Pediatric emergency care最新文献

{"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":"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":"436-442"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","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":"Response to Rohl S, Meredith M, Anderson T, et al. Comparing the Use of Crotaline-Polyvalent Immune Fab (Ovine) Versus Observation in Children.","authors":"Caitlin Bonney, Spencer Greene","doi":"10.1097/PEC.0000000000003373","DOIUrl":"10.1097/PEC.0000000000003373","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"e32"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663769","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":"Children's Emergency Department Provider Experiences With Lethal Means Restriction Counseling and Firearm Access.","authors":"Arielle Shibi Rosen, Kirsten Bechtel","doi":"10.1097/PEC.0000000000003363","DOIUrl":"10.1097/PEC.0000000000003363","url":null,"abstract":"<p><strong>Objective: </strong>Assessing firearm access and providing lethal means restriction counseling (LMRC) is paramount for harm reduction, but evidence indicates that it is not commonly provided by Children's Emergency Department (ED) providers. This study aimed to explore provider perspectives and determine avenues to increase discharge safety for patients with behavioral health emergencies.</p><p><strong>Methods: </strong>Twenty-nine Children's ED providers completed semistructured interviews which were recorded, transcribed, iteratively coded, and organized into themes.</p><p><strong>Results: </strong>We identified the following 5 themes: (1) Children's ED providers have varying experiences with firearms which could influence their clinical practices. (2) Most providers expressed knowledge of LMRC as a necessary component of safety planning for behavioral health patients. (3) The role of medical providers is commonly assumed to be only in medical clearance, with LMRC falling to social workers and psychiatrists. (4) Many Children's ED providers seem to underestimate the gravity of risk associated with firearm access for children with behavioral health complaints. (5) Training and resources could help facilitate effective LMRC and support caregiver implementation of firearm secure storage.</p><p><strong>Conclusions: </strong>Despite a wide range of perspectives and barriers that prevent the consistent provision of LMRC, we saw that providers are amenable to interventions to increase comfort, consistency, and efficacy of safety planning. Understanding these perspectives can inform future initiatives for comprehensive LMRC that include firearm secure storage and address this crucial gap in care.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"456-463"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516300","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":"The Use of POCUS to Identify Subgaleal Fluid Collections and Intracranial Infections.","authors":"Shaheen Andreas, Henry Chicaiza, Rahul Shah","doi":"10.1097/PEC.0000000000003311","DOIUrl":"10.1097/PEC.0000000000003311","url":null,"abstract":"<p><strong>Abstract: </strong>Point-of-care ultrasound (POCUS) has been useful in describing soft tissue infections, such as cellulitis and abscesses. There has been limited use of ultrasound to describe findings of intracranial infections, such as Pott's puffy tumor, in cases of forehead prominence and signs of infection. In this case series we present POCUS findings in 2 cases of intracranial infections and one case of soft tissue edema without intracranial involvement from a single pediatric tertiary care center. Ultrasound findings revealed subgaleal fluid collections with associated periosteal lifting of the frontal bone in cases of Pott's Puffy tumor and intracranial infection, but no bony disruption or periosteal lifting in the patient with traumatic soft tissue edema. As pediatric intracranial infections may continue to have uncharacteristic seasonal peaks, POCUS may be considered as a first-line imaging technique for patients presenting with forehead swelling for differentiating infectious and traumatic etiologies as well as judging the need for further imaging techniques such as computed tomography and magnetic resonance imaging.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"486-488"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801978","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":"Oxygen Saturation Sub-analyses Errors in the Dominant Meta-analysis Used to Deimplement Albuterol as a Therapeutic Option for Bronchiolitis.","authors":"Larry Mellick, Gabriella Weston, Paul Walsh, Shane McKinney, Hongyan Xu","doi":"10.1097/PEC.0000000000003352","DOIUrl":"10.1097/PEC.0000000000003352","url":null,"abstract":"<p><strong>Objective: </strong>Clinical experience and patient-level physiological studies indicate that albuterol transiently reduces oxygen saturation, irrespective of the underlying respiratory condition causing the wheezing. Three revisions of the Cochrane review, Bronchodilators for Bronchiolitis (Review), have found that albuterol temporarily increases oxygen saturation. Rarely, these findings were even statistically significant, but the direction of effect is consistently opposite from physiological studies. In this study, we attempted to resolve this apparent paradox.