Pediatric Emergency Department Research Articles

Procedural sedation and analgesia in Swiss Pediatric Emergency Departments: a national subgroup analysis of a European cross-sectional survey

This study aims to provide a national overview of procedural sedation and analgesia practices within Pediatric Emergency Departments in Switzerland, focusing on the availability of pharmacologic agents, the presence of safety protocols, the utilization of non-pharmacological interventions, and to identify specific local limitations. We conducted a detailed subgroup analysis of Swiss data from a European cross-sectional survey on emergency department pediatric Procedural Sedation and Analgesia (PSA) practice, isolating data from Swiss sites. The survey, conducted between November 2019 and March 2020, covered various aspects of procedural sedation and analgesia practices. The survey included nine Swiss sites, treating a total of 252,786 patients in 2019. Topical analgesia, inhaled equimolar nitrous oxide-oxygen mixture, and ketamine were largely available. All sites had nurse-directed triage protocols in place; however, opioid administration was included in the protocols in only 66% of sites. Only 33% of hospitals reported common use of intravenous sedation. Barriers to procedural sedation and analgesia implementation included staffing shortages (89% of sites) and lack of dedicated spaces (78%).Conclusions: Despite a broad array of pharmacological and options available in Swiss Pediatric Emergency Departments, challenges remain in standardizing practices across the country. Limited space and staffing and enhancing training on non-pharmacological interventions were identified as potential areas for improving pain and anxiety management in pediatric emergency care. This study underscores the need for national guidelines to harmonize emergency department PSA practices across Switzerland, ensuring all children have access to effective and evidence-based procedural comfort.What is Known:• Recent research, conducted in European emergency departments, suggests that in pediatric Procedural Sedation and Analgesia (PSA) resources are limited, and practice is heterogeneousWhat is New:• Swiss pediatric hospitals offer a wide range of pharmacological options for pain and anxiety management. However, significant barriers to PSA were identified. These include external control of intravenous sedation and insufficient integration of non-pharmacological interventions, such as child life specialists and procedural hypnosis. National guidelines are needed to harmonize PSA practices

Children in Mental Health Crisis: Pediatric Primary Care Providers' Role in Bridging Treatment Following Higher Levels of Care.

The current study examines the role of pediatric PCPs in bridging treatment for youth who have experienced mental health crises and the characteristics of these patients for whom PCPs sought psychiatric consultation and referral support from a child psychiatry access program, Maryland Behavioral Health Integration in Pediatric Primary Care. Psychiatric consultation and referral calls between 2012 and 2021 were included if a) the patient was recently seen in a higher level of care and b) the PCP was bridging treatment following the patient's discharge; 208 calls met criteria. The most common mental health concerns included depressed mood, suicidal thoughts/gestures, and anxiety. Acute concerns of aggression, suicide attempts, and hallucinations were also reported. Over half of the patients had two or more mental health diagnoses. At the time of the call, only one quarter of these patients had outpatient therapy services while about half were receiving medication treatment. Most of these patients were discharged from the higher level of care without a care plan. Pediatric PCPs are managing their patients' complex mental health concerns following receipt of higher levels of care. Improvements in collaboration and care coordination between pediatric PCPs and emergency department providers are needed.

Performance of blood enterovirus and parechovirus polymerase chain reaction testing in young febrile infants: a prospective multicentre observational study

ObjectivesTo analyse the performance of blood enterovirus and parechovirus PCR testing (ev-PCR) for invasive bacterial infection (IBI) (isolation of a single bacterial pathogen in a blood or cerebrospinal fluid culture)...

Characteristics of oncology patients with fever and invasive bacterial infections diagnosed.

