Pediatric Emergency Center Research Articles

Comparison of Clinical and Laboratory Manifestations Between Acute Appendicitis and Mesenteric Lymphadenitis in Children.

Acute appendicitis is a major causeof emergency surgery in children and adolescents. Mesenteric lymphadenitis is also one of the most common differential diagnoses in children with acute appendicitis, and despite its high prevalence, few clinical studies have examined its features. The clinical signs of mesenteric lymphadenitis in children are very similar to those of acute appendicitis. The aim of this study was to determine the clinical manifestations of acute appendicitis and mesenteric lymphadenitis in children. In this cross-sectional study, patients less than 15 years old admitted to the pediatric emergency center of Afzalipour Hospital in Kerman from 2018 to 2021 were studied, and those who had a final diagnosis of appendicitis, mesenteric lymphadenitis, or appendectomy were included in the study by census. Data collection from the records of these patients included age, sex, clinical signs, duration of emergency until diagnosis, fever, number of times of vomiting, leukocytosis, lymphocyte, neutrophil count, neutrophil-to-lymphocyte ratio, sonographic findings, and pathology findings. SPSS software and descriptive and analytical statistics were used to analyze the data. The results showed that unlike sex (p=0.11), there was a significant difference between the two groups in terms of age (p<0.001). Nausea, vomiting, anorexia, pain shift, and leukocytosis were more common in the acute appendicitis group than in the mesenteric lymphadenitis group, with a significant difference between the two groups (p<0.001). There was a significant difference between the two groups in terms of neutrophil percentage and neutrophil-to-lymphocyte ratio (p<0.001). The present study was conducted with the aim of assisting medical professionals due to the possibility of misdiagnosing mesenteric lymphadenitis with acute appendicitis. Differentiation of these two diseases is facilitated by the significant differences in their clinical signs and test results. These results can be a useful guide for physicians to better diagnose the diseases.

Post-extubation dysphagia in pediatric trauma patients: a single-center case-series study

We aimed to investigate whether ventilator support time influences the occurrence of dysphagia in pediatric trauma patients. This case-series study was conducted in a single pediatric emergency and critical care center from April 2012 to March 2022. Trauma patients aged < 16 years who underwent tracheal intubation were divided into two groups based on the occurrence of dysphagia within 72 h after extubation, and their data were analyzed. Tracheal intubation was performed in 75 pediatric trauma patients, and 53 of them were included in the analysis. A total of 22 patients had post-extubation dysphagia and head trauma. The dysphagia group tended to have more severe head injuries (Abbreviated Injury Scale (AIS) 4 [4–5] vs. 4 [0–4]; p < 0.05), a longer ventilator support time (7 days [4–11] vs. 1 day [1–2.5]; p < 0.05), and a longer length of hospital stay (27 days [18.0–40.3] vs. 11 days [10.0–21.0]; p < 0.05). Severe head trauma and a long duration of tracheal intubation may be risk factors for dysphagia in pediatric trauma patients. Therefore, early recognition of these risk factors could assist in treatment planning for speech-language pathologist intervention and nutritional routes of administration.

Kawasaki Disease: Case Report of an Unexpected Diagnosis in a 5-Month-Old Infant with Fever without Source

Background Fever without a source of infection (FWS) is a common presentation in infants and children. Kawasaki disease (KD) is a rare but serious illness that can sometimes present with FWS. Early diagnosis of KD is important in infants younger than 6 months because delayed treatment has a poor outcome in this age group. Case presentation A 5-month-old male child, who was first taken by his parents to the primary health center with a complaint of fever, was referred to the hospital Pediatric Emergency Center (PEC). A viral cause was suspected, and he was sent home on oral antipyretic medicine. The next day, the infant developed decreased oral intake and lethargy, so he was admitted to the PEC for observation. The infant was initially diagnosed with sepsis and admitted to the pediatric intensive care unit (PICU). On the fourth day of fever, the infant developed a skin rash, bilateral nonpurulent conjunctival congestion, strawberry tongue, and left posterior cervical lymphadenopathy. The infant was diagnosed with KD and received intravenous immunoglobulin (IVIG) and aspirin. The infant made a full recovery and was discharged home after 11 days of hospitalization. Discussion KD is a rare but serious illness that can affect infants and children. Infants younger than 6 months with KD tend to have incomplete forms of the disease, which can make the diagnosis difficult. Delays in the diagnosis and treatment of KD can have serious consequences, including the development of coronary artery aneurysms (CAAs). Conclusion This case report highlights the early presentation of KD in a 5-month-old infant. The early signs and symptoms of KD can be vague or mimic other common illnesses such as viral infections and sepsis. The diagnostic criteria may not be met in the early phase of the disease. Laboratory tests are not specific or diagnostic. Early diagnosis and treatment are essential to prevent serious complications. The patient in this case report was fortunate to be diagnosed and treated early. He responded well to treatment and made a full recovery.