</p><p><strong>Methods: </strong>The original trial publications included in multiple oxygen saturation sub-analyses in the 2006, 2010, and 2014 updates of the Cochrane review were assessed for appropriate study inclusion, correctness of calculations, and correct analysis with respect to direction of effect. The studies were also reviewed to assess whether the data was correctly transferred to the meta-analysis software. We repeated the meta-analyses calculations after correcting for suspected errors and plotted the results of the meta-analyses as originally reported and in their corrected form on an albatross plot.</p><p><strong>Results: </strong>We found data miscalculations, errors of transposition of albuterol and placebo data, the inclusion of inpatient data in outpatient analyses, and questionable study inclusions in the 3 Cochrane review updates. After corrections were made, the direction of effect of albuterol switched negative, albeit nonsignificantly, a finding most consistent with clinical and physiological observations. In addition, the very wide heterogeneity between the original meta-analyses disappeared.</p><p><strong>Conclusion: </strong>After multiple suspected data flaws were corrected our reanalyses of the reported data confirmed that decreased oxygen saturation can be expected following administration of albuterol to infants presenting with bronchiolitis syndrome, thereby resolving the apparent paradox in favor of clinical observation and research physiology.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"423-428"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483883","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":"Changes in Seasonal Patterns for Common Pediatric Respiratory Viruses During the COVID Pandemic.","authors":"Tara Lozy, Rimma Perotte, Austin Eigen, Karen Eigen, Ashley Kourgialis, Timothy Scheinert, Sondra Maureen Nemetski","doi":"10.1097/PEC.0000000000003340","DOIUrl":"10.1097/PEC.0000000000003340","url":null,"abstract":"<p><strong>Objectives: </strong>Observed alterations in seasonal patterns of common pediatric respiratory viruses during and immediately after the COVID-19 pandemic had far-reaching implications for the care of ill children. Here, we quantify the effects of the pandemic and related nonpharmaceutical interventions on the prevalence and seasonality of common pediatric respiratory illnesses.</p><p><strong>Methods: </strong>We performed a retrospective chart review within a large health network to identify incidence rates of common respiratory viruses and compared them to historical trends. Time series analyses using seasonal autoregressive integrated moving average models were utilized to identify seasonal patterns for the different virus types and quantify deviations from expected incidence rates.</p><p><strong>Results: </strong>Overall, we noted a steep decline in non-COVID viral infection rates at the onset of the COVID pandemic in March 2020, largely coincident with the institution of mask mandates and lockdown measures. This trend continued until the Spring of 2021, at which time non-COVID infections resurged to rates higher than pre-COVID levels. In addition, the historically observed seasonality of these viruses was significantly disrupted by the pandemic. In particular, the historical peaks for influenza A and human metapneumovirus shifted from February and March, respectively, to bimodal peaks in December 2021 and May 2022; respiratory syncytial virus demonstrated an unprecedented Spring/Summer season in 2021; parainfluenza type 1 was unusually active in 2022, an even-numbered year; and influenza B virtually disappeared during and immediately after the pandemic.</p><p><strong>Conclusions: </strong>Our observations add to the growing body of literature supporting the hypothesis that human interactions are one of the key drivers of pediatric respiratory viral seasonality in addition to climate. Understanding the effect of human interactions on disease spread is crucial for the development of effective mitigation measures for future pandemics while avoiding dangerous spikes of other illnesses once those interventions are lifted.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"415-422"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123404","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":"Dieulafoy Lesion in a Pediatric Patient.","authors":"Meylakh Barshay, Maiya Cowan, Meghan Beucher","doi":"10.1097/PEC.0000000000003347","DOIUrl":"10.1097/PEC.0000000000003347","url":null,"abstract":"<p><strong>Objective: </strong>Our aim is to describe a rare etiology of an upper gastrointestinal bleeding (UGIB) to help pediatric emergency medicine clinicians improve their understanding of its presentation as well as the standard therapeutic approach to UGIB.</p><p><strong>Methods: </strong>This is a retrospective case report of a patient who presented to the Pediatric Emergency Department of Hasbro Children's Hospital and who was found to have a UGIB secondary to a Dieulafoy lesion.</p><p><strong>Results: </strong>The etiology of UGIBs varies by geography and patient age but includes esophagitis, Mallory-Weiss tears, gastritis, peptic ulcers, and foreign body ingestion. Given the overlapping presenting symptoms, history and physical are critical to identifying likely etiology and guiding treatment. This patient improved after definitive treatment with endoscopy and hemo-clips.