Pediatric emergency care最新文献

{"title":"Reporting of Sociodemographic and Equity-Related Factors in Emergency Department Pain Trials for Children: A Scoping Review.","authors":"Elise Kammerer, Samina Ali, Calveen Basi, Patricia Candelaria, Jaspreet K Khangura, Sahra Kaahiye, Leilani Sapon, Lexyn Iliscupidez, Zoe Zelyck, Sarah A Elliott, Liz Dennett, Tehseen Ladha, Maria Mayan, Shannon Scott, Shannon Ruzycki, Lisa Hartling","doi":"10.1097/PEC.0000000000003717","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003717","url":null,"abstract":"<p><strong>Context: </strong>Effective management of children's acute pain in emergency departments (EDs) is essential, yet health disparities exist. The applicability of evidence to diverse pediatric populations depends on clear demographic reporting. The PROGRESS-Plus framework identifies social determinants of health that influence care and outcomes, but it is unclear to what extent randomized controlled trials (RCTs) in pediatric ED pain management report these variables.</p><p><strong>Objective: </strong>This scoping review examines the frequency and completeness of PROGRESS-Plus reporting in RCTs evaluating acute pain interventions for children in EDs in Canada and the USA.</p><p><strong>Data sources: </strong>Using Joanna Briggs Institute methodology and the Participant, Concept, Context framework, we conducted a scoping review of RCTs published between 2013 and 2025. MEDLINE, PsycINFO, CINAHL, and CENTRAL were searched using a peer-reviewed strategy.</p><p><strong>Study selection: </strong>Eligible studies involved children and youth experiencing acute presenting or procedural pain in ED settings. Two reviewers independently screened studies.</p><p><strong>Data extraction: </strong>Data were extracted using standardized forms refined with input from patient partners. Narrative synthesis and descriptive statistics were applied to summarize PROGRESS-Plus reporting.</p><p><strong>Results: </strong>Of 3667 records identified, 65 RCTs met inclusion criteria. Thirty-five studies focused on procedural pain interventions, and 30 on interventions for painful presentations. Age was reported in all studies, and gender and/or sex in 98%. Race and/or ethnicity was reported in 40%, and chronic illness and/or disability in 18%. No studies reported socioeconomic status or place of residence.</p><p><strong>Conclusions: </strong>RCTs addressing pediatric pain in the ED rarely report equity-relevant demographic variables beyond age and gender and/or sex, limiting assessment of intervention effectiveness across diverse populations. Standardized demographic reporting is needed to support equitable, evidence-based pain research and care.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113575","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 Patients-Are Sometimes Just Small Adults.","authors":"Victor N Oboli, Marc Auerbach","doi":"10.1097/PEC.0000000000003720","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003720","url":null,"abstract":"<p><p>The phrase \"children are not small adults\" has appropriately emphasized the distinct physiological, developmental, pharmacologic, and psychosocial needs of pediatric patients. Yet when educators and health systems convey this message without placing equal emphasis on Pediatric Readiness, they may unintentionally imply that pediatric emergency care is primarily the domain of pediatric specialists. This implication conflicts with the reality that more than 80% of children receive emergency care outside specialized children's hospitals, often in settings where pediatric specialists are not physically present. This Special Feature calls for Pediatric Readiness to be understood as essential infrastructure for every emergency department that cares for children. Rather than diminishing pediatric specialization, we reframe pediatric expertise as a system-level resource that can be extended through education, protocols, simulation, teleconsultation, transfer collaboration, and advocacy. The next imperative in pediatric emergency care is to preserve what is distinct about children while ensuring that every emergency setting can care for them safely, competently, and collaboratively.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113586","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 \"Selective Use of Magnetic Resonance Imaging for Facial Palsy in the Pediatric Emergency Department\".","authors":"Kishankumar Mahida, Snehal Rajendra Jagtap","doi":"10.1097/PEC.0000000000003594","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003594","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":"42 10","pages":"e140"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081781","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":"Ultrasonography-Based Prediction of the Need for Surgical Intervention in Pediatric Intussusception.","authors":"İbrahim Halil Akkış, Sinan Seyrek, Selahattin Durmaz, Mehmet Muhsin Kefçi, Zeynep Kandemirli, Vedat Burak Kandemirli, Abdülkadir Baziki, Hatice Hatun Tanriöver Gülağaci, Feryal Gün Soysal, Zuhal Bayramoğlu, Şükrü Mehmet Ertürk","doi":"10.1097/PEC.0000000000003642","DOIUrl":"10.1097/PEC.0000000000003642","url":null,"abstract":"<p><strong>Objectives: </strong>Intussusception is a major cause of acute intestinal obstruction in children. While most cases resolve with nonsurgical methods, some require surgical intervention. This study aimed to evaluate ultrasonographic features that may predict the need for surgery in pediatric intussusception.