Characteristics of children hospitalized through the pediatric emergency department and effects of pediatric emergency ward hospitalization

Purpose: To evaluate the efficiency of the pediatric emergency ward (PEW) through the outcomes of children hospitalized to the ward by the department of pediatric emergency medicine (PEM).Methods: A chart review was completed for children (&lt; 15 years) who were hospitalized to the PEW via the pediatric emergency center from March through May 2021. We compared the general characteristics and details regarding the outcomes depending on the departments they were hospitalized to, namely PEM, pediatrics (PED), and others.Results: We analyzed a total of 606 hospitalized children: PEM, 91; PED, 456; and others, 59. In the order listed above, their median ages were 2 years (interquartile range, 1-6), 1 year (0-4), and 9 years (7-14) (P &lt; 0.001). The numbers of children with Korean Triage and Acuity Scale of 1-3 were 71 (78.0%), 400 (87.7%), and 33 (55.9%) (P &lt; 0.001). Median length of stay (LOS) in the emergency department (ED) and hospital tended to be shorter in PEM (ED LOS: PEM, 4.3 hours vs. PED and others, 4.0-6.3 hours; hospital LOS: PEM, 19.0 hours vs. PED and others, 58.5-63.8 hours; all Ps &lt; 0.001). The differences in the LOS were prominent between others and PEM (ED LOS, 1.538 [95% confidence interval, 1.353-1.749]; hospital LOS, 3.375 [2.741-4.157]). Transfers to other departments occurred only in PEM (4.4%) and PED (3.9%) whereas intensive care was performed only in others (27.1%). Return visits showed no difference among the 3 departments. Top 5 chief complaints and primary diagnoses of the children hospitalized to PEM were vomiting, fever, abdominal pain, head injury, and poisoning, and gastroenteritis, concussion, syncope, poisoning, and upper respiratory infection, respectively.Conclusion: Hospitalization to PEWs for short-term treatment or observation may relieve overcrowding in EDs or in hospitals, with comparable frequency of return visits.

Pediatric emergency patients in the emergency departments of aGerman metropolitan region : Aretrospective cross-sectional study over aone-year period

To date, no detailed analysis of pediatric emergencies treated in emergency departments (ED) exists. However, in the context of capacity planning and upcoming emergency care reform in Germany, these data are urgently needed. Retrospective, multicenter cross-sectional study for the period 01July2013 to 01June2014 of pediatric cases in emergency departments in Munich. Atotal of 103,830 cases were analyzed (age: 6.9 ± 5.4years, boys/girls 55%/45%). A total of 85.9% of cases were treated as outpatients, 12.4% (9.6per 100,000 children) were admitted to normal and 1.7% (1.0 per 100,000 children) to intensive care. However, the real bed requirements exceeded these guideline numbers, with an absolute requirement of 4.9ICU beds and 35.1normal ward beds per day. Load peaks were seen on Wednesday and Friday afternoons and on weekends. Every 8thpatient who presented to an ED as aself-referral was treated as an inpatient. Capacity planning for inpatient emergency care of pediatric patients requires planning for more beds than can be expected on apopulation basis. The availability of panel physician care influences patient volume in the EDs. Initial medical assessment tools for treatment need and urgency are needed to distribute patients. The pediatric emergency centers planned as part of the current reform of emergency care must be adequately staffed and financed in order to be able to handle-in close cooperation with statutory health insurance-accredited medical care-the expected demand for care.

