Pediatric Emergency Setting Research Articles

The impact of the Italian guidelines on antibiotic prescription practices for acute otitis media in a paediatric emergency setting.

BackgroundAcute otitis media (AOM) is one of the most common childhood infectious diseases. The recent Italian Pediatric Guidelines for the treatment of AOM constitutes a step forward in the management of children with uncomplicated AOM. The aim of this study was to evaluate antibiotic prescription patterns for AOM in a Pediatric Emergency Department (PED) after those guidelines were introduced and to assess the relationship between implementation of the “watchful waiting” strategy and the incidence of acute mastoiditis in the PED.MethodsThis retrospective study was conducted between 1st January 2007 to 31st December 2013 at the PED of the University of Modena and Reggio Emilia in Modena (Italy). All children between 0 and 14 years who were examined because of symptoms and/or signs of AOM and acute mastoiditis were enrolled. Pearson’s chi-squared test was used to evaluate if introduction of the Italian Paediatric Guidelines was associated with a reduction in the antibiotic prescription pattern in children with AOM and/or with an increase in mastoiditis frequency.Results4,573 (89.4%) patients were included in our analysis, antibiotics were prescribed to 81% cases of the children diagnosed with AOM. The frequency of antibiotic prescribing continued to be stable after the Italian guidelines were introduced (82% versus 81%).Forty children were admitted to hospital with a diagnosis of acute mastoiditis. Our study did not find any association between the number of cases of acute mastoiditis and the percentage of patients treated with antibiotics; the annual incidence of mastoiditis before and after the new guidelines were published was, in fact, stable.ConclusionsDespite the diffusion of clinical guidelines recommending a “watchful waiting” approach for children with AOM, the antibiotic prescription rate continues to be high. It appears to be more difficult to impact the percentage of cases for which antibiotics are prescribed than the type of antibiotic that is utilized. In view of these findings, a close follow-up control by the primary care paediatrician or a scheduled follow-up appointment at the PED and incisive campaigns to promote parents’ awareness of proper antibiotic use appear to be warranted.

PRM45 - Big Data In Emergency Department Care Delivery: Benefits Of Radio Frequency Identification

Lack of a coordinated primary care system is forcing individuals to seek emergency departments (EDs) as gateway into the health system. As volumes increase and cases become more complex, combined with inadequate downstream capacity lead to boarding, bottlenecks and wait times. The goal was to review benefits of Radio Frequency identification (RFID) demonstrated in the literature in the ED. Article searches were conducted and they were categorized based on benefits in three areas: patients, staff, assets. Evidence of use of RFID in ED went as far back as 2006 with both domestic and international applications mostly using active technology. Majority of the articles demonstrated reducing wait times in the ED. One of the articles in turn demonstrated impact on patient satisfaction. Reduction in wait times were demonstrated when admitting patients into ICU from the emergency setting. In case of staff, use of RFID demonstrated increased satisfaction in a pediatric emergency setting. Evidence also exists in better tracking of assets and equipment in the ED. Very little evidence of use of RFID in simulation and analytical models exist. Most of the studies were retrospective in nature. Wait times and asset tracking are tangible benefits with direct impact on return-on-investment. RFID has been used is various settings in healthcare and quality benefits have been demonstrated. Lesser evidence of RFID use in the ED exists. RFID benefits have primarily been demonstrated with regard to wait times and asset tracking and management. Patient and staff satisfaction are more intangible benefits. As EDs start to reap benefits with wait times, use in simulation and advanced analytical models could potentially inform workload, team configuration and team dynamics studies. As healthcare moves into the era of big data, live streaming RFID data can be tapped for real-time decision making.

