Pediatric emergency care最新文献

{"title":"External Validation of Diagnosis Codes to Identify Pediatric Mental Health Emergency Department Visits for Aggression.","authors":"Julia H Wnorowska, Alexis Harmon, Doug Lorenz, Jennifer A Hoffmann","doi":"10.1097/PEC.0000000000003564","DOIUrl":"10.1097/PEC.0000000000003564","url":null,"abstract":"<p><strong>Objective: </strong>To externally validate a set of 9 ICD-10-CM billing diagnosis codes to identify pediatric ED encounters with agitation and aggression by determining their sensitivity and specificity compared with electronic health record (EHR) review.</p><p><strong>Methods: </strong>We performed a retrospective cross-sectional single-test diagnostic accuracy study of mental health encounters in the pediatric ED of an academic urban children's hospital, utilizing EHR data for mental health encounters by children 6 to 18 years old from April 12, 2023, to December 30, 2023. The index test was the presence of any of 9 aggression-related diagnosis codes as utilized by Peleggi et al The reference test consisted of a structured EHR review to confirm that agitation/aggression was a reason for the visit. Sensitivity, specificity, positive predictive value and negative predictive value were calculated with 95% CIs.</p><p><strong>Results: </strong>We identified 855 pediatric mental health encounters (63%, 13 to 18 y old, 59% female). The diagnosis code set identified agitation/aggression in 62 encounters (7%), compared with 118 encounters (14%) confirmed to have agitation/aggression based on clinician notes. The 9 diagnosis codes yielded a sensitivity of 40% (95% CI: 31%, 49%) and specificity of 98% (95% CI: 97%, 99%) compared with EHR review, with a positive predictive value of 76% (63%, 85%) and a negative predictive value of 91% (89%, 93%).</p><p><strong>Conclusions: </strong>Upon external validation, a set of 9 billing diagnosis codes had poor sensitivity and excellent specificity for the identification of pediatric ED visits with agitation/aggression. Novel methods such as natural language processing may be needed to accurately identify pediatric ED visits with aggression/agitation.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"375-379"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12888791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143219","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}

{"title":"PEMTalk: Improving Delivery of Serious News in Pediatric Emergency Medicine.","authors":"Ji Young Lee, Lillian L Emlet, Sylvia Choi, Melinda Hamilton, Scott H Maurer, Amanda W Brown, Melissa M Tavarez, Noel B Spears, Maren M Lunoe","doi":"10.1097/PEC.0000000000003549","DOIUrl":"10.1097/PEC.0000000000003549","url":null,"abstract":"<p><strong>Objectives: </strong>Pediatric emergency medicine (PEM) physicians deliver serious news (DSN) in stressful situations that impact both families and physicians. Our objective was to assess the impact of a PEM-focused workshop on DSN in improving the self-perceived preparedness, skill level, and stress management of PEM physicians.</p><p><strong>Methods: </strong>We designed a simulation-based communication workshop, \"PEMTalk,\" utilizing simulated parents to teach PEM attendings and fellows to effectively DSN. The workshop was conducted in a virtual and in-person format from 2018 to 2023. We developed 3 scenarios unique to PEM. Pre- and postintervention surveys were administered to assess the workshop's impact.</p><p><strong>Results: </strong>A total of 74 participants completed surveys. Among the 34 first-time participants, there were improvements in provider's self-perceived ability to DSN (41% vs. 97%; P <0.001), respond to emotions (50% vs. 97%; P <0.001), and decrease in stress (47% vs. 21%; P =0.003) due to DSN. Among the 23 participants who participated in the study more than once, there were sustained improvements in their self-perceived ability to DSN (39% vs. 69%; P =0.02). Fellows (53% of participants) were more likely than attendings to report improvement in DSN [OR 6; 95% CI (1.05-41.67); P =0.04]. There was no difference in outcomes between in-person and virtual formats.</p><p><strong>Conclusion: </strong>PEMTalk enhanced participants' self-reported comfort while reducing stress associated with DSN in a simulated setting. Next steps include incorporating objective assessments, evaluating the impact on patient care, and disseminating the workshop to the broader PEM community.