</p><p><strong>Methods: </strong>Medical records of patients under 18 years diagnosed with intussusception between January 2020 and June 2023 at a tertiary hospital were retrospectively reviewed. Patients were categorized into surgical and nonsurgical groups. Ultrasound examinations were performed by staff radiologists at our hospital with patients in the supine position using high-frequency linear probes. Demographic data and imaging features (segment length, type) were recorded. Data were analyzed in Python 3.10 using χ 2 tests, ROC analysis, and multivariable logistic regression (statsmodels, no regularization). ORs with 95% CIs were obtained, the optimal cutoff was determined by the Youden index, and bootstrap resampling was used to account for the limited number of surgical events.</p><p><strong>Results: </strong>A total of 101 patients (53 males, 48 females; median age, 2.5 years (range, 0.5-15 years)) were included. Ileocolic intussusception was the most common type (n=60, 59.4%). Overall, 18 patients (17.8%) required surgical intervention, while 83 (82.2%) were managed nonsurgically. When stratified by type, surgical intervention was required in 21% (13/60; 95% CI, 11%-30%) of ileocolic intussusceptions and 12% (5/41; 95% CI, 5.3%-25.5%) of small-bowel intussusceptions. The median length of the intussuscepted segment was significantly greater in the surgical group [55 mm (IQR, 32.5 to 90)] than in the nonsurgical group [25 mm (IQR, 15 to 40); P < 0.001]. A 30-mm cutoff yielded 100% sensitivity and 53% specificity (AUC, 0.80), whereas a 91-mm cutoff achieved 100% specificity with 28% sensitivity.</p><p><strong>Conclusion: </strong>Ultrasonographic measurement of the invaginated segment length is a valuable noninvasive predictor of surgical necessity in pediatric intussusception. A dual-threshold approach may help guide conservative versus surgical management.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"e149-e155"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259226","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":"Delayed Consent for Research During the Emergent Care of Febrile Young Infants: Feasible, Acceptable, Doable.","authors":"Brett Burstein, Kelley-Anne Dionne, Alexandra Yannopoulos, Caroline Wolek, Ran D Goldman","doi":"10.1097/PEC.0000000000003635","DOIUrl":"10.1097/PEC.0000000000003635","url":null,"abstract":"<p><strong>Objective: </strong>To assess the feasibility and parental acceptability of delayed consent for research involving blood samples collected from febrile infants aged 60 days or younger during emergent care.</p><p><strong>Methods: </strong>This was a substudy of a pilot trial at a tertiary pediatric ED to detect biomarkers of serious bacterial infections among febrile young infants. Families were provided an introductory letter indicating that, after clinically necessary blood tests, a small volume of additional blood would be collected and stored for research for which they could opt out at any time. After hospital discharge, all families received telephone follow-up for a delayed consent discussion, allowing them to accept or refuse participation in the main biomarker trial. A 6-month consecutive sample of parents was invited to complete a questionnaire regarding the acceptability of research blood collection with delayed telephone consent.</p><p><strong>Results: </strong>Among 345 consecutive infants, 22 (6.4%) families opted out of research blood collection during ED care, and 136 (42.1%) had research blood collected after clinical sampling. Nearly all families (333/345; 96.5%) had telephone follow-up, and questionnaires were completed by 312/333 (90.4%). Most families found delayed consent for research blood collection acceptable (271/312; 86.9%) or somewhat acceptable (34/312; 10.9%), and 81.5% provided consent to use their infants' research blood samples.</p><p><strong>Conclusions: </strong>Delayed consent for research is feasible andhighly acceptable to parents of febrile infants in the ED. This methodology may minimize stress during emergent care, enhance inclusivity, and facilitate timely, ethical pediatric research when there are barriers to standard prospective consent. Broader implementation should consider study risk, context, and ethical oversight.