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Prevalence of Gender Identity and Incongruence in Adolescent Patients Presenting With Positive Behavioral Health Screens to a Pediatric Emergency Department. 在儿科急诊科表现为积极行为健康筛查的青少年患者中性别认同和不一致的患病率
IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2026-02-01 Epub Date: 2025-11-21 DOI: 10.1097/PEC.0000000000003515
Ryan Waddell, Beverly Spray, Lee Crawley, Jason Williams, Samuel Bornia De Campos, Lauren E Howard, David M Spiro

Objectives: The objective of this study was to determine the prevalence of gender identity and gender incongruence among adolescents who screened positive for behavioral health concerns in a pediatric emergency department. The study aimed to assess the relationship between gender incongruence, emotional distress, and suicidality.

Methods: This cross-sectional study was conducted in a single academic pediatric emergency department. Adolescents aged 13 to 18 years with positive behavioral health screens were approached for anonymous participation via electronic tablet without caregivers present. A validated self-report tool, the Gender Preoccupation and Stability Questionnaire-2 (GPSQ-2), was used to determine gender identity and sexual orientation. The primary outcomes were the prevalence of gender incongruence and gender identity. Secondary outcomes included levels of distress and suicidal ideation. Descriptive statistics and χ 2 or Fisher exact test were used for analysis.

Results: Among 131 eligible adolescents, 102 (78%) completed the study between August 2023 and August 2024 (mean age 15.1 y; 59% female at birth). Gender incongruence was reported by 16.6% (n=17), and 37% identified as nonheterosexual. Distress levels were significantly greater among gender-incongruent individuals compared with gender-congruent peers ( P <0.001). No statistically significant difference in suicidal ideation was observed between groups ( P =0.204).

Conclusions: A higher than expected proportion of adolescents presenting with behavioral health concerns in a pediatric emergency setting reported gender identity and incongruence with associated psychological distress. If further studies confirm our results, these findings support incorporating inclusive screening practices and tailored mental health interventions in emergency care settings for adolescents at risk of self-harm.

目的:本研究的目的是确定在儿科急诊科行为健康问题筛查阳性的青少年中性别认同和性别不一致的患病率。本研究旨在评估性别不一致、情绪困扰和自杀之间的关系。方法:本横断面研究在单一学术儿科急诊科进行。在没有看护人在场的情况下,通过电子平板电脑匿名接触13至18岁行为健康筛查呈阳性的青少年。一种有效的自我报告工具,性别关注和稳定性问卷-2 (GPSQ-2),被用来确定性别认同和性取向。主要结果是性别不一致和性别认同的患病率。次要结果包括痛苦程度和自杀意念。采用描述性统计和χ2或Fisher精确检验进行分析。结果:在131名符合条件的青少年中,102名(78%)在2023年8月至2024年8月期间完成了研究(平均年龄15.1岁,59%出生时为女性)。16.6% (n=17)报告性别不一致,37%被认定为非异性恋。与性别一致的同龄人相比,性别不一致的个体的痛苦水平显著更高(结论:在儿科急诊环境中,表现出行为健康问题的青少年报告的性别认同和不一致与相关的心理痛苦的比例高于预期)。如果进一步的研究证实了我们的结果,这些发现支持在有自残风险的青少年的紧急护理环境中纳入包容性筛查实践和量身定制的心理健康干预措施。
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引用次数: 0
Decreased Lumbar Puncture Utilization Following Implementation of Febrile Infant Guidelines in a Pediatric ED. 在儿科急诊科实施发热婴儿指南后腰椎穿刺使用率降低。
IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2026-02-01 Epub Date: 2025-10-16 DOI: 10.1097/PEC.0000000000003499
David Guernsey, Clara Horner, Priyanka Patel

Background: Fever in infants under 60 days old raises concern for invasive bacterial infections. In 2021, the American Academy of Pediatrics (AAP) released updated guidelines, including revised recommendations for infants aged 22 to 28 days, to reduce unnecessary lumbar punctures (LP), hospitalizations, and antibiotic use. This study hypothesized that the guidelines would reduce LPs, specifically in the newly stratified age group.

Methods: We conducted a retrospective cohort study at a single pediatric emergency department of febrile infants aged 22 to 60 days presenting between October 1, 2019, and September 30, 2023, with October 1, 2021, being the division between groups. Infants were excluded if ill-appearing, <37 weeks of gestation, or had complex medical histories. The primary outcome was the proportion undergoing LP. Subgroup analysis was performed by age group, and those identified as low-risk by initial laboratory evaluation. Secondary outcomes included hospital admission, length of stay, and antibiotic use.