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"339-345"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145990240","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":"Medically Unnecessary Venipuncture in Autism Spectrum Disorder Behavior Assessments.","authors":"Dylan P Hurley, Alexis C Pavlov, Amy E Pattishall, Rebecca K Burger, Nathan A Call, Claudia R Morris","doi":"10.1097/PEC.0000000000003550","DOIUrl":"10.1097/PEC.0000000000003550","url":null,"abstract":"<p><strong>Objective: </strong>Assess the clinical value of routine laboratory testing in the emergency department (ED) during behavioral disturbance evaluations in children with autism spectrum disorder (ASD).</p><p><strong>Methods: </strong>A retrospective chart review of patients ages 3 to 21 years with ASD presenting to 3 pediatric EDs with behavioral disturbance from January 2019 to January 2020. Local laboratory standards were used to determine abnormal ranges in ED screening labs. Patients with abnormal findings were reviewed for medical significance, defined as the need for a medical intervention, inpatient observation, or the inclusion of a nonbehavioral diagnostic code due to an abnormal laboratory test result.</p><p><strong>Results: </strong>A total of 209 eligible ED encounters were reviewed. Mean age was 14.5±3.1 years, and 84% were male. Of those, 84% (176/209) received venipuncture for screening labs per protocol, of which 97% (170/176) featured abnormal test results. Only 2 abnormal labs (1%) revealed clinically significant findings. Compared with whites, more patients of non-White race received venipuncture (90% vs. 73%, P =0.001) but less non-whites receiving venipuncture were admitted to psychiatric facilities (44% vs. 62%, P =0.01).</p><p><strong>Conclusion: </strong>This study demonstrates that routine screening labs in asymptomatic children with ASD presenting to the ED with behavioral disturbances are often outside the range of normal, but without clinical relevance. This practice may lead to unnecessary and painful venipuncture. Children with ASD are a uniquely vulnerable population for whom we should choose wisely.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"333-338"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147309118","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 Carbon Monoxide Poisoning in Southern Israel-Causality and Outcome.","authors":"Or Kaplan, Nimrod Kleinhaus, Gidon Test, Ibrahim Tawatha, Inbal Kestenbom, Oren Tavor","doi":"10.1097/PEC.0000000000003565","DOIUrl":"10.1097/PEC.0000000000003565","url":null,"abstract":"<p><strong>Objectives: </strong>CO intoxication is a leading cause of poisoning-related death worldwide. Little is known about the connection between the source of poisoning and the clinical outcome. Our primary goal in this study was to establish this connection.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data retrieved from medical records of all cases presented to the Pediatric Emergency Department at University Medical Center (UMC), between 2016 and 2024, of children aged 0 to 18 years who were admitted with suspected CO intoxication and carboxyhemoglobin (COHb) levels exceeding 5%. \"The exposure mechanisms were categorized into 3 groups: smoke inhalation by fire, intentional heating, or gas used for water heating.\"</p><p><strong>Results: </strong>Ninety-five children had COHb levels above 5%. The mean age of patients varied across exposure groups ( P <0.001). Individuals exposed to gas were older (13.65±3.2 y), compared with smoke inhalation (6.9±5.85 y) or heating-related incidents (10.26±4.64 y). Poor outcomes (defined as death, intensive care admission, or hyperbaric chamber treatment) were most frequent in the gas group (90%, P = 0.002), followed by fire exposures (65%) and heating-related cases (49%).</p><p><strong>Conclusions: </strong>We found a strong correlation between causality (gas for water heating) and outcomes. We also showed some correlation between clinical and laboratory features that could result in severe outcomes. These findings could help guide preventive measures and further studies in the future.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"385-390"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113811","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":"Acute Drug-Induced Dystonia in Children: Risk Factors, Clinical Characteristics, and Emergency Management.","authors":"Bilge Akkaya, Fatma Şule Erdem, Betül Öztürk, Raziye Merve Yaradilmiş, Ahmet Serkan Özcan, Orkun Aydin, Ali Güngör, Nilden Tuygun","doi":"10.1097/PEC.0000000000003624","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003624","url":null,"abstract":"<p><strong>Background: </strong>Drug-induced acute dystonia is an adverse drug reaction that is concerning in pediatric patients but resolves rapidly with appropriate treatment. In children, data on risky drugs, clinical patterns, and the management of dystonia in the emergency department are limited. This study aimed to evaluate the demographic and clinical findings and treatment outcomes of children presenting to the pediatric emergency department with drug-induced acute dystonia.