When pediatric patients require mechanical ventilation in the emergency department, the emergency clinician should be prepared to select initial ventilator settings and respond to an intubated patient's dynamic physiologic needs to ensure ongoing oxygenation, ventilation, and hemodynamic stability. Pressure-targeted ventilation is generally recommended in pediatric patients, with initial ventilator settings varying depending on age and the etiology of respiratory failure. This issue reviews indications for mechanical ventilation and offers recommendations for ventilator settings and dosing of analgesics, sedatives, and neuromuscular blockers, with a focus on patient populations in whom the approach to mechanical ventilation may be different.
{"title":"Mechanical ventilation of pediatric patients in the emergency department.","authors":"Casey Carr, Courtney W Mangus, J Kate Deanehan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>When pediatric patients require mechanical ventilation in the emergency department, the emergency clinician should be prepared to select initial ventilator settings and respond to an intubated patient's dynamic physiologic needs to ensure ongoing oxygenation, ventilation, and hemodynamic stability. Pressure-targeted ventilation is generally recommended in pediatric patients, with initial ventilator settings varying depending on age and the etiology of respiratory failure. This issue reviews indications for mechanical ventilation and offers recommendations for ventilator settings and dosing of analgesics, sedatives, and neuromuscular blockers, with a focus on patient populations in whom the approach to mechanical ventilation may be different.</p>","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"17 7","pages":"1-16"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38062189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.22470/pemj.2019.00129
J. Yoo, Jung-In Ko, W. Yeo, Taejin Park, S. K. Jung, J. Kwon
Purpose: To study the appropriateness of rabies post-exposure prophylaxis (rPEP) for children with animal bite who visited the emergency department (ED). Methods: The study enrolled children younger than 18 years with animal bite who visited the National Medical Center ED between January 2014 and October 2017. The children’s electronic medical records were retrospectively reviewed. Data for analysis included age, sex, body parts bitten by animals, species of animals, regions where animal bites occurred, history of recent antibiotics therapy and tetanus vaccination, and justification by the 2017 Guidelines for Rabies Control in Korea and implementation of rPEP. In children who underwent unjustified rPEP or did not undergo justified one, we recorded their guardians’ opinion for or against rPEP. Results: Of the 63 enrolled children, rPEP was justified for 38 children by the Korean guidelines. Of the 38 children, 35 actually underwent rPEP. Among the remaining 3 children, 2 did not undergo the prophylaxis as per the guardians’ requests. Among the 25 children whose rPEP was not justified, 8 underwent the prophylaxis. Of these 8 children, 7 did based on the guardians’ requests. Conclusion: In this study, inappropriate rPEP was usually affected by the guardians’ requests, regardless of the criteria for such prophylaxis. Thus, their requests for or against rPEP should be discussed with emergency physicians who are aware of the relevant criteria to prevent occurrence of rabies or unnecessary use of medical resources.
{"title":"Appropriateness of rabies post-exposure prophylaxis in pediatric patients visiting the emergency department due to animal bite","authors":"J. Yoo, Jung-In Ko, W. Yeo, Taejin Park, S. K. Jung, J. Kwon","doi":"10.22470/pemj.2019.00129","DOIUrl":"https://doi.org/10.22470/pemj.2019.00129","url":null,"abstract":"Purpose: To study the appropriateness of rabies post-exposure prophylaxis (rPEP) for children with animal bite who visited the emergency department (ED). Methods: The study enrolled children younger than 18 years with animal bite who visited the National Medical Center ED between January 2014 and October 2017. The children’s electronic medical records were retrospectively reviewed. Data for analysis included age, sex, body parts bitten by animals, species of animals, regions where animal bites occurred, history of recent antibiotics therapy and tetanus vaccination, and justification by the 2017 Guidelines for Rabies Control in Korea and implementation of rPEP. In children who underwent unjustified rPEP or did not undergo justified one, we recorded their guardians’ opinion for or against rPEP. Results: Of the 63 enrolled children, rPEP was