To describe the characteristics of febrile oncology patients seen in the Paediatric Emergency Department and microbiological characteristics of the invasive bacterial infections (IBIs) diagnosed. We conducted a prospective observational study of febrile oncology patients seen between 2016 and 2022. We divided haematologic cancers by the aggressiveness of the chemotherapy received at the time. We included 418 episodes (272 haematologic cancers, 146 solid tumours). The median duration of fever was 2 h (interquartile range: 1-3) and 97.6% of patients were well-appearing on arrival. We diagnosed 61 IBIs (14.6%), including six episodes of bacterial sepsis. One other episode was coded as sepsis without microbiological confirmation, yielding seven episodes overall (1.7%). Rates of IBI and sepsis were higher among patients with high-risk haematologic cancers than those with low-risk haematologic cancers or solid tumours (22.9%, 5.4% and 10.3%, p < 0.01; 3.4%, 0% and 0.7%, p = 0.06, respectively). Leading causes were S. epidermidis (42.6%) and E. coli (14.7%). Gram-positive bacteria caused 67.2% of non-septic IBIs and 50% of septic episodes. Most febrile oncology patients are well-appearing and present with a very short history of fever. Prevalence of IBI and sepsis and the main disease-causing bacteria differ by cancer type and the presence of sepsis.

A Randomized Controlled Comparison of Guardian-Perceived Cosmetic Outcome of Simple Lacerations Repaired With Either Dermabond, Steri-Strips, or Absorbable Sutures.

The aim of this study was to compare the guardian-perceived 3-month cosmetic outcome for pediatric lacerations repaired with absorbable sutures, Dermabond, or Steri-Strips. Secondarily, pain and satisfaction with the procedure from both guardian and provider perspectives were compared. In this randomized controlled trial, we enrolled a convenience sample of children aged 0 to <18 years who presented with simple linear lacerations (≤5 cm in length, ≤0.5 cm in width, and <12 hours old) to a pediatric emergency department. Children were randomized to receive laceration repair with absorbable sutures, Dermabond, or Steri-Strips. Topical L.E.T. solution (lidocaine, epinephrine, tetracaine) was applied to wounds which were then closed by the primary team. Guardians and providers completed questionnaires regarding perceived pain and satisfaction with the procedure. Guardians were contacted 3 months after the repair and asked to email a picture of the scar with their perception of cosmesis rated on a visual analog scale from 0 to 100. Fifty-five patients were enrolled, of whom 30 completed 3-month follow-up (12 suture, 7 Dermabond, 11 Steri-strips). There was no statistical evidence of an association between scar appearance and closure method based on medians and interquartile ranges for cosmetic ratings of scar: suture median 70.5 (IQR 59.8-76.8), Dermabond median 85 (IQR 73-90), Steri-strips median 67 (IQR 55-78) (P = 0.254). Guardian satisfaction with length of stay, guardian and physician satisfaction with the procedure, and guardian and physician-perceived pain also showed no differences. No differences were observed in guardian-perceived cosmesis of simple lacerations repaired with sutures, Dermabond, or Steri-Strips when evaluated 3 months after intervention. In addition, there were no differences in guardian or physician-perceived pain or satisfaction with the closure methods. The results of this study suggest that all 3 closure methods appear to be clinically equivalent, which is largely consistent with other evidence. Further study should be expanded to a larger demographic.

Racial and Socioeconomic Disparities in Pediatric Asthma Emergency Care

The aim of this paper is to build a model to compare the relative impact of race and ethnicity and insurance type on pediatric Emergency Department utilization for asthma. A binary logistic regression model using relevant variables from 2022 NHIS survey data was conducted to compare asthma ED visit odds ratios of racial and ethnic minorities and publicly insured children. The results suggest that insurance type has slightly greater influence over asthma ED visits than race and ethnicity. Publicly insured children had the highest unadjusted odds ratio (1.88 [CI 95% 1.09-3.24)]) followed by Non-Hispanic Black children (1.80 [0.92-3.52]) and Hispanic children (1.51 [0.80-2.86]). The data are possibly biased toward exclusion of well-controlled asthmatics that may affect the resulting odds ratios. More socioeconomic variables would provide a more complete analysis. The paper has direct implications for health service providers and policymakers. Providers are encouraged to provide equitable, culturally competent care to asthmatics and policymakers are encouraged to embrace policies that promote better access for Medicaid beneficiaries, improved air quality and housing conditions for low-income children, and better racial representation in the provider workforce. The paper collates many existing sources of research on asthma disparities as a backdrop for examination of recent survey data pertaining to differences in asthma ED utilization between populations. It supports existing theories and work being done to mitigate poor asthma outcomes in children that are exacerbated by biological and systemic factors.

