Pediatric emergency care最新文献

{"title":"The Need to Screen and Treat Iron Deficiency in Women.","authors":"Toby Richards","doi":"10.1097/PEC.0000000000003356","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003356","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557670","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":"Perceptions and Experiences of Refugee Families in the Pediatric Emergency Department: A Qualitative Interview Study.","authors":"Ronine L Zamor, Jamie Pattee, Abhiram R Manda, Rishab H Bhatt, Joanna Yu, Saria Hassan, Brittany Murray","doi":"10.1097/PEC.0000000000003357","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003357","url":null,"abstract":"<p><strong>Objectives: </strong>Refugees face significant barriers that make acculturation and utilization of the US health care system challenging. Prior literature regarding health care access for the refugee population has focused on adult refugee patients. However, children and adolescents account for approximately 40% of refugees arriving in the United States annually. The objective of this study is to explore the perceptions and experiences of refugee families in the pediatric emergency department when accessing emergent care for their children.</p><p><strong>Methods: </strong>We performed a qualitative study of pediatric refugee families presenting for emergency care through semistructured interviews of refugee families within the pediatric emergency department and focus group sessions with community stakeholders in Atlanta, Georgia over a 3-month period. Interviews were conducted until thematic saturation was reached. All interviews were transcribed and reviewed using an iterative and inductive approach to discover emerging themes.</p><p><strong>Results: </strong>A total of 1000 families were screened, and 40 (4.0%) were eligible refugee families. Of these families, 20 (50%) completed interviews, 10 (25%) declined participation, and 10 (25%) agreed to participate but had scheduling conflicts. Four major themes emerged from the thematic analysis: (1) impact of social support on navigating the US healthcare system, (2) exacerbation of pre-existing family stressors, (3) language and communication, and (4) respect during the health care encounter.</p><p><strong>Conclusions: </strong>This study identified important areas of concern to families of pediatric refugees when accessing emergent care. These areas should be further explored as potential areas to optimize equitable emergency department care for pediatric refugee patients.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542993","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":"Antivenom Administration Strategies in Pediatric Snake Envenomation.","authors":"Kevin Baumgartner, David B Liss, Michael E Mullins","doi":"10.1097/PEC.0000000000003361","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003361","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542985","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 Difficult Intravenous Access Scores in a Low-Resource Setting: An External Validation Study.","authors":"Panida Kanjanauptom, David Kessler, Sirin Khongjaroensakun, Suphalak Darunaitorn, Worapant Kriengsoontornkij","doi":"10.1097/PEC.0000000000003332","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003332","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to establish and evaluate validity data for pediatric difficult intravenous access (DIVA) scores in low-resource emergency care settings within low- to middle-income countries (LMIC). We also sought to explore associated factors for DIVA that could contribute to a modified pediatric DIVA score with optimal performance in our setting.</p><p><strong>Methods: </strong>We performed a prospective cross-sectional study in children aged 0 to 15 years who required urgent or emergent peripheral intravenous access (PIVA) over a 10-month period in a large university hospital in Bangkok, Thailand. DIVA was defined as a failure of PIVA on the first attempt. For each candidate DIVA model, receiver operating characteristic curves were constructed, and the area under the curves was calculated. Additional candidate predictive factors of patients and providers were collected and analyzed using a logistic regression model.