Pediatric emergency care最新文献

{"title":"Point-of-Care Ultrasound Versus X-ray for Pediatric Upper Extremity Injuries: A Safe and Radiation-Free Alternative?","authors":"Ioannis Delniotis, Vangelis Bontinis, Alexandros Delniotis, Alkis Bontinis, Elena E Drakonaki, Kiriakos Ktenidis, Nikiforos Galanis","doi":"10.1097/PEC.0000000000003446","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003446","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to compare the diagnostic accuracy of point-of-care ultrasound (POCUS) and x-ray in detecting upper extremity fractures in children, focusing on sensitivity, specificity, and overall diagnostic performance. Particular attention was given to distal forearm fractures, the most common fracture site in children.</p><p><strong>Methods: </strong>This prospective diagnostic accuracy study was conducted in 2024 at a pediatric orthopedic emergency department. A cohort of 106 children aged 0 to 16 years, presenting with suspected upper extremity fractures, was enrolled. Each participant underwent both POCUS and x-ray imaging within a 24-hour period. POCUS was performed by a clinician, while x-ray images were interpreted by radiologists. The study evaluated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios for both general upper extremity fractures and specifically for distal forearm fractures.</p><p><strong>Results: </strong>Among the 106 participants, POCUS demonstrated an overall sensitivity of 88.3% (95% CI: 77.4-95.2) and specificity of 87.0% (95% CI: 73.7-95.1). The PPV was 89.8% (95% CI: 79.2-96.2), and the NPV was 85.1% (95% CI: 71.7-93.8). In the subgroup analysis of distal forearm fractures, POCUS exhibited enhanced diagnostic performance, with a sensitivity of 96.9% (95% CI: 83.8-99.9) and specificity of 93.3% (95% CI: 68.1-99.8). The PPV and NPV for distal forearm fractures were 96.9% (95% CI: 83.8-99.9) and 93.3% (95% CI: 68.1-99.8), respectively.</p><p><strong>Conclusions: </strong>POCUS proves to be a reliable, radiation-free diagnostic tool for detecting upper extremity fractures in children, particularly distal forearm fractures. However, due to the joint's complex anatomy, caution is advised when using POCUS for elbow fractures, which may increase the risk of misinterpretation.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of Point-of-Care Ultrasound for Acute Pediatric Ankle Injuries.","authors":"Kathleen M Smith, Elise Zimmerman, Zola Trotter, Shannon Wai","doi":"10.1097/PEC.0000000000003439","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003439","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to determine test performance characteristics of point-of-care ultrasound (POCUS) in the diagnosis of pediatric ankle fractures compared with ankle x-rays. Secondary objectives were to determine if POCUS can reduce the number of x-rays, analyze diagnostic errors, compare the Ottawa Ankle Rules (OAR) with POCUS, and determine if the outcome of the ultrasound results is affected by the musculoskeletal ultrasound experience of the pediatric emergency physicians.</p><p><strong>Methods: </strong>This was a prospective study of children aged 6 to 18 years who presented to the emergency department with ankle injuries with no prior x-rays. The physicians received a 2-hour training session, performed an ultrasound with a standardized protocol, and documented the POCUS results as positive or negative for fracture. The reference standard was the radiologist's x-ray interpretation.</p><p><strong>Results: </strong>We enrolled 118 patients with a median age of 12 years (interquartile range, 10 to 14 years). There were 17 fractures among 15 patients; 8 were clinically significant. Overall, POCUS would reduce x-rays by 105 (89%), but miss 6 fractures, including 1 clinically significant fracture. For detecting all ankle fractures, POCUS yielded a sensitivity of 60% (95% CI, 32.3-83.7), a specificity of 96% (95% CI, 90.4-98.9), a positive predictive value of 69.2 (95% CI, 44.2-86.5), and a negative predictive value of 94.3 (95% CI, 89.9-96.9). For the detection of clinically significant fractures, POCUS yielded a sensitivity of 87.5% (95% CI, 47.4-99.7), a specificity of 94.6% (95% CI, 88.5-97.9), a positive predictive value of 53.9 (95% CI, 33.9-72.6), and a negative predictive value of 99.1 (95% CI, 94.3-99.9). The sensitivity of POCUS + OAR and OAR alone was 90% (95% CI, 55.5-99.8), but the specificity was 0% (95% CI not computed).