Intravenous Sedation and Analgesia in a Pediatric Emergency Department: A Retrospective Descriptive Study.

Background Painful procedures in the pediatric emergency department often require the use of sedation and analgesia to ensure adequate pain control, a right of children and adolescents. This study aims to describe the procedural sedation and analgesia with intravenous medications performed in a pediatric emergency department. Methods This is a retrospective descriptive study of intravenous sedoanalgesia used in a pediatric emergency department of a level II district hospital in the Lisbon metropolitan area from October 2018 to December 2023. The type of intervention, drugs used, and adverse events were analyzed. Results A total of 615 patients were included in the study; 65.7% (n=404) were male with a median age of 6 years. The most frequently performed procedures were wound suturing (50.9%, n=313) and fracture reduction (36.3%, n=223). The drugs used for sedation and analgesia were ketamine (99.2%, n=610), midazolam (95.8%, n=589), propofol (1.6%, n=10), and morphine (0.5%, n=3). The majority of patients received midazolam and ketamine in association (93.8%, n=577). A total of 50 adverse events (8.1%) were recorded in 42 patients. The most frequent side effects were transient oxygen desaturation (2%, n=12), vomiting (1.5%, n=9), apnea/bradypnea (1%, n=6), and hallucinations (0.8%, n=5). The occurrence of adverse events was not dose-dependent (p >0.05). Respiratory complications resolved without requiring invasive interventions. Children were sedated by a pediatric intensivist in 68.1% (n=419), by a general pediatrician in 26.7% (n=164), and by a pediatric resident in 2% (n=12). Conclusions The results of this study demonstrate that intravenous sedoanalgesia, particularly the combination of ketamine and midazolam, is a safe method for sedation in pediatric patients, with a low rate of adverse events.

Initiation of Buprenorphine Treatment of Opioid Use Disorder in Pediatric Emergency Departments.

Pediatric emergency departments (EDs) in the United States are facing a rise in the number of children and adolescents who present with opioid use disorder (OUD), often driven by illicitly manufactured fentanyl. Medication treatment of pediatric OUD in the ED setting is often limited to symptomatic treatment of opioid withdrawal. Pediatric patients are rarely offered medications for OUD, especially in the ED setting. Buprenorphine is a partial opioid agonist that is Food and Drug Administration-approved for the treatment of OUD in patients aged 16 years and older. Adult studies have demonstrated that ED initiation of medication for OUD such as buprenorphine is feasible, safely treats withdrawal symptoms, and can improve patient compliance with outpatient follow-up. However, initiation of buprenorphine in the ED has not been well-studied in the pediatric population. We present 2 cases of adolescent patients, a 16-year-old male and 17-year-old female, who presented to the ED with opioid withdrawal. They were both diagnosed with severe OUD because of their use of counterfeit pills containing fentanyl. Both patients were successfully started on buprenorphine/naloxone in the pediatric ED before transitioning to an outpatient addiction clinic for continued treatment. The case series demonstrates the feasibility of ED-based buprenorphine initiation for adolescents, an important and timely intervention for adolescents with OUD.

Acute Confusional Migraines: A Case Report.

Acute confusional migraine (ACM) is a rare variant of migraine that is benign and self-resolving but difficult to diagnose. Without known causative pathophysiology and a lack of recognition in the International Classification of Headache Disorders (ICHD-3), ACM offers a puzzling clinical presentation. There currently is no standardized treatment for ACM, but with a growing anecdotal dataset there is the opportunity to formally recognize and establish protocols to improve patient care and outcomes. A 14-year-old female presented to the emergency department (ED) with acute onset of confusion, vision changes, right-sided weakness, and dysarthria one hour prior to arrival. A stroke workup at the initial ED offered no pertinent findings. The patient was transferred to a pediatric specialty ED where all symptoms, aside from numbness and a mild headache, resolved during transfer. After administration of a migraine cocktail at the pediatric specialty ED, all remaining symptoms completely resolved. The patient was discharged home from the ED the same evening with outpatient follow-up. This case presents the difficulty of diagnosing and treating ACM prior to its self-resolution. It highlights the need for formal recognition of the condition by the ICHD-3. In doing so, greater recognition will promote more research, awareness, and establishment of a standardized treatment for ACM.