Results: A total of 132 infants met the inclusion criteria (52 pre-guidelines, 80 post-guidelines), and no exclusion criteria were applied. Following guidelines, the proportion of LPs had a statistically significant decrease ( P =0.02), with the reduction maintained in the 22- to 28-day subgroup ( P =0.002). The rate of hospital admission and antibiotics followed a similar statistically significant decrease post-guideline introduction, which also maintained for the 22- to 28-day subgroup. There was no statistically significant difference for length of stay or in the 29- to 60-day subgroup analyses. For infants identified as low-risk by laboratory risk-stratification, we discovered a statistically significant reduction in LP following the guidelines ( P <0.001).

Conclusions: Implementation of the 2021 AAP guidelines was associated with reduced LPs, hospitalizations, and antibiotic use in infants aged 22 to 60 days, with the greatest impact in the 22- to 28-day subgroup. These guidelines improve risk stratification and reduce invasive interventions while maintaining safe care. While the small sample size limits generalizability, these findings suggest a positive shift in clinical practice.

背景:60天以下婴儿发热引起对侵袭性细菌感染的关注。2021年,美国儿科学会(AAP)发布了更新的指南,包括针对22至28天婴儿的修订建议,以减少不必要的腰椎穿刺(LP)、住院治疗和抗生素使用。本研究假设该指南可以降低脂多糖,特别是在新分层的年龄组中。方法:以2021年10月1日为分组时间,对2019年10月1日至2023年9月30日在单一儿科急诊科就诊的22至60天发热婴儿进行回顾性队列研究。结果:共有132名婴儿符合纳入标准(指南前52例,指南后80例),未采用排除标准。遵循指南,LPs比例有统计学意义上的显著下降(P=0.02),在22天至28天的亚组中保持下降(P=0.002)。在指南引入后,住院率和抗生素使用率也出现了类似的统计学显著下降,这在22至28天的亚组中也保持不变。在住院时间和29- 60天亚组分析中,没有统计学上的显著差异。对于实验室风险分层确定为低风险的婴儿,我们发现遵循指南后LP的减少具有统计学意义(P结论:实施2021年AAP指南与22至60天婴儿LP、住院和抗生素使用的减少有关,其中22至28天亚组的影响最大。这些指南改善了风险分层,减少了侵入性干预,同时保持了安全护理。虽然小样本量限制了普遍性,但这些发现表明在临床实践中有积极的转变。
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引用次数: 0
Care or Crisis? Exploring Variations in Emergency Department Management of Pediatric Suicide Risk. 关心还是危机?探讨急诊科对儿童自杀风险管理的差异。
IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2026-02-01 Epub Date: 2025-10-24 DOI: 10.1097/PEC.0000000000003500
Laura M Prichett, Hanae Fujii-Rios, Amanda Finney, Emily E Haroz

Objectives: Acute care settings often serve as the first point of contact for pediatric patients at risk of suicide, requiring clinicians to make complex decisions about care. There is significant variability in suicide risk management across pediatric emergency departments (EDs) in the United States. In this work, we examined the care provided to pediatric patients with suicide risk in the ED setting and whether this care varies by key demographic factors, such as age, race, sex, or income status.

Methods: In this retrospective analysis of electronic health record (EHR) data from 2 pediatric ED settings, we used a series of mixed multilevel regression models to evaluate differences in ED length of stay, admission, and the odds of ordered home psychotherapeutic medications or intramuscular restraint medications in patients with identified suicide risk.

Results: Among visits with identified suicide risk, patients with private insurance were more likely to have home psychotherapeutic medication ordered (aOR: 1.74, 95% CI: 1.25-2.43). Compared with White patients, Black patients had a 23% shorter LOS (aIRR: 0.77, 95% CI: 0.65-0.91), were 65% less likely to receive ED-ordered home psychotherapeutic medication (aOR: 0.35, 95% CI: 0.25-0.49), and were 48% less likely to be admitted (aOR: 0.52, 95% CI: 0.35-0.76). Hispanic/Latino patients had 72% lower odds of receiving ED-ordered home psychotherapeutic medication (aOR: 0.28, 95% CI: 0.16-0.49).

