Pediatric emergency care最新文献

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.

Objective: Aggressive behavior by pediatric patients in emergency departments (EDs) threatens safety and care delivery, yet few studies have evaluated tools to identify children at risk. We examined the association between Dynamic Appraisal of Situational Aggression (DASA) scores and the use of safety medications or physical restraints during pediatric ED encounters.

Methods: In this cross-sectional study, patients aged 5 to 17 presenting to 5 EDs from January 11 to December 31, 2023, were assigned a DASA score at triage. Clinical information was abstracted from the electronic health record, and patients were stratified into low, moderate, high, or imminent aggression risk categories. The primary outcome was the use of a behavioral intervention (physical restraint or injected safety medications). Adjusted prevalence ratios (PRs) by risk category were estimated using modified Poisson regression.

Results: We identified 17,482 qualifying ED encounters [median age 12 (IQR: 8-15); 49.4% female]. Higher DASA scores were strongly associated with greater use of behavioral interventions. Compared with low-risk patients, those with imminent-risk scores had an adjusted prevalence ratio (PR) of 11.45 (95% CI: 8.16-16.06; P <0.001) for any intervention, 46.67 (95% CI: 31.53-60.61; P<0.001) for physical restraint, and 11.30 (95% CI: 7.99-15.98; P<0.001) for medication administration.

Conclusions: Elevated DASA scores at ED triage are associated with increased use of behavioral interventions in pediatric patients, representing the first aggression prediction tool with demonstrated value in both adult and pediatric populations. Future research should examine whether proactive, DASA-guided interventions can reduce aggression risk.

Objectives: To describe the youngest and second ever reported patient with real-time point-of-care ultrasound (POCUS) visualization of motile Enterobius vermicularis within the appendix and to demonstrate how real-time intraluminal motion aids in distinguishing parasitic infestation from typical obstructive appendicitis.

Methods: We present the clinical course, ultrasound findings, and management of a 23-month-old girl with acute intermittent abdominal pain.

Results: POCUS revealed a dilated, noncompressible appendix containing multiple linear echogenic structures demonstrating serpiginous, independent motion-highly suggestive of E. vermicularis. Mild periappendiceal echogenicity suggested early acute appendicitis. The patient was successfully managed nonoperatively with albendazole and intravenous antibiotics, experiencing complete symptom resolution within 24 hours. This represents the youngest and second-ever reported patient in whom real-time sonographic visualization of live appendiceal parasites has been reported.

Conclusions: True intraluminal motility is a critical sonographic discriminator of parasitic infestation and can fundamentally alter management decisions. In this case, early identification of E. vermicularis supported a safe, nonoperative strategy for early appendicitis. Incorporating POCUS early in the evaluation of atypical pediatric abdominal pain may prevent unnecessary surgical intervention.

Background: Sepsis is one of the leading causes of death among children worldwide. The Society of Critical Care Medicine Pediatric Sepsis Definition Task Force developed and validated the Phoenix sepsis criteria, new clinical criteria for pediatric sepsis and septic shock based on organ dysfunction. Although this represents a significant advancement in standardizing sepsis and septic shock definitions, its applicability in emergency department (ED) settings remains unexplored.

Importance: Given that EDs are often the first point of contact for critically ill children, we must examine the use of the Phoenix criteria in these settings and across varying resource levels. In this CME review article, we explore the evolution of pediatric sepsis definitions to the Phoenix sepsis criteria, and its utility, strengths, and limitations in emergency care in both high-resource and low-resource ED settings.

Objectives: Can an innovative projective drawing test assist children in disclosing their bullying exposure? Bullying leads to recurrent emergency department visits for physical or emotional trauma, hindered by children's reluctance to verbalize. Identifying patterns, referred to as graphic indicators, can characterize forms of trauma linked to bullying.

Methods: Sixty-four children aged 7 to 18 years with psychosomatic complaints at a pediatric hospital emergency department were asked to draw themselves on paper. Drawings were scored blindly by counting the frequency of 22 graphic indicators on self-figure drawings used to assess various forms of child abuse. Children were categorized using the Illinois Bully Scale score. Discriminant analysis evaluated the relative weighting of the 22 graphic indicators, aiming for optimal discrimination between the bullied and non-bullied groups. ROC analysis was utilized to maximize the diagnostic accuracy of the drawing test.

Results: Four graphic indicators emerged as potential markers of bullying: (1) missing legs or feet, (2) dots, hollowed or crossed eyes, (3) double line, hollowed, or shaded facial contours, and (4) asymmetric or horizontal arm positions. Discriminant scores ranged from 0.00 (indicating no bullying) to 4.76 (indicating bullying). The criterion separating the two groups was a discriminant score >1.90. The resulting area under the curve was 0.88 ( P < 0.001), indicating good predictive ability. The test demonstrated a sensitivity of 69% and a specificity of 91%.

Conclusions: Identifiable drawing cues in children may signal bullying, highlighting the need for further research to develop a standardized tool for early identification of bullying exposure before it can be applied in practice.

Objectives: Dental abscesses are common pediatric emergencies requiring prompt intervention. It is unclear which treatment approach is superior in pediatric populations. This retrospective study compared outcomes between pediatric patients treated with drainage and those managed with antibiotic treatment alone.

Methods: Data from 211 patients at 2 campuses of the same medical center were analyzed, assessing demographics, clinical presentation, laboratory findings, treatment modalities, and outcomes.

Results: Demographics, symptom duration, fever characteristics, or laboratory parameters were comparable between the two groups. There were no significant differences in hospitalization length or treatment failure rates. However, admission rates were significantly lower in the drainage group compared with the conservative treatment group (49% vs 63%, P = 0.04).

Conclusion: Antibiotic treatment was found to be noninferior to drainage in terms of treatment failure and hospitalization duration, although admission rates were higher in the antibiotic treatment group. These findings suggest that antibiotic management may be an appropriate alternative in selected cases. Further prospective studies are needed to define the optimal treatment strategy based on clinical presentation and patient-specific factors.

In 2025, we reported our experience with the following regimen for pediatric ED procedural sedation: 6 mg/kg oral (PO) ketamine (max 200 mg) and 0.5 mg/kg PO midazolam (max 15 mg). We present 2 children who received this regimen with respiratory depression after apparent recovery. PO ketamine and midazolam may cause a delayed sedative effect, which may limit its usefulness.