justified for 38 children by the Korean guidelines. Of the 38 children, 35 actually underwent rPEP. Among the remaining 3 children, 2 did not undergo the prophylaxis as per the guardians’ requests. Among the 25 children whose rPEP was not justified, 8 underwent the prophylaxis. Of these 8 children, 7 did based on the guardians’ requests. Conclusion: In this study, inappropriate rPEP was usually affected by the guardians’ requests, regardless of the criteria for such prophylaxis. Thus, their requests for or against rPEP should be discussed with emergency physicians who are aware of the relevant criteria to prevent occurrence of rabies or unnecessary use of medical resources.","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"58 1","pages":"23-27"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85648502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.22470/pemj.2020.00080
Kwang Yeon Kim
Recently, neodymium magnetic beads became popular in Korea. The beads, each 5 mm in diameter, can be connected in dozens to hundreds or even thousands to create the desired shape. As the popularity of magnetic beads increases, ingestion of the beads is presumed to become more frequent. Because infants and toddlers lack communicating skills, the guardians may not recognize swallowing of the beads without witness. This is of particular concern because children who swallow multiple magnets are at risk of abdominal complications such as necrosis, perforation, fistula, and stenosis. Here, we report a child who swallowed multiple neodymium magnetic beads unwitnessed. The case report was exempted by the Institutional Review Board with a waiver for the requirement of informed consent (IRB no. PC20ZAS10072). 여러 개의 자석을 삼킨 소아: 병력 청취를 통한 의심의 중요성
{"title":"A case of ingested multiple magnetic beads: the importance of suspicion based on medical history","authors":"Kwang Yeon Kim","doi":"10.22470/pemj.2020.00080","DOIUrl":"https://doi.org/10.22470/pemj.2020.00080","url":null,"abstract":"Recently, neodymium magnetic beads became popular in Korea. The beads, each 5 mm in diameter, can be connected in dozens to hundreds or even thousands to create the desired shape. As the popularity of magnetic beads increases, ingestion of the beads is presumed to become more frequent. Because infants and toddlers lack communicating skills, the guardians may not recognize swallowing of the beads without witness. This is of particular concern because children who swallow multiple magnets are at risk of abdominal complications such as necrosis, perforation, fistula, and stenosis. Here, we report a child who swallowed multiple neodymium magnetic beads unwitnessed. The case report was exempted by the Institutional Review Board with a waiver for the requirement of informed consent (IRB no. PC20ZAS10072). 여러 개의 자석을 삼킨 소아: 병력 청취를 통한 의심의 중요성","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"42 1","pages":"41-44"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85548646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.22470/pemj.2019.00164
S. Shin, H. Choi, Bogeum Choi
Purpose: Advanced pediatric emergency centers play an important role in professional treatment of children. We analyzed the characteristics of children who visited an advanced pediatric emergency center. Methods: The study enrolled children younger than 15 years who had visited Keimyung University Dongsan Medical advanced pediatric emergency center between April 2016 and March 2018. We reviewed the children’s age group characteristics, time of visit, triage results by the Korean Triage and Acuity Scale (KTAS), use of the emergency medical service ambulances, emergency department length of stay, final diagnosis, and final disposition. Results: A total 41,355 children (mean age, 3.1 ± 3.0 years) were enrolled, and those aged 1-4 years accounted for 65.7%. The visit was most frequent in December, at night (40.2%), and at holiday hours (30.2%) (c.f., business hours, 11.5%). Fever (33.2%) and eyelid laceration (11.5%) were the most common final diagnoses of diseases and injuries, respectively. The children triaged as the KTAS 1-2 accounted for 5.9% of the study children (c.f., KTAS 3-4, 91.5%). According to time of visit, the proportion of hospitalization (31.4%) and transfer from other hospitals (34.7%) were most frequent at business hours than other times of visit (P < 0.001). Conclusion: The children tended to visit the center with minor diseases or injuries, especially during holidays and at night. Further research is needed for optimizing the roles of advanced pediatric emergency centers, taking into account the characteristics of patients and demand for the centers.