</p><p><strong>Methods: </strong>This retrospective observational study includes children aged 1 month to 18 years who were diagnosed with acute dystonia in a tertiary pediatric emergency department between October 2022 and March 2025. The diagnosis was made by a pediatric emergency subspecialist based on clinical findings. Patients were classified according to clinical phenotype as focal/segmental dystonia (group I) and multifocal/generalized dystonia (group II). Demographic data, drug exposures, clinical characteristics, and treatment responses were analyzed.</p><p><strong>Results: </strong>A total of 79 patients were included in the study. The median age was 11 years (IQR: 7 to 16) in group I and 10 years (IQR: 6 to 16) in group II. The most commonly associated drug groups were antipsychotics (55.6%), antiemetics (26.6%), and psychostimulants (20.3%). Focal dystonia is the most common clinical pattern, affecting the head and neck muscles in 61% of cases. The use of metoclopramide was significantly higher in group I (OR: 0.21; 95% CI: 0.04-0.99). All patients were treated with parenteral biperiden.</p><p><strong>Conclusions: </strong>Antipsychotics and antiemetics are the main triggers of drug-induced acute dystonia in children. Dystonia usually appears within the first 72 hours after starting the drug. It can develop even at therapeutic doses. Dystonias associated with antiemetic drugs often show focal or segmental distribution. Parenteral biperiden is a fast and effective treatment option. Acute dystonia can mimic serious etiologies in the emergency department. Obtaining a detailed drug history can facilitate the diagnostic process.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778097","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":"Clinical Phenotypes and Early Risk Stratification in Pediatric Acute Myocarditis: A Single-Center Experience in the Postpandemic Context.","authors":"Mattia Pasquinucci, Marco Scaglione, Daniele Caratozzolo, Alessandra Siboldi, Davide Meneghesso, Elena Morelli, Gianluca Trocchio, Sara Bondanza, Carmelo M Arcidiacono, Roberto Formigari, Roberta Caorsi, Stefano Volpi, Marco Gattorno, Maria E Derchi","doi":"10.1097/PEC.0000000000003623","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003623","url":null,"abstract":"<p><strong>Objectives: </strong>Pediatric acute myocarditis presents with a heterogeneous clinical spectrum. The primary aim of this study was to identify early clinical and laboratory predictors of severe disease requiring intensive care unit (ICU) admission. A secondary aim was to describe the clinical characteristics of cases diagnosed in the postpandemic context.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of children admitted to a tertiary center with acute myocarditis between 2012 and 2024. Patients requiring ICU admission were compared with those managed in standard wards to identify risk factors for severity. Data were analyzed using descriptive statistics, nonparametric tests, and effect size calculations.</p><p><strong>Results: </strong>Thirty-eight cases were identified, with 76% of diagnoses occurring after 2020. The median age was 12.5 years. Two distinct clinical phenotypes emerged: patients with chest pain (59%) and those with cardiogenic shock (15%). Admission to the ICU was strongly associated with hemodynamic instability (P < 0.001), lower left ventricular ejection fraction (P < 0.001), and the absence of reported chest pain (P < 0.001). Among biomarkers, higher levels of NT-pro-BNP (P = 0.005) and elevated Procalcitonin (P = 0.02) were associated with severe disease. Parvovirus B19 was the most frequently detected pathogen in the recent period.</p><p><strong>Conclusions: </strong>In our cohort, pediatric myocarditis presented with increased frequency in the postpandemic years. Risk stratification remains crucial: \"infarct-like\" chest pain was associated with a milder course in older children. Conversely, severe cases, often occurring in younger patients unable to report pain, were identified by hemodynamic stress (shock, elevated NT-pro-BNP) and systemic inflammation (procalcitonin).