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"770-775"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148199854","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":"Optimizing a Level 1 Trauma Pediatric Emergency Department Tracking Board-A Quality Improvement Initiative.","authors":"Alejandro Pasaret, Nina Mbadiwe, Daniel Bickley, Rachel Baccile, Marc Sycip","doi":"10.1097/PEC.0000000000003641","DOIUrl":"10.1097/PEC.0000000000003641","url":null,"abstract":"<p><strong>Background: </strong>Efficient monitoring of patient flow is essential to emergency department (ED) operations. Electronic tracking boards organize real-time clinical data but often display nonessential information. We evaluated whether optimizing an ED tracking board design was associated with improved throughput metrics in a pediatric ED.</p><p><strong>Methods: </strong>The ED tracking board was optimized by removing 8 nonpertinent columns and adding vital signs, bed status, floor orders, and unassigned patients ready to be seen. Primary outcomes were mean daily door-to-doc, room-to-doc, doc-to-disposition, and bed-to-admit times in the postintervention period compared with the preintervention period. Analyses were stratified by provider type and adjusted for ED volume, patient acuity, provider coverage, and month.</p><p><strong>Results: </strong>We analyzed 68,979 ED encounters from April 2022 to March 2024. Left without being seen (LWBS) rates decreased from 13.9% to 6.9% ( P <0.001). Among all providers, the postintervention period was associated with lower door-to-doc time (82.9 vs. 59.1 min), room-to-doc time (9.8 vs. 7.2 min), and total ED length of stay (318.9 vs. 296.5 min; all P <0.001). These improvements persisted after the adjusted analysis. There was no significant difference in doc-to-disposition or bed-to-admit times.</p><p><strong>Conclusions: </strong>Multiple factors influence ED throughput. In this pediatric ED, tracking board optimization was associated with significant reductions in door-to-doc time, room-to-doc time, LWBS rates, and total ED LOS across all provider types, persisting after adjustment for volume, acuity, provider coverage, and month. As tracking boards are used by all ED providers, their optimization represents a broadly applicable and low-cost target for throughput improvement.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"781-788"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272368","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":"Comment on \"Psychiatric Emergency Service Use by Transgender and Gender-Diverse Youth\".","authors":"Prajnasini Satapathy, Rachana Mehta, Ranjana Sah","doi":"10.1097/PEC.0000000000003516","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003516","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":"42 10","pages":"e136"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081824","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":"Hypodermoclysis for Fluid Administration in Hospitalized Pediatric Patients: A Scoping Review.","authors":"Mariana de Siqueira Silva, Beatriz Bernava Sarinho, Thamires Da Silva Feres, Yasmin Fortunato Teixeira, Sandra Cristina Brassica, Inajara Rotta, Marília Berlofa Visacri","doi":"10.1097/PEC.0000000000003646","DOIUrl":"10.1097/PEC.0000000000003646","url":null,"abstract":"<p><strong>Objective: </strong>Hypodermoclysis is an alternative for hydrating children with difficult venous access. This study aimed to map the literature on its use for fluid administration in neonates, infants, and children up to 12 years old in hospital settings.</p><p><strong>Methods: </strong>A scoping review was conducted on December 4, 2024, and updated on July 25, 2025, in PubMed, Scopus, Web of Science, and CINAHL. Primary studies on hospitalized children (0 to 12 y) receiving fluids through hypodermoclysis were included. Two reviewers independently screened the articles.</p><p><strong>Results: </strong>Ten studies, published between 1950 and 2025, were conducted in emergency, inpatient, and palliative care settings. The most used fluid was 0.9% sodium chloride; hyaluronidase was used in 8 studies. Outcomes most frequently assessed were safety (n=8), efficacy/effectiveness (n=4), and ease of use/comfort/satisfaction (n=3). The data demonstrate that hypodermoclysis is safe, with expected local adverse effects related to subcutaneous administration and rare severe local or systemic adverse effects. Moreover, dehydrated patients were successfully treated using this technique. The studies also indicate that hypodermoclysis is simple to perform, well accepted by health care professionals, facilitates parenteral rehydration with fewer needle insertions, and is satisfactory to caregivers.</p><p><strong>Conclusion: </strong>Hypodermoclysis appears to be a safe, effective, and well-accepted option for pediatric dehydration. Its incorporation into pediatric clinical protocols may reduce the need for repeated venipuncture and associated distress, thereby improving patient comfort and family satisfaction.