Pediatric emergency care最新文献

{"title":"Emergency Department Evaluation of Pediatric Patients With Abdominal Pain and Trauma During the National Intravenous Iodinated Contrast Media Shortage.","authors":"Lauren Klein, Cornelia Muntean, Adam Mei, Kevin DiMagno, Christopher Raio, Eric Decena, Stavros Lalos, Adam Schwartz, Shaun Steigman","doi":"10.1097/PEC.0000000000003391","DOIUrl":"10.1097/PEC.0000000000003391","url":null,"abstract":"<p><strong>Introduction: </strong>Research on the effects of the 2022 national intravenous iodinated contrast media (ICM) shortage on the pediatric population in the emergency department is limited. The purpose of this study was to evaluate pediatric patients who had a computed tomography (CT) of the abdomen/pelvis during the 2022 ICM shortage, and to identify whether any important abdominal diagnoses were missed or if additional CT scans were obtained to accommodate for a lack of available ICM. We hypothesized a decrease in ICM utilization without any increased incidence in missed diagnoses.</p><p><strong>Methods: </strong>This is a multi-center retrospective chart review of pediatric patients (<18 years old) who had a CT of the abdomen/pelvis in the emergency department for any indication (abdominal pain or trauma) during the ICM shortage (May 12, 2022-June 29, 2022). A control group from March 22, 2022 to May 11, 2022 was included. The primary outcome was the rate of missed clinically significant diagnoses after initial non-contrast CT.</p><p><strong>Results: </strong>There were 446 patients included; 403 patients presented for abdominal pain (224 controls) and 43 patients presented due to trauma (23 controls). ICM utilization decreased significantly during the shortage period: for the abdominal pain cohort, ICM utilization decreased by 55% (95% CI: 47-63), for trauma patients ICM utilization decreased by 41% (95% CI: 17-64). There were no cases of clinically significant missed diagnoses due to noncontrast studies during the shortage period, in both abdominal pain and trauma cohorts. In the abdominal pain cohort, there were 3 (1.7%) repeat CT scans during the shortage period and 1 (0.5%) during the control period (difference: 1.2%, 95% CI: -0.9% to 3.2%). None of these additional studies were contrast-enhanced after an initial noncontrast study. There were no repeat CT scans in the trauma cohort.</p><p><strong>Conclusion: </strong>Despite the decrease in IV contrast CT scans ordered, our study did not identify any patients with missed diagnoses in the setting of the ICM shortage. We believe this data adds to the body of literature exploring the necessity of intravenous contrast when it is not utilized or unable to be utilized in computed tomography imaging.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"535-541"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040646","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 Dog Bite Injury Trends During the COVID-19 Pandemic.","authors":"Paul T Menk, E Melinda Mahabee-Gittens, Stephanie Ruest, Holly R Hanson, Margaret Formica, Maneesha Agarwal, Mark R Zonfrillo, Elizabeth Curtis, Wendy J Pomerantz","doi":"10.1097/PEC.0000000000003378","DOIUrl":"10.1097/PEC.0000000000003378","url":null,"abstract":"<p><strong>Objective: </strong>To examine differences between dog bite injuries among below 18-year-old patients seen in pediatric emergency departments (PEDs) during the COVID-19 pandemic to those seen before the pandemic.</p><p><strong>Methods: </strong>This is a subanalysis of a cross-sectional study of injured children below 18 years old seen in 40 PEDs, from January 1, 2019, through December 31, 2020. Patients studied had an ICD-10 code for dog bite (W54.0XXA). Cases before the pandemic (March 17, 2019, to December 31, 2019) were compared with cases during the pandemic (March 15, 2020, to December 31, 2020).</p><p><strong>Results: </strong>In total, 3891 dog bites occurred during the pandemic, and 3696 occurred before the pandemic. The proportion of dog bites to all injuries was greater during the pandemic than before (1.6% vs. 1.1%, P < 0.001). Children aged 5 to 9 years represented a higher proportion of cases during the pandemic than before (36.3% vs. 33.0%, P <0.05). More dog bites occurred during daytime hours (8:00 am to 4 pm ) during the pandemic (26.1% vs. 24.3%, P <0.05). During the pandemic, the admission rate for dog bites was higher (12.9% vs. 11.4%, P <0.05). More injuries to the head, face, or neck occurred during the pandemic than before (62.8% vs. 58.3%, P < 0.01).</p><p><strong>Conclusions: </strong>Pediatric dog bites accounted for a significantly higher number and proportion of injuries seen during the COVID-19 pandemic. Stay-at-home orders may have had some influence on pediatric dog bite demographics, as evidenced by more bites occurring from 8 am to 4 pm and more school-aged children 5 to 9 years old sustaining dog bites. Location of body parts injured and increased admissions suggest more severe injuries occurred during the pandemic.