Conclusions: There is substantial variation in the emergency care of youth presenting with suicide risk. Our findings demonstrate significant differences in LOS, discharge disposition, and ED-medication management across insurance types and racial and ethnic groups.

目的:急症护理机构通常是有自杀风险的儿科患者的第一接触点,要求临床医生做出复杂的护理决定。美国儿科急诊科(ed)的自杀风险管理存在显著差异。在这项工作中,我们检查了在急诊科为有自杀风险的儿科患者提供的护理,以及这种护理是否因关键人口因素而异,如年龄、种族、性别或收入状况。方法:回顾性分析来自2个儿科急诊科的电子健康记录(EHR)数据,我们使用一系列混合多水平回归模型来评估急诊科住院时间、入院率以及确定有自杀风险的患者使用家庭心理治疗药物或肌肉约束药物的几率的差异。结果:在确定有自杀风险的患者中,有私人保险的患者更有可能订购家庭心理治疗药物(aOR: 1.74, 95% CI: 1.25-2.43)。与白人患者相比,黑人患者的LOS缩短了23% (aIRR: 0.77, 95% CI: 0.65-0.91),接受ed安排的家庭心理治疗药物的可能性减少了65% (aOR: 0.35, 95% CI: 0.25-0.49),入院的可能性减少了48% (aOR: 0.52, 95% CI: 0.35-0.76)。西班牙裔/拉丁裔患者接受ed安排的家庭心理治疗药物的几率低72% (aOR: 0.28, 95% CI: 0.16-0.49)。结论:对有自杀危险的青少年的紧急护理存在实质性差异。我们的研究结果表明,不同保险类型和种族和民族在LOS、出院处置和ed药物管理方面存在显著差异。
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引用次数: 0
Ultrasound-Based Prediction Model for Air Enema Failure in Pediatric Ileocolic Intussusception: Comparison of Point-of-Care Ultrasound and Radiologist-Performed Ultrasound. 基于超声的儿童回肠肠套叠空气灌肠失败预测模型:现场超声与放射科超声的比较。
IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2026-01-21 DOI: 10.1097/PEC.0000000000003554
Sung-Ha Kim, Jae-Hyun Kwon, So-Hyun Paek, Soo Hyun Park, Min-Jung Kim, Young-Hoon Byun, Ho-Young Song, Jin Hee Kim

Objectives: Pediatric ileocolic intussusception often presents without classic symptoms, making early diagnosis and management challenging. While the enema reduction is the standard treatment, failed reduction may lead to surgical intervention. This study aimed to identify predictors of reduction failure focusing on ultrasonographic features, to develop a predictive model and to assess capabilities of point-of-care ultrasound (POCUS).

Methods: We conducted a retrospective study at a pediatric emergency center from January 2020 to December 2024. Children who underwent air enema reduction for ileocolic intussusception were included. Univariable and multivariable logistic regression analyses were performed to identify predictors of reduction failure. A prediction model was constructed using ultrasound features and validated using a distinct cohort. Paired comparative analysis between POCUS and radiologist-performed ultrasound was performed.

Results: Among 179 children, 35 experienced failure. Most of the demographic and symptom-based variables were not significantly associated with outcomes. Radiologist-performed US revealed that lymph nodes around the lesion, greater invagination length, hypoechoic ring thickness, and suspected low vascularity were associated with failure. A multivariable logistic regression model using 6 ultrasound features demonstrated good predictive performance. External validation with 58 patients yielded good predictive performance and 100% sensitivity. Comparative analysis showed that radiologists more frequently assessed long-axis views and vascularity, identifying risk features more comprehensively than pediatric emergency physicians.

Conclusions: Ultrasound-based features are possibly more reliable predictors of enema reduction failure in pediatric emergency settings. Our validated model and comparative analysis highlight the importance of standardized ultrasound assessment and support the expanded role of POCUS.