</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778083","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":"Patient-Provided Video Footage of Injuries in the Pediatric Emergency Department: A Novel Adjunct to Patient History.","authors":"Lyndsay Lee, Patrick Yoo, Francesca Bullaro, Jonathan Golden, Jane Cerise, Kristy Williamson","doi":"10.1097/PEC.0000000000003620","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003620","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of viewing video footage during a pediatric emergency department (ED) encounter on the medical assessment of children with traumatic injuries, specifically its influence on clinical decision-making and management.</p><p><strong>Methods: </strong>Data was collected over 35 months at a pediatric level 1 trauma center. Pediatric emergency medicine (PEM) providers completed a survey after evaluating patients presenting with an injury and reviewing video footage shown to them depicting what happened to the child. The survey included basic video information and whether video footage influenced the providers' approach to patient care.</p><p><strong>Results: </strong>Fifty-one surveys were completed after families voluntarily showed PEM providers video footage of the patient's mechanism of injury. In 27 cases (53%), ED providers reported that observing the video influenced management. Review of footage influenced providers' decision regarding radiologic imaging in 18 cases (35%); providers performed imaging in 11 cases where they would not have otherwise, and did not perform imaging in 7 cases where they would have otherwise. Review of footage influenced providers' decision regarding laboratory studies in 5 cases (10%). Six (12%) providers indicated they consulted specialists after viewing the video footage when they otherwise would not have.</p><p><strong>Conclusion: </strong>The study findings indicate that viewing video footage related to the mechanism of injury affected the clinical decision-making processes of PEM providers in more than half of the observed instances (53%). This suggests that video surveillance footage has potential utility as an adjunct to traditional history-taking in the trauma evaluation of patients presenting to the ED.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778224","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":"Enhancing Prehospital Care for Medically Complex Children: The Evolution of the STARS Program.","authors":"Michelle Pintea, Joseph Finney, Nicholas Salzman, Lindsay Clukies, Mirela Miljkovic, Fahd A Ahmad, Steven Laffey","doi":"10.1097/PEC.0000000000003610","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003610","url":null,"abstract":"<p><strong>Objectives: </strong>The population of children and youth with special health care needs (CYSHCN) has grown significantly. This includes children with medical complexity (CMC), those with chronic conditions, functional limitations, or reliance on medical technology. Due to advances in medical care, these children are now able to live at home, making encounters with emergency medical services (EMS) more likely. EMS clinicians receive limited pediatric training and have infrequent encounters with this population, resulting in variable comfort and preparedness. Utilization of emergency care among CMC is further influenced by social determinants of health, with disadvantaged communities experiencing higher emergency department use and increased child mortality. To bridge these gaps, the Special Needs Tracking and Awareness Response System (STARS) was developed to enhance EMS readiness, promote health equity, and improve prehospital care for CMC.</p><p><strong>Methods: </strong>Launched in 2014 as an EMS-driven initiative, STARS has evolved into a hospital-based, physician-led program with individualized emergency care plans stored in a secure electronic system. A major focus of STARS is to create and provide emergency care education to EMS and community EDs in their catchment area regarding STARS.</p><p><strong>Results: </strong>As of 2025, STARS has enrolled 2424 patients. The program has reduced unnecessary transports, strengthened disaster response, and offered an opportunity to address health inequities in CMC.</p><p><strong>Conclusions: </strong>STARS provides a scalable and collaborative model that prioritizes medically complex, high-risk pediatric populations through targeted EMS training, interdisciplinary care coordination, and real-time access to patient-specific plans. This approach offers a unique opportunity to advance prehospital care and improve health outcomes for CMC.