Mode of Transport and Patient Status Upon Arrival at a Tertiary Pediatric Emergency Department in a Developing Country: A Prospective Observational Study.

Introduction In children with acute illness or injury, timely access to healthcare is crucial for optimal outcomes, including early identification, prompt stabilization, and appropriate referral. Prehospital transport practices often represent a weak link in the system and are frequently underreported. Enhancing these practices could greatly benefit pediatric care. This study aims to analyze the mode of transport and condition upon arrival of children at our hospital's pediatric emergency department. Methods This hospital-based prospective observational study was conducted from August 2019 to March 2020. Data on referral status, mode of transport, vital parameters at admission, and final outcomes in terms of survival were collected prospectively from patient admission records. Results Out of 1,658 children, 1,326 (80%) were referred from another health facility. Among these, only 10.8% received prior notification about their arrival. The most common mode of transport was a bus (39.3%), followed by locally available ambulances (24.4%), two-wheelers (15.6%), and cars (10.9%). In terms of medical conditions, 47.5% of the children had respiratory infections, 15.8% had renal ailments, and 14.1% had neurological complaints. Upon arrival, 1,214 (73.2%) were in stable condition, while 444 (26.8%) were unstable. Common alterations in vital parameters included hypothermia (16.6%), SpO2 <92% (9.9%), abnormal heart rate (32.5%), and abnormal respiratory rate (56%). Additionally, 111 (6.6%) children required CPR upon arrival. Conclusions The data highlights the need for improvements in our referral systems and the modes of transport for sick children within our population.

Impact of respiratory pathogens detection by a rapid multiplex polymerase chain reaction assay on the management of community-acquired pneumonia for children at the paediatric emergency department. A randomized controlled trial, the Optimization of Pneumonia Acute Care (OPTIPAC) study

ObjectivesThe pathogen of community-acquired pneumonia (CAP) in children is typically uncertain during initial treatment, leading to systematic empiric antibiotic use. This study investigates if having rapid multiplex PCR results in the emergency department (ED) improves empiric treatment. MethodsOPTIPAC, a French multicentre study (2016–2018), enrolled patients consulting for CAP at the paediatric ED in 11 centres. Patients were randomized to either receive a multiplex PCR test plus usual care or usual care alone and followed for 15 days. The primary outcome was the appropriateness of initial antimicrobial management, determined by a blinded committee. ResultsOf the 499 randomized patients, 248 were tested with the multiplex PCR. Appropriateness of the antibiotic treatment was higher in the PCR group (168/245, 68.6% vs. 120/249, 48.2%; Relative risk 1.42 [1.22–1.66]; p < 0.0001), chiefly by reducing unnecessary antibiotics in viral pneumonia (RR 3.29 [2.20–4.90]). No adverse events were identified. DiscussionThe multiplex PCR assay result at the ED improves paediatric CAP's antimicrobial stewardship, by both reducing antibiotic prescriptions and enhancing treatment appropriateness.

Physician Follow-Up of Pediatric and Young Adult Emergency Department Visits for Substance Use in Ontario, Canada

PurposeTo study the proportion and predictors of outpatient physician follow-up within 60 days of substance-related emergency department (ED) visits for Ontario youth. MethodsWe examined administrative data on substance-related ED visits before and during the COVID-19 pandemic among youths aged 10–24 years in Ontario, Canada. Substance-related visits were identified using International Classification of Diseases-10-CA codes. We described demographic characteristics, receipt of mental health services in the year before the ED visit, disposition from the ED, and follow-up services within 60 days of the ED visit. ResultsBetween April 1, 2017, and May 31, 2021, 64,236 youth had at least one ED visit for substance use. Visits for alcohol were the most common (49%), followed by cannabis (32.3%). ED visits for all substances were more prevalent during the pandemic than prepandemic, except visits for alcohol. The receipt of follow-up physician care for substance use was low (33.2% prepandemic) but increased during the pandemic (41.7%; adjusted odds ratio 1.34, 95% CI 1.28, 1.39) and varied between substances. Mental health service history in the year before the substance-related ED visit had the strongest association with receipt of follow-up physician care within 60 days (adjusted odds ratio 6.86, 95% CI 6.57, 7.17). DiscussionYouth frequently do not receive physician follow-ups within two months of the substance-related ED visit, although higher follow-up proportions were seen during the pandemic after the implementation of virtual care. Further research is required to understand why follow-up is low and to examine interventions that can increase connection to care.