Unusual Presentation of Brain Tumor in a Child: A Case Report

The most popular type of neurological tumor in childhood is medulloblastoma, which is the most malignant neoplasm of the posterior fossa and cerebellum. Central nervous system neoplasms can cause symptoms and signs due to local invasion, compression of normal structures, and increased intracranial pressure by either a mass effect or obstruction of cerebrospinal fluid flow, resulting in hydrocephalus. Usually, headache is the most common symptom of central nervous system tumors, and the median duration between symptoms beginning and diagnosis of brain tumors in children ranges from 2.5 to 3.5 months. Furthermore, several predisposing factors for brain tumors have been identified such as Epstein–Barr virus infection, exposure to ionizing radiation, and inherited diseases. Recently, the advances in diagnosis and treatment have improved the survival of many children with neurological neoplasms. However, this therapy is associated with long-term complications, and its prognosis remains poor. We present the case of a 4-year-old girl with adequate neuropsychomotor development who presented to the pediatric emergency center with a 14-day history of headache, which was prominent in the morning, neck, back, and bilateral leg pain two days prior to presentation. Brain and Spine Magnetic resonance imaging revealed a cerebellar mass lesion in the posterior fossa. The patient underwent surgery, followed by histopathological and immunohistochemical staining. This case is considered rare and distinctive because the symptoms included only headache for two weeks, no impaired vision, no vomiting, no mental disorders, no abnormal gait, and no ataxia or body imbalance. We report this case to focus on the features of the manifestation and hence increase the chances of timely diagnosis in the future. Consequently, the probability of central nervous system tumors should always be considered in children with headache, and they must be under regular follow-up for early diagnosis and treatment.

Current status of imaging studies and application of clinical decision rules for pediatric blunt cervical spine injury

Purpose: We investigated the current status of imaging studies for pediatric blunt cervical spine injury, and applied 3 clinical decision rules to children with blunt trauma of the head or neck in a pediatric emergency center in Korea. The rules included National Emergency X-Radiography Utilization Study (NEXUS) criteria, Canadian Cervical Spine Rule, and Pediatric Emergency Care Applied Research Network risk factors.Methods: This was a retrospective study conducted on 399 children aged 15 years or younger who visited the center after the blunt trauma, and underwent cervical spine radiographs from January 2020 through December 2021. We examined the clinical characteristics per age groups (0-1, 2-5, 6-12, and 13-15 years). Using the 3 rules, we selected children with a potential need for imaging studies (PNI). For this purpose, we analyzed the absence of low-risk variables and the presence of high-risk variables. Predictive performances of the rules were measured for the imaging-confirmed cervical spine injury.Results: The study population (n = 399) had a median age of 5.0 years (interquartile range, 2.0-9.0) and a 64.2% boys’ proportion. Fall (36.6%) was the most common injury mechanism. Two children had the cervical spine injuries. As per NEXUS criteria, Canadian Cervical Spine Rule, and Pediatric Emergency Care Applied Research Network risk factors, 72 (18.0%), 289 (72.4%), and 74 children (18.5%) were classified as those with PNI, respectively. Resultantly, 291 children (72.9%) were classified as having PNI whereas the other 108 (27.1%) were deemed to undergo unnecessary imaging. The 3 rules had nearly 100% sensitivity and negative predictive value, except a 50% sensitivity of NEXUS criteria.Conclusion: Imaging studies can be minimized for children with blunt trauma of the head or neck who are deemed without PNI per the 3 current clinical decision rules. More elaborate criteria are needed to make a timely diagnosis.