A randomized comparison of the Laryngoscope with Fiber Optic Reusable Flexible Tip English Macintosh blade to the conventional Macintosh laryngoscope for intubation in simulated easy and difficult child airway with chest compression scenarios

IntroductionWe hypothesized that the Laryngoscope with Fiber Optic Reusable Flexible Tip English Macintosh blade (TMAC) is beneficial for the intubation of child manikins while performing cardiopulmonary resuscitation (CPR). In the present study, we evaluated the effectiveness of the conventional Macintosh laryngoscope (MAC) and TMAC in 3 simulated CPR scenarios. MethodsA randomized crossover simulation trial was designed. One hundred seven paramedics intubated the trachea of a PediaSIM CPR training manikin (FCAE HealthCare, Sarasota, FL) using the MAC and TMAC in a normal airway scenario (scenario A), normal airway with chest compression scenario (scenario B), and difficult airway with chest compression scenario (scenario C). The participants were directed to make a maximum of 3 attempts in each scenario. The success rate, time required for intubation, Cormack-Lehane grade, dental compression, and the ease of intubation were measured. ResultsThe median time of intubation with MAC and TMAC in scenario A was 19.6 (interquartile range [IQR], 18-23) vs 19 (IQR, 16.2-21.8); in scenario B, 29.5 (IQR, 25-31) vs 26 (IQR, 23.5-29) seconds; and in scenario C, 38 (IQR, 32.5-45) vs 29 (IQR, 25-31) seconds, respectively. The overall efficacy for each of the scenarios was as follows: in scenario A, it was 100% vs 100%; in scenario B, it was 79.4% vs 100% (P = .007); and in scenario C, it was 68.2% vs 90.7% (P < .001), respectively. ConclusionsThe TMAC seems to be a superior intubating device compared with the conventional MAC when used in simulated normal and difficult child airway with chest compression scenarios. Future studies should explore the efficacy of TMAC in pediatric clinical emergency settings.

Ultrasound-guided forearm nerve blocks in kids: a novel method for pain control in the treatment of hand-injured pediatric patients in the emergency department.

Ultrasound-guided forearm nerve blocks have been shown to safely reduce pain for emergency procedures in the adult emergency department (ED). Although ultrasonography is widely used for forearm nerve blocks in the adult ED and in the pediatric operating room, no study to date has examined its use in the pediatric emergency setting. We conducted a prospective nonblinded descriptive study of ultrasound-guided ulnar, median, and radial nerve blocks in a convenience sample of pediatric patients with hand injuries requiring procedural intervention who presented to a freestanding pediatric ED. The mean initial pain score for the sample was 5.8, and the mean postprocedure score was 0.8, with a mean on the 10-point visual pain scale of 5 (interquartile range [IQR], 3-6; P = 0.04). Seven patients reported complete resolution of their pain that was signified by a score of 0. The mean time to completion for ulnar nerve block was 79 seconds (IQR, 67-103 seconds). The mean time to completion for median nerve block was 76 seconds (IQR, 70-112 seconds). The mean time to completion for radial nerve block was 69 seconds (IQR, 60-100 seconds). No immediate complications, including vascular puncture, carpal tunnel injury, or direct nerve injection, were noted during the study. At 1-year follow-up, no adverse effects were reported. Ultrasound-guided forearm nerve blocks are effective for pediatric patients in the ED. The procedure provides effective analgesia and facilitates care while minimizing iatrogenic risk.

Kidney Injury Molecule-1 and Cardiovascular Diseases: From Basic Science to Clinical Practice.

Despite the recent findings concerning pathogenesis and novel therapeutic strategies, cardiovascular disease (CVD) still stays the leading cause of morbidity and mortality in patients with renal dysfunction, especially acute kidney injury (AKI). Early detection of patients with impaired renal function with cardiovascular risk may help ensure more aggressive treatment and improve clinical outcome. Kidney injury molecule-1 (KIM-1) is a new, promising marker of kidney damage which is currently the focus of countless studies worldwide. Some recent animal and human studies established KIM-1 as an important marker of acute tubular necrosis (ATN) and reliable predictor of development and prognosis of AKI. Food and Drug Administration (FDA) in USA acclaimed KIM-1 as an AKI biomarker for preclinical drug development. Recent data suggest the importance of monitoring of KIM-1 for early diagnosis and clinical course not only in patients with various forms of AKI and other renal diseases but also in patients with cardiorenal syndrome, heart failure, cardiopulmonary bypass, cardiothoracic surgical interventions in the pediatric emergency setting, and so forth. The aim of this review article is to summarize the literature data concerning KIM-1 as a potential novel marker in the early diagnosis and prediction of clinical outcome of certain cardiovascular diseases.