{"title":"Utilization characteristics of an advanced pediatric emergency center: a single center study over 2 years","authors":"S. Shin, H. Choi, Bogeum Choi","doi":"10.22470/pemj.2019.00164","DOIUrl":"https://doi.org/10.22470/pemj.2019.00164","url":null,"abstract":"Purpose: Advanced pediatric emergency centers play an important role in professional treatment of children. We analyzed the characteristics of children who visited an advanced pediatric emergency center. Methods: The study enrolled children younger than 15 years who had visited Keimyung University Dongsan Medical advanced pediatric emergency center between April 2016 and March 2018. We reviewed the children’s age group characteristics, time of visit, triage results by the Korean Triage and Acuity Scale (KTAS), use of the emergency medical service ambulances, emergency department length of stay, final diagnosis, and final disposition. Results: A total 41,355 children (mean age, 3.1 ± 3.0 years) were enrolled, and those aged 1-4 years accounted for 65.7%. The visit was most frequent in December, at night (40.2%), and at holiday hours (30.2%) (c.f., business hours, 11.5%). Fever (33.2%) and eyelid laceration (11.5%) were the most common final diagnoses of diseases and injuries, respectively. The children triaged as the KTAS 1-2 accounted for 5.9% of the study children (c.f., KTAS 3-4, 91.5%). According to time of visit, the proportion of hospitalization (31.4%) and transfer from other hospitals (34.7%) were most frequent at business hours than other times of visit (P < 0.001). Conclusion: The children tended to visit the center with minor diseases or injuries, especially during holidays and at night. Further research is needed for optimizing the roles of advanced pediatric emergency centers, taking into account the characteristics of patients and demand for the centers.","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"17 1","pages":"16-22"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86927982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.22470/pemj.2019.00143
J. Lee, Dong Hyun Kim, Y. Kwon
Spinal epidural hematoma (EDH) can occur after substantial spinal trauma, originating from thinwalled venous plexus lying to the spinal cord. Clinically significant traumatic spinal EDH occurs uncommonly. Guillain-Barrésyndrome (GBS) is a postinfectious autoimmune demyelinating polyradiculoneuropathy mainly involving motor and/or sensory and autonomic nerves. Clinical manifestations 길랭-바레증후군으로 오인된 외상 척추경막외혈종에서 신경학적 합병증 없이 회복된 소아 1례
can occur after substantial Spinal trauma, originating from thinwalled venous plexus lying to the Spinal cord。Clinically significant traumatic spinal EDH occurs uncommonly。Guillain- Barresyndrome (GBS) is a postinfectious autoimmune demyelinating polyradiculoneuropathy mainly involving motor and/or sensory and autonomic nerves。Clinical manifestations被误认为是吉兰-巴莱综合症的外伤脊椎硬膜外血肿中没有神经并发症恢复的小儿1例
{"title":"Recovery without neurological sequelae of traumatic spinal epidural hematoma masquerading as Guillain-Barré syndrome in a child","authors":"J. Lee, Dong Hyun Kim, Y. Kwon","doi":"10.22470/pemj.2019.00143","DOIUrl":"https://doi.org/10.22470/pemj.2019.00143","url":null,"abstract":"Spinal epidural hematoma (EDH) can occur after substantial spinal trauma, originating from thinwalled venous plexus lying to the spinal cord. Clinically significant traumatic spinal EDH occurs uncommonly. Guillain-Barrésyndrome (GBS) is a postinfectious autoimmune demyelinating polyradiculoneuropathy mainly involving motor and/or sensory and autonomic nerves. Clinical manifestations 길랭-바레증후군으로 오인된 외상 척추경막외혈종에서 신경학적 합병증 없이 회복된 소아 1례","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"11 1","pages":"49-52"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84172754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.22470/pemj.2019.00136
Soo-Hong Kim, Y. Cho, Hae-Young Kim
The spleen is an intraperitoneal organ, and located in the left upper quadrant, fixed with the gastrosplenic, splenocolic, and splenorenal ligaments. Wandering spleen (also known as ectopic spleen) is a condition in which the spleen is not found in its usual location or presentation. The entity is caused by absence or laxity of the ligaments fixing the spleen. Due to this laxity, splenic vascular pedicle can be twisted easily, incurring splenic torsion. Splenic torsion leads to infarction, requiring prompt diagnosis and treatment. In this report, we present 2 cases of splenic infarction due to torsion of wandering spleen, which was successfully treated with laparoscopic splenectomy. This study was approved by the Institutional Review Board (IRB no. 05-2019-157).
