Pediatric Emergency Room Research Articles

Refractory seizure in a neonate with severe hypernatraemic dehydration – A case report

Hypernatraemic dehydration is a common clinical condition seen in neonates especially when they lose weight by more than 10%. Such neonates should be carefully followed up for rising sodium levels and need to be encouraged adequate feeding to prevent complications. Term-appropriate neonate born to a non-consanguineous couple with an uneventful perinatal period was brought to the paediatric emergency room on day 15 of life with multiple seizures and was diagnosed with hypernatraemic dehydration. Her brain imaging demonstrated sagittal venous thrombosis with intraventricular haemorrhage and parenchymal bleeding with infarct. She was managed with respiratory support and fluid management. Parents were counselled regarding the guarded prognosis. She was discharged against medical advice.

Pain Management in Children Admitted to the Emergency Room: A Narrative Review.

Pain is a biopsychosocial experience characterized by sensory, physiological, cognitive, affective, and behavioral components. Both acute and chronic pain can have short and long-term negative effects. Unfortunately, pain treatment is often inadequate. Guidelines and recommendations for a rational approach to pediatric pain frequently differ, and this may be one of the most important reasons for the poor attention frequently paid to pain treatment in children. This narrative review discusses the present knowledge in this regard. A literature review conducted on papers produced over the last 8 years showed that although in recent years, compared to the past, much progress has been made in the treatment of pain in the context of the pediatric emergency room, there is still a lot to do. There is a need to create guidelines that outline standardized and easy-to-follow pathways for pain recognition and management, which are also flexible enough to take into account differences in different contexts both in terms of drug availability and education of staff as well as of the different complexities of patients. It is essential to guarantee an approach to pain that is as uniform as possible among the pediatric population that limits, as much as possible, the inequalities related to ethnicity and language barriers.

Trends of Patients Admitted to Pediatric Surgery Department Due to Unintentional Trauma at A Tertiary Care Hospital, Karachi

Objective: To determine the frequency and factors associated with unintentional trauma and its management in children under 14 years of age. Study Design and Setting: This study is retrospective, descriptive and was conducted at the Pediatric Surgery Department and Emergency Room at Liaquat National Hospital and Medical College, Karachi. Methodology: Total duration of the study was from 1st January 2020 to 31st December 2020 and all the unintentional trauma cases in children below 14 years of age were included. Details of history, examination, and any procedure done were recorded through a predesigned proforma in regard to their age, gender, day of presentation and, factors related to trauma like the anatomical site, place, mode and type of injury along with their treatment outcomes. Descriptive statistics were run using SPSS version 26. Results: Out of 103 children, (66%) were males in the age group of 2-4 years. The surge of injuries was on weekdays (71.8%). Domestic injuries were 68.9% which is significantly higher. The most affected region was the head/ neck (28.2%) with lacerations (40.0%) and bruises (90.0%). Amongst the management outcomes, the invasive procedures were frequent (48.5 %) for laceration (48.0%). Conclusion: Amongst the (6.4%) of unintentional trauma cases, the majority of these injuries were blunt trauma in children under four years of age on the head/ neck region. We conclude that the majority of these pediatric injuries were moderate in nature and required invasive treatment strategies but these injuries are preventable.

Safety and efficacy of pediatric sedation protocol for diagnostic examination in a pediatric emergency room: A retrospective study.

Pediatric patients undergoing diagnostic tests in the pediatric emergency room are frequently sedated. Although efforts are made to prevent adverse events, no sedation protocol has specified the optimal regimen, dosage, and interval of medication to prevent adverse events. This study analyzed the safety and efficacy of sequential pediatric sedation protocols for pediatric patients undergoing diagnostic tests in the pediatric emergency room of a single tertiary medical center. The medical records of patients aged < 18 years who visited the pediatric emergency room of Seoul Asan Medical Center between January and December 2019 for diagnostic testing were retrospectively reviewed. Sedation protocols consisted of 50 mg/kg and 25 mg/kg chloral hydrate, 0.1 mg/kg and 0.1 mg/kg midazolam, and 1 mg/kg and 0.5 to 1 mg/kg ketamine, administered sequentially at intervals of 30, 20, 10, 10, and 10 minutes, respectively. Patients were assessed prior to sedation, and adverse events were investigated. Of the 289 included patients, 20 (6.9%) experienced adverse events, none serious, and nine (3.1%) failed to reach the depth of sedation required to complete the test. The regimen (P = .622) and dosage (P = .777) of the sedatives were unrelated to the occurrence of adverse events when sedation was performed according to protocol. The sedation protocol used in these patients, consisting of sequential administration of minimum dosages, achieved a sufficient depth of sedation with relatively few adverse events, indicating that this protocol can be used safely and effectively for painless sedation in pediatric patients undergoing diagnostic testing.