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"789-796"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278376","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":"Factors Associated With Use of Procedural Sedation in Pediatric Facial Laceration Repair in the Emergency Department: A Retrospective Cross-Sectional Study.","authors":"Isabella G Steidley, David Mills, Elizabeth Waltman, Michael C Monuteaux, Todd Lyons, Andrew Miller, Chris A Rees, Assaf Landschaft, Amanda Stewart, Eric W Fleegler, Amir Kimia","doi":"10.1097/PEC.0000000000003628","DOIUrl":"10.1097/PEC.0000000000003628","url":null,"abstract":"<p><strong>Objective: </strong>To identify factors associated with the utilization of procedural sedation during pediatric facial laceration repair.</p><p><strong>Methods: </strong>We performed a retrospective cross-sectional study at a tertiary care pediatric ED from 2016 to 2020 of patients aged 0 to 18 with facial lacerations repaired with sutures. Our primary outcome was utilization of procedural sedation (ketamine, propofol alone or plus fentanyl or ketamine, midazolam plus fentanyl), with a secondary outcome of utilization of anxiolysis (intranasal midazolam). We measured the association of covariates, including provider subspecialty and patient age, sex, race and ethnicity, insurance status, time and day, laceration characteristics, mechanism, and layers of repair in a multivariate analysis and multinomial logistic regression.</p><p><strong>Results: </strong>We identified 4943 patient visits, with 3859 (78.8%) laceration repairs performed by emergency medicine providers and 1084 (21.9%) performed by plastic surgery. Procedural sedation was used in 373 (7.6%) visits. Lacerations repaired by plastic surgery were 25 times more likely to involve procedural sedation compared with those repaired by emergency medicine providers [adjusted odds ratio (aOR): 25.0, 95% CI: 17.1-36.5]. Additional factors included: laceration length (≥5 vs. <2.5 cm, aOR: 3.87, 95% CI: 1.88, 7.94), laceration complexity (complex vs. simple aOR: 2.50, 95% CI: 1.75, 3.57), and time of presentation (overnight vs. day, aOR: 2.58, 95% CI: 1.36, 4.91).</p><p><strong>Conclusion: </strong>Provider specialty was the strongest independent predictor of procedural sedation use, even after adjustment for wound characteristics. These findings highlight substantial practice variation and suggest an opportunity to develop standardized, clinically driven approaches to sedation decision-making for pediatric facial lacerations.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"743-749"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964551","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":"Racial Disparity and Disproportionality Among Emergency Department Visits for Child Maltreatment: Evidence From the Nationwide Emergency Department Sample (NEDS): 2019 to 2020.","authors":"Corbinian Wanner, Amy A Hunter, Meghan Fish, Nina Livingston","doi":"10.1097/PEC.0000000000003630","DOIUrl":"10.1097/PEC.0000000000003630","url":null,"abstract":"<p><strong>Background: </strong>Each year in the US, approximately 600,000 (8.1 per 1000 child population) children are victims of maltreatment. In 2023, rates among Black/African American children were 47% higher than the overall national rate. It is unclear whether similar disparities exist in national emergency department (ED) data, as the Nationwide Emergency Department Sample (NEDS) just began including race and ethnicity in data in 2019.</p><p><strong>Objective: </strong>To evaluate racial disparity and disproportionality among a nationally representative sample of ED visits involving child maltreatment concerns.</p><p><strong>Methods: </strong>International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes were used to identify ED visits for confirmed (T74) and suspected (T76) child maltreatment concerns in patients under 18 years old from 1/1/2019 to 12/31/2020. NEDS sampling weights were applied to produce national estimates. Racial disparity and disproportionality were calculated using the Disparity Index (DI) and the Disproportionality Representation Index (DRI), respectively.</p><p><strong>Results: </strong>A total of 29,667 ED visits (130,981 weighted) involving child maltreatment concerns were identified. The DRI revealed that non-Hispanic Black children had maltreatment codes applied at a rate that was 1.8 greater times what was expected given their proportion in the general population. The DI showed that non-Hispanic Black children were twice as likely to have a maltreatment-related diagnosis code applied when compared with their non-Hispanic White counterparts.</p><p><strong>Conclusions: </strong>This research exposes racial differences in the application of diagnosis codes for child maltreatment concerns in a nationally representative ED sample. Future research should explore factors which may influence the application of maltreatment-related diagnosis codes.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"750-755"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147942361","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}