{"title":"Two cases of splenic infarction due to torsion of wandering spleen requiring laparoscopic splenectomy in adolescent girls","authors":"Soo-Hong Kim, Y. Cho, Hae-Young Kim","doi":"10.22470/pemj.2019.00136","DOIUrl":"https://doi.org/10.22470/pemj.2019.00136","url":null,"abstract":"The spleen is an intraperitoneal organ, and located in the left upper quadrant, fixed with the gastrosplenic, splenocolic, and splenorenal ligaments. Wandering spleen (also known as ectopic spleen) is a condition in which the spleen is not found in its usual location or presentation. The entity is caused by absence or laxity of the ligaments fixing the spleen. Due to this laxity, splenic vascular pedicle can be twisted easily, incurring splenic torsion. Splenic torsion leads to infarction, requiring prompt diagnosis and treatment. In this report, we present 2 cases of splenic infarction due to torsion of wandering spleen, which was successfully treated with laparoscopic splenectomy. This study was approved by the Institutional Review Board (IRB no. 05-2019-157).","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"40 1","pages":"45-48"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84496696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.22470/pemj.2019.00157
S. Choi
Hydrogen peroxide has antibacterial effects, and is frequently used to disinfect wounds and devices. However, when the colon is exposed to this chemical, reaction with catalase can cause acute colitis due to the release of oxygen. Symptoms include abdominal pain, hematochezia, diarrhea, and tenesmus. Colonoscopy findings of this condition, including white plaques, erythema of the surrounding mucosa, and multiple ulcers, are similar to those of other causes of colitis, such as ischemic colitis. Therefore, the differentiation is essential. Although several cases of hydrogen peroxide-induced colitis have been reported, there is a lack of relevant reports in children. We present here a pediatric case of hydrogen peroxide-induced proctocolitis with a literature review. This study was approved by the Institutional Review Board (IRB No. 2019-11042).
{"title":"A case of hydrogen peroxide-induced proctocolitis in a child","authors":"S. Choi","doi":"10.22470/pemj.2019.00157","DOIUrl":"https://doi.org/10.22470/pemj.2019.00157","url":null,"abstract":"Hydrogen peroxide has antibacterial effects, and is frequently used to disinfect wounds and devices. However, when the colon is exposed to this chemical, reaction with catalase can cause acute colitis due to the release of oxygen. Symptoms include abdominal pain, hematochezia, diarrhea, and tenesmus. Colonoscopy findings of this condition, including white plaques, erythema of the surrounding mucosa, and multiple ulcers, are similar to those of other causes of colitis, such as ischemic colitis. Therefore, the differentiation is essential. Although several cases of hydrogen peroxide-induced colitis have been reported, there is a lack of relevant reports in children. We present here a pediatric case of hydrogen peroxide-induced proctocolitis with a literature review. This study was approved by the Institutional Review Board (IRB No. 2019-11042).","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"1 1","pages":"53-56"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90552158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.22470/pemj.2020.00024
Myung Hun Kim, Y. Kwak
한국 정부와 사회의 예방 노력에도 불구하고 아동학대 가 꾸준히 증가하고, 이로 인한 사망 사건이 종종 발생하 고 있어 사회적 충격을 주고 있다. 아동학대 예방부터 종 합적 피해자에 지원까지 학대에 대한 국가의 책임을 강화 하는 취지로 보건복지부에선 2019년 1월 전담 부서로 아 동학대대응과를 설치했다. 더불어, 같은 해 5월 학대 대응 체제를 포함한 아동보호체계를 개편하여 보호 필요 아동 에 대한 국가의 책임을 강화하는 취지의 포용국가 아동정 책을 발표했다. 같은 해 7월, 아동권리보장원이 출범하여 아동보호 및 권리 보장을 위한 정책과 서비스를 통합적으 로 지원하는 체제를 정비했다. 중앙아동보호전문기관은 아동권리보장원의 아동학대예방본부로 편입되어, 학대 예 방, 대응 체계 개선, 학대 후 가족관계 회복을 위한 서비스 개선 등 보다 포괄적인 활동을 운영하게 된다. 대한의사협회에서 2002년“아동학대예방전문위원회” 를 설치하여 학대 문제에 적극적으로 참여하기 시작했다. 종합병원 내 학대아동보호팀 구성을 촉진하고, 학대에 이 해를 갖춘 인력을 양성하여 고통받는 어린이를 눈 크게 뜨 고 구하자는 취지의“왕눈이 운동”을 시작했다. 2003년 한국을포함한각국의아동학대전담의료기관유사사례고찰