</p><p><strong>Conclusions: </strong>POCUS alone or combined with OAR is an inadequate screening tool to detect pediatric ankle fractures.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serial Trauma Abdominal Ultrasound in Children (STAUNCH): Assessment of Utilization.","authors":"Benjamin K Nti, Pamela Soriano, Sean Thompson","doi":"10.1097/PEC.0000000000003443","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003443","url":null,"abstract":"<p><strong>Objectives: </strong>Point-of-care ultrasound has established utility within pediatric emergency medicine (PEM) and has the added benefit of avoiding excessive radiation exposure. The serial Focused Assessment with Sonography for Trauma (sFAST) examination is an underutilized tool in pediatric trauma patients. We sought to understand current practices and viewpoints regarding serial ultrasound (US) examinations.</p><p><strong>Methods: </strong>Thirty-three PEM institutions were surveyed regarding attitudes and practices toward serial FAST examination. We included all faculty and staff who had oversight or leadership in a POCUS program. We were provided with basic demographic data from institutions through our survey.</p><p><strong>Results: </strong>Among institutions that performed serial FAST examinations, the region with the highest number of respondents was the Northeast (38.7%). In total, 75.8% of respondents noted that serial ultrasound was a useful tool in pediatric trauma. The most common barrier was insufficient evidence for efficacy (50%), with the perception that it infrequently changed management (78.9%). Serial FAST was not routinely performed, and only one institution had a protocol for it.</p><p><strong>Conclusions: </strong>Although there is institutional support for serial FAST examinations as part of trauma evaluations, several barriers remain that hinder their routine use in pediatric trauma patients.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a Pediatric Residents' Procedural Sedation Training Program: Feasibility, Quality, and Complication Rate.","authors":"Michal Vinker-Shuster, Uriel Ezra, Noy Cohen-Ronen, Moti Zeev Eini","doi":"10.1097/PEC.0000000000003438","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003438","url":null,"abstract":"<p><strong>Purpose: </strong>Procedural sedation (PS) became a crucial component of pediatric care in the late 20th century, necessitating an effective and safe balance. Due to growing demand, it is often performed by pediatric residents, sometimes without formal training. The study aimed to assess the quality and complication rates of a pediatric residents' PS training program.</p><p><strong>Methods: </strong>This is a retrospective analysis of all pediatric PSs (aged 1 to 18 years) treated by pediatric residents alone or with staff physicians' supervision (Pediatric-Emergency-Care-Specialists or Intensive-Care-Specialists) in our general hospitals' pediatric PS qualification program (November 2017 to July 2021). PS data, including the reason for sedation, course, drugs, and complications, were collected and analyzed. Major complications were defined as the need for positive-pressure ventilation, laryngospasm, cardiopulmonary resuscitation, or unplanned admission.</p><p><strong>Results: </strong>In all, 3156 PSs were performed, 1386 (43.9%) were conducted by sedation-trained pediatric residents and 1770 (56.1%) with staff physicians' supervision. All the sedations were successful. The percentage of sedations performed by pediatric residents alone increased annually. Midazolam was used in 1652 (52.3%) PSs, ketamine in 1080 (34.2%), and a midazolam-ketamine combination in 943 cases (29.9%). In 3107 (98.4%), PS had no adverse events. Mild adverse events were reported in 50/3156 (1.6%) of the PS with need for airway repositioning (27 cases, 0.9%), intranasal-O2 (13, 0.4%), mild hypoxia (12, 0.4%), suction (9, 0.3%), and intravenous fluids (3, 0.1%). There was only 1 hospital admission due to prolonged recovery. By multivariate analysis, slightly higher odds ratio (OR) for mild adverse event was found among patients with any chronic disease (OR=2.48, 95% CI: 1.20-5.14, P=0.014), and PS performed by pediatric residents alone versus pediatric residents guided by staff physicians (OR=2.26, 95% CI: 1.23-4.13, P=0.008).