目的:儿童回结肠肠套叠通常没有典型症状,这给早期诊断和治疗带来了挑战。虽然灌肠复位是标准的治疗方法,但复位失败可能导致手术干预。本研究旨在通过超声特征确定复位失败的预测因素,建立预测模型并评估点护理超声(POCUS)的能力。方法:我们于2020年1月至2024年12月在儿科急诊中心进行回顾性研究。包括因回结肠肠套叠而接受空气灌肠的儿童。进行单变量和多变量logistic回归分析,以确定减少失败的预测因素。使用超声特征构建预测模型,并使用不同的队列进行验证。将POCUS与放射科超声进行配对比较分析。结果:179例患儿中有35例出现失败。大多数人口统计学和基于症状的变量与结果没有显著相关性。放射科医生进行的超声检查显示,病变周围的淋巴结、较大的内陷长度、低回声环厚度和可疑的低血管密度与失败有关。一个包含6个超声特征的多变量逻辑回归模型显示出良好的预测性能。58例患者的外部验证获得了良好的预测性能和100%的灵敏度。对比分析显示,放射科医生比儿科急诊医生更频繁地评估长轴视野和血管状况,更全面地识别风险特征。结论:在儿科急诊情况下,基于超声的特征可能是更可靠的灌肠复位失败的预测因素。我们验证的模型和比较分析强调了标准化超声评估的重要性,并支持POCUS扩大作用。
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引用次数: 0
Video Versus Direct Laryngoscope for Pediatric Intubation During Cardiopulmonary Resuscitation: A Systematic Review and Meta-analysis of Simulation-based Trials. 视频与直接喉镜在儿童心肺复苏插管中的比较:基于模拟的试验的系统回顾和荟萃分析。
IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2026-01-21 DOI: 10.1097/PEC.0000000000003559
In Kyung Lee, Kyeong Hun Lee, In Young Choi, Na Jin Kim, Kyunghoon Kim

Purpose: High-quality cardiopulmonary resuscitation (CPR) is crucial for improving survival in cardiac arrest. Effective airway management can enhance outcomes but remains challenging due to anatomical and physiological factors in children. However, whether endotracheal intubation is superior to bag-valve-mask ventilation during CPR remains uncertain. Video laryngoscopes have emerged as an alternative to direct laryngoscopes, offering enhanced visualization; however, their efficacy for pediatric CPR remains unclear. This systematic review and meta-analysis aimed to compare the efficacy of video laryngoscopes and direct laryngoscopes during pediatric CPR in simulation-based studies.

Methods: A systematic search of PubMed, Embase, and The Cochrane Library was conducted up to February 2025. Only randomized controlled trials conducted in simulation settings comparing video and direct laryngoscopes in pediatric CPR were included. The primary outcomes were the first attempt success rate and the overall success rate. The secondary outcomes included intubation time, Cormack and Lehane grade as an indicator of glottic visualization, and dental compression. The risk of bias for the included studies was assessed using the Cochrane Risk of Bias tool. Two reviewers independently evaluated each domain, and disagreements were resolved by consensus.

Results: Thirteen simulation-based studies with 2080 intubation attempts in manikins were included. Direct laryngoscopes demonstrated a 35% lower relative first-attempt success rate (RR: 0.65, 95% CI: 0.59-0.71) and a 17% lower relative overall success rate (RR: 0.83, 95% CI: 0.80-0.88) compared with video laryngoscopes. Intubation time was 8.13 seconds longer with direct laryngoscopes (MD: 8.13 s, 95% CI: 4.82-11.44). Furthermore, direct laryngoscopes were associated with a 39% lower relative likelihood of Cormack and Lehane grade 1 view (RR: 0.61, 95% CI: 0.49-0.76), and 6.05 times higher relative risk of dental compression (RR: 6.05, 95% CI: 2.93-12.52) compared with video laryngoscopes.

Conclusion: Video laryngoscopes significantly improve intubation success rates and reduce intubation time during simulation-based pediatric CPR. Future research should validate these findings in clinical settings and evaluate device-specific features to optimize outcomes.

