Clinical Pediatric Emergency Medicine最新文献

The COVID-19 pandemic has created conditions which heighten risk for child abuse. As key players in times of crisis, pediatric emergency medicine providers must be equipped with the tools to recognize, respond to, and mitigate risk of child abuse. An exploration of the scientific literature, stakeholder organization reports and lay press was undertaken to understand the impact of large-scale U.S. crises, including infectious disease, financial downturn, natural disaster, and violence, on child abuse risk and inform prevention strategies. Review of the literature suggests a relationship between crises and child abuse risk, though gaps in the research remain. We outline the role of pediatric emergency medicine providers in partnering with communities in organizing and advocating for systems that better protect children and strengthen families.

When a child presents to the emergency department with injuries concerning for abuse, a complete evaluation must look beyond the patient's physical exam to identify potential sources of harm as well as protective factors in the family's psychosocial environment. Here we discuss a structured, evidence-based assessment tool designed by our research team for use in its complete form by social workers (when available), or in its abbreviated form by licensed independent practitioners. Even amidst the controlled chaos of the acute care setting, providers can utilize trauma-informed communication strategies to effectively and efficiently elicit an unbiased narrative of relevant historical information and key psychosocial risk factors in the patient's home environment. Without understanding the contributory role of each component to the child's overall risk of abusive injury, it remains difficult to address the root cause of the problem, and the door is thus left open for ongoing harm.

In the United States, 1 in 4 children lives in an immigrant family. State and national policies have historically precluded equitable access to health care among children in immigrant families. More recently, increasingly restrictive policies, political rhetoric, and xenophobic stances have made immigrant families less able to access health care and less comfortable in attempting to do so, thus increasing the likelihood that patients will present to the emergency department. Once in the emergency department, language, cultural, and health literacy barriers make providing high-quality care potentially challenging for some families. Emergency care professionals can therefore glean critical insight regarding inequities from clinical work to inform advocacy and policy changes at institutional, community, regional, and national levels.

Firearms remain a common cause of injury in children. Advocacy is a tool that can be useful in effecting systemic change. Yet for firearm injury prevention, traditional methods of effecting change face unique barriers not experienced in other areas of pediatric injury prevention. As pediatric emergency medicine physicians, we are on the front lines, and as part of the receiving end of the trauma inflicted on our communities by firearms, ours is a powerful voice well suited to overcome these barriers. Current firearm advocacy efforts include raising awareness via social media or editorials, organizing larger advocacy groups for support, challenging legislation, and implementing hospital-based violence intervention programs. Future advocacy directions should include collaborating with unique partners, teleadvocacy, direct action, and finding common ground with gun regulation opposition. Physician advocacy is essential to firearm injury prevention. Continuing to innovate around our advocacy efforts will be vital to the health and safety of our patients.

Human trafficking is a pervasive problem throughout the world and is largely underreported, particularly within the pediatric population. Signs of trafficking can be subtle, and it is important for clinicians to be familiar with red flags and how to advocate for children whom they suspect of being trafficked. This article provides a brief overview of pediatric human trafficking and methods of successfully advocating for pediatric victims.

Transgender and gender-expansive (TGE) youth represent a diverse population with unique health needs. Inadequate education and training in gender-related health hamper pediatric emergency medical providers' ability to offer affirming care to TGE youth. Increasing staff education and competency and advocating for welcoming spaces and inclusive practices are ways that emergency medical care providers can offer culturally affirming clinical care to patients and families. Additionally, emergency medical providers can play key roles in advocating for improved health care for TGE youth both within and outside of their health organization.

Escalating numbers of pediatric patients are presenting to emergency departments seeking care for emotional and behavioral crises. This surge in emergency service needs is a manifestation of both increasing mental health acuity among young people as well as inadequate community mental health resources, particularly in underserved communities. Improving emergent mental health care for children in crisis will require significant patient advocacy to drive systems improvements across treatment settings and enable coordinated approaches that bridge care beyond an emergency setting. Targets for emergency mental health advocacy include implementing universal suicide screening, increasing community mental health resources, development of mobile crisis services, and implementation of emergency department telepsychiatry programs. There are numerous examples of advocacy efforts, often fostered by professional organizations, leading to meaningful change in mental health care systems. As frontline witnesses to the harms of suboptimal mental health care systems, emergency medicine physicians can be critical advocates for change.

Suicide is the second leading cause of death among youth aged 10-19 years in the United States. Pediatricians and emergency physicians have the opportunity to contribute to youth suicide prevention in their daily practice. Moreover, clinicians can advocate for local practice improvements and national policies to achieve a broader population-based impact on youth suicide reduction. Strategies that hold promise for improved care include integration of behavioral health care into the medical home, suicide screening in the emergency department setting, health care system quality improvement, and increased access to affordable mental health care. We review strategies for pediatricians and emergency physicians to prevent youth suicide at the level of the individual patient, practice, health care system, and nation.

Advocacy is a vitally important activity as it applies to all aspects and settings where pediatric care is provided. Advocacy also offers a forum for scholarship, professional and layperson education, mentorship and research. In this issue of Clinical Pediatric Emergency Medicine we explore different topics in pediatric emergency medicine, and examine how we can use our patient care experiences and our position as health care providers to advocate for the well-being of children both inside and outside of the hospital.

Button batteries (BBs) are a severe potential hazard present in household settings, and BB injuries in children continue to be a significant source of morbidity and mortality. When lodged in the body, BBs can cause serious injury within as little as 2 hours. Without a known history of BB ingestion, the diagnosis can be challenging because symptoms may be nonspecific and mimic common viral illnesses seen in children. Based on recent research on esophageal BBs, novel mitigation strategies can be used in the urgent care and emergency department settings, or during transport between facilities <12 hours from ingestion. These include the preremoval use of honey or sucralfate to help decrease the rate of esophageal tissue injury. All emergency care providers should be aware of these interventions for esophageal BB and help to expedite these children to the operating room for removal.