Pediatric emergency care最新文献

Objective: To systematically evaluate the impact of virtual reality (VR) technology on pediatric patients during venous access in the emergency departments (EDs).

Methods: Randomized controlled trials (RCTs) investigating the effects of VR technology on pediatric patients during venous access in the EDs were retrieved from databases including CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, Embase, and Web of Science, with the search period spanning from inception to July 2025. Data analysis was performed using RevMan 5.2 software.

Results: A total of 8 RCTs involving 629 pediatric patients in the EDs were included. The analysis revealed that the VR technology group showed significantly better outcomes in pain scores compared with the control group (SMD=-0.73, 95% CI=-1.42 to -0.04, P=0.04). However, no significant differences were observed between the 2 groups in fear scores (SMD=-0.94, 95% CI=-2.13 to 0.26, P=0.12) or first-attempt success rate (OR=1.01, 95% CI=0.60-1.72, P=0.96).

Conclusion: VR technology may help alleviate pain in pediatric patients during venous access in the EDs, but no significant improvements were found in reducing fear or increasing the first-attempt success rate.

Objective: Current scoring tools are suboptimal to predict care escalation in infants with bronchiolitis. Single-center studies suggest that respiratory oxygenation index (ROX) and ROX-heart rate (ROX-HR) may have predictive value. We evaluated the ability of these measures to predict care escalation in a multicenter cohort of infants with bronchiolitis initiated on high-flow nasal cannula (HFNC).

Methods: We performed a secondary analysis of a retrospective multicenter cohort study of infants with bronchiolitis initiated on HFNC at 3 pediatric emergency departments (EDs) between February 1, 2018 and March 1, 2020. ROX [(SpO2/FiO2)/RR] and ROX-HR (ROX/HR × 100) were calculated at triage and pre-HFNC initiation. We defined care escalation as the need for positive pressure ventilation or ICU care.

Results: Of 738 infants, 73 (9.9%) required care escalation. These infants had higher maximum heart and respiratory rate, greater proportion were hypoxemic and required higher HFNC support. While there were no significant differences in mean initial ROX [9.4 (3.1) vs 9.4 (3.0); P = 0.81], pre-HFNC ROX [9.4 (3.0) vs 9.0 (2.9); P = 0.24] and initial ROX-HR [6.4 (2.7) vs 6.4 (2.5); P = 0.94], there was a small difference in pre-HFNC ROX-HR (5.7±2.0 vs 5.4±2.0; P = 0.048) between those who did and did not require care escalation. AUROCs for initial and pre-HFNC ROX were 0.51 (95% CI, 0.43-0.58) and 0.54 (95% CI, 0.47-0.61), and initial and pre-HFNC ROX-HR were 0.50 (95% CI, 0.43-0.58) and 0.57 (95% CI, 0.49-0.64), respectively.

Conclusion: ROX and ROX-HR showed poor ability to predict care escalation in infants with bronchiolitis initiated on HFNC.

Objectives: Ultrasonographic measurement of optic nerve sheath diameter (ONSD) is emerging as a noninvasive method for assessing intracranial pressure (ICP) in children. However, its practical application is limited by the lack of adequate age-specific normative data for healthy children. This study aimed to establish age-specific reference ranges for ONSD in healthy children aged 4 to 18 years and assess how anthropometric factors such as body mass index (BMI), height, and weight affect ONSD measurements.

Methods: This cross-sectional study included 150 healthy children aged 4 to 18 years, with no suspicion of increased ICP or chronic illness. ONSD was measured bilaterally using standardized transorbital ultrasonography. Anthropometric z-scores were calculated and correlations and percentile-based reference intervals were determined.

Results: The mean ONSD was 3.67±0.50 mm, with higher values in the 11 to 18 years group compared with the 4 to 10 years group (3.80±0.45 mm vs. 3.51±0.51 mm, P<0.001). ONSD positively correlated with age, height, weight, and BMI in the overall sample. Subgroup analyses revealed that BMI was significantly associated with ONSD only in the 11 to 18 years group. The age-specific 97th percentile upper limits were 4.33 mm (4 to 10 y) and 4.40 mm (11 to 18 y).

Conclusions: This study provides age-specific normative reference intervals for ONSD in healthy children and shows the impact of BMI on ONSD measurements in adolescents. These findings enhance the clinical interpretation of ONSD in pediatric settings and support its integration into noninvasive ICP assessment protocols. Further multicenter studies are required to validate the reference values.

Objectives: This study explored the use of different applied machine learning (ML) classification algorithms to predict hospital admission for infants treated by emergency medical services (EMS) after a suspected brief resolved unexplained event (BRUE).

Methods: Data from a large regionalized pediatric care system were obtained for infants in which paramedic suspected a BRUE and who were transported between July 2017 and February 2021. After data pre-processing, a random 80%/20% split for training and testing was performed. First, a random forest ML classification model was used to identify and select the most important variables influencing the prediction of hospital admission. Then, multiple ML-based models and a statistical model were trained with this subset of variables and evaluated the performance of each to predict hospital admission. Model performance characteristics including the area under the receiver operator curve (AUROC) were reported.