目的:高质量的心肺复苏(CPR)对提高心脏骤停患者的生存率至关重要。有效的气道管理可以提高预后,但由于儿童解剖和生理因素仍然具有挑战性。然而,心肺复苏术中气管插管是否优于气囊-瓣膜-面罩通气仍不确定。视频喉镜已成为直接喉镜的替代方案,提供增强的可视化;然而,它们对儿童心肺复苏术的疗效尚不清楚。本系统综述和荟萃分析旨在比较视频喉镜和直接喉镜在基于模拟的儿童心肺复苏术中的疗效。方法:系统检索PubMed、Embase和Cochrane图书馆,检索截止到2025年2月。仅包括在模拟环境中进行的比较视频喉镜和直接喉镜在儿童心肺复苏术中的随机对照试验。主要结果为第一次尝试成功率和总成功率。次要结果包括插管时间、Cormack和Lehane分级(声门显像指标)和牙压。纳入研究的偏倚风险使用Cochrane偏倚风险工具进行评估。两名评论者独立地评估每个领域,分歧由共识解决。结果:包括13项基于模拟的研究,在人体模型中进行了2080次插管尝试。与视频喉镜相比,直接喉镜的相对首次尝试成功率低35% (RR: 0.65, 95% CI: 0.59-0.71),相对总成功率低17% (RR: 0.83, 95% CI: 0.80-0.88)。直接喉镜下插管时间长8.13 s (MD: 8.13 s, 95% CI: 4.82 ~ 11.44)。此外,与视频喉镜相比,直接喉镜与Cormack和Lehane 1级视点的相对可能性降低39% (RR: 0.61, 95% CI: 0.49-0.76)和牙压的相对风险高6.05倍(RR: 6.05, 95% CI: 2.93-12.52)相关。结论:视频喉镜可显著提高插管成功率,缩短插管时间。未来的研究应该在临床环境中验证这些发现,并评估设备的特定特征以优化结果。
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引用次数: 0
Using Human Factors and Systems Simulation to Optimize the Usability of a Code Documentation Tool. 使用人为因素和系统模拟来优化代码文档工具的可用性。
IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2026-01-21 DOI: 10.1097/PEC.0000000000003558
Susan Biesbroek, Mirette Dubé, Jennifer Arnold, Myrna Chan-MacRae, Daniel J Kats, Lauren Coogle, Melanie Swenson, Jonathan D Hron

Objectives: Implementing a new electronic health record (EHR) system in high-pressure, high-stakes environments, such as documenting during pediatric and neonatal cardiac and respiratory arrest scenarios, can be challenging for health care staff. Poorly designed tools or technology that don't align with existing workflows may lead to incomplete or inaccurate documentation. Lower adoption rates and continued reliance on paper forms for code documentation can result in gaps in patient data within the EHR, requiring the transcription of critical information after the event.

Methods: This project utilized human factors usability testing and systems-focused simulation evaluation methods to assess code documentation tools with end-users from critical care areas (ED, ICU, NICU) during the EHR design phase.

Results: A total of 202 recommendations to enhance the EHR's usability and functionality were made across the 3 testing cycles (2 rounds of usability testing and 1 cycle of systems simulation sessions). The majority of recommendations were focused on improvements to the software and technology of the code narrator tool directly. Post-launch assessment showed that nearly 2/3 of the usability recommendations were implemented within the first year of use.

Conclusions: Improving the design of these tools and ensuring seamless workflow integration is essential for increasing adoption and enhancing the accuracy of patient records.

目的:在高压、高风险的环境中实施新的电子健康记录(EHR)系统,例如在儿科和新生儿心脏和呼吸骤停情况下进行记录,对卫生保健人员来说可能具有挑战性。设计不佳的工具或技术与现有工作流不一致可能导致不完整或不准确的文档。较低的采用率和继续依赖纸质形式的代码文档可能导致EHR中的患者数据出现空白,需要在事件发生后转录关键信息。方法:本项目利用人为因素可用性测试和以系统为中心的模拟评估方法,在EHR设计阶段对来自重症监护领域(ED、ICU、NICU)的最终用户进行代码文档工具评估。结果:在3个测试周期(2轮可用性测试和1轮系统模拟会话)中,共提出202条建议,以提高电子病历的可用性和功能。大多数建议都集中在直接改进代码叙述者工具的软件和技术上。发布后的评估显示,近三分之二的可用性建议在使用的第一年就得到了实施。结论:改进这些工具的设计并确保工作流程的无缝集成对于提高患者记录的采用率和准确性至关重要。
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引用次数: 0
PEMTalk: Improving Delivery of Serious News in Pediatric Emergency Medicine. PEMTalk:改善儿科急诊医学重大新闻的传递。
IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2026-01-16 DOI: 10.1097/PEC.0000000000003549
Ji Young Lee, Lillian L Emlet, Sylvia Choi, Melinda Hamilton, Scott H Maurer, Amanda W Brown, Melissa M Tavarez, Noel B Spears, Maren M Lunoe

Objectives: Pediatric emergency medicine (PEM) physicians deliver serious news (DSN) in stressful situations that impact both families and physicians. Our objective was to assess the impact of a PEM-focused workshop on DSN in improving the self-perceived preparedness, skill level, and stress management of PEM physicians.