Sickle cell anaemia: Morbidity profile and outcome in a paediatric emergency setting in Nigeria

Background: Sickle Cell Anemia (SCA) is an inherited disorder which is associated with significant morbidity and mortality. Early recognition as well as prompt and effective management of the morbidities seen in SCA is key to the survival of patients with the disease. Objective: To determine the morbidity profile and outcome of patients with sickle cell anemia (SCA) admitted into an Emergency Pediatric Unit (EPU) of a tertiary health center in Nigeria. Methods: A retrospective study in which records of admissions of children with SCA over a two-year period (June 2011 to May 2013) were obtained from the EPU records. Information retrieved included age, sex, diagnosis and outcome as far as the unit is concerned. Results: One hundred and forty-seven children, 11.9% of the total (1,234 patients) EPU admission, aged between six months and 18 years (mean age being 84.76 ± 57.24 months) were studied. Male: female ratio was 1.3: 1. Vaso-occlusive (53.2%), hyper-hemolytic (37.6%) and acute sequestration crises (9.2%) were noted but no case of aplastic crisis was seen. Among infections, Malaria (56.2%), Sepsis (15.6%) and pneumonia (12.5%) were the major cases documented. Two (50-0%) patients died of acute sequestration crisis, one (25.0%) of meningitis and another (25.0%) of hyper-hemolytic crisis with severe anemia. Mortality rate was 2.7%. Conclusion/ Recommendation: SCA admissions in our EPU are mainly due to vaso-occlusive crises and infections. Acute sequestration crisis was the leading cause of death followed by meningitis and hyper-hemolytic crisis. Prompt and effective transfusion services, the use of pneumococcal conjugate vaccine as well as judicious use of appropriate antibiotics will augment the chances of survival in these children.

A randomized controlled trial of capnography during sedation in a pediatric emergency setting

ObjectiveData suggest that capnography is a more sensitive measure of ventilation than standard modalities and detects respiratory depression before hypoxemia occurs. We sought to determine if adding capnography to standard monitoring during sedation of children increased the frequency of interventions for hypoventilation, and whether these interventions would decrease the frequency of oxygen desaturations. MethodsWe enrolled 154 children receiving procedural sedation in a pediatric emergency department. All subjects received standard monitoring and capnography, but were randomized to whether staff could view the capnography monitor (intervention) or were blinded to it (controls). Primary outcome were the rate of interventions provided by staff for hypoventilation and the rate of oxygen desaturation less than 95%. ResultsSeventy-seven children were randomized to each group. Forty-five percent had at least 1 episode of hypoventilation. The rate of hypoventilation per minute was significantly higher among controls (7.1% vs 1.0%, P = .008). There were significantly fewer interventions in the intervention group than in the control group (odds ratio, 0.25; 95% confidence interval [CI], 0.13-0.50). Interventions were more likely to occur contemporaneously with hypoventilation in the intervention group (2.26; 95% CI, 1.34-3.81). Interventions not in time with hypoventilation were associated with higher odds of oxygen desaturation less than 95% (odds ratio, 5.31; 95% CI, 2.76-10.22). ConclusionHypoventilation is common during sedation of pediatric emergency department patients. This can be difficult to detect by current monitoring methods other than capnography. Providers with access to capnography provided fewer but more timely interventions for hypoventilation. This led to fewer episodes of hypoventilation and of oxygen desaturation.