P02 Evaluating the impact of antimicrobial stewardship interventions in a UK paediatric emergency department

P02 Evaluating the impact of antimicrobial stewardship interventions in a UK paediatric emergency department

External Validation of Two Clinical Prediction Models for Pediatric Pneumonia

ObjectiveTo externally validate two prediction models for pediatric radiographic pneumonia. MethodsWe prospectively evaluated the performance of two prediction models (Pneumonia Risk Score [PRS] and Catalyzing Ambulatory Research in Pneumonia Etiology and Diagnostic Innovations in Emergency Medicine [CARPE DIEM] models) from a prospective convenience sample of children 90 days – 18 years of age from a pediatric emergency department undergoing chest radiography for suspected pneumonia between January 1, 2022, and December 31st, 2023. We evaluated model performance using the original intercepts and coefficients and evaluated for performance changes when performing recalibration and re-estimation procedures. ResultsWe included 202 patients (median age 3 years, IQR 1–6 years), of whom radiographic pneumonia was found in 92 (41.0%). The PRS model had an area under the receiver operator characteristic curve of 0.72 (95% confidence interval [CI] 0.64–0.79), which was higher than the CARPE DIEM (0.59; 95% CI 0.51–0.67) (P < 0.01). Using optimal cutpoints, the PRS model showed higher sensitivity (65.2%, 95% CI 54.6–74.9) and specificity (72.7%, 95% CI 63.4–80.8) compared to the CARPE DIEM model (sensitivity 56.5 [95% CI 45.8–66.8]; specificity 60.9 [95% CI 50.2–69.2]). Recalibration and re-estimation of models improved performance, particularly for the CARPE DIEM model, with gains in sensitivity and specificity, and improved calibration. ConclusionThe PRS model demonstrated better performance than the CARPE DIEM model in predicting radiographic pneumonia. Among children with a high rate of pneumonia, these models did not reach a level of performance sufficient to be used independently of clinical judgment. These findings highlight the need for further validation and improvement of models to enhance their utility.

Epidemiology and risk stratification of young infants presenting to the emergency department with hypothermia.

Hypothermic infants are presumed to be at high risk for a serious bacterial infection (SBI) or herpes simplex virus (HSV) infection. In contrast to febrile infants, the emergency department (ED) management of hypothermic infants is variable in the absence of consensus guidelines, potentially resulting in low-value care and missed diagnoses. We investigated the diagnostic workup conducted for hypothermic infants in our academic pediatric ED, the incidence of SBI and HSV infection, and risk factors associated with infection. We conducted a single-center retrospective study of infants ≤90 days of age with a rectal temperature ≤36.5°C in the ED between 2013 and 2022. From their medical records, we abstracted the type(s) of testing each infant received in the ED and the diagnosis of SBI and HSV, analyzing characteristics associated with each. Of 1095 hypothermic infants identified, 402 (37%) underwent testing for SBI or HSV. Among these, 34/402 (8.5%) had an SBI or HSV. A minimum temperature below 36°C and hospital admission were characteristics associated with higher rates of infectious testing. Infants aged 29‒90 days, compared to 0‒28 days, were more likely to have a urinary tract infection (odds ratio 3.28, 95% confidence interval 1.47‒7.32). Hypothermic infants have slightly lower rates of SBI or HSV than febrile infants, for whom infectious studies are widely recommended, but still high enough to warrant an infectious workup in most cases. Further research is required to risk stratify hypothermic infants in the ED to standardize care and improve outcomes while optimizing resource utilization.