Methods: We designed a simulation-based communication workshop, "PEMTalk," utilizing simulated parents to teach PEM attendings and fellows to effectively DSN. The workshop was conducted in a virtual and in-person format from 2018 to 2023. We developed 3 scenarios unique to PEM. Pre- and postintervention surveys were administered to assess the workshop's impact.

Results: A total of 74 participants completed surveys. Among the 34 first-time participants, there were improvements in provider's self-perceived ability to DSN (41% vs. 97%; P<0.001), respond to emotions (50% vs. 97%; P<0.001), and decrease in stress (47% vs. 21%; P=0.003) due to DSN. Among the 23 participants who participated in the study more than once, there were sustained improvements in their self-perceived ability to DSN (39% vs. 69%; P=0.02). Fellows (53% of participants) were more likely than attendings to report improvement in DSN [OR 6; 95% CI (1.05-41.67); P=0.04]. There was no difference in outcomes between in-person and virtual formats.

Conclusion: PEMTalk enhanced participants' self-reported comfort while reducing stress associated with DSN in a simulated setting. Next steps include incorporating objective assessments, evaluating the impact on patient care, and disseminating the workshop to the broader PEM community.

目的:儿科急诊医学(PEM)医生在影响家庭和医生的压力情况下传递严重新闻(DSN)。我们的目的是评估以PEM为重点的DSN研讨会在提高PEM医生的自我感知准备、技能水平和压力管理方面的影响。方法:我们设计了一个基于模拟的交流研讨会,“PEMTalk”,利用模拟家长来教PEM主治医师和研究员有效地进行DSN。该研讨会于2018年至2023年以虚拟和面对面的形式进行。我们为PEM开发了3种独特的场景。进行了干预前和干预后的调查,以评估讲习班的影响。结果:74名参与者完成了问卷调查。在34名首次参与者中,提供者对DSN的自我感知能力有所改善(41%对97%)。结论:PEMTalk增强了参与者自我报告的舒适度,同时减少了模拟环境中DSN相关的压力。接下来的步骤包括纳入客观评估,评估对病人护理的影响,并向更广泛的PEM社区传播讲习班。
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引用次数: 0
ED Lung Ultrasound of Suspected Atelectasis and Assessment of Reaeration in Children: A Case Series. ED肺超声诊断疑似肺不张及儿童通气评估:一个病例系列。
IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2026-01-16 DOI: 10.1097/PEC.0000000000003524
Jen Heng Pek, James W Tsung

Objectives: Point-of-care ultrasound of the lung is a useful tool in the assessment of pediatric patients with acute respiratory distress or hypoxemia. However, the sonographic features of atelectasis and pneumonia appear similar. Unlike pneumonia, the use of lung ultrasound to diagnose atelectasis and assess its reaeration in children is not well described. We describe the lung ultrasound features of atelectasis correlated with radiographic imaging and clinical context.

Methods: This series describes 5 pediatric ED patients with atelectasis, confirmed by lung ultrasound with radiographic correlation, to illustrate the use of PoCUS in guiding interventions such as chest physiotherapy and assessing reaeration.

Results: In all 5 cases, lung ultrasound identified lung consolidations consistent with atelectasis, which appeared sonographically similar to pneumonia. Static air bronchograms were seen in all cases. In 1 case of asthma exacerbation, repeat ultrasound demonstrated complete resolution of atelectasis following chest physiotherapy, correlating with clinical improvement. In the other 4 cases, including patients with cystic fibrosis and bronchiolitis, the consolidations persisted on repeat ultrasound despite various treatments for atelectasis.

Conclusions: The overlap between the sonographic features of lung consolidation in atelectasis and pneumonia in children makes it difficult to distinguish between the 2 conditions reliably based on lung ultrasound alone. Clinicians will need to interpret PoCUS images within the patient's clinical context, using radiographic correlation when available. Assessment of atelectasis reaeration on lung ultrasound is feasible and easily repeatable at the point of care, allowing for real-time monitoring of lung consolidations in response to therapy.