{"title":"A review of the designated health care institution for child abuse in Korea and the compatible systems in other countries","authors":"Myung Hun Kim, Y. Kwak","doi":"10.22470/pemj.2020.00024","DOIUrl":"https://doi.org/10.22470/pemj.2020.00024","url":null,"abstract":"한국 정부와 사회의 예방 노력에도 불구하고 아동학대 가 꾸준히 증가하고, 이로 인한 사망 사건이 종종 발생하 고 있어 사회적 충격을 주고 있다. 아동학대 예방부터 종 합적 피해자에 지원까지 학대에 대한 국가의 책임을 강화 하는 취지로 보건복지부에선 2019년 1월 전담 부서로 아 동학대대응과를 설치했다. 더불어, 같은 해 5월 학대 대응 체제를 포함한 아동보호체계를 개편하여 보호 필요 아동 에 대한 국가의 책임을 강화하는 취지의 포용국가 아동정 책을 발표했다. 같은 해 7월, 아동권리보장원이 출범하여 아동보호 및 권리 보장을 위한 정책과 서비스를 통합적으 로 지원하는 체제를 정비했다. 중앙아동보호전문기관은 아동권리보장원의 아동학대예방본부로 편입되어, 학대 예 방, 대응 체계 개선, 학대 후 가족관계 회복을 위한 서비스 개선 등 보다 포괄적인 활동을 운영하게 된다. 대한의사협회에서 2002년“아동학대예방전문위원회” 를 설치하여 학대 문제에 적극적으로 참여하기 시작했다. 종합병원 내 학대아동보호팀 구성을 촉진하고, 학대에 이 해를 갖춘 인력을 양성하여 고통받는 어린이를 눈 크게 뜨 고 구하자는 취지의“왕눈이 운동”을 시작했다. 2003년 한국을포함한각국의아동학대전담의료기관유사사례고찰","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"13 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87769948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.22470/pemj.2020.00038
H. Lee, Y. Kwak, J. Park, Do Kyun Kim, Se Uk Lee
Purpose: Differentiation of urinary tract infection (UTI) from viral infection is a critical challenge in febrile children in emergency departments (EDs). This study aimed to assess the predicting performances of creatinine, C-reactive protein (CRP), and white blood cell (WBC) for predicting UTI in the children. Methods: This study was a retrospective analysis of a prospectively enrolled cohort of febrile children who presented to our children’s hospital ED from August 2016 through February 2018. We included previously healthy, febrile (≥ 38。C) children younger than 24 months whose urine cultures were obtained. Accuracy of creatinine, CRP, and WBC were assessed by optimal cutoffs, which were calculated using receiver operating characteristic curves. Results: Among the total 33,013 children to the ED, 7,847 (23.8%) febrile children were registered to the fever registry. Finally, 506 children were included, and UTI was diagnosed in 127 (25.1%). The areas under the curve of creatinine, CRP, and WBC to predict UTI were 0.41 (95% confidence interval [CI], 0.35-0.46), 0.71 (95% CI, 0.66-0.77), and 0.66 (95% CI, 0.60-0.72), respectively. The cutoffs were 0.26 mg/dL for creatinine, 2.3 mg/dL for CRP, and 14.4 × 10 cells/μL for WBC. Creatinine showed worse performance than the other variables. The application of creatinine added to the other variables led to an increase only in the sensitivity, but at the expense of a lower specificity, positive predictive value, and negative predictive value. Conclusion: Serum creatinine showed a poor performance in predicting UTI in the febrile young children. Since a single biomarker can neither rule in nor rule out UTI in the children, the prediction of UTI can be achieved by the interpretation of both clinical and laboratory findings.
{"title":"Performances of serum creatinine, C-reactive protein and white blood cell to predict urinary tract infection in febrile children younger than 24 months of age","authors":"H. Lee, Y. Kwak, J. Park, Do Kyun Kim, Se Uk Lee","doi":"10.22470/pemj.2020.00038","DOIUrl":"https://doi.org/10.22470/pemj.2020.00038","url":null,"abstract":"Purpose: Differentiation of urinary tract infection (UTI) from viral infection is a critical challenge in febrile children in emergency departments (EDs). This study aimed to assess the predicting performances of creatinine, C-reactive protein (CRP), and white blood cell (WBC) for predicting UTI in the children. Methods: This study was a retrospective analysis of a prospectively enrolled cohort of febrile children who presented to our children’s hospital ED from August 2016 through February 2018. We included previously healthy, febrile (≥ 38。C) children younger than 24 months whose urine cultures were obtained. Accuracy of creatinine, CRP, and WBC were assessed by optimal cutoffs, which were calculated using receiver operating characteristic curves. Results: Among the total 33,013 children to the ED, 7,847 (23.8%) febrile children were registered to the fever registry. Finally, 506 children were included, and UTI was diagnosed in 127 (25.1%). The areas under the curve of creatinine, CRP, and WBC to predict UTI were 0.41 (95% confidence interval [CI], 0.35-0.46), 0.71 (95% CI, 0.66-0.77), and 0.66 (95% CI, 0.60-0.72), respectively. The cutoffs were 0.26 mg/dL for creatinine, 2.3 mg/dL for CRP, and 14.4 × 10 cells/μL for WBC. Creatinine showed worse performance than the other variables. The application of creatinine added to the other variables led to an increase only in the sensitivity, but at the expense of a lower specificity, positive predictive value, and negative predictive value. Conclusion: Serum creatinine showed a poor performance in predicting UTI in the febrile young children. Since a single biomarker can neither rule in nor rule out UTI in the children, the prediction of UTI can be achieved by the interpretation of both clinical and laboratory findings.","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"43 1","pages":"28-34"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82669705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.22470/pemj.2020.00010