Ultrasound-assisted Lumbar Puncture in Pediatric Emergency Medicine

BackgroundUltrasound-assisted lumbar puncture in the pediatric emergency medicine setting has not been well established, but ultrasound could serve as a valuable tool in this setting. ObjectiveTo assess whether ultrasound increases provider confidence in identifying an insertion point for lumbar puncture. MethodsA feasibility study was conducted using a convenience sample of pediatric emergency patients requiring lumbar puncture. Provider confidence in selecting a needle insertion site for lumbar puncture using ultrasound assistance was compared to provider confidence using traditional landmarks alone. A simple technique using a linear probe is described. ResultsNineteen patients were included in the study, with the primary end point the mean confidence score (based on a five-point Likert scale) in identifying a needle insertion site prior to and after using ultrasound. Using the Wilcoxon signed-rank test, the mean confidence score was 2.89 with the landmark procedure alone, and 4.79 with ultrasound assistance, yielding an average score difference of 1.90 (95% confidence interval 1.23–2.56; Wilcoxon p < 0.001, paired t-test p < 0.001). Thus, compared to the landmark procedure, the use of ultrasound was associated with a significantly higher average confidence score. ConclusionThe use of ultrasound in the pediatric emergency setting can be a valuable adjunct with lumbar puncture.

Screening for post-traumatic stress disorder after injury in the pediatric emergency department - a systematic review protocol

BackgroundPediatric injury is highly prevalent and has significant impact both physically and emotionally. The majority of pediatric injuries are treated in emergency departments (EDs), where treatment of physical injuries is the main focus. In addition to physical trauma, children often experience significant psychological trauma, and the development of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) is common. The consequences of failing to recognize and treat children with ASD and PTSD are significant and extend into adulthood. Currently, screening guidelines to identify children at risk for developing these stress disorders are not evident in the pediatric emergency setting. The goal of this systematic review is to summarize evidence on the psychometric properties, diagnostic accuracy, and clinical utility of screening tools that identify or predict PTSD secondary to physical injury in children. Specific research objectives are to: (1) identify, describe, and critically evaluate instruments available to screen for PTSD in children; (2) review and synthesize the test-performance characteristics of these tools; and (3) describe the clinical utility of these tools with focus on ED suitability.MethodsComputerized databases including MEDLINE, EMBASE, CINAHL, ISI Web of Science and PsycINFO will be searched in addition to conference proceedings, textbooks, and contact with experts. Search terms will include MeSH headings (post-traumatic stress or acute stress), (pediatric or children) and diagnosis. All articles will be screened by title/abstract and articles identified as potentially relevant will be retrieved in full text and assessed by two independent reviewers. Quality assessment will be determined using the QUADAS-2 tool. Screening tool characteristics, including type of instrument, number of items, administration time and training administrators level, will be extracted as well as gold standard diagnostic reference properties and any quantitative diagnostic data (specificity, positive and negative likelihood/odds ratios) where appropriate.DiscussionIdentifying screening tools to recognize children at risk of developing stress disorders following trauma is essential in guiding early treatment and minimizing long-term sequelae of childhood stress disorders. This review aims to identify such screening tools in efforts to improve routine stress disorder screening in the pediatric ED setting.Trials registrationPROSPERO registration: CRD42013004893

Barriers and facilitators to pediatric emergency telemedicine in the United States.

Pediatric emergency telemedicine has the potential to improve the quality of pediatric emergency care in underserved areas, reducing socioeconomic disparities in access to care. Yet, telemedicine in the pediatric emergency setting remains underutilized. We aimed to assess the current state of pediatric emergency telemedicine and identify unique success factors and barriers to widespread use. We conducted a telephone survey of current, former, and planned pediatric emergency telemedicine programs in the United States. We surveyed 25 respondents at 20 unique sites, including 12 current, 5 planned, and 3 closed programs. Existing programs were located primarily in academic medical centers and served an average of 12.5 spoke sites (range, 1-30). Respondents identified five major barriers, including difficulties in cross-hospital credentialing, integration into established workflows, usability of technology, lack of physician buy-in, and misaligned incentives between patients and providers. Uneven reimbursement was also cited as a barrier, although this was not seen as major because most programs were able to operate independent of reimbursement, and many were not actively seeking reimbursement even when allowed. Critical success factors included selecting spoke hospitals based on receptivity rather than perceived need and cultivating clinical champions at local sites. Although pediatric emergency telemedicine confronts many of the same challenges of other telemedicine applications, reimbursement is relatively less significant, and workflow disruption are relatively more significant in this setting. Although certain challenges such as credentialing can be addressed with available policy options, others such as the culture of transfer at rural emergency departments require innovative approaches.