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778058","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":"Managing and Communicating Diagnostic Uncertainty in Pediatric Emergency Care: National Insights and Opportunities for Intervention.","authors":"Alexandra T Geanacopoulos, Molly S Totman, Kelsey A Miller, Mark I Neuman, Alon Peltz","doi":"10.1097/PEC.0000000000003614","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003614","url":null,"abstract":"<p><strong>Background: </strong>Effective management and communication of diagnostic uncertainty are critical, yet understudied, drivers of patient safety in pediatric emergency care. We explored how clinicians manage and communicate diagnostic uncertainty and identified opportunities for intervention.</p><p><strong>Methods: </strong>Four 1-hour-long focus groups were conducted with 19 geographically diverse emergency medicine physicians. Discussions focused on clinical vignettes with diagnostic uncertainty. Reflexive thematic analysis was used to generate themes.</p><p><strong>Results: </strong>Participants described diagnostic uncertainty as a multidimensional experience involving complex interactions between the clinician, caregiver, and context. We identified 3 distinct themes: (1) Intersection of clinician's usual practice pattern with caregiver and contextual factors: Within the guardrails of safety and evidence-based care, clinicians adjust management and communication to caregiver expectations, health literacy, resources, acuity, and volume. (2) Synergies at the clinician, caregiver, and context interfaces: Shared decision-making, decision support tools, and primary care continuity facilitate clinician-caregiver alignment and safety. (3) Tensions at the interfaces: Perceived misaligned clinician-caregiver expectations, space constraints, and limited access to care promote additional work-up and hinder communication. Participants highlighted intervention opportunities to promote patient safety in uncertainty and reduce ED work-up: (1) standard tools to communicate uncertainty, (2) disease-specific risk prediction models with visual aids to effectively communicate risk, (3) improvements to the physical space, and (4) interventions to streamline access to primary care.</p><p><strong>Conclusion: </strong>Diagnostic uncertainty in pediatric emergency care is a multidimensional experience influenced by synergies and tensions between the clinician, caregiver, and context. Communication tools, decision-support strategies, and systems-level interventions can strengthen diagnostic safety in pediatric emergency care.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778172","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":"Performance of Open-Source LLMs in Identifying Pediatric Pneumonia From Free-Text Chest Radiograph Reports.","authors":"Saki Amagai, Elizabeth C Powell, Elizabeth R Alpern, Todd A Florin, Yikuan Li, David Liebovitz, Yuan Luo, Juan Espinoza, Anthony F Wong, Sriram Ramgopal","doi":"10.1097/PEC.0000000000003616","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003616","url":null,"abstract":"<p><strong>Objectives: </strong>To develop and internally validate an automated system for classifying chest radiograph (CXR) reports for community-acquired pneumonia in children.</p><p><strong>Methods: </strong>We performed a retrospective single-center study using 1000 pediatric emergency department encounters (2016 to 2022) with CXR. Reports were adjudicated by two physicians as positive, negative, or indeterminate for pneumonia. We evaluated five open-source LLMs (Gemma2 9B, Gemma2 27B, Falcon3 7B, DeepSeek R1 Distill Llama 8B, and Llama3.1 8B) on a 70/30 train-test split for an outcome of pneumonia. We reported performance metrics for both three-class and binary classification (pneumonia + indeterminate vs. no pneumonia).</p><p><strong>Results: </strong>The median patient age was 4.2 years (IQR 1.7 to 10.5), and 54.4% were admitted from the ED. After clinician adjudication, 27.8% of reports were labeled pneumonia, 13.7% indeterminate, and 58.5% no pneumonia. Gemma2 9B achieved the best performance overall, with a pneumonia F1 score of 0.82 and no-pneumonia F1 score of 0.97 in three-class classification. Binary classification further improved performance (F1=0.97 for Gemma2 9B and 0.93 for 27B). Discrepancies between model and human labels often involved ambiguous language, highlighting interpretive subjectivity rather than model error. All LLMs substantially outperformed traditional NLP classifiers such as XGBoost, random forest, and logistic regression.</p><p><strong>Conclusions: </strong>Open-source LLMs accurately classified pediatric CXR reports for pneumonia. These findings support the feasibility of integrating LLMs into decision support and quality improvement pipelines to enhance radiographic interpretation and improve pediatric emergency care.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729652","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}