Epidemiology and Etiology of Facial Injuries in Children.

Pediatric Trauma results in over 8 million emergency department visits and 11,000 deaths annually. Unintentional injuries continue to be the leader in morbidity and mortality in pediatric and adolescent populations in the United States. More than 10% of all visits to pediatric emergency rooms (ER) present with craniofacial injuries. The most common etiologies for facial injuries in children and adolescence are motor vehicle accidents, assault, accidental injuries, sports injuries, nonaccidental injuries (eg, child abuse) and penetrating injuries. In the United States, head trauma secondary to abuse is the leading cause of mortality among non-accidental trauma in this population.

Meningitis in the Course of Herpes Zoster Ophthalmicus in an Immunocompetent Boy.

To the Editors: Herpes zoster tends to be recognized as a regional manifestation of varicella-zoster virus (VZV) reactivation, but it might be accompanied by complications in the central nervous system, such as cranial nerve palsies, meningoencephalitis or myelitis. Meningitis in the course of VZV reactivation in immunocompetent children is very rare, showing an incidence of 5.4% in children with zoster.1 VZV travels also to the arterial adventitia, and thus, it may lead to vascular complications. Zoster ophthalmicus in particular can lead to the involvement of the cerebral arteries and subsequent stroke.2 A 12-year-old boy presented to the emergency room with suspicion of herpes zoster ophthalmicus. Six days before admission, the patient developed a fever >39 °C, a left-sided headache, followed by 2 episodes of vomiting. Three days before the admission, the patient’s mother noticed vesicular lesions on the left upper eyelid and eyebrow (Fig. 1). The boy had no history of head trauma nor any gait/balance disturbances. He had been diagnosed with varicella at the age of 2 weeks (direct contact with a sibling suffering from chickenpox). The patient reported no chronic diseases, no recurrent infections or loss of weight. The patient had been consulted in the Pediatric emergency room 1 day before the admission and had been referred to an ophthalmologist. On the day of admission, the ophthalmologist diagnosed him with herpes zoster ophthalmicus, but no further investigations were undertaken. On admission to our department, the patient was under a fair general condition, GCS 15, with normal vital signs, with an adequate psychological condition. Vesicular lesions on an erythematous basis without signs of bacterial superinfection were found on the left upper eyelid, the left eyebrow, and the left frontotemporal region. Some of the lesions were in the stage of crusts. His head was tender on palpation in the regions of C2-C3 dermatomes. Submandibular lymph nodes were enlarged to 1.5 cm. Meningeal and cerebellar signs were negative. No nuchal rigidity was observed. No other abnormalities were found on physical examination. Blood analysis showed no abnormalities except for slight domination of lymphocytes in the peripheral blood smear. Inflammatory markers were low. Cerebrospinal fluid (CSF) analysis revealed pleocytosis of 223 (94% lymphocytes), with normal protein and glucose levels. Multiplex PCR testing of CSF detected DNA of VZV. Diagnosis of zoster meningitis was established. Intravenous acyclovir in the dosage of 500 mg/m2 every 8 hours was implemented for 10 days. The patient was discharged home in good general condition with no neurologic complications.FIGURE 1.: Herpes zoster ophthalmicus lesions before admission to the hospital.In the study by Petursson et al, patients were followed for up to 6 years and no association between the risk of undiagnosed malignancy and shingles in childhood was found. We want to highlight that collecting thorough history of a patient is sufficient for selecting patients at the risk of neoplasms or immune deficiencies and broad laboratory testing, imaging studies or invasive investigations are not indicated in children with zoster.3 This article draws attention to the early recognition of zoster and even more its complications in immunocompetent children.