Comparison of temporal artery to mercury and digital temperature measurement in pediatrics

AimThe aim of the study was to compare the temporal artery thermometer measurements with the mercury and digital axillary thermometer measurements in children. MethodsThis study was conducted at the Pediatric Emergency Department of Akdeniz University Hospital over a three-month period in Turkey. The sample for the study comprised 218 children (aged 0–18years). Three different methods were applied to each patient at the same time. After acquiring necessary institutional permission to conduct the study, the informed consent to participate was obtained from parents before the subjects were included in the study. The data were evaluated using general linear models. The differences between the groups were analyzed by Least Significant Difference method. ResultsThe average temperature measured by temporal artery, mercury and digital thermometers were 38.9°C, 38.3°C and 38°C respectively. ConclusionTemporal artery thermometer values might be considered as core temperature. Rectal temperature is about 2°F (1°C) higher than an axillary temperature. In our study the difference between the temperature measured values was found to be consistent with the range provided in the literature. Temporal artery thermometers are recommended especially pediatric emergency settings, where an accurate, quick and safe body temperature measurement is of vital importance.

Clinical dehydration and glomerular filtration rate in acute paediatric gastroenteritis

To evaluate changes in glomerular filtration rate in acute gastroenteritis. The correlation between two clinical diagnostic scales and glomerular filtration rate has been investigated in 113 children with acute gastroenteritis in a paediatric emergency setting. A significant reduction of GFR was found in 10% children less than, and 5% children higher than, 2years of age with acute gastroenteritis. The differences observed as for risk of renal hypoperfusion suggests to consider the age of children as an important determinant to consider the dehydration status in acute gastroenteritis.

Triage of children with headache at the ED: a guideline implementation study

We present a multicenter validation of a modified Manchester Triage System (MTS) flowchart for pediatric patients who present with headache to the emergency department.A prospective observational study was conducted across 5 European pediatric emergency departments. The standard MTS headache flowchart and a modified MTS headache flowchart were tested in the participating centers, and results were compared with triage categories identified by either the physician at the end of the clinical examination or the reference classification matrix (RCM). Fifty-three patients were enrolled in the preimplementation phase and 112 in the postimplementation phase. When compared with physician's triage and RCM, the modified MTS flowchart demonstrated good sensitivity (79% and 70%, respectively), specificity (77% and 76%, respectively), and a high positive likelihood ratio (9.14 and 16.75, respectively) for the identification of low-risk children.Conclusions: Our modified headache flowchart is safe and reliable in pediatric emergency settings, especially for lower classes of urgency.

Current situation and standardization of pediatric emergency system

The current situation of pediatric emergency medicine and the pediatric emergency medical service systems were analyzed.The equipment configuration,personnel allocation and the requirement of professional knowledge and technology in pediatric emergency setting,the triage system,the process of medical services for patients with acute illness or trauma,and the optimizing process of diagnosis and treatment for emergency cases and critical cases were discussed.The nationwide development model of pediatric emergency service systems were reviewed. Key words: Emergency medicine; Emergency medical service; Emergency medical care; Pediatrics

Continuous Insulin infusion therapy for acute stress hyperglycaemia secondary to asthma exacerbation in a paediatric emergency setting

