Pediatric emergency care最新文献

{"title":"Firearm Screening and Gun Lock Distribution in an Urban, Academic Pediatric Emergency Department.","authors":"Theresa Timm, Kristen Mueller, Monica Lim, Melissa An, Erica Jamro-Comer, Fahd A Ahmad, Lindsay Clukies","doi":"10.1097/PEC.0000000000003384","DOIUrl":"10.1097/PEC.0000000000003384","url":null,"abstract":"<p><strong>Objectives: </strong>To examine firearm access and storage practices among parents/guardians of pediatric emergency department (PED) patients, and to determine whether the distribution of gun locks impacts overall storage practices.</p><p><strong>Materials and methods: </strong>This was a single-center, prospective observational cohort study in an urban, academic PED with ∼50,000 annual patient visits. From October 2021 through April 2022, parents/guardians of pediatric patients received a firearm triage survey and were offered gun locks. Participants who received locks were contacted for a follow-up phone survey one to two months later.</p><p><strong>Results: </strong>Among the 11,771 parents/guardians who completed the triage survey, 17% reported access to a firearm, 70% reported safe storage methods (firearm locked and unloaded), and 16% requested a gun lock. Among the 257 participants who received a gun lock and completed the follow-up survey, 69% reported using the lock. When comparing the triage survey to the follow-up call survey, access to firearms remained constant (88% triage vs 89% follow-up; P = 0.76), as did keeping the firearm unloaded (76% triage vs 79% follow-up; P = 0.10). However, there was an increase in the use of overall locked storage methods ( P < 0.001) as the use of multiple locked storage methods increased from 11% at triage to 59% at follow-up. The absence of locked storage methods decreased from 12% to 3%.</p><p><strong>Conclusions: </strong>Firearm screening and gun lock distribution in a PED can contribute to the increased use of safe storage practices in this patient cohort.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"528-534"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987398","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":"Ketorolac as an Analgesic in Pediatric Acute Pain Management: A Systematic Review and Meta-analysis.","authors":"Mohammed Alsabri Hussein Alsabri, Rehab Adel Diab, Basel F Alqeeq, Mohamed Rifai, Khaled Abouelmagd, Dina Essam Abo-Elnour, Luis L Gamboa","doi":"10.1097/PEC.0000000000003381","DOIUrl":"10.1097/PEC.0000000000003381","url":null,"abstract":"<p><strong>Background: </strong>Acute pain is a common complaint in the pediatric emergency department. Ketorolac, a nonsteroidal anti-inflammatory drug, is approved for use in adults but remains underinvestigated in pediatric patients. This meta-analysis aims to evaluate the efficacy and safety of Ketorolac for acute pain management in children.</p><p><strong>Methods: </strong>A systematic search was conducted using electronic databases, including PubMed, Web of Science, Scopus, and CENTRAL. Studies investigating the use of Ketorolac for acute pain in children were included. We followed the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0).</p><p><strong>Results: </strong>Twenty-four studies were included in this systematic review. The mean change in pain scores with Ketorolac was -2.06 (95% CI: -5.01 to 0.88, P <0.01). The pooled rate of pain freedom at discharge in 103 patients across 3 studies was 66.06% (95% CI: 49.64-82.47, P =0.02). The pooled rate of discharge from the emergency department in 130 patients across three studies was 85.34% (95% CI: 58.83-100, P <0.01). The pooled rate of gastrointestinal adverse events in 267 patients across four studies was 1.53% (95% CI: 0.00-3.39, P =0.07).</p><p><strong>Conclusions: </strong>Ketorolac appears to be a safe and effective option for managing acute pain in the pediatric population. The results indicate significant pain reduction and a relatively low risk of adverse events. However, randomized controlled trials are necessary to validate these findings and establish appropriate dosing regimens.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"e34-e47"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024760","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":"Shifting Place of Death of Children in the United States, 1999-2023.","authors":"Gabriella Orbach, Cordelia Mannix, Rebekah Mannix, Jason Levy","doi":"10.1097/PEC.0000000000003364","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003364","url":null,"abstract":"<p><strong>Objectives: </strong>Recent increases in pediatric all-cause mortality have highlighted significant disparities based on race, ethnicity, age, sex, and cause of death. Our aim is to explore where these deaths occur, which is critical for designing interventions to mitigate these worrying trends.</p><p><strong>Methods: </strong>Mortality data for children under 18 years of age from 1999 to 2023 were obtained from the Centers for Disease Control and Prevention's Wide-ranging ONline Data for Epidemiologic Research database, categorizing deaths by place [inpatient, emergency department (ED)/outpatient, dead on arrival, and other]. Place of death was stratified by demographic factors including age, race, ethnicity, gender (sex), and cause of death. Crude mortality rates were calculated using population estimates, and trends were analyzed using joinpoint regression to identify inflection points and annual percentage change (APC).