</p><p><strong>Conclusions: </strong>These findings highlight the feasibility of a PS service led by trained pediatric residents, as confirmed by the high PS success rate and 98.4% rate of no adverse reactions.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-Care Ultrasound Diagnosis of Restrictive Cardiomyopathy in a 3-Year-Old Patient.","authors":"Thuy Nguyen, Arjith Rathakrishnan, Madison Bompard, Trent She, Henry Chicaiza","doi":"10.1097/PEC.0000000000003343","DOIUrl":"10.1097/PEC.0000000000003343","url":null,"abstract":"<p><p>Restrictive cardiomyopathy is a rare form of cardiomyopathy in children, representing only 2.5%-3% of all pediatric cardiomyopathies, and is typically diagnosed between the ages of 6 and 10. The underlying etiology varies depending on age and region; however, idiopathic, genetic, and endomyocardial fibrosis are among the most common. Cohort studies have demonstrated mortality as high as 50% within 2 years of diagnosis, as well as high rates of adverse events including thromboembolism, pulmonary hypertension, and sudden cardiac death. There is a paucity of literature on point-of-care ultrasound (POCUS) for the diagnosis of pediatric restrictive cardiomyopathy. We present a case of a 3-year-old female whose diagnosis of heart failure was rapidly identified via POCUS which subsequently expedited life-saving treatment.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"563-565"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Intensive Care Utilization for Patients With MIS-C in the Emergency Department.","authors":"Erin Aldag, Allayne Stephans, Doug Lorenz, Guliz Erdem, Ron L Kaplan, Jennifer Y Colgan, Risa Bochner, Thomas Graf, Bari Winik, Nathan M Money","doi":"10.1097/PEC.0000000000003383","DOIUrl":"10.1097/PEC.0000000000003383","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with multisystem inflammatory syndrome in children (MIS-C) frequently require intensive care. Few studies have evaluated presenting signs and symptoms suggesting severe disease. We aimed to identify risk factors for intensive care utilization in patients with MIS-C on presentation to the emergency department (ED).</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort analysis among patients aged 6 months to 18 years diagnosed with MIS-C at 5 academic hospitals in the United States from 2020 to 2022. Demographics, initial examination, laboratory results, and outcomes were obtained by electronic health record review. Adjusted odds ratios were derived to measure the association between covariables and intensive care needs. An exploratory analysis was performed among patients transferred from the medical floor to the intensive care unit to identify factors indicating delayed decompensation.</p><p><strong>Results: </strong>Among 432 patients with MIS-C, 190 required intensive care. Factors in the ED associated with increased odds of intensive care utilization on multivariable analysis were older age, delayed capillary refill, hypotension, tachypnea, hypoxemia, elevated prothrombin time, B-type natriuretic peptide, procalcitonin, and alanine transaminase. The full multivariable model exhibited a raw area under the curve of 0.92. In an exploratory analysis among 40/242 patients admitted to the medical floor but subsequently required transfer to the intensive care unit, older age, higher maximum ED temperature, severe tachycardia, elevated d -dimer, absolute neutrophil count, and C-reactive protein were associated with pediatric intensive care unit transfer in univariate analysis.</p><p><strong>Conclusions: </strong>Presenting signs, symptoms, and laboratory findings may be utilized in the ED to identify patients with MIS-C who have increased odds of initial intensive care utilization and potential later clinical deterioration. These data may help ED physicians identify patients who would benefit from more intensive monitoring or transfer to a tertiary care facility, where appropriate.