Introduction Hyperglycaemia is thought to be an adaptive response to stress and is recognized to be associated with an adverse outcome. Although mild stress hyperglycaemia in paediatric illness is common, severe hyperglycaemic responses (≥25 mmol/L) to stress are unusual in children. The role of intravenous insulin infusion therapy in the treatment

Intérêt du dosage de la tryptase sérique aux urgences pédiatriques

Acute anaphylaxis (AAN) is rare in children and is difficult to diagnose especially in cases of inaugural manifestation. A wide range of disorders are seen in paediatric emergency medicine, including allergies. Aim of the study Analyse the usefulness of serum tryptase assay in children admitted to a paediatric emergency department (PED) for suspected AAN. Type of study Retrospective analysis of 77 children admitted to a PED for suspected acute allergy (AA). Results Of the 77 cases reviewed, 61 were included because they had clinical manifestations consistent with AA. 40 had symptoms suggestive of AAN, and 21 had isolated urticaria (IU). Average age was the same in both groups (6.47 years vs. 6.07 years). In patients with AAN, the levels of serum tryptase were significantly higher (12.41 ± 8.9 μg/l) than those in cases of IU (5.55 ± 3.17 μg/l), P = 0.0005. Among the children with AAN, those with the severest symptoms (arterial hypotension) had the highest tryptase values (21.67 ± 13.77 μg/l), P < 0.001. A threshold tryptase value of more than 8.9 μg/l seems to be sufficient for recommending further specialised examinations (specificity 85.6%, sensitivity 60%). All the children with a high tryptase level were referred for consultation with a specialist. Serum tryptase assay should be systematically performed in a paediatric emergency setting in the event of suspected AAN. It helps guide diagnosis and referral to a specialist.

Pain Management of Musculoskeletal Injuries in Children

Pain is the most common reason for seeking health care in the Western world and is a contributing factor in up to 80% of all emergency department (ED) visits. In the pediatric emergency setting, musculoskeletal injuries are one of the most common painful presentations. Inadequate pain management during medical care, especially among very young children, can have numerous detrimental effects. No standard of care exists for the management of acute musculoskeletal injury-related pain in children. Within the ED setting, pain from such injuries has been repeatedly shown to be undertreated. Upon completion of this CME article, the reader should be better able to (1) distinguish multiple nonpharmacological techniques for minimizing and treating pain and anxiety in children with musculoskeletal injuries, (2) apply recent medical literature in deciding pharmacological strategies for the treatment of children with musculoskeletal injuries, and (3) interpret the basic principles of pharmacogenomics and how they relate to analgesic efficacy. Pediatric musculoskeletal injuries are both common and painful. There is growing evidence that, in addition to pharmacological therapy, nonpharmacological methods can be introduced to improve analgesia in the ED and after discharge. Traditionally, acetaminophen with codeine has been used to treat moderate orthopedic injury-related pain in children. Other oral opioids (hydrocodone, oxycodone) are gaining popularity, as well. Current data suggest that ibuprofen is at least as effective as acetaminophen-codeine and codeine alone. Medication compliance might be improved if adverse effects were minimized, and ibuprofen has been shown to have a similar or better adverse effect profile than the oral opioids to which it has been compared. Pharmacogenomic data show that nearly 50% of individuals have at least 1 reduced functioning allele resulting in suboptimal conversion of codeine to active analgesic, so it is not surprising that codeine analgesic efficacy is not optimal. At the same time, nonpharmacological therapies are emerging as commonly used treatment options by parents and adjuncts to analgesic medication. The efficacy and role of techniques (massage, music therapy, transcutaneous electrical nerve stimulation), although promising, require further clarification in the treatment of orthopedic injury pain. There is a need to optimize the measurement, documentation, and treatment of pain in children. There is growing evidence that nonpharmacological methods can be introduced to improve analgesia in the ED, and efforts to help parents implement these methods at home might be advantageous to optimize outpatient treatment plans. In pharmacotherapy, ibuprofen has emerged as an appropriate first-line choice for mild-moderate orthopedic pain. Other oral opioids (hydrocodone, oxycodone) are gaining popularity over codeine, because of the current understanding of the pharmacogenomics of such medications.