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"509-513"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670574","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":"Reply: Short-term Outpatient Parenteral Antimicrobial Therapy Administration in the Pediatric Emergency Department.","authors":"Syed Amir Ahmad","doi":"10.1097/PEC.0000000000003374","DOIUrl":"10.1097/PEC.0000000000003374","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"e49"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692858","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":"Short-term Outpatient Parenteral Antimicrobial Therapy Administration in the Pediatric Emergency Department.","authors":"David Troxler","doi":"10.1097/PEC.0000000000003367","DOIUrl":"10.1097/PEC.0000000000003367","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"e48"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692572","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":"Prehospital and Resuscitation Factors Associated With Favorable Pediatric Drowning Outcomes.","authors":"Rohit P Shenoi, Trung Nguyen, Colleen Driscoll, Kyle S Liu, Donna Mendez, Jennifer L Jones, Elizabeth A Camp","doi":"10.1097/PEC.0000000000003382","DOIUrl":"10.1097/PEC.0000000000003382","url":null,"abstract":"<p><strong>Objectives: </strong>Drowning is a leading cause of unintentional injury death in children in the United States. There is a need to identify prehospital factors that affect drowning outcomes. We sought to study prehospital and resuscitation factors associated with favorable neurological outcomes at hospital discharge among pediatric drowning patients.</p><p><strong>Methods: </strong>This was a retrospective study of drowning patients younger than 18 years in an urban area from 2010 to 2017. Submersion, prehospital, and patient data were obtained from hospital, Emergency Medical Services, and fatality records. The outcome was classified as favorable or poor neurological status at hospital discharge based on the Cerebral Performance Category (CPC). Logistic regression determined prehospital predictors associated with favorable outcomes.</p><p><strong>Results: </strong>There were 803 submersions; outcomes were available in 759 (94.5%) cases. The median age was 3 years (IQR: 2, 5), and 60% were males. Eighty-four percent of patients had favorable neurological outcomes at hospital discharge. Bivariate analysis revealed that age <5 years, drowning in constructed bodies of water, witnessed drownings, supervisor present, submersions of 0 to 5 minutes duration, non-Emergency Medical Services transport, or absence of bystander cardiopulmonary resuscitation (BCPR) were associated with favorable outcomes. Predictive factors for favorable outcomes included supervisor presence, drowning in constructed bodies of water, submersion of 0 to 5 minutes, or no BCPR. Patients in cardiac arrest who attained return of spontaneous circulation at the emergency department arrival had higher odds of a favorable outcome than patients who did not attain a return of spontaneous circulation [OR: 6.6 (95% CI: 1.9-28.3)]. No association between bystander resuscitation and favorable outcomes in patients in cardiac arrest due to drowning [OR: 2.98 (95% CI: 0.31-145.81)] was observed.</p><p><strong>Conclusions: </strong>In an urban area, pediatric drowning patients who have a supervisor present, with brief submersion times, and who drown in constructed bodies of water are more likely to experience favorable neurological outcomes at hospital discharge. No association between BCPR and favorable pediatric drowning outcomes was observed.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"514-520"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701145","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 of a Pediatric Mediastinal Mass: A Case Report.","authors":"Phoebe Greenwald, Joni E Rabiner","doi":"10.1097/PEC.0000000000003329","DOIUrl":"10.1097/PEC.0000000000003329","url":null,"abstract":"<p><strong>Abstract: </strong>Point-of-care ultrasound may be used for identification of thoracic pathology, including mediastinal masses. In this case report, we describe the case of an otherwise healthy 17-year-old boy who presented with generalized pruritis. Point-of-care ultrasound was useful in identifying a complex cystic and solid mediastinal mass extending into the thoracic cavities as well as an associated pericardial effusion.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"560-562"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143041045","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":"Psychiatric Emergency Service Use by Transgender and Gender-Diverse Youth.","authors":"Luis Martinez Agulleiro, Mehmet Utku Kucuker, Fei Guo, Aron Janssen, Cheryl R Stein, Argelinda Baroni","doi":"10.1097/PEC.0000000000003331","DOIUrl":"10.1097/PEC.0000000000003331","url":null,"abstract":"<p><strong>Objectives: </strong>To document the proportion of transgender and gender diverse (TGD) youth presenting to a pediatric psychiatric emergency department (ED) and examine whether their demographic and clinical characteristics differ from cisgender youth.</p><p><strong>Methods: </strong>We analyzed electronic health records of youth ages 5 to 17 years presenting to a specialized pediatric psychiatric ED (N = 2728), including sociodemographic characteristics, gender identity, suicidal risk at admission, and diagnoses at discharge. We examined differences by gender identity using χ 2 tests (categorical variables), 2-sample t tests, or Mann-Whitney U tests (continuous variables). Adjusted Poisson regression models estimated the prevalence ratio of the association between gender identity and clinical diagnoses.</p><p><strong>Results: </strong>Of youth, 6% seeking emergency psychiatric care identified as TGD. Compared with cisgender peers, TGD youth exhibited a higher risk for suicide, longer hospital stays, and received more psychiatric diagnoses at discharge, including a higher prevalence of suicidal thoughts and behaviors (prevalence ratio: 1.50, 95% CI: 1.16, 1.90).