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"521-527"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Point-of-Care Ultrasound (POCUS) in Adolescents With Chest Pain or Syncope in the Emergency Department: Is There a Sex Discrepancy?","authors":"Ndah Akwesi Poteh, Joshua Kim, Kahir S Jawad, Paul Adeeb Khalil","doi":"10.1097/PEC.0000000000003386","DOIUrl":"10.1097/PEC.0000000000003386","url":null,"abstract":"<p><p>Cardiac POCUS is sometimes performed in patients with chest pain or syncope in the pediatric ED. It is possible that adolescent females are less likely to receive a scan due to provider discomfort with the potential obstruction of breast tissue. The primary aim of this study was to compare the proportion of cardiac POCUS obtained in adolescent males versus females to determine whether there is a difference. This was a retrospective chart review of adolescent patients who presented with chest pain or syncope from the year 2018 to 2020. Cardiac POCUS scans obtained on this cohort were reviewed, and the patients were then compared by sex to see whether there were differences in the number and proportion of scans obtained. The quality of the overall scans was also evaluated and compared to see whether there was a sex-based difference. Descriptive statistics was calculated, and differences were assessed by sex using χ 2 test. A total of 2814 patients were enrolled in the study; 1096 were male, and 1718 were female. Of those, 259 received cardiac POCUS; 132 (51%) were male and 127 (49%) were female. There was a significant difference in the proportion of patients who received cardiac POCUS, based on sex ( P <0.0001). There was no significant difference in the sex of the patient and the quality of the images obtained. Interrater reliability between a Pediatric Emergency Medicine fellow who has had cardiac POCUS training and a pediatric cardiologist was compared and yielded a kappa of 0.565. There was a significant difference in the sex of the patients who received cardiac POCUS for the complaint of chest pain or syncope.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"542-546"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardization of Clinician Outcomes for Croup Using a Clinical Pathway.","authors":"Yongtian T Tan, Emily A Hartford, Dwight Barry, Lori E Rutman, Russell T Migita","doi":"10.1097/PEC.0000000000003385","DOIUrl":"10.1097/PEC.0000000000003385","url":null,"abstract":"<p><strong>Objective: </strong>Croup management varies significantly between hospitals and clinicians. We assessed the level of clinician variation with a clinical croup pathway in the pediatric emergency department (PED) and the impact of a pathway change on admission rates.</p><p><strong>Methods: </strong>This was a retrospective cohort study of children with croup in a PED at an academic referral hospital between 2018 and 2022. Primary outcome measures were the proportion of admissions to the hospital and mean PED length of stay. The main exposures were the primary clinician and their use of racemic epinephrine. We used generalized linear mixed models to evaluate interclinician variability in outcome measures and outcomes by self-identified race, ethnicity, and language.</p><p><strong>Results: </strong>There was no variability in the use of racemic epinephrine, odds of admission, or odds of unplanned PED returns among 59 clinicians; there was variability in length of stay with a difference of ten minutes. Black patients had 87% higher odds of being admitted (Odds Ratio: 1.87; 95% CI: 1.04, 3.38), and patients identifying as \"other\" racial group had 94% higher odds of unplanned PED returns (Odds Ratio: 1.94, 95% CI: 1.21, 1.53). Quarterly admit rates decreased from 7.8% to 5.1% after pathway change, with no statistical change in unplanned PED returns or intensive care unit transfers.</p><p><strong>Conclusions: </strong>In the presence of a clinical croup pathway, there was minimal clinician variation in care. There were differences by patient race in admissions and PED return visits, but no differences by language for care. With a change in the pathway, admissions were reduced without a change in balancing measures.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"554-559"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Emergency Medicine Fellows' Procedural Experiences During Training.","authors":"Elizabeth D Moran, Deborah Hsu, Mary Wisbon, Elizabeth A Camp, Ellen Duncan, Alaa Elkarim, Aimee Baer Ellington, Danielle Graff, Karen A Mangold, Katherine McVety, Joshua Nagler, Lina Patel, Selin T Sagalowsky, Amy D Thompson, Tien T Vu, Cheryl Yang, Esther M Sampayo","doi":"10.1097/PEC.0000000000003377","DOIUrl":"10.1097/PEC.0000000000003377","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric Emergency Medicine (PEM) fellows are expected to perform many procedures during their fellowship, but they often have limited opportunities to practice rare procedures. The number of procedures required to achieve competence remains unclear; however, research suggests that increased practice correlates with skill development. The objective of this study is to quantify the frequency of procedures performed by fellows. Also, we describe how programs currently track their trainees' experiences.