Results: A total of 508 infants were included; 300 (59%) were admitted and 76 (15%) required critical care. The most important variables in predicting hospital admission were age, history of bystander interventions (ie, cardiopulmonary resuscitation and back blows), presence of past medical history, and a normal appearing examination. In the prediction of hospital admission, the support vector machine model achieved the highest AUROC of 0.85, with a sensitivity of 0.88 (95% CI: 0.80-0.96) and specificity of 0.71 (95% CI: 0.57-0.85). The predictive performance of the extreme gradient boosting, RF, and logistic regression models were similar (AUROC: 0.83 to 0.84).

Conclusions: The applied ML models demonstrated good predictive performance for hospital admission for EMS-treated infants with a paramedic suspected BRUE. ML and statistical models had similar predictive performance.

Objective: To externally validate a set of 9 ICD-10-CM billing diagnosis codes to identify pediatric ED encounters with agitation and aggression by determining their sensitivity and specificity compared with electronic health record (EHR) review.

Methods: We performed a retrospective cross-sectional single-test diagnostic accuracy study of mental health encounters in the pediatric ED of an academic urban children's hospital, utilizing EHR data for mental health encounters by children 6 to 18 years old from April 12, 2023, to December 30, 2023. The index test was the presence of any of 9 aggression-related diagnosis codes as utilized by Peleggi et al The reference test consisted of a structured EHR review to confirm that agitation/aggression was a reason for the visit. Sensitivity, specificity, positive predictive value and negative predictive value were calculated with 95% CIs.

Results: We identified 855 pediatric mental health encounters (63%, 13 to 18 y old, 59% female). The diagnosis code set identified agitation/aggression in 62 encounters (7%), compared with 118 encounters (14%) confirmed to have agitation/aggression based on clinician notes. The 9 diagnosis codes yielded a sensitivity of 40% (95% CI: 31%, 49%) and specificity of 98% (95% CI: 97%, 99%) compared with EHR review, with a positive predictive value of 76% (63%, 85%) and a negative predictive value of 91% (89%, 93%).

Conclusions: Upon external validation, a set of 9 billing diagnosis codes had poor sensitivity and excellent specificity for the identification of pediatric ED visits with agitation/aggression. Novel methods such as natural language processing may be needed to accurately identify pediatric ED visits with aggression/agitation.

Objective: To identify clinical and laboratory risk factors for invasive infection in febrile oncology patients seen in the Pediatric Emergency Department, depending on the type of cancer.

Methods: We conducted a prospective observational study of febrile oncology patients seen between 2016 and 2023 at the Pediatric Emergency Department of a tertiary teaching hospital. Invasive infection was defined microbiologically (isolation of a bacterial pathogen in sterile fluid or a commensal bacterial species in 2 different blood cultures) or clinically (death, meeting Phoenix criteria for sepsis, receiving inotropic support, or developing acute complications or sequelae). We performed separate multivariate analyses for hematologic cancers and solid tumors. Hematologic cancers were further classified considering the myelotoxicity of the chemotherapy received. We classified the following as high-risk hematologic cancers: acute lymphoblastic leukemia and non-Hodgkin lymphoma in the induction, reinduction, or consolidation phase or relapse, and acute myeloid leukemia in any phase.

Results: We included 471 episodes: 306 hematologic cancers and 165 solid tumors. The median age was 4 years (interquartile range: 2 to 10) and the median duration of fever was 2 hours (interquartile range: 1 to 3). Invasive infections were diagnosed in 69 cases (14.6%). The rate was higher among patients with high-risk hematologic cancers (n=45, 23.2%), than among those with solid tumors (n=18, 10.9%; P=0.002) or with low-risk hematologic cancers (n=6, 5.4%; P<0.001). Among patients with hematological cancers, presenting a high-risk cancer (OR: 6.006; 95% CI: 2.459-18.200) and elevated procalcitonin levels (OR: 1.668; 95% CI: 1.205-2.571) were predictors of invasive infection [AUC for the model: 0.718 (95% CI: 0.640-0.795)]. Only age (OR: 1.145; 95% CI: 1.036-1.267) was found to be an independent risk factor in patients with solid tumors.

Conclusions: In patients with hematologic cancers and very recent onset fever, the type of cancer and procalcitonin level are useful for predicting the risk of invasive infection.

Objective: To evaluate rates of critical illness and significant infection among children discharged from the emergency department (ED) with a pending blood culture.

Methods: We conducted a cross-sectional study of children 90 days to 18 years old discharged from one of 37 pediatric EDs between 2016 and 2024 with a complete blood count or C-reactive protein performed. Our primary outcome was a diagnosis of specific bacteremia on representation to the ED within 3 days. Secondary outcomes on 3-day return visit included: (1) sepsis, (2) intensive care unit admission, and (3) receipt of ≥3 days of systemic antibiotics. We evaluated for differences in outcomes based on the performance of a blood culture on the index visit.