BNT162b2 immunization-related myocarditis in adolescents and consequent hospitalization: Report from a medical center

To investigate Pfizer-BioNTech 162b2 mRNA COVID-19 vaccine (BNT162b2) immunization-related myocarditis and describe the risk factors for consequent hospitalization in the pediatric intensive care unit (PICU) in children between 12 and 18 years. Children and adolescents 12 years of age and older who presented with discomfort after BNT162b2 immunization (BNTI) and visited pediatric emergency room (PER) at Chang Gung Memorial Hospital from September 22, 2021 to March 21, 2022, were included for analysis. 681 children presented with discomfort after BNTI and visited our PER. The mean age was 15.1±1.7 years. Three hundred and ninety-four (57.9%) and 287 (42.1%) events were after 1st and 2nd dose, respectively. 58.4% (n=398) were male. The most common complaints were chest pain (46.7%) and chest tightness (27.0%). The median (interquartile range [IQR]) interval of discomfort after BNTI was 3.0 (1.0-12.0) days. BNTI-related pericarditis, myocarditis and myopericarditis were diagnosed in 15 (2.2%), 12 (1.8%) and 2 (0.3%) patients, respectively. Eleven (1.6%) needed hospitalization in PICU. The median (IQR) hospital stay was 4.0 (3.0-6.0) days. There was no mortality. More patients were diagnosed myocarditis (p=0.004) after 2nd dose BNTI. PICU admission occurred more commonly after 2nd dose BNTI (p=0.007). Risk factors associated with hospitalization in PICU were abnormal EKG findings (p=0.047) and abnormal serum troponin levels (p=0.003) at PER. Myocarditis in children aged 12-18 years occurred more commonly following 2nd dose BNTI. Most cases were of mild or intermediate severity without death. Factors predicting BNTI-related myocarditis and consequent hospitalization in PICU were abnormal EKG findings and abnormal serum troponin levels at PER in this study.

Clinical decision-making training using the Script Concordance Test and simulation: A pilot study for pediatric residents

BackgroundEach year, new pediatric residents begin their shifts in the pediatric emergency room. While technical skills are often acquired during workshops, non-technical skills such as communication, professionalism, situational awareness, or decision-making are rarely tested. Simulation enables non-technical skills to be developed in situations frequently encountered in pediatric emergencies. Adopting an innovative approach, we combined two pedagogical methods: the Script Concordance Test (SCT) and simulation to improve clinical reasoning and non-technical skills of first-year pediatric residents in dealing with clinical situations involving febrile seizures. The aim of this work is to report the feasibility of such a combined training. MethodsThe first-year pediatric residents participated in a training session on how to manage a child attending the emergency department with a febrile seizure. At the beginning of the session, the trainees had to complete the SCT (seven clinical situations) and then participated in three simulation scenarios. Student satisfaction was assessed by means of a questionnaire at the end of the session. ResultsIn this pilot study, 20 residents participated in the training. The SCT scores for the first-year pediatric residents were lower and more widely distributed than those of the experts with better concordance for diagnostic items compared to investigation or treatment items. All were satisfied with the teaching methods employed. Further sessions on additional topics relating to the management of pediatric emergency cases were requested. ConclusionAlthough limited by the small size of our study, this combination of teaching methods was possible and seemed promising for the development of non-technical skills of pediatric residents. These methods are in line with the changes being made to the third cycle of medical studies in France and can be adapted to other situations and other specialties.

Acute otitis media in the first two months of life and the impact of pneumococcal conjugate vaccines: A retrospective cohort study.