</p><p><strong>Conclusions: </strong>Children with symptoms of UGIB should receive prompt resuscitation and stabilization, and clinicians should maintain an index of clinical suspicion for less common pediatric pathologies, such as malignancy or arterial bleeding.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"496-498"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468527","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":"10.1097/PEC.0000000000003361","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"e30"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","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":"Impact of the Coronavirus Disease 2019 Pandemic on Clinical Trends in Pediatric Intentional Self-Poisonings.","authors":"Hannah Wilkins, Jennifer Perry, Chary Akmyradov, Erica Liebelt","doi":"10.1097/PEC.0000000000003376","DOIUrl":"10.1097/PEC.0000000000003376","url":null,"abstract":"<p><strong>Objectives: </strong>During the coronavirus disease 2019 pandemic, there was a significant increase in pediatric emergency department visits and hospital admissions for suicidality and self-harm, including deliberate self-poisoning. This study compares demographics, clinical characteristics, management, and outcome data of pediatric patients with intentional self-poisonings before and during the pandemic. A secondary aim is to identify predictors of severe outcomes.</p><p><strong>Methods: </strong>De-identified data were retrieved from the Toxicology Investigators Consortium registry of patients ages 6 to 18 years presenting with intentional self-poisoning. χ 2 analyses and Fisher exact test were performed to determine associations among variables between the \"pre-pandemic\" (April 2017 to February 2020) and \"pandemic\" (March 2020 to October 2022) periods, with P value <0.05 considered statistically significant. Multivariable logistic regression analysis was conducted to explore correlates of severe outcomes.</p><p><strong>Results: </strong>There were 7034 cases identified, 3480 pre-pandemic and 3604 pandemic. The pandemic group was associated with a higher percentage of patients aged 7 to 12 years, patients identifying as transgender or gender non-conforming, and the use of non-opioid analgesics as a primary agent. The pre-pandemic group had more frequent polysubstance ingestions and severe outcomes. Subgroup analysis of severe outcomes showed few differences between pre-pandemic and pandemic groups. No demographic characteristics were strongly associated with severe outcomes.</p><p><strong>Conclusions: </strong>The demographic differences between time periods suggest the pandemic may have had a disparate impact on these vulnerable populations. Identifying trends in pediatric self-poisonings may help guide public health strategies and resources for prevention and harm reduction.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"470-474"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664284","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":"Drivers of Bronchodilator Use in Bronchiolitis: Analyzing Treatment Trends From Pediatric Emergency Department Practices.","authors":"Andrea Rivera-Sepulveda, Timothy Maul, Anna Jurlina, Kathryn V Blake, Matthew M Davis, Kenneth Alexander","doi":"10.1097/PEC.0000000000003360","DOIUrl":"10.1097/PEC.0000000000003360","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to evaluate patient characteristics associated with bronchodilator (BD) use at various stages of bronchiolitis illness and evaluate corresponding patient outcomes in the emergency department (ED).</p><p><strong>Methods: </strong>This retrospective, cross-sectional study involves secondary data analysis from a sample of 932 children ages 3 to 24 months who received a diagnosis of bronchiolitis during an ED visit (1057 cases). Predictor variables included demographics, past medical history, family history, physical findings, medication use, and disposition. Outcomes included BD use for bronchiolitis symptoms in the pre-ED and ED settings, and associated care outcomes in the ED. Predictors of BD use in the ED with statistical significance were incorporated in a predictive multivariable logistic regression model with a training-validation split of 70% to 30%.</p><p><strong>Results: </strong>Children with prior BD use were significantly more likely than children without such history to receive BD treatment during their current bronchiolitis illness before the ED [odds ratio (OR): 23.7, 95% CI: 14.4-39], in the ED (OR: 2.6, 95% CI: 1.76-3.77), and as a prescription upon discharge from the ED (OR: 3.7, 95% CI: 2.49-5.58). In multivariable regression analyses, older age, parental asthma history, and wheezes and retractions on ED physical examination were significantly associated with BD use in the ED ( P <0.05). The area under the curve for the validation model with these variables was 0.826 (95% CI: 0.794-0.858).</p><p><strong>Conclusions: </strong>Prior BD use was associated with subsequent use during the current illness, during ED care, and subsequent prescription, forming a cyclical pattern. A perceived bronchospastic phenotype of bronchiolitis may influence clinical practice in ED settings.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"448-455"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524118","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}