Results: We included 416,357 discharges (median encounter age 6.3 y, IQR: 2.1 to 12.7). Of these, 229,269 (55.1%) had a blood culture collected. Among encounters with a blood culture, 0.1% (n = 151; 95% CI: 0.1-0.1) had specific bacteremia on return visit. Encounters with a blood culture at the index visit had higher odds of specific bacteremia [odds ratio (OR) 10.86, 95% CI: 5.8-20.34], sepsis (OR: 3.16, 95% CI: 1.88-5.30), intensive care unit admission (OR: 2.82, 95% CI: 1.94-4.12), and ≥3 days of systemic antibiotics (OR: 4.77, 95% CI: 4.17-5.46).

Conclusions: Children discharged with a pending blood culture have higher rates of significant bacteremia and other clinically important return visits than children discharged without a blood culture, though absolute rates of these outcomes were low. Improved guidelines are needed to better identify children who require blood cultures.

Objectives: We aimed to describe patient and encounter characteristics of patient portal users and nonusers and to evaluate usage of specific portal functions in a pediatric emergency department (PED).

Methods: A single-center retrospective analysis of patients up to 21 years of age at an urban, tertiary care pediatric emergency department was conducted. Portal registration status of patients was analyzed. Relations between variables and usage were evaluated using logistic regression. Portal functions were analyzed for prevalence and timing of usage with respect to the PED encounter.

Results: Portal users made up 48.4% of 29,881 patients. Variables associated with portal usage included multiple prior PED visits (aOR 2.19, CI: 2.04-2.35), multiple admissions (aOR 2.61, CI: 2.00-3.46), PED length of stay greater than 6 hours (aOR 1.30, CI: 1.17-1.5,) and patient Hispanic ethnicity (aOR 1.24, CI: 1.13-1.36). Non-English primary language (aOR 0.64, CI: 0.60-0.70) and patient male sex (aOR 0.90, CI: 0.84-0.96) were associated with lower likelihood of usage. About 17% of users viewed laboratory and imaging results during the PED visit, and 67% within 7 days after visit.

Conclusions: Between portal users and nonusers, there are differences with respect to patient sex, ethnicity, primary language, number of prior emergency visits and admissions, and length of stay in the pediatric emergency department. Portals are not commonly accessed during visits but are commonly used to view laboratory and imaging data after the emergency visit.

Objectives: CO intoxication is a leading cause of poisoning-related death worldwide. Little is known about the connection between the source of poisoning and the clinical outcome. Our primary goal in this study was to establish this connection.

Methods: We conducted a retrospective cohort study using data retrieved from medical records of all cases presented to the Pediatric Emergency Department at University Medical Center (UMC), between 2016 and 2024, of children aged 0 to 18 years who were admitted with suspected CO intoxication and carboxyhemoglobin (COHb) levels exceeding 5%. "The exposure mechanisms were categorized into 3 groups: smoke inhalation by fire, intentional heating, or gas used for water heating."

Results: Ninety-five children had COHb levels above 5%. The mean age of patients varied across exposure groups (P <0.001). Individuals exposed to gas were older (13.65±3.2 y), compared with smoke inhalation (6.9±5.85 y) or heating-related incidents (10.26±4.64 y). Poor outcomes (defined as death, intensive care admission, or hyperbaric chamber treatment) were most frequent in the gas group (90%, P = 0.002), followed by fire exposures (65%) and heating-related cases (49%).

Conclusions: We found a strong correlation between causality (gas for water heating) and outcomes. We also showed some correlation between clinical and laboratory features that could result in severe outcomes. These findings could help guide preventive measures and further studies in the future.

Background: Pediatric out-of-hospital cardiac arrest (P-OHCA) has a low incidence rate with a survival rate ranging from 2% to 11%. While national guidelines exist for P-OHCA management, they do not clearly address how long EMS providers should treat on-scene and when to initiate transportation.

Objective: This study aims to explore the factors influencing scene time and its correlation with the return of spontaneous circulation (ROSC) in pediatric cases using the National Emergency Medical Services Information System (NEMSIS).

Methods: This retrospective cohort study analyzed NEMSIS data from 2019 to 2020. P-OHCA cases who received EMS treatment and were transported to the ED were included. We examined demographic and scene-related factors influencing EMS scene time and categorized interventions by scene time groups (<10, 10 to 30, >30 min). Using multivariable logistic regression, the study explored the relationship between scene time and ROSC, adjusting for various clinical and demographic predictors, and validated the model with calibration plots and sensitivity analyses.

Results: A total of 8467 cardiac arrest cases met the inclusion criteria for analysis. The most common EMS scene time was 10 to 30 minutes, and longer scene times were significantly associated with ROSC. ROSC was more likely with older age, public or health care arrest locations, and defibrillation use, while airway interventions and medications were associated with lower odds of ROSC.

Conclusion: We found that younger children had shorter EMS scene times, while those who achieved ROSC had longer scene times. Further investigation is needed to clarify the underlying factors and their impact on survival and neurological outcomes.