目的:点护理超声肺是一个有用的工具,在评估儿科患者急性呼吸窘迫或低氧血症。然而,肺不张和肺炎的声像图特征相似。与肺炎不同,在儿童中使用肺超声诊断肺不张并评估其再通气尚未得到很好的描述。我们描述肺不张的超声特征与影像学和临床相关。方法:本文报道5例经肺超声证实肺不张的儿科急诊科患者,以说明PoCUS在指导胸部物理治疗和评估通气等干预措施中的应用。结果:5例肺超声均发现肺实变符合肺不张,超声表现与肺炎相似。所有病例均可见静态空气支气管图。1例哮喘加重,重复超声显示胸部物理治疗后肺不张完全消失,与临床改善相关。在其他4例患者中,包括囊性纤维化和细支气管炎患者,尽管对肺不张进行了各种治疗,但反复超声检查仍存在实变。结论:肺不张实变的声像图特征与儿童肺炎的声像图特征重叠,使得仅凭肺部超声很难可靠地区分两者。临床医生需要在患者的临床背景下解释PoCUS图像,在可用的情况下使用放射学相关性。肺超声对肺不张再通气的评估是可行的,并且易于在护理点重复,允许实时监测肺巩固对治疗的反应。
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引用次数: 0
A Novel Approach Using Relative Value Units to Quantify Workload and Its Association With Patient and Family Experience in the Pediatric Emergency Department. 使用相对价值单位量化儿科急诊科工作量及其与患者和家庭经验的关系的新方法。
IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2026-01-15 DOI: 10.1097/PEC.0000000000003547
Trang Ha, Kenneth W McKinley, James M Chamberlain, Joseph J Zorc, Molly Walker, Sephora N Morrison

Objectives: To measure the association between overall workload and patient and family experience (PFE) in a pediatric emergency department (ED). Our secondary objective was to assess the construct validity of total ED Relative Value Units (RVUs) as an overall ED workload measure.

Methods: We performed a retrospective study from January 2022 to August 2023 using data from a large, urban, academic pediatric ED with approximately 85,000 patient visits annually. PFE was measured by surveys distributed to all patients discharged from ED. The association of overall ED workload with PFE was assessed using multivariate ordinal logistic regression. We examined the construct validity of total ED RVUs by replacing this measure with National Emergency Department Overcrowding Scale (NEDOCS) in the logistic regression model.

Results: Of 126,336 discharged visits, 7128 (5.6%) completed surveys. We found a statistically significant association between ED workload and PFE. For each 10 RVUs added to ED workload, the odds of more positive PFE decreased by 9% (95% CI: 8%-9%). The adjusted odds ratio of NEDOCS demonstrated a less pronounced association in the same direction; an increase of 10 points in NEDOCS was associated with 6% (95% CI: 5%-6%) decrease in the likelihood of higher PFE ratings.

Conclusions: High ED workload, as measured by overall RVUs, was significantly associated with negative PFE. Similar results were found when we substituted NEDOCS for overall RVUs. Our findings suggest that overall RVUs may be a useful measure of ED workload and might provide a quantitative target for quality improvement.

目的:测量儿科急诊科(ED)总工作量与患者和家庭经验(PFE)之间的关系。我们的第二个目标是评估总ED相对价值单位(RVUs)作为ED总体工作量测量的构建有效性。方法:我们进行了一项回顾性研究,从2022年1月至2023年8月,使用来自大型城市学术儿科急诊科的数据,每年约有85,000名患者就诊。通过分发给所有ED出院患者的调查来测量PFE。使用多变量有序逻辑回归评估ED总工作量与PFE的关系。我们通过在logistic回归模型中用国家急诊科过度拥挤量表(NEDOCS)取代该指标来检验ED总rvu的结构有效性。结果:126336例出院患者中,7128例(5.6%)完成问卷调查。我们发现ED工作量和PFE之间有统计学意义的关联。ED工作量每增加10个rvu, PFE阳性的几率降低9% (95% CI: 8%-9%)。调整后的NEDOCS优势比表明,在同一方向上的相关性不太明显;NEDOCS评分每增加10分,PFE评分升高的可能性降低6% (95% CI: 5%-6%)。结论:以总rvu衡量的高ED负荷与PFE负相关。当我们用NEDOCS代替总rvu时,也发现了类似的结果。我们的研究结果表明,总体rvu可能是ED工作量的有用衡量标准,并可能为质量改进提供定量目标。
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引用次数: 0
Development of an Implementation Strategy Plan to Improve Care for Pediatric Emergency Department Patients With a Possible Sexually Transmitted Infection. 一项实施策略计划的发展,以改善护理儿科急诊科患者与可能的性传播感染。
IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE Pub Date : 2026-01-15 DOI: 10.1097/PEC.0000000000003551
Roland C Merchant, Daniela Ramirez-Castillo, Christopher Strother, Rachel Solnick, Patricia Mae Martinez, Brendan Connell, John Steever, Melissa A Clark

Objectives: Despite the existence of evidence-based guidelines from the Centers for Disease Control and Prevention, studies have demonstrated the need for improvement in the evaluation and treatment of adolescents and young adults with a possible sexually transmitted infection (STI) presenting for care in pediatric emergency departments (PEDs) and general emergency departments (EDs) in the United States. We created an implementation strategy plan for our PED designed to improve STI care for patients.