</p><p><strong>Results: </strong>Distribution of deaths by place has shifted over time. ED/outpatient deaths decreased between 2006 and 2012 (APC: -3.28, P = 0.001), a trend that was reversed between 2019 and 2023 (APC: 4.22, P < 0.001). Similarly, deaths in the home decreased significantly from 2006 to 2010 (APC: -9.59, P < 0.001) before increasing significantly between 2018 and 2023 (APC: 5.59, P < 0.001). Black children had elevated mortality rates in inpatient, ED/outpatient, home, and other settings, with the greatest overall increase seen in ED/outpatient deaths in black children (APC: 9.66, P = 0.014).</p><p><strong>Conclusions: </strong>This study identifies significant trends and disparities in pediatric mortality by place of death. Enhanced surveillance and targeted interventions are essential to address the underlying causes of these disparities and reduce pediatric mortality across all settings.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497662","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 Prevalence of Facial Petechiae in Infants Evaluated for Excessive Crying.","authors":"Heather L Edward, Jessica Moore, Phinnara Has, Stephanie M Ruest, Amy P Goldberg, Jessica Bagley, Pamela High, Cynthia L Loncar, Christine E Barron","doi":"10.1097/PEC.0000000000003434","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003434","url":null,"abstract":"<p><strong>Objectives: </strong>Petechiae on the face in infants are known to be caused by trauma; however, they are also sometimes attributed to infant crying. This study aims to determine the prevalence of facial petechiae in infants with excessive crying.</p><p><strong>Methods: </strong>We conducted a single-center, retrospective record review of 138 infants (under 1 y old) evaluated at a specialized outpatient clinic for crying and fussiness between January 2015 and March 2020. Medical records were reviewed for caregiver-reported crying by clinical history and behavior diaries, and the presence of facial petechiae on physical exam (specifically documented with a checkbox on the exam form). Descriptive statistics were used to describe the average time spent crying, medical history, and prevalence of facial petechiae.</p><p><strong>Results: </strong>There were 138 infants (mean age 2 mo) evaluated by a pediatrician for facial petechiae (N=187 physical exams). Colic was diagnosed in 74% of the infants. Infants were excessive criers with no statistically significant difference between the time that infants were reported to cry and/or fuss per day by caregivers' clinical history (median 4 h/d) and by caregiver-completed home behavior diaries (median 3.8 h/d). No infants had facial petechiae on physical exam.</p><p><strong>Conclusions: </strong>While facial petechiae is believed to be due to excessive crying, this study supports that facial petechiae in infants is rare and that there is no association between crying and facial petechiae. In the absence of medical causes, facial petechiae in infants should be evaluated as a potential traumatic injury and practitioners should consider possible physical abuse.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476292","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: Variable Yet Distinctive: Revisiting Radiographic Features of Mycoplasma Pneumoniae Pneumonia.","authors":"Tamara Garcia, Lilliam Ambroggio","doi":"10.1097/PEC.0000000000003427","DOIUrl":"10.1097/PEC.0000000000003427","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369135","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":"Gaps in Safe Sleep Knowledge and Practices Among Parents of Infants in an Urban Children's Hospital Emergency Department.","authors":"Thomas Gilmartin, Jessica Hayes, Donald H Arnold","doi":"10.1097/PEC.0000000000003431","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003431","url":null,"abstract":"<p><strong>Objective: </strong>Sudden Unexpected Infant Death (SUID) remains a leading cause of mortality, particularly in the Southeast United States. While previous studies have examined aspects of parental safe sleep knowledge and practices, the objective of this study was to evaluate (1) knowledge and (2) practice of adherence by caretakers to all American Academy of Pediatrics (AAP) A-level recommendations related to placing an infant to sleep.</p><p><strong>Methods: </strong>Investigators administered a survey study in an urban, academic pediatric emergency department in the Southeast United States from 2022 to 2023. A convenience sample of parents of infants (≤12 mo) were surveyed regarding knowledge and practices pertaining to sleep position, safe surfaces, surface sharing, objects in bed, cardiopulmonary monitors, and pacifier use. Wilcoxon signed-rank tests were used to compare knowledge of each AAP recommendation with practice of the same recommendation.</p><p><strong>Results: </strong>Among 200 surveyed participants, most demonstrated correct knowledge of safe sleep position (183, 91.5%), surfaces (167, 83.5%), location (186, 93.0%), and crib-safe objects (177, 88.5%). Correct practices of AAP recommendations were reported for sleep position (155, 77.5%), sleep surface (155, 77.5%), location (157, 78.5%), objects in the crib (130, 65.0%), and pacifier use (73, 37.5%). For the 5 AAP recommendations, Wilcoxon signed-rank tests indicated statistically significant variance between knowledge and practice: safe sleep position (P<0.001), surfaces (P=0.040), location (P<0.001), crib-safe objects (P<0.001), and pacifier use (P=0.002).</p><p><strong>Conclusions: </strong>This research identifies gaps between safe sleep knowledge