Habeck Jo, H. W. Yoo, Seong Heon Kim, Young Mi Kim, H. Kim
Purpose: To investigate the effect of lifestyle changes on patterns of carbon monoxide (CO) exposure and the association between neurologic symptoms and outcomes in Korean children with CO intoxication. Methods: We reviewed the medical records of patients (< 18 years) with CO intoxication who visited the emergency department of Pusan National University Hospital between February 2012 and January 2020. We collected clinical findings, including age and sex, transfer from other hospitals, source, time and duration of exposure, manifestations with neurologic symptoms (syncope, seizure, and altered mental status), intensive care unit hospitalization, hospital length of stay, implementation of hyperbaric oxygen therapy, and findings of neuroimaging. These variables were compared between children with and without neurologic symptoms. In addition, levels of carboxyhemoglobin and lactate were compared between patients with and without specific manifestations. Results: The enrolled 47 patients’ median age was 10 years (interquartile range, 4.5-14.0). The most common source of exposure was fire (46.8%), followed by camping (23.4%). The most common times of exposure were night (44.7%) and winter (44.7%). The patients with neurologic symptoms (14 [29.8%]) showed longer duration of exposure and hospital length of stay (P < 0.001 and P = 0.007, respectively). Of the 14 patients, 2 were hospitalized to the intensive care unit without an in-hospital mortality. A significant association was found between dyspnea and lactate level (P = 0.049), also between syncope or presyncope and carboxy hemoglobin level (P = 0.017). Conclusion: CO intoxication in Korean children is most often caused by fire and camping, and at night and in winter. There is a correlation between neurologic symptoms and duration of exposure to CO.
{"title":"Clinical features of children with carbon monoxide intoxication: a single center study","authors":"Habeck Jo, H. W. Yoo, Seong Heon Kim, Young Mi Kim, H. Kim","doi":"10.22470/pemj.2020.00010","DOIUrl":"https://doi.org/10.22470/pemj.2020.00010","url":null,"abstract":"Purpose: To investigate the effect of lifestyle changes on patterns of carbon monoxide (CO) exposure and the association between neurologic symptoms and outcomes in Korean children with CO intoxication. Methods: We reviewed the medical records of patients (< 18 years) with CO intoxication who visited the emergency department of Pusan National University Hospital between February 2012 and January 2020. We collected clinical findings, including age and sex, transfer from other hospitals, source, time and duration of exposure, manifestations with neurologic symptoms (syncope, seizure, and altered mental status), intensive care unit hospitalization, hospital length of stay, implementation of hyperbaric oxygen therapy, and findings of neuroimaging. These variables were compared between children with and without neurologic symptoms. In addition, levels of carboxyhemoglobin and lactate were compared between patients with and without specific manifestations. Results: The enrolled 47 patients’ median age was 10 years (interquartile range, 4.5-14.0). The most common source of exposure was fire (46.8%), followed by camping (23.4%). The most common times of exposure were night (44.7%) and winter (44.7%). The patients with neurologic symptoms (14 [29.8%]) showed longer duration of exposure and hospital length of stay (P < 0.001 and P = 0.007, respectively). Of the 14 patients, 2 were hospitalized to the intensive care unit without an in-hospital mortality. A significant association was found between dyspnea and lactate level (P = 0.049), also between syncope or presyncope and carboxy hemoglobin level (P = 0.017). Conclusion: CO intoxication in Korean children is most often caused by fire and camping, and at night and in winter. There is a correlation between neurologic symptoms and duration of exposure to CO.","PeriodicalId":38199,"journal":{"name":"Pediatric emergency medicine practice","volume":"26 1","pages":"35-40"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89759825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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