Information on pneumococcal vaccination's impact on the prevention of acute otitis media (AOM) at very young ages is limited. To define the trends in tympanocentesis-proven AOM incidence, clinical characteristics, microbiology, and antibiotic resistance in infants <2 months of age in southern Israel, before and after the sequential introduction of 7- and 13-valent PCVs. A retrospective population-based cohort study including children <2 months of age diagnosed with AOM at the pediatric emergency room between January 2005-Decmber 2009 (pre-vaccination group, group 1) and January 2013-July 2021 (post-PCV13 introduction, group 2). 160 patients were enrolled, 89 (55.6%) in group 1 and 71 (44.4%) in group 2. The mean incidence of AOM decreased from 1.2 cases/1000 live births for group 1 to 0.45 cases/1000 live births for group 2, P<0.001.130 (81.25%) patients were hospitalized, with higher hospitalization rates in group 1 vs. group 2 (84/89, 94% vs. 46/71, 65%, P<0.001). Hospitalization length was longer in group 1 vs. group 2 (4.07±4.09 days vs. 2.70±1.82 days, P=0.021). Positive MEF cultures were reported in 94/160 (58.75%) patients, with a decrease in positivity rates between the 2 groups (71/89, 80% vs. 23/71, 32%, P<0.001). S. pneumoniae was the most common pathogen (55/94, 58.5%); it was the most frequent pathogen isolated in group 1 (46/71, 65%), and the second most common pathogen in group 2 (9/23, 39%), P=0.03. A significant increase was recorded in the percentages of patients with negative MEF cultures (from 21% to 68%, P<0.001). The introduction and implementation of PCV13 in southern Israel was associated with a decrease in AOM in children <2 months of age and of S. pneumoniae recovery in these patients and was accompanied by less admissions and shorter hospitalizations. An increase in the proportions of negative bacterial cultures from MEF was recorded during the study period.

DRUG-INDUCED DYSTONIA IN PEDIATRIC PATIENTS: PATTERNS AND OUTCOMES AT THE PAEDIATRIC EMERGENCY ROOM OF A TEACHING HOSPITAL IN SOUTHWESTERN NIGERIA

Drug-induced dystonia is a movement disorder characterized by involuntary muscle contractions and abnormal postures resulting from the use of certain medications. This study investigates the patterns and outcomes of drug-induced dystonia in pediatric patients presenting to the Pediatric Emergency Room (PER) of a teaching hospital in southwestern Nigeria. A retrospective analysis of medical records was conducted, focusing on pediatric patients diagnosed with drug-induced dystonia over a specified period. Demographic information, clinical characteristics, implicated medications, management approaches, and outcomes were analyzed. The study aims to provide insights into the epidemiology and management of drug-induced dystonia in the pediatric population in Nigeria, aiding in early recognition, appropriate treatment, and improved patient outcomes. The findings of this study contribute to the existing literature on drug-induced dystonia and inform healthcare providers about the specific challenges faced in the Nigerian context, facilitating targeted interventions and better patient care.

Low-Field-Strength MRI and Ventilation-Perfusion Mismatch after Pediatric COVID-19

HomeRadiologyVol. 307, No. 3 Previous CommunicationsFree AccessErratumLow-Field-Strength MRI and Ventilation-Perfusion Mismatch after Pediatric COVID-19Harriet J. PaltielHarriet J. PaltielHarriet J. PaltielPublished Online:Apr 24 2023https://doi.org/10.1148/radiol.239009MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Originally published in:https://doi.org/10.1148/radiol.222360Low-Field-Strength MRI and Ventilation-Perfusion Mismatch after Pediatric COVID-19Harriet J. PaltielErratum in:https://doi.org/10.1148/radiol.239009A sentence was incorrect and corrected to: This condition is an immune-mediated disease that occurs in fewer than 0.1% of children 2–6 weeks following COVID-19 infection.Article HistoryPublished online: Apr 24 2023 FiguresReferencesRelatedDetailsAccompanying This ArticleLow-Field-Strength MRI and Ventilation-Perfusion Mismatch after Pediatric COVID-19Oct 11 2022RadiologyRecommended Articles Perceived Impact of COVID-19 on Pediatric Radiology Departments around the World: World Federation of Pediatric Imaging COVID-19 Task Force Survey Results from Six ContinentsRadiology: Cardiothoracic Imaging2020Volume: 2Issue: 5Low-Field-Strength MRI and Ventilation-Perfusion Mismatch after Pediatric COVID-19Radiology2022Volume: 306Issue: 3Thoracic Imaging Findings of Multisystem Inflammatory Syndrome in Children Associated with COVID-19: What Radiologists Need to Know NowRadiology: Cardiothoracic Imaging2020Volume: 2Issue: 4The 2017 RadioGraphics Monograph Issue: Pediatric ImagingRadioGraphics2017Volume: 37Issue: 6pp. 1609-1611Point-of-Care Bone Age Evaluation: The Increasing Role of US in Resource-limited PopulationsRadiology2020Volume: 296Issue: 1pp. 170-171See More RSNA Education Exhibits A Rational Approach to Pediatric MRI OptimizationDigital Posters2020The Top 10 Radiological Diagnosis for the Pediatric Emergency Room: A Practical and Pictorial Review from Head to ToeDigital Posters2019Understanding Pediatric Neuroimmune Disorders Conflicts: A Neuroradiological Approach in the Molecular EraDigital Posters2019 RSNA Case Collection Pediatric Idiopathic Intervertebral Disc CalcificationRSNA Case Collection2020 IntussusceptionRSNA Case Collection2021Subperiosteal AbscessRSNA Case Collection2021 Vol. 307, No. 3 Metrics Altmetric Score Open AccessThis article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.PDF download