</p><p><strong>Results: </strong>Among a convenience sample of 392 children enrolled, the DIVA rate was 30.1%. Three-variable DIVA (DIVA3) and 4-variable DIVA scores (DIVA4) demonstrated similar test characteristics in our population in identifying patients with first attempt failure rate of at least 50%. Vein visibility, vein palpability, younger age, and history of DIVA were statistically significant factors related to DIVA. Through the inclusion of 4 factors associated with DIVA, the LMIC-DIVA score was developed and exhibited superior discriminative ability compared with the DIVA3 and DIVA4 scores. The area under the curves for LMIC-DIVA, DIVA3, and DIVA4 were 0.79 (95% CI=0.74-0.83), 0.65 (95% CI=0.59-0.70), and 0.62 (95% CI=0.56-0.67), respectively.</p><p><strong>Conclusion: </strong>This study provides external validation data for DIVA3 and DIVA4 scores in the LMIC setting. The novel modified 4-variable LMIC-DIVA score improves test characteristics and accuracy in identifying pediatric DIVA in our population.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542988","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":"Letter to the Editor Regarding 'Excessive Use of Benzodiazepines Is a Risk Factor for Endotracheal Intubation in Children Who Present to Emergency With Prehospital Status Epilepticus'.","authors":"Emel Ulusoy, Murat Duman","doi":"10.1097/PEC.0000000000003301","DOIUrl":"10.1097/PEC.0000000000003301","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"e18"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584038","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":"Use of Emergency Telemedicine Physicians for Telephone Triage Disposition of Pediatric Patients.","authors":"Meghan R Cain, Benjamin W Iliff, Christopher S Russi, Aidan F Mullan, Ronna L Campbell","doi":"10.1097/PEC.0000000000003312","DOIUrl":"10.1097/PEC.0000000000003312","url":null,"abstract":"<p><strong>Objectives: </strong>Telemedicine is a growing field, with limited data around its utility supporting pediatric emergency care telephone triage. We instituted telemedicine physician support for nurse telephone triage decisions. When the nursing protocols recommended urgent or emergent care, a telemedicine physician reviewed and modified care urgency if appropriate. Our primary study objectives were to evaluate the proportion of patients who were downgraded to less urgent care and assess for potential harm related to the downgrade in care urgency.</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study of pediatric telephone calls to the Mayo Clinic Health System nurse triage line that were directed to the emergency department telemedicine physician from January 1, 2019, to December 31, 2019. Electronic medical records of patients whose care urgency was downgraded and presented to medical care within 72 hours of the triage call were reviewed.</p><p><strong>Results: </strong>There were 8559 nurse line calls regarding pediatric patients, 882 of which were referred to the telemedicine physician. Among these, 396/882 (44.9%, 95% confidence interval 41.6-48.3) were downgraded. Of downgraded cases, 198 (50.0%) patients sought care within 72 hours of the original call, of which 193 (97.5%) patients were discharged home from that medical visit and 5 (2.5%) patients required admission. No patients were determined to have suffered harm due to the downgrade of visit urgency.</p><p><strong>Conclusions: </strong>Our data suggests that telemedicine physicians can safely downgrade nurse triage care recommendations for pediatric patients. Most downgraded patients sought outpatient care, avoiding unnecessary utilization of the emergency department without evidence of associated harm.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"190-194"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789628","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":"Does Virtual Interviewing Provide the Information for a Satisfactory Rank Decision?: A Perspective From the Pediatric Emergency Medicine Fellowship Interviews.","authors":"Simi Gotewal, Sing-Yi Feng, Bharati Beatrix Chandra Bansal, Jo-Ann Nesiama","doi":"10.1097/PEC.0000000000003307","DOIUrl":"10.1097/PEC.0000000000003307","url":null,"abstract":"<p><strong>Objective: </strong>The primary aim of this study was to determine whether current fellows and program directors in pediatric emergency medicine (PEM) were satisfied with virtual interviewing (VI) in terms of their respective matches. The secondary goal was to assess areas in which the virtual interview process could be improved.