Emerging Resilience and Level of Compassion of Pediatric Emergency Nurses during the COVID-19 Pandemic

Several studies had explored compassion and resilience, however, most of these studies focused on the relationship between resilience and compassionate fatigue, or resilience and self-compassion. This study aimed to determine the level of emerging resilience and level of compassion of pediatric emergency nurses while caring for COVID 19 pediatric patients and the correlation between Compassion level and Emerging Resilience of nurses. Participants were 190 emergency nurses conducted in Pediatric Emergency Center COVID-19 facility. The study data were collected utilizing the questionnaire comprised of demographics, Compassionate Scale and Brief Resilience Scale. Statistically significant difference was found between the age variable of the nurses and “common humanity” sub-scale as well as years in service and sub-scale “Indifference items”. There was a significant difference between the education level of the nurses and their status of showing kindness to the patients (p &lt; .05). When the subscales were added together, there was no significant difference between the Compassionate Scale total score and the baseline characteristics of the nurses. In terms of Brief Resilience Scale, a mean score of 3.18 (±0.47) was found that showed the resilience level of the nurses as normal. Significant difference between educational status and brief resilience scale (p&lt;.05) was found. The level of compassion of the nurses was “moderate” and the Resilience was “normal resilient coping.” Nurses’ baseline data negatively predicted the level of compassion and the emerging resilience of Pediatric Emergency Nurses. There was no correlation between the Nurses’ Level of compassion with the Nurses’ level of resilience. Keywords: Compassion, Resilience, Compassion Fatigue, Child, Self-compassion, Covid-19

Cardiac Point-of-Care Ultrasound and Multi-Disciplinary Improvement Opportunities in Acute Systolic Heart Failure Management in a Pediatric Emergency Center.

Cardiac point-of-care ultrasound (POCUS) has the ability to rapidly assess function and identify systolic heart failure (HF), an often-missed diagnosis. POCUS has the potential to expedite medical intervention, improving overall outcomes. There have been limited studies describing pediatric emergency center (EC) utilization of cardiac POCUS and its impact on outcomes in pediatric patients. Authors performed a retrospective chart review at a tertiary children's hospital to identify all patients admitted from the EC to the Cardiac Intensive Care Unit (CICU) with acute systolic HF between January 2017 and August 2019. Outcome measures included EC length of stay (LOS), CICU LOS, and time until first IV HF medicine was administered. A total of 21 patients and 24 encounters meeting criteria were identified. Cardiac POCUS agreed with standard echocardiography in 8 of 9 cases. Patients who had a cardiac POCUS in the EC seemed more likely to receive their first dose of intravenous heart failure medication while in the Emergency Center (70% vs 43%). There was a trend toward significance, but it did not reach statistical significance (p = 0.1). EC and CICU LOS were not significantly different between POCUS and non-POCUS groups. Cardiac POCUS has the potential to have a valuable role in the early diagnosis of acute systolic HF in children. However, early diagnosis by POCUS did not translate into shorter EC or CICU LOS. This pilot data serves as a baseline for efforts to promote earlier clinical recognition of acute HF and more efficient collaboration between clinical services.

Anxiety symptoms among children visiting a pediatric emergency center in Qatar during the COVID-19 pandemic: A cross-sectional study.

Although the evidence base regarding the impact of the COVID-19 pandemic on children has been growing, descriptions of their experiences remain scarce. In this cross-sectional study, the authors used the Child-Reported Spence Children's Anxiety Scale to collect data from 91 children visiting a pediatric emergency center in Qatar during the pandemic. Around 25% of the children reported elevated levels of overall anxiety. Obsessive-compulsive symptoms were the most common, with 59.3% of children reporting elevated symptoms. The mean score of physical injury fears was significantly affected by gender, with females having higher scores. Overall rates for elevated anxiety symptoms were similar in natives and expatriate children. The findings suggest that the effects of the pandemic on children may depend on several vulnerability factors, including developmental age and gender. This study highlights the need to plan multidisciplinary strategies to enhance children's access to mental health services during and after the current health crisis.

The Timely Administration of Epinephrine and Related Factors in Children with Anaphylaxis.