A case of sexual abuse and art therapy

This article presents a case study. Sexual abuse greatly affects children's behavior, emotions and way of thinking. One of the most frequent disorders after exposure or experiencing sexual abuse is post-traumatic stress disorder. The assault does not end with the action, the way of experiencing this trauma affects the later life of the child full of long-term negative effects, if it is not intervened at the right time. Harassment or sexual abuse leads also to a weak physical health. The case of Emma, who was presented to the pediatric emergency room, with numerous physiological complaints, such as; dizziness, severe headache, unconsciousness, vomiting. Specific examinations showed the absence of any possible organic cause. Based on the sessions conducted with the patient, it appears that the girl was sexually abused. During the clinical conversation, the patient is very withdrawn, isolated and does not want to talk. Appreciating her silence, the use of art therapy was seen as appropriate. Art therapy reached very interesting findings, which were later confirmed by other medical examinations as well as subsequent conversations with the patient. Art therapy was used to assess her emotional, cognitive and rational state. Its use increased the efficiency of assessment and promoted the definition of treatment objectives. The girl was asked to draw all the members of her family. Interpretation of drawing when observed for therapeutic purposes.

Everything I needed to know to be a pediatric emergency room doctor, I learned as a waitress

Everything I needed to know to be a pediatric emergency room doctor, I learned as a waitress

Rapid antigen test for adenovirus in children: Age and onset of symptoms are important

IntroductionRespiratory infection is the most common human adenovirus (HAdV) disease accounting for 7–8% of viral respiratory diseases in children less than 5 years. Differentiation of bacterial infections and viral infections is a common clinical problem. Material and methodsOne hundred oropharyngeal swabs obtained from October 2019 to November 2020 from patients attending the paediatric emergency room with suspicion of upper respiratory tract infection and negative results in influenza and RSV tests were included. Oropharyngeal swabs specimens were rapidly processed with STANDARD™ F Adeno Respi Ag FIA and the results were confirmed by RealStar® Adenovirus PCR Kit 1.0 (Altona diagnostics). ResultsSTANDARD™ F Adeno Respi Ag FIA had sensitivity and specificity values of 71.93% and 100% respectively. The performance of the test was higher in samples from children younger than 24 months and taken less than 72h since the beginning of symptoms. In this subgroup the test had 88.8% sensitivity and 100% specificity. ConclusionSTANDARD™ F Adeno Respi Ag FIA may improve the management of respiratory diseases in children younger than 24 months and less than 72h since the beginning of symptoms in paediatric emergency rooms.

Factors Associated With Emergency Department Visits or Readmission of Late Preterm Infants at the Neonatal Intensive Care Department, National Guard Health Affairs, Riyadh.

