of true bacteremia identified through medical record evaluation by two raters. The primary outcome was pathogen distribution. Potential pathogen-associated independent variables included demographics, vaccination status, recent travel, clinical presentation, and known risk factors. The primary analysis focused on pathogen prevalence, while secondary analysis assessed associations between predictors and pathogens using Chi-squared tests.

Results: Among 368 bacteremia cases (median age: 39 months), the most common pathogens were Staphylococcus aureus (25%), Escherichia coli (16%), Streptococcus pneumoniae (9.0%) and non-typhoidal Salmonella (8.7%). Overall, 175 (48%) had risk factors, including internal devices (n = 80, 22%), age less than 3 months (n = 59, 16%), or immunosuppression (n = 55, 15%). Significant associations emerged: 34% (n = 38) of Staphylococcus spp. infections involved internal devices, 62% (n = 24) of Salmonella spp. infections had recent travel, and 38% (n = 22) of E. coli infections and 69% (n = 11) of group B Streptococcus infections occurred in infants aged under 3 months.

Conclusions: Our study highlights current key pathogens and associated predictors in pediatric bacteremia. Travel history, internal hardware, age, and immunosuppression are crucial for clinicians to consider in its assessment and management.

Social determinants of health can profoundly impact child and adolescent health outcomes. As demands on Canadian primary health care continue to grow, there is an increasing risk that patients' needs will go unmet. Social prescribing offers a practical way to address these concerns across all ages. Using a personalized approach, social prescribing enables healthcare professionals to identify individuals' non-medical needs and connect them with appropriate community resources via dedicated community connectors. These connectors can collaborate with children, adolescents, and their families to explore their values, co-create a social prescription, support its implementation, and provide longitudinal follow-up. Pediatric healthcare providers are particularly well-poised to make these referrals to deliver comprehensive care that supports their patients' holistic development. This commentary highlights representative examples of Canadian social prescribing initiatives that can benefit pediatric patients, emphasizing how these practices can be adapted across developmental stages and grow alongside the individual.