Anaphylaxis is a severe allergic reaction that requires immediate recognition and intervention. This study investigated the factors related to the timely administration of epinephrine in cases of pediatric anaphylaxis. We performed a retrospective chart review of 107 patients who visited a pediatric emergency center with anaphylaxis between 2015 and 2017. In total, 76 patients received epinephrine injections. We analyzed factors including allergy history, anaphylaxis signs and symptoms, allergen sensitization, anaphylaxis triggers, and time of epinephrine injection. Anaphylactic patients who received epinephrine took a median of 50 min to arrive at the hospital, and patients who did not receive epinephrine took a median of 94 min. Epinephrine administration was significantly delayed by more than 60 min from symptom onset in patients <2 years old. Patients presenting with wheezing symptoms or history of bronchial asthma were significantly more likely to receive epinephrine within 60 min of symptoms onset, while patients with food allergen sensitization were significantly more likely to receive epinephrine within 30 min of hospital arrival. Wheezing, history of asthma, age (≥2 years old), food triggers, and food allergen sensitivity were significant factors for the rapid administration of epinephrine. An immediate diagnosis of anaphylaxis and a rapid administration of epinephrine are essential.

Optimizing Antibiotic Treatment of Skin Infections in Pediatric Emergency and Urgent Care Centers.

The objective was to optimize antibiotic choice and duration for uncomplicated skin/soft tissue infections (SSTIs) discharged from pediatric emergency departments (EDs) and urgent cares (UCs). Pediatric patients aged 0 to 18 years discharged from 3 pediatric EDs and 8 UCs with a diagnosis of uncomplicated SSTIs were included. Optimal treatment was defined as 5 days of cephalexin for nonpurulent SSTIs and 7 days of clindamycin or trimethoprim/sulfamethoxazole for purulent SSTIs. Exclusion criteria included erysipelas, folliculitis, felon, impetigo, lymphangitis, paronychia, perianal abscess, phlegmon, preseptal or orbital cellulitis, and cephalosporin allergy. Baseline data were collected from January 2018 to June 2019. Quality improvement (QI) interventions began July 2019 with a revised SSTI guideline, discharge order set, and maintenance of certification (MOC) QI project. MOC participants received 3 education sessions, monthly group feedback, and individual scorecards. Balancing measures included return visits within 10 days requiring escalation of care. Data were monitored through March 2021. In total, 9306 SSTIs were included. The MOC QI project included 50 ED and UC physicians (27% of eligible physicians). For purulent SSTI, optimal antibiotic choice, plus duration, increased from a baseline median of 28% to 64%. For nonpurulent SSTI, optimal antibiotic choice, plus duration, increased from a median of 2% to 43%. MOC participants had greater improvement than non-MOC providers (P < .010). Return visits did not significantly change pre- to postintervention, remaining <2%. We improved optimal choice and reduced duration of antibiotic treatment of outpatient SSTIs. MOC participation was associated with greater improvement and was sustained after the intervention period.

Prevalence and presentation of neonatal sepsis at a paediatric emergency department in Johannesburg, South Africa.

BackgroundDespite a significant reduction in the prevalence of neonatal sepsis over the past three decades, the prevalence still remains high, especially in low- and middle-income countries. The aim of this study was to determine the prevalence and presenting features of neonatal sepsis at a paediatric emergency centre (PEC).MethodsMedical records of all neonates presenting to an academic hospital PEC over a six-month period were analysed. Data was compared between neonates with and without sepsis. The odds ratio was calculated to determine factors associated with neonatal sepsis.ResultsOf the 210 neonates who were included, 43 (20.5%) were diagnosed with neonatal sepsis. Of these, 19 (44.2%) presented within the first 72 hours of life (early-onset neonatal sepsis) and 4 (9.3%) died prior to hospital discharge. A history of maternal employment (odds ratio (OR) 2.38, p=0.021), preterm birth (OR 3.24, p=0.019), low birth weight (<2.5kg) (OR 2.67, p=0.026), perinatal human immunodeficiency virus exposure (OR 3.35, p=0.002), not being breast fed (OR 4.36, p=0.001), and signs of lethargy (OR 14.01, p<0.001), dehydration (or 11.14, p<0.001), poor feeding (OR 7.20, p<0.001), irritability (OR 6.93, p<0.001), fever (OR 5.50, p<0.001), vomiting (OR 4.14, p<0.001) and respiratory distress (OR 4.12, p<0.001) were significantly associated with neonatal sepsis.ConclusionAmong neonates presenting to the PEC, various clinical features on history and examination may be useful in predicting the diagnosis of neonatal sepsis. Clinicians working in the PEC must adopt a high index of suspicion when attending to neonates presenting with these features.