Potentially Avoidable Emergency Department Transfers for Acute Pediatric Respiratory Illness

BackgroundAcute pediatric respiratory illness is one of the most common reasons for emergency department (ED) transfer; however, few studies have examined predictors of potentially avoidable ED transfer (PAT) in this subpopulation. This study aimed to characterize patterns and predictors of PATs in children with acute respiratory illness. MethodsCross-sectional analysis of 8,402,577 visits for patients ≤17 years from 2018 to 2019 Health Care Utilization Project State ED and Inpatient Datasets from New York, Maryland, Wisconsin, and Florida. ED transfers matched to a visit at a receiving facility with a primary diagnosis of pneumonia, croup/other URI, bronchiolitis, or asthma were included. PAT was defined as discharge from receiving ED or within 24 hours of inpatient admission without specialized procedures, as previously described. PATs were compared with necessary transfers using a 3-level generalized linear mixed model with adjustment for patient and hospital covariates. ResultsAmong 4409 matched respiratory transfers, 25.5% were potentially avoidable. Most PATs originated from EDs within the third highest quartile of annual pediatric ED visits (n = 472, 42.0%). In the multivariable model, the likelihood of PAT was higher for patients with croup/other URI (OR 2.72 (2.09–3.5) and if referring ED was in the highest quartile of annual pediatric ED volumes (OR 0.48 95% CI 0.26–0.88). ConclusionsPediatric respiratory transfers with a diagnosis of croup/other URI were the most likely to be potentially avoidable. Future implementation efforts to reduce PATs should consider focusing on croup management in EDs in the lower 3 quartiles of pediatric volume.

Effects of COVID-19-targeted non-pharmaceutical interventions on pediatric emergency department use: a quasi-experimental study interrupted time-series analysis in North Italian hospitals, 2017 to 2022.

The use of Non-Pharmaceutical Interventions (NPIs) during the COVID-19 pandemic is debated. Understanding the consequences these measures may have on vulnerable populations including children and adolescents is important. This is a multicenter, quasi-experimental before-after study involving 12 hospitals of the North Italian Emilia-Romagna Region, with NPI implementation as the intervention event. The 3 years preceding NPI implementation (in March 2020) constituted the pre-pandemic phase. The subsequent 2 years were further subdivided into a school closure phase (SC) and a subsequent mitigation measures phase (MM) with milder restrictions. Interrupted Time Series (ITS) regression analysis was used to calculate PED Standardized Incidence Rate Ratios (SIRR) on the diagnostic categories exhibiting the greatest frequency and/or variation. In the 60 months of the study there were 765,215 PED visits. Compared to the pre-pandemic rate, overall PED presentations dropped by 58 and 39% during SC and MM, respectively. "Symptoms, signs and Ill-defined conditions," "Injury and poisoning" and "Diseases of the Respiratory System" accounted for 74% of the reduction. A different pattern was instead seen for "Mental Disorders," which exhibited the smallest decrease during SC, and is the only category which rose already at the end of SC. ITS analysis confirmed the strong decrease during SC (level change, IRR 0.17, 95%CI 0.12-0.27) and a significant increase in MM (slope change, IRR 1.23, 95%CI 1.13-1.33), with the sharpest decline (-94%) and rise (+36%) observed in the "Diseases of the Respiratory System" category. Mental Disorders showed a significant increasing trend of 1% monthly over the whole study period exceeding pre-pandemic levels at the end of MM. Females and adolescents showed higher increasing rates both in SC and MM. NPIs appear to have influenced PED attendance in different ways according to diagnostic categories, mirroring different mechanisms of action. These effects are beneficial in some cases and harmful in others, and establishing a clear balance between pros and cons is a difficult task for public health decision makers. The role of NPIs on PED use appropriateness deserves investigation. The rise in pediatric mental disorders independent of the pandemic makes interventions addressing these issues urgent.

Understanding caregiver preferences and technology access to plan improvement of pediatric emergency department discharge instructions.