Background Infants who are born between 34 0/7 and 36 6/7 weeks of pregnancy as a result of maternal or fetal factors are defined as "late preterm infants". Compared to term infants, late preterm infants are more predisposed to pregnancy complications because they are less mature physiologically and metabolically. In addition, health practitioners still face difficulties in differentiating between term and late preterm infants due to similar general appearance.The aim of this study is to explore the epidemiology of readmission among late preterm infants at the National Guard Health Affairs. The objectives of the study were to calculate the rate of readmission among late preterm infants in the first month after discharge and to identify the associated risk factors for readmission. Methods A retrospective cross-sectional study was carried out at the neonatal intensive care unit (NICU at King Abdulaziz Medical City in Riyadh). We identified preterm infants bornin 2018 and the risk factors for readmission within the first month of life. Data on risk factors were collected using the electronic medical file. Results A total of 249 late preterm infants with a mean gestational age of 36 weeks were included in the study. Of them, 64 infants (25.7%) suffered from at least a subsequent admission and stayed overnight in either the inpatient department or pediatric emergency room. Maternal diabetes was a significant risk factor for readmission; on the other hand, a positive maternal Rh factor was a protective factor against readmission. Among readmitted infants (n=64), 51 infants were admitted to the emergency room (79.69%), eight infants were readmitted to the pediatric ward (12.5%), and five infants were readmitted to both (7.8%). The most common cause for pediatric ER visits was gastrointestinal(GIT) problems(27%), followed by upper respiratory tract infection(URTI) (18%) and jaundice (14%). The most common cause for direct ward readmission was jaundice (n= 5; 62%). Conclusion Gastrointestinal (GIT) issues and upper respiratory tract infections (URTIs) were the leading causes of pediatric emergency room admissions. In contrast, jaundice, congenital diaphragmatic hernia (CDH), airway problems, and regurgitation were the most frequent causes of admission to the ward, with jaundice being the primary cause. Although studies suggest that the late preterm population is at a higher risk for long-term health issues, further research is necessary to investigate this topic thoroughly.

Malarial retinopathy in a preschool child: A case report with long-term paediatric and ophthamological follow-up.

To report a paediatric case of retinopathy-positive cerebral malaria, emphasizing the clinical significance of long-term neurological and ophthalmological follow-up (5,5 years). After a recent journey in Ghana, a 17-month-old African female child was admitted at the Paediatric Emergency Room with fever and vomiting. Blood smear confirmed a Plasmodium Falciparum parasitaemia. Iv quinine was promptly administered, but after a few hours, the child developed generalized seizures, requiring benzodiazepine therapy and assisted ventilation for severe desaturation. Brain imaging (CT and MRI), lumbar puncture and several electroencephalograms showed data compatible with cerebral involvement of malaria. Schepens ophthalmoscopy and Ret-Cam pictures acquisition revealed macular haemorrhages in the left eye with central whitening and bilateral capillary abnormalities, typical signs of malarial retinopathy. Antimalarial therapy and iv Levetiracetam allowed neurological improvement. Eleven days after the admission, the child was discharged, showing no neurological symptoms and with an improved EEG signal, a normalized fundus oculi and brain imaging. Neurological and ophthalmological long-term follow-up were conducted: EEG controls didn't reveal abnormalities and the complete ophthalmological assessment showed a regular visual acuity and fundus oculi, as well as a normal SD-OCT and electrophysiologic testing. Cerebral malaria is a severe complication, characterized by a high fatality rate and challenging diagnosis. A helpful instrument for diagnostic and prognostic evaluation is the ophthalmological detection of malarial retinopathy and its monitoring over time. In our patient the long term visual follow-up didn't reveal any adverse outcome.

Case Cards: A Novel Learner-Centered Initiative to Improve Resident Education in the Pediatric Emergency Room.

The pediatric emergency department (PED) provides a wealth of learning opportunities for residents. However,delivering dedicated educationcan be a significant challenge due to considerable variability inday-to-dayschedules, volume, cases, time, and resource availability. Case-based and learner-centered teaching models are well suited for ambulatory settings like the emergency department. Using the Kern model, we designed an educational intervention titled "Case Cards" to facilitate active learning conversations in pediatric emergency medicine (PEM). Our goal was to improve clinical teaching in the PED to demonstrate self-reported satisfaction, knowledge acquisition, confidence, and commitment among residents rotating in this fast-paced, challenging clinical environment. After general and targeted needs assessments, we developed a compendium of 30high-yield case cards to facilitate case-based learning conversations between learners and preceptors. Case topicsmirror the American Board of Pediatrics Content Outline of Emergent Conditions. The "Learner Card" presents a PEM case for the learner to read and hold, while the "Teacher Card" contains evidence-based teaching prompts following established learner-centered clinical teaching models to guide and facilitate the case.Post-implementation surveys queried Kirkpatrick New World educational outcomes in a retrospectiveformat. We collected data from 24 pediatric and emergency medicine residents between July 2021 and January 2022. All respondentsagreed or strongly agreed that case cards are enjoyable, educational, applicable to clinical practice, enhanced confidence, and would be recommended to others. Case cards for learner-centered teaching in the pediatric emergency setting are well-received and demonstrate resident self-reported satisfaction, knowledge, and confidence in core PEM conditions. Having established and readily available teaching topics, such as case cards, can enhance the clinical experience in the PED and other challenging settings and augment clinical exposure to core content. Educators may wish to expand and explore evolving technologies to facilitate learner-centered clinical teaching.