</p><p><strong>Methods: </strong>After institutional review was obtained, fellow surveys were piloted to non-PEM fellows to solicit feedback. Surveys were distributed via the PEM Survey committee from September 18, 2023, to November 13, 2023. There were 2 separate surveys: one for PEM program directors (PDs) and another for PEM fellows. The first survey targeted PEM fellows who matched in interview cycles from 2020 to 2022; it evaluated VI accuracy in representing program attributes and assessed the effectiveness of specific interview components. The second survey was for PEM PDs and explored the types of interview components employed and the evolution of the VI process. Both surveys gauged overall satisfaction with the VI process regarding their matches and preference for interview modality (VI vs in-person vs hybrid).</p><p><strong>Results: </strong>A response rate of 25% (n = 56) from fellows and 44% (n = 40) from PDs were obtained. Three-quarters (75%) of fellows were satisfied or highly satisfied with the information obtained via the virtual interview in terms of being able to accurately assess their program. PD satisfaction trended upward from 2020 to 2022 regarding virtual interviewing. Sixty-four percent of fellows, compared to 72% of PDs believed that their in-person experience aligned well or very well with the perception they obtained via virtual interviewing.</p><p><strong>Conclusions: </strong>Despite high satisfaction rates with the VI regarding matches and strong alignment of perception obtained via VI with in-person assessment during fellowship, both PDs and fellows continue to prefer a form of hybrid interviews. Our study provides valuable insights for guiding recommendations in future implementations of VI.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"165-171"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009673","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":"Virtual Reality as Active Distraction in Laceration Repair: A Game Changer?","authors":"Anne O McEvoy, Olivia B Vincent, Turaj Vazifedan, Todd P Chang, Joel M Clingenpeel, Rupa Kapoor","doi":"10.1097/PEC.0000000000003319","DOIUrl":"10.1097/PEC.0000000000003319","url":null,"abstract":"<p><strong>Objectives: </strong>We conducted an unblinded, randomized control trial to determine if immersive virtual reality (VR) goggles decrease pain and fear scores in children undergoing laceration repair in the pediatric emergency department (PED) compared to the standard of care. Secondary outcomes included duration of procedure, physical holding, anxiolytic usage, and desire to use VR goggles again.</p><p><strong>Methods: </strong>Ninety-one patients aged 6-17 years in a PED with simple lacerations sutured by PED staff completed surveys. Eligible patients were randomized to receive either VR or standard of care. Guardians and providers also completed surveys. Self-reported pain scores were assessed by the Wong-Baker Faces Pain Scale and fear scores by Children's Fear Scale.</p><p><strong>Results: </strong>There were significant reductions in pain and fear scores for VR goggles compared to standard of care. Patients rated their mean pain score as 3.7 in controls and 2.3 in the VR group, and mean fear score of 3.0 and 2.2. The likelihood of physical holding was significantly lower among those who used VR goggles (adjusted odds ratio = 0.34, 95% confidence interval [0.13-0.92], P  = 0.033). The likelihood of receiving anxiolytics was lower among the 12- to 17-year-olds (adjusted odds ratio = 0.27, 95% confidence interval [0.11-0.69], P  = 0.006). There was no significant difference in the procedure duration ( P  = 0.06). A total of 97.9% of parents, 93.6% of patients, and 95.7% of providers would use VR again.</p><p><strong>Conclusion: </strong>Virtual reality goggles are an effective tool for distraction for simple laceration repairs. Their use leads to decreased pain and fear. Children who used VR goggles did not require to be held as often for sutures. There was no significant difference in anxiolytics or duration of procedure.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"208-212"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786437","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":"Spinal Anatomy Ultrasound in Young Infants With Implications for Lumbar Puncture.","authors":"Margaret B Rinaldi, Matthew Lipton, Rebecca Kidd, Donald H Arnold, Marla C Levine","doi":"10.1097/PEC.0000000000003313","DOIUrl":"10.1097/PEC.0000000000003313","url":null,"abstract":"<p><strong>Background: </strong>Lumbar puncture (LP) in young infants may challenge clinicians due to the infrequency of the procedure and anatomic variability. The use of ultrasound (US) to characterize young infant spinal anatomy prior to performing an LP may help determine the most favorable site for intervention.