Anaphyl-Crisis: Rising Rates of Pediatric Anaphylaxis.

Anaphylaxis is a serious allergic reaction that has the potential to be life-threatening if not recognized and managed rapidly. Several regional studies have shown increased incidence of anaphylaxis over the past decade. The objectives of this study were to determine rates of pediatric anaphylaxis in southeast Michigan between January 1, 2010, and December 31, 2019, and to describe the epidemiology of pediatric patients presenting to emergency centers in southeast Michigan with anaphylaxis. We performed a retrospective chart review of all pediatric patients aged 0 to 17 years presenting to 2 large emergency centers from 2010 to 2019 with a diagnosis of anaphylaxis using International Classification of Diseases , Ninth and Tenth Revision , Clinical Modification codes. Epidemiological and visit data, including length of stay, use of intravenous medication, and emergency severity index, were extracted and analyzed. Pediatric anaphylaxis rates were calculated based on detected anaphylaxis cases divided by total pediatric emergency department visits to the 2 emergency centers. A Poisson regression model was used to predict rates of anaphylaxis per 100,000 emergency department visits. One thousand three hundred ninety-one pediatric visits for anaphylaxis were identified during a period between January 1, 2010, and December 31, 2019. There was a significant rate of increase in pediatric anaphylaxis cases over the 10-year study period at both suburban emergency centers, with an annual increase of 21% and 13%. There was no significant change in trends in demographic factors. Most anaphylaxis cases were young, White males with private insurance. Most children did not receive intravenous medications (77%). The median length of stay increased by 1.5 hours over the study period and 92% of patients were discharged home. Pediatric emergency center visits and length of stay for anaphylaxis in southeast Michigan have markedly increased over the past 10 years.

Efficacy of corticosteroids in reducing the renal scarring in acute pyelonephritis in children

Abstract Background: Renal scarring is a serious and chronic consequence of acute pyelonephritis in children, which may cause late complications in young adults, such as hypertension, chronic renal failure, and preeclampsia. Urinary tract infection is the most common serious infection in childhood, accounts for 5% to 14% of all pediatric emergency centers. This study aimed to evaluate the effect of dexamethasone in reducing or preventing renal scarring in children who were treated with antibiotics for acute urinary tract infection. Methods: This is a multicenter, randomized, placebo-controlled, double-blind clinical trial, which evaluates the efficacy of dexamethasone in preventing or reducing renal scarring in febrile children (2 months to 14 years) with a first-diagnosed urinary tract infection. A total of 120 participants will be enrolled over a 3-year period from 6 sites in Qatar. Participants will be randomized into a therapy arm and a placebo arm; each arm will comprise 60 participants. Participants were allocated to the therapy arm and received dexamethasone, while those who were allocated to the placebo arm received a placebo, orally in the same regime, twice daily for 3 days. Blood and urine investigations will be performed at presentation and after 3 days from beginning antibiotics, renal ultrasonography will be performed over the first month and DMSA scan will be performed 6 months after enrolment. Study medication will be administered in the first 48 hours of starting antibiotics. The DMSA scan for all participants will be read by 3 reference radiologists without knowledge of clinical features or trial arms. Discussion: The formation of renal scarring will be compared between participants in both arms, the severity of renal scars and all adverse events of the therapy is determined. Trial registration: This trial has been registered at ClinicalTrials.gov: NCT04654507 (December 4, 2020), https://clinicaltrials.gov/ct2/show/NCT04654507.

