Pediatric emergency care最新文献

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.

Objective: To evaluate the impact of nurse-led visits on in-person referrals for clinical evaluation from pediatric urgent care telehealth.

Methods: We conducted this quality improvement study within our 3 freestanding in-person pediatric urgent care clinics and telehealth service. In May 2022, we implemented nurse-led visits to offer diagnostic and therapeutic interventions including rapid group A streptococcal testing, urinalysis, respiratory viral testing, and intramuscular antibiotic injections without requiring an additional clinical evaluation following a telehealth encounter. We measured the percentage of telehealth encounters with in-person referrals as the primary outcome. We tracked the percentage of encounters with nurse-led visits and return visits within 72 hours as process and balancing measures, respectively. We used control charts to identify special cause variation over time.

Results: In-person referrals following telehealth visits decreased from 23.0% to 12.3% after implementing nurse-led visits. The use of nurse-led visits increased over time from 4.0% to 6.8%. Rapid group A streptococcal testing accounted for most nurse-led visits (64.0%). Only 2.8% of nurse-led visits resulted in return visits within 72 hours. Nurse-led visits were associated with shorter length of stays (32 min) compared with in-person clinical evaluations (69 min) and had an average cost-savings of $135 compared with visits of similar medical complexity.

Conclusion: Integrating nurse-led visits into urgent care telehealth encounters provides a safe and effective option for diagnostic and therapeutic interventions in the virtual setting. The results support the use of nurse-led visits to expand access to high-quality acute care, reduce unnecessary referrals, and promote evidence-based practice.

Diagnosing pneumonia in children presenting with nonspecific symptoms such as chest or back pain can be challenging. We present two cases in which specific positioning and ultrasonography technique were necessary to detect retroscapular consolidations, which traditionally have been thought to be difficult or impossible to visualize with point-of-care lung ultrasound (POCUS).

Objectives: Pediatric out-of-hospital cardiac arrest (OHCA) is rare but critical, requiring rapid and effective cardiopulmonary resuscitation (CPR). Delivering high-performance CPR (HPCPR) in the prehospital setting is challenging, especially for EMS clinicians with limited pediatric exposure. This study aimed to assess EMS clinicians' pediatric CPR experience, confidence in HPCPR, and access to CPR feedback systems. A secondary objective was to evaluate perceptions of augmented reality (AR) feedback systems.

Methods: A cross-sectional survey was distributed electronically to EMS clinicians in 5 Maryland counties from January to May 2024. The survey included items on demographics, CPR experience, confidence in pediatric resuscitation, feedback device usage, and opinions on AR-based guidance. Descriptive and comparative analyses were conducted based on clinician type, experience, and administrative role.

Results: Fifty-eight EMS clinicians participated. While 78% had performed pediatric CPR, experience differed significantly by clinician type and years of service. Paramedics (87%) and clinicians with >6 years' experience (87%) had greater exposure than EMTs (46%) and less experienced clinicians (42%) ( P <0.05). Confidence in HPCPR was higher for adults (98%) than for infants (84%) and toddlers (83%). Only 52% had access to pediatric CPR feedback devices, although 97% of users reported improved CPR quality. Among those without access, 93% believed feedback would improve performance. Interest in AR feedback was moderate; barriers included cost, reliability, and training.

Conclusions: EMS clinicians vary in pediatric CPR experience and access to performance tools. Expanded pediatric training and real-time feedback technologies may improve prehospital resuscitation outcomes.

Objectives: Testicular torsion is a surgical emergency in which a timely diagnosis under 6 hours can significantly increase the survivability of the testicle. This study aims to retrospectively analyze cases of testicular torsion to determine whether the use of point-of-care ultrasound (POCUS) expedites care compared with radiology department ultrasound (RADUS). We evaluated POCUS effect on emergency department (ED) workflow, urological consultation time, and time to the operating room (OR).

Methods: We conducted a retrospective review of patients diagnosed with testicular torsion between January 2021 and October 2024. Inclusion criteria were patients confirmed to have testicular torsion intraoperatively. Demographics were taken of each patient as well as multiple time intervals of events such as radiologic imaging, consult time, and time to surgery. Patients were grouped into 3 cohorts, POCUS only, POCUS followed by RADUS, and RADUS only. Mann-Whitney U tests were performed for pairwise comparisons between groups.

Results: Sixty-five patients were eligible for the study. The time between physician initial assessment (PIA) to the OR in the subgroups of POCUS only, POCUS/RADUS, and RADUS only were 97, 141, and 195 minutes, respectively. A 98-minute difference in the PIA to OR time between POCUS-only and RADUS-only groups (P < 0.001) was found to be statistically significant.