</p><p><strong>Conclusions: </strong>TGD youth have more severe clinical presentations in the psychiatric ED compared with cisgender youth. Further research is essential to develop targeted interventions to support the mental health of TGD youth.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"499-503"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038491","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":"These Hips Don't Lie: Deep Vein Thrombosis in an Adolescent With an Inferior Vena Cava Anomaly.","authors":"Brandon Ho, Dewesh Agrawal","doi":"10.1097/PEC.0000000000003375","DOIUrl":"10.1097/PEC.0000000000003375","url":null,"abstract":"<p><p>Congenital anomalies of the inferior vena cava can predispose adolescents to deep vein thrombosis. A 13-year-old male with left hip pain after a sports injury was found to have extensive deep vein thromobis due to an interrupted inferior vena cava. The diagnosis led to catheter-directed thrombolysis and anticoagulation, resolving symptoms.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"573-575"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625506","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":"Liberalizing Maximum High-Flow Nasal Cannula Flow Rates in the General Inpatient Ward Is Associated With Decreased Intensive Care Admissions for Infants With Bronchiolitis.","authors":"Chris Miller, Michelle Dunn, Jeremy Jones, Rachel Rothstein, Joseph J Zorc","doi":"10.1097/PEC.0000000000003333","DOIUrl":"10.1097/PEC.0000000000003333","url":null,"abstract":"<p><strong>Objective: </strong>To compare the use of intensive care for infants with bronchiolitis following a policy change increasing the rate maximums for high-flow oxygen given by nasal cannula [high-flow nasal cannula (HFNC)] allowable in the inpatient (IP) ward setting.</p><p><strong>Methods: </strong>This was a retrospective pre-post cohort study at an urban, tertiary care children's hospital. Infants without complex chronic conditions presenting to the emergency department with bronchiolitis from December 2018 to March 2019 and December 2019 to March 2020 were included in the study. In December 2019, our institution increased the allowable HFNC flow rate on IP to 2 liters per minute/kilogram. The primary outcome was patient disposition from the emergency department. Secondary outcomes were the need for IP to pediatric intensive care unit (PICU) transfer, the need for care escalation to positive airway pressure or invasive mechanical ventilation, and hospital length of stay.</p><p><strong>Results: </strong>In total, 1043 and 1104 patients were included in the 2018 to 2019 and 2019 to 2020 cohorts, respectively. Infants in the second cohort were more likely to be admitted, though this association was not significant after adjusting for patient age and triage acuity. Infants in the second cohort had a lower risk of admission to the PICU, before and after adjusting for age and triage acuity. The risk of IP-to-PICU transfer, risk of care escalation, and length of stay did not increase.</p><p><strong>Conclusions: </strong>Increasing HFNC flow rates up to 2 liters per minute/kilogram on IP wards was associated with a reduction in intensive care admission and appears safe by balancing measures of care escalation.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"504-508"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796138","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":"Harnessing AI for Improved Diagnosis and Management of Pediatric Sepsis: Current Advances, Challenges, and Future Directions.","authors":"Pavlos Siolos, Saif Pasha, Maria Triantafyllou, Nora Wolff, Zara Ibrahim, Panagiotis Kratimenos, Rishi Kamaleswaran, Tom Velez, Ioannis Koutroulis","doi":"10.1097/PEC.0000000000003397","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003397","url":null,"abstract":"<p><p>Artificial intelligence (AI) has been applied to early recognition and management of rapidly progressive, community-acquired pediatric sepsis, a leading cause of childhood mortality. The broad adoption of electronic health records combined with rapid advances in digital technologies have enabled the federated training of both knowledge-driven AI, known as expert systems, trained by teams of collaborating clinicians, and data-driven AI, known as machine learning (ML), to derive predictive, clustering algorithms trained on \"big data.\" An important subset of ML is \"deep learning,\" which includes tools that understand, interpret, and manipulate human imagery and language, such as natural language processing and its subset large language models. We are in an era of rapid deployment of AI/ML-powered tools ranging from real-time electronic health records-embedded decision support tools to continuous wearable vital sign monitors and mobile/conversational virtual assistants/triage apps. These applications have the potential of transforming the timeliness of life-saving sepsis care delivery. This review explores the current and potential AI/ML applications in sepsis care, including tools for screening/early detection, risk stratification/outcome prediction, personalized treatment, and continuous patient monitoring. We highlight successful implementations and ongoing clinical trials, emphasizing the impact on patient outcomes. Finally, we address practical considerations for the future, such as bias mitigation and integration into clinical workflows.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":"41 7","pages":"576-585"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541846","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}