Utilization of Emergency Services by Children with Asthma in Qatar

Background: Asthma is a leading chronic disease in children worldwide, which if left untreated or poorly controlled, can lead to altered lung function and poor quality of life.1 Early detection and improved control of asthma are recommended to decrease utilization of emergency services and hospitalizations. Respiratory diseases are the most common conditions seen in Pediatric Emergency Centers (PECs) in Qatar.2 The five PECs are an essential point of healthcare access for severely sick children, however, many people utilize them for potentially preventable reasons.3Methods: This was a quantitative retrospective observational study of children with asthma utilizing the five PECs during 2019. More than 18 variables were extracted from routine healthcare records, and data were analyzed via descriptive statistics using STATA to understand the characteristics of the population. Results: There were 41,343 visits to PECs due to asthma in 2019 from 18,382 children of more than 100 different nationalities. Around 60% were boys aged 2 to 13 years, with the peak of utilization in October and November (Figure 1) and during the day between 2:00 PM to 10:00 PM. The majority were seen in less than 30 mins (93%) and stayed in the PEC for 2 hours or less (84%) (Figure 2). Most did not have fever and 88% received Salbutamol. Around 900 children were admitted (1.6%) and almost 20 children attended once a month or more. Conclusion: From the severity of the cases, length of stay, prescriptions, and health care providers’ notes, it was clear that many PEC Emergency Department (ED) visits due to asthma were preventable. Hence; appropriate preventative medical care, education, and follow-ups are recommended to reduce hospital admissions and re-attendance. Understanding the characteristics and pattern of visits amongst this population will guide future qualitative research to explore reasons for attendance in more depth and identify potential opportunities for interventions to reduce ED attendances.

Current management for foreign body and toxic agent ingestion in a paediatric primary emergency centre.

Accidental foreign body ingestion (FBI) and toxic agent ingestion (TAI) are commonly encountered among children in primary emergency settings. Early detection and appropriate medical intervention are crucial to improve outcomes. Although many reports from tertiary institutions have shown improvements in therapy, data are still lacking from primary emergency facilities. We performed a retrospective analysis based on medical records of FBI/TAI over 4 years at the Kobe Children's Primary Emergency Medical Center. We collected patient information, including age, sex, time between FBI/TAI occurrence and centre visit, provision of first aid, symptoms, type of FBI/TAI, examinations, treatments, and outcomes. A total of 580 children were enrolled. The median age was 1.3 years, and patients under 2 years old accounted for 70% of total cases. Cigarettes (17.5%) were the most common ingested foreign body, followed by medicines (15.3%), detergents (8.1%), in TAI, plastics (14.1%), metal (13.4%), batteries (9.0%) in FBI, and others (22.6%). A total of 42 patients were transferred to advanced hospitals; among these, 22 patients were hospitalised but the foreign body was removed in only 3 (0.9%) patients. Transferred patients were significantly older (P<0.05) in FBI and had a higher rate of any of symptoms (P<0.05) in FBI/TAI. This large-scale retrospective study of accidental FBI/TAI conducted at a primary emergency facility clarified current management, including treatment at a primary facility. Very few cases of FBI/TAI were treated, even when they were transferred to an advanced treatment hospital. Unified protocols should be established, to improve the management of FBI/TAI.

Household cleaning products poisoning in a pediatric emergency center: A 10- year cross-sectional study and literature review

Poisoning by household cleaning products(HCPs) is common in children. Some HCPs are toxic and may cause severe complications. We assessed HCP poisonings treated in a pediatric emergency department(PED). This was a retrospective study of patients aged under 18 years with HCP poisoning admitted to the largest PED in Taiwan from 2011 to 2020 were recruited. The records over a 10-year period from 103 children admitted to the PED because of HCP poisoning(70 boys [68%] and 33 girls [32%]), mean age 3.54 years(standard deviation [SD]=3.15 years) were evaluated. Most poisonings were unintentional(99%, n=102) and occurred at home(96%, n=99). The HCPs included alkaline(74%, n=76), acidic(25%, n=26), and neutral(1%, n=1) agents. Most were orally ingested(86%, n=89). Panendoscopy was performed in 25 patients(24%), and the endoscopic(Zargar) grade was used to determine the severity of injury. Medications(steroids [9%, n=9], antibiotics [10%, n=10], or antacids [30%, n=23]) were prescribed. Alkaline HCP ingestion induced severe esophageal injury(p=0.04) and esophageal stricture(p=0.04). Five patients(5%) exhibited esophageal strictures and required balloon dilation. On multivariate analysis, alkaline HCP ingestion(p=0.04), severe esophageal caustic injury(Zargar grade≥3) (p<0.001), and medications(steroids [p<0.001], antibiotics [p<0.001], and antacids [p=0.001]) were associated with esophageal stricture. Alkaline HCP ingestion and severe esophageal caustic injury(Zargar grade≥3) were associated with esophageal stricture. Physicians tended to prescribe medications(steroids, antibiotics, or antacids) for patients with severe esophageal injuries to reduce the risk of esophageal stricture. The usefulness of these medications requires further study.