</p><p><strong>Methods: </strong>This was a retrospective, multicenter, cross-sectional, descriptive study exploring procedures performed by PEM fellows enrolled in ACGME-accredited programs between July 2019 and June 2020. Fellow and program demographics were collected. We analyzed procedural tracking collected through self-reported logs and documentation within the electronic medical record. In addition, we explored how programs currently track these experiences. Procedures were standardized based on the ACGME list of required procedures.</p><p><strong>Results: </strong>Eleven fellowship programs submitted the self-reported procedure logs of 104 fellows. Of those, 2 sites reported electronic medical record-based logs. The most frequently documented procedures included medical and trauma resuscitations, procedural sedations, and intubations. The most infrequently reported were nasal packing for nosebleeds and cardiac pacing. Most participating programs tracked experiences through fellow self-report and many offer opportunities for faculty to assess competence.</p><p><strong>Conclusions: </strong>PEM fellows do not consistently report performing all ACGME-required procedures during the fellowship. In addition, there is significant variation in how fellowship programs track trainees' procedural experiences. This study may inform the development of supplemental educational curricula and the potential revision of the ACGME list of required procedures. Future research could focus on assessing procedural competence.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"566-572"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Future Acute Care Visit Risk in Kids With Asthma (PARKA): A Nested Cohort Study.","authors":"Dhenuka Radhakrishnan, Patricia Li, Meltem Tuna, Madhura Thipse, Nick Barrowman, Vid Bijelic, Naveen Poonai, Dominic Chalut, Roger Zemek, Eric I Benchimol, Francine M Ducharme","doi":"10.1097/PEC.0000000000003336","DOIUrl":"10.1097/PEC.0000000000003336","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to develop a clinical risk score to predict future asthma acute care visits [emergency department (ED) visits or hospitalizations] within 1 year following a discharge from 1 of 2 tertiary care pediatric EDs in Ontario, Canada.</p><p><strong>Methods: </strong>We assembled a nested Ontario cohort from the multicenter prospective DOORWAY cohort study and included children 1 to 17 years of age, with an ED visit for a moderate/severe asthma exacerbation. We linked this with provincial health administrative data. We used multivariable regression to derive and internally validate a practical clinical risk score to predict future asthma acute care visits.</p><p><strong>Results: </strong>A total of 257 children [32% female, median age 3.0 years (IQR 1 to 7 y)] were included, and 58 experienced an asthma visit within the following year. These were best predicted by 4 factors: food allergy (OR 4.2, 95% CI: 1.2-14.9), family history of asthma (OR 0.5, 95% CI: 0.3-0.9), prior acute asthma medical visits (OR 2.8, 95% CI: 0.9-8.6), and prior emergency room visits for any respiratory diagnosis (OR 3.0, 95% CI: 1.4-6.4). A score of 0, 1, or 2 points was applied to each factor for up to a maximum of 6 points; the PARKA score has very good overall performance with a scaled Brier score of 0.11 on internal validation and good discrimination with an AUC of 0.72 (95% CI: 0.64-0.78).</p><p><strong>Conclusions: </strong>The PARKA score predicts the risk of a future asthma acute care visit in a cohort of Ontario children with a moderate/severe asthma ED visit. Following external validation, this tool may aid ED clinicians in accurately targeting resource-intensive preventative interventions for at-risk children.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"547-553"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12199803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}