Spinal Cord Injury From Spontaneous Epidural Hematoma

Two cases of acute spinal cord injury resulting from spontaneous spinal epidural hematoma are reported, both of which had a cavernous vascular malformation origin. Both spontaneous spinal epidural hematoma and intramedullary cavernous malformation are rare in children. In the pediatric emergency setting, spontaneous epidural hematoma should be considered as part of the differential diagnosis for acute extremity weakness and paresthesia. Immediate magnetic resonance imaging of the brain and spine as well as prompt neurosurgical consult is recommended for the best chance of improved outcome.

Head injuries related to sports and recreation activities in school‐age children and adolescents: Data from a referral centre in Victoria, Australia

Head injuries (HI) in children are common and even mild HI can lead to ongoing cognitive and behavioural changes. We set out to determine the causes of sport-related HI in school-age children presenting to a large urban ED as a basis for future interventions. Identification and medical record review of all sport-related HI in children aged 6-16 years at a tertiary children's hospital ED in Victoria, Australia, over a 1 year period. Information was collected on demographics, injury variables and radiology findings. HI were classified as mild, moderate and severe based on GCS and radiography reports. Over 12 months there were 406 HI in school-age children. Seventy per cent were male. A large number of HI (129; 33%) were related to sports. Of these, most were classified as mild and 13% were classified as moderate or severe. Among a range of sports, Australian Rules football was associated with more than 30% of all HI attributable to a sport and recreation cause. Equestrian activities were the main cause of moderate HI. The present study identified sports as a major cause of HI in the Victorian paediatric emergency setting with Australian Rules football the most commonly involved sport. Further prevention initiatives should consider targeting Australian Rules football and equestrian activities.

Neck Complaints in the Pediatric Emergency Department

To describe the spectrum of pathologies responsible for neck ailments in a primary care pediatric emergency setting and evaluate their outcome. All children aged 16 years or younger, who presented to the emergency department of the Children's Hospital of Lausanne during a 1-year period, were retrospectively identified and charts were reviewed. Causes of neck complaints were classified as traumatic (group 1), infectious (group 2), postural (group 3), or miscellaneous (group 4) according to the final diagnosis. History and physical examination findings, radiological and laboratory results, as well as patient outcomes were recorded. During the study period, 28,722 children were observed in the emergency department, and 170 were identified as having neck complaints. The number of patients with neck ailments in group 1 was 105 (62%). Group 2 contained 33 patients (19%), of which 28 (16.5%) had a viral infection and 5 (2.9%) had a bacterial infection. Group 3 contained 30 children (17.6%) and group 4 contained 2 children (1.2%). Cervical spine radiography was performed on an emergency basis in 60 children (57 in group 1, 2 in group 2, and 1 in group 3). Significant abnormalities were observed in 6 children. Cervical computed tomography (CT) was performed in 9 children, from which 5 were in group 1, 3 were in group 2, and 1 was in group 4. The CT scan revealed pathologic findings in 6 children. Follow-up data were available in 135 patients (79.4%), of which 129 (95.6%) experienced complete recovery in less than 2 weeks. Admission to the hospital was necessary in 4 children (1 in group 1 and 3 in group 2), including 2 for emergency surgical drainage of retropharyngeal abscesses. One child with posttraumatic torticollis was treated conservatively as an outpatient and recovered in 7 weeks. One child was had his/her condition eventually diagnosed with osteoid osteoma and treated with oral nonsteroidal anti-inflammatory drug. Most cases of neck ailments in children presenting to the emergency department were due to trauma or infection, which were effectively managed as outpatients. When signs and symptoms suggested an emergent cause, CT provided a definitive diagnosis. The evaluation of a child presenting with acute neck complaints should be based on history and physical examination. Plain radiographs and CT scan are contributive in selected cases.