Methods: Using the Tailored Implementation in Chronic Diseases (TICD) determinants framework, we identified, prioritized, and investigated determinants of implementation success of our initiative. We then conducted stakeholder interviews to refine and design an implementation strategy plan that addressed identified barriers and facilitators.

Results: The resulting implementation strategy included: (1) a standardized STI care protocol; (2) electronic health record (EHR) enhancements, including smart phrases and tailored order sets; (3) staff training materials and academic detailing sessions for physicians and nurses; (4) an adolescent-friendly discharge instruction handout; (5) an EHR-based referral system to an adolescent health clinic; (6) visual aids to support accurate STI sample collection'and (7) an evaluation plan to assess protocol uptake, documentation quality, treatment accuracy, and follow-up linkage.

Conclusions: This TICD-informed, stakeholder-driven approach may serve as a model for EDs aiming to enhance STI care delivery for adolescent and young adult patients.

目的:尽管美国疾病控制和预防中心有循证指南,但研究表明,在美国儿科急诊科(PEDs)和普通急诊科(EDs)就诊的可能患有性传播感染(STI)的青少年和年轻人的评估和治疗方面需要改进。我们为PED制定了一项实施战略计划,旨在改善性病患者的护理。方法:使用慢性病量身定制实施(TICD)决定因素框架,我们确定,优先考虑并调查了我们的倡议实施成功的决定因素。然后,我们进行了利益相关者访谈,以完善和设计实现战略计划,解决已确定的障碍和促进因素。结果:最终的实施策略包括:(1)标准化的性传播感染护理方案;(2)电子健康记录(EHR)增强功能,包括智能短语和定制订单集;(3)医师、护士的员工培训材料和学术详谈;(四)青少年友好型出院指导手册;(5)建立以电子病历为基础的青少年健康诊所转诊系统;(6)支持准确STI样本采集的可视化辅助工具;(7)评估方案采用情况、文件质量、治疗准确性和随访联系的评估计划。结论:这种基于ticd的利益相关者驱动的方法可以作为急诊科的一种模式,旨在加强青少年和年轻成人患者的性传播感染护理服务。
{"title":"Development of an Implementation Strategy Plan to Improve Care for Pediatric Emergency Department Patients With a Possible Sexually Transmitted Infection.","authors":"Roland C Merchant, Daniela Ramirez-Castillo, Christopher Strother, Rachel Solnick, Patricia Mae Martinez, Brendan Connell, John Steever, Melissa A Clark","doi":"10.1097/PEC.0000000000003551","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003551","url":null,"abstract":"<p><strong>Objectives: </strong>Despite the existence of evidence-based guidelines from the Centers for Disease Control and Prevention, studies have demonstrated the need for improvement in the evaluation and treatment of adolescents and young adults with a possible sexually transmitted infection (STI) presenting for care in pediatric emergency departments (PEDs) and general emergency departments (EDs) in the United States. We created an implementation strategy plan for our PED designed to improve STI care for patients.</p><p><strong>Methods: </strong>Using the Tailored Implementation in Chronic Diseases (TICD) determinants framework, we identified, prioritized, and investigated determinants of implementation success of our initiative. We then conducted stakeholder interviews to refine and design an implementation strategy plan that addressed identified barriers and facilitators.</p><p><strong>Results: </strong>The resulting implementation strategy included: (1) a standardized STI care protocol; (2) electronic health record (EHR) enhancements, including smart phrases and tailored order sets; (3) staff training materials and academic detailing sessions for physicians and nurses; (4) an adolescent-friendly discharge instruction handout; (5) an EHR-based referral system to an adolescent health clinic; (6) visual aids to support accurate STI sample collection'and (7) an evaluation plan to assess protocol uptake, documentation quality, treatment accuracy, and follow-up linkage.</p><p><strong>Conclusions: </strong>This TICD-informed, stakeholder-driven approach may serve as a model for EDs aiming to enhance STI care delivery for adolescent and young adult patients.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Pediatric emergency care
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