Conclusion: With a difference in PIA to OR time of close to 100 minutes between POCUS-only and RADUS-only groups, our findings suggest that POCUS significantly reduces time to urological consultation and has the potential to expedite surgical intervention if POCUS can reliably replace RADUS. These results highlight the value of integrating POCUS into ED workflows for testicular torsion.

Objectives: Acute gastroenteritis (AGE) is one of the most common diseases in children, and detecting dehydration status is important for managing it. Volume depletion and altered urate excretion through the gastrointestinal tract can cause hyperuricemia. This study aimed to evaluate the role of hyperuricemia in assessing the severity of dehydration in children.

Methods: This retrospective study included patients aged 7 to 18 years who were diagnosed with AGE. We used both the clinical dehydration scale and measured amount of weight loss at the time of emergency room visiting to evaluate the dehydration status. Age-based and sex-based reference values of uric acid were used to define hyperuricemia.

Results: Of the 95 patients with AGE, 40 (42.1%) showed moderate-to-severe dehydration. Hyperuricemia was observed in 44 (46.3%) patients and was more common (95.0 vs. 10.9%, P <0.001) in patients with moderate-to-severe dehydration than in those with mild dehydration. In multivariate analysis, hyperuricemia (OR: 5.13; 95% CI: 2.453-10.526) and bicarbonate levels <15 mmol/L (OR: 3.25; 95% CI: 0.225-7.259) were significant factors associated with moderate-to-severe dehydration.

Conclusions: Uric acid levels were correlated with dehydration in children with AGE.

Objectives: Adolescence is a critical period of growth and development, shaped by the social conditions in which youth are immersed. Many adolescents use emergency departments (EDs) as their primary source of care, often bypassing routine health care systems where preventative screenings and counseling are provided. This may lead to missed opportunities to address social or mental health needs. Partners in Equity and Empowerment through Resources and Support (PEERS), based out of Boston Medical Center's pediatric ED, bridges the gap between patients' health-seeking behaviors and the ED's capacity to provide preventive care. PEERS engages medical and public health students to conduct social and mental health screenings, connecting adolescent and young-adult (AYA) patients with community-based resources that support their holistic health needs.

Methods: From 2021 to 2023, medical and public health students performed bedside screenings of 13- to 23-year-old pediatric ED patients using a blended survey developed from validated screening tools for social drivers of health (SDoH) (e.g., food insecurity, housing, employment, sexual health, substance use) and mental health. Following verbal consent/assent, survey screenings, and brief negotiated interviews, patients were referred to curated, need-specific resources for further support.

Results: During our 28-month pilot, 246 AYA patients were screened, with 97.2% reporting at least one SDoH need and 93.1% referred to at least one community-based resource. The most commonly requested resources were education (46.3%), employment (38.6%), and mental health (32.9%). Younger age was associated with higher requests for educational resources (OR: 1.38; 95% CI: 1.10-1.79), while male gender was linked to fewer mental health resource requests (OR: 0.27; 95% CI: 0.07-0.88).

Conclusions: An interprofessional, student-led team can provide AYA patients with the necessary SDoH resources to bridge care gaps without disrupting ED workflow, supporting the feasibility and benefit of this innovative program to promote health.

Objectives: Intussusception is a medical emergency requiring reduction with a pneumatic or hydrostatic enema. Although evidence supports the safety of medications to reduce distress during the procedure, their use remains limited. This quality improvement (QI) project aimed to provide analgesic and anxiolytic medications to all eligible patients undergoing pneumatic reduction within 1 year.

Methods: A multidisciplinary team developed a standardized clinical pathway to provide both intranasal fentanyl and midazolam for all patients undergoing intussusception reduction. The interventions included staff education, team engagement, and process interventions through sequential Plan-Do-Study-Act cycles. The primary outcome measure was pathway provision. Process measures included documentation of pain and sedation scores, while balancing measures assessed adverse events, failed reductions, and perforation rates.

Results: Over the project period, 25 patients were diagnosed with intussusception. Two patients with lead points proceeded directly to surgery. Among the 23 patients with planned pneumatic reduction, 19 (82%) had successful reductions, 2 had spontaneous reductions, and 2 required surgical intervention due to failed reductions. Pathway provision improved from 0% at baseline to 100% by the project's end. Pain score documentation reached 100%. No cases of serious adverse events or intestinal perforation were reported. Pathway compliance remained at 100% during the sustainment period. The interval number of days between patients who did not receive analgesia and anxiolysis was short initially but progressively lengthened.

Conclusions: This QI initiative improved rates of analgesic and anxiolytic provision to reduce distress in patients undergoing intussusception reduction, without adverse outcomes. This project highlights the effectiveness of structured interventions in optimizing pediatric procedural pain management and potentially serves as a model for spread to other pediatric emergency departments.