True Bacteremia or Contamination? Predictive Factors for Contamination in Blood Cultures Obtained in the Pediatric Emergency Room

True Bacteremia or Contamination? Predictive Factors for Contamination in Blood Cultures Obtained in the Pediatric Emergency Room

Comparison of anaphylaxis epidemiology between urban and suburban pediatric emergency departments

BackgroundAnaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. To date, there are no published data on epidemiology of pediatric anaphylaxis in Michigan. Our objective was to describe and compare the time trends in incidence of anaphylaxis in urban and suburban populations of Metro Detroit.MethodsWe performed a retrospective study of Pediatric Emergency Department (ED) anaphylaxis visits from January 1, 2010, to December 1, 2017. The study was conducted at 1 suburban ED (SED) and 1 urban ED (UED). We identified cases using an International Classification of Diseases (ICD) 9 and 10 query of the electronic medical record. Patients were included if they aged 0–17 years and met the 2006 National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphylaxis Network diagnostic criteria for anaphylaxis. The anaphylaxis rate was calculated as the number of detected cases divided by the total number of pediatric emergency room visits for that month. Anaphylaxis rates were compared between the two EDs using Poisson regression.ResultsA total of 8,627 patient encounters had ICD codes for anaphylaxis, of which 703 visits fulfilled the inclusion criteria and were used in subsequent analyses. Overall, the incidence of anaphylaxis was more common in males and in children < 4 years of age in both centers. Although the total number of anaphylaxis related visits was higher at UED over the eight-year time frame for this study, the anaphylaxis rate (cases per 100,000 ED visits) throughout the study was higher at the SED. While the observed anaphylaxis rate at UED was 10.47 – 162.05 cases per 100,000 ED visits, the observed anaphylaxis rate at SED was 0 – 556.24 cases per 100,000 ED visits.ConclusionPediatric anaphylaxis rates differ significantly between urban and suburban populations in metro Detroit EDs. The rate of anaphylaxis related visits to the ED has significantly increased over the past 8 years in the metro Detroit area, with significantly higher rise in suburban compared to urban ED. More studies are needed to explore the reasons for this observed difference in increase rates.

Clinical and Forensic Aspects of the Management of Child Abuse: The Experience of the Paediatric Emergency Department in Novara, North-West Italy.

Child abuse is an endemic phenomenon that refers to any form of violence aimed at children and adolescents. The Emergency Room is often the entry point to healthcare for the abused child. This is a cross-sectional study including minors, aged 0-18 years, of all genders, who experienced any form of violence examined at the Paediatric Emergency Department of the 'Maggiore della Carità' Hospital in Novara (North-West Italy) between 1 January 2017 to 31 December 2021. Data were extrapolated by looking at the diagnosis at discharge. A comparison of the different variables collected was made between the pre-COVID-19 period and the COVID era. 120 minors presented to the paediatric emergency room seeking help for violence. The average age was 10 years, 55% of the victims were male and 75% of them were Italian. In the pre-COVID period, the number of presentations for abuse was 62, while in the COVID period it was 58 with an increase of peer violence (from 38.71% to 62.07%) and with a statistically significant impact of the pandemic on the phenomenon (p-value < 0.00001). In general, peer violence accounts for 50% of the cases reviewed and resulted in fewer reports to the judicial authority and requests for forensic advice. The SARS-CoV-2-related pandemic has had an impact on total emergency room admissions and the types of abuse perpetrated.