Approximately 95% of children treated in emergency departments (EDs) in Alberta, Canada, are discharged home. Discharge teaching is an opportunity to provide caregivers with the information that they need to manage their child's condition at home and ensure appropriate follow-up. Our ED lacked a standard discharge instruction process. In preparation for local quality improvement, we sought to understand caregiver preferences regarding discharge instructions by assessing the preferred format, need for translated resources, and ability to effectively access electronic information using a Quick Response (QR) code. This project was completed at a tertiary pediatric ED in Calgary, Alberta in July and August 2021. Caregivers of pediatric patients were invited to complete a survey. Families requiring an interpreter were not eligible; however, this was recorded to estimate translation needs. Survey questions addressed preference of discharge instruction modality (verbal, printed, electronic), primary language spoken at home, ability to use English resources, and ability to use QR codes. Descriptive analyses were performed, and preferences were compared. Of 117 caregivers approached, 104 completed the survey (89%). Caregivers had a strong preference for receiving written discharge instructions, with 98% desiring either electronic or printed resources in addition to verbal instructions. There was a similar likelihood of using printed (75%) versus electronic (79%) resources (p = 0.5). Three percent of families were unable to complete the survey due to a language barrier. Of the 104 participants, 19% noted that their primary language at home was not English but that they would still use English discharge instructions. Eighty percent of participants were able to successfully use the QR code. Caregivers had a strong preference for receiving written discharge instructions, with electronic or paper formats preferred equally. Translated resources will be important for some families. QR codes may be an effective tool for distributing electronic resources to most but not all families.

Infantile Idiopathic Intracranial Hypertension: Case Report of an 8-Month-Old Child

AbstractIdiopathic intracranial hypertension (IIH), a clinical disorder also known as pseudotumor cerebri, is characterized by increased intracranial pressure of unknown causes. Although it is most commonly observed in young obese women, IIH can also occur in the pediatric population; however, it is extremely rare in infants. Infants do not typically exhibit characteristic signs and symptoms of IIH, making it challenging to diagnose. Additionally, treatment modalities for this disease remain uncertain. We report an 8-month-old female child admitted to the pediatric emergency department with IIH. Our patient presented initially with fever, vomiting, and diarrhea, and then she developed inability to abduct the left eye. Papilledema was not detected in our patient. Magnetic resonance imaging and lumbar puncture contributed to diagnosis of the patient. Dexamethasone (0.5 mg/kg/d, twice a day) and acetazolamide (5 mg/kg/d) were administered; dexamethasone was stopped at the 48th hour after esotropia had resolved. The patient developed left ptosis in the first month after discharge. Acetazolamide was administered for a duration of 5 months and was discontinued once the patient's eye findings improved. With a sudden onset of neurological findings in a healthy infant with normal neuroimaging, IIH should be considered in the differential diagnosis and cerebrospinal fluid pressure should be measured. The principles of treatment for this disease are based on adult guidelines, but the efficacy of acetazolamide has also been reported in the pediatric population, like in our case.

Quality of life of emergency department nurses in pediatric and general hospitals in Greece: A cross sectional study

Introduction: The Emergency Department (ED) is a quite stressful workplace for nurses, affecting their quality of life. The existence of factors that affect the quality of life of ED nurses in daily clinical practice, leads to exhausted nurses. Consequently, there is a need to find the factors and the implementation of interventions that will improve the quality of life of nurses. Purpose: To investigate the factors that affect the quality of life of nurses in children's and adult hospitals. Method: The sample of this cross-sectional study consisted of ED nurses in children's and adult hospitals in Greece. To assess the nurses' quality of life, the WHOQOL-BREF questionnaire was used for the ED nurses. Analysis was done with IBM SPSS 26.0. A value of p&lt;0.05 was considered as the level of significance and all statistical tests were two-tailed. Results: Study population included 210 nurses. No statistical significance was found for the relationship between pediatric ED nurses and adult ED nurses regarding their quality of life, sleep, and fatigue. However, a statistically significant relationship was found regarding social relationships tending to a better score in pediatric nurses compared to adults (p=0.011). In all five dimensions of life evaluated by the tool, the quality of life of the nurses in our sample was at moderate levels (Mean-General=69.32, Mean-Physical health=64.70, Mean-Psychological health=67.85, Mean-social relations=69.01 and Mean-Environment =57.60). Conclusion: One or more factors are sufficient to affect or have an impact on the quality of life, sleep completeness and fatigue levels of ED nurses.