</p><p><strong>Objectives: </strong>1) Evaluate potential sites for LP in young infants with US at L2/L3 through L5/S1 to determine differences in needle insertion depth (NID), spinal canal width (SCW), and subarachnoid fluid width (SAW).2) Describe the location of the conus medullaris.3) Predict NID of L2/L3 through L5/S1 based on variables including age, gestational age, height, and weight.</p><p><strong>Methods: </strong>We studied a convenience sample of participants aged 0-6 months in a tertiary children's emergency department. We recorded characteristic data and used a Sonosite PX US with a linear 15-MHz transducer to image each participant's spine. We used the paired t -test to examine univariate differences in NID, SCW, and SAW and multiple linear regression models to derive predictive equations for NID.</p><p><strong>Results: </strong>Among 50 participants, the mean NID for sites L2/L3 through L5/S1 did not differ significantly; however, at sites L2/L3 through L5/S1, there were statistically significant differences in the mean SCW and mean SAW, which were both consistently measured to be larger the more cephalad the site. Weight was the only statistically significant variable associated with NID after adjusting for other covariates.</p><p><strong>Conclusions: </strong>Spinal canal width and SAW were consistently measured to be larger at more cephalad sites, suggesting there is a larger target fluid volume available at higher interspaces. Subarachnoid fluid width was measured to be small, highlighting the importance of precise movements. Location of the needle site did not change expected needle depth (approximately 1 cm across all sites). The conus medullaris was not often visualized while scanning the L2/L3-L5/S1 interspaces. Weight can be used to estimate optimal NID; although, it is unclear such small differences would have clinical significance.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"203-207"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813967","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":"Incidence of Sexually Transmitted Infections and Pregnancy Among Adolescents Experiencing Sex Trafficking.","authors":"Whitney Ficker, Lauren Ehrhardt-Humbert, Stacy Reynolds","doi":"10.1097/PEC.0000000000003317","DOIUrl":"10.1097/PEC.0000000000003317","url":null,"abstract":"<p><strong>Objective: </strong>There is a lack of data regarding the incidence of sexually transmitted infections (STIs) and pregnancy among adolescents experiencing sex trafficking. This study aimed to determine the incidence proportion of STIs and pregnancy among adolescents evaluated for sex trafficking at an urban tertiary children's hospital compared to the community adolescent population.</p><p><strong>Methods: </strong>This retrospective, cross-sectional study looked at adolescents aged 11 to 21 years experiencing sex trafficking from March 2019 to March 2022. Data were abstracted from the hospital's human trafficking advocacy team database and the electronic medical record (EMR), including demographics, type and setting of trafficking, presenting complaints, and STI and pregnancy test results. Using Fisher's exact test, the incidence of STIs and pregnancy among adolescents experiencing sex trafficking was compared to adolescents in the community using local county health department data.</p><p><strong>Results: </strong>Fifty-four patients met the eligibility criteria. Females comprised 93% (n = 50) of the group. The average age was 16 years. The racial demographics most represented were African American at 56% (n = 30) and White at 30% (n = 16). History of abuse prior to trafficking was found in 78% (n = 42). Incidence proportions of STIs, compared to county health data, are as follows: 64.8% for Chlamydia trachomatis (CT) versus 7.8% (OR, 22; 95% CI, 12-40), 51.9% for Neisseria gonorrhoeae (GC) versus 2.2% (OR, 47; 95% CI, 26-83), 9.3% for syphilis versus 0.1% (OR, 111; 95% CI, 34-283), and 5.6% for HIV versus 0.1% (OR, 83; 95% CI, 16-261). There was a high individual cumulative incidence of STIs among patients over time, and patients presented with a variety of presenting complaints. The incidence proportion for pregnancy was 11.1% compared to 1.3% (OR, 10; 95% CI, 3-22).</p><p><strong>Conclusions: </strong>Adolescents experiencing sex trafficking have a significantly higher rate of STIs and pregnancy than the community adolescent population.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"213-218"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882074","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}