Investigation of the Correlation between Scalp Hematoma and Cranial Fractures and Intracranial Lesions in Children Presenting with Minor Head Trauma

Introduction: Minor head trauma is one of the common causes of pediatric reference to emergency ward. This study investigated the correlation between scalp hematoma,cranial fractures and intracranial lesions in children presenting with minor head traumata. Methods: This was a descriptive cross-sectional study. The data gathering were done in 2016-17. All children under 18 years of age (933 individuals) who referred to Shahid Rahnemoun Pediatric Emergency Center in Yazd with a complaint of minor head trauma and underwent a CT scan according to American Academy Criteria were included in the study. The mean age of the children was 11.67 years. CT scan of 209 patients (%22.41) reported scalp hematoma. A radiologist who did not have any information about the study was asked to interpret the CT scans using a predesigned checklist. Finally, the data were encoded into an Excel file and statistically analyzed by STATA10 software using Chi-square test and logistic regression. Results: The scalp hematoma was significantly related to intraventricular hemorrhage (P&lt;0.001), subarachnoid hemorrhage (P&lt;0.001), intracerebral hemorrhage (P&lt;0.001), cerebral edema (P&lt;0.001), subepidural hemorrhage (P&lt;0.001), cerebral concussion (P&lt;0.001), cerebral shift (P&lt;0.001), pneumocephalus (P&lt;0.001), and cranial fracture (P&lt;0.001); however, scalp hematoma was not significantly related to diffuse axonal injury (P=0.27). Conclusion: Our findings confirmed the importance of presence of scalp hematoma in clinical assessment of children with minor head trauma aged less than 18 years. It is recommended that children with minor head trauma be treated and evaluated more in the emergency department more vigilantly and meticulously.

Salmonella Infections among Pediatric Population in Qatar: Phenotypic Resistance and Associated Genotypic Determinants

Salmonella is a significant public health burden worldwide and being the most common bacterial diarrheal illness among infants and young children. In the last few years, Qatar reports a high incidence of salmonellosis outbreaks coupled with a significant increase of Multidrug-Resistant (MDR) among pediatric populations every year. This study aims to elucidate the molecular mechanisms underlying resistance to ceftriaxone, cefepime, amoxicillinclavulanate tetracycline, trimethoprim-sulfamethoxazole, chloramphenicol, and azithromycin among Salmonella isolated from the pediatric population. A total of 246 Salmonella isolates were collected from children under 18 years old admitted to the Pediatric Emergency Center (PEC), Hamad Medical Corporation (HMC) from Jan. 2018 to Dec 2019 with gastroenteritis. Isolates were tested for antibiotic susceptibility against nineteen relevant antibiotics using E-test. Resistance was confirmed using PCR-specific primers for 38 genes. Resistance was detected against 14 antibiotics, and 38.2% of isolates were resistant to at least one antibiotic. Overall, we reported 23.9%, resistance to tetracycline 21.1%, ampicillin 18.7%, AMC, and 13% sulfamethoxazole-trimethoprim. Further, 16.2% of the isolates were Multidrug-Resistant (MDR), with 4.1% being Extended-Spectrum Β Lactamase (ESBL) producers. 90% of ESBL producers harbored one of bla CTX-M-Group. Class 1 AMC resistant samples showed the highest resistance to different antibiotics. Our results indicate a high antimicrobial resistance pattern of Salmonella and the presence of Class (1) cassette that involves the transmission and expression of the resistance among AMC resistance isolates, which might lead to increased multi-drug resistance. This study provides evidence guidance to activate and implement the pillars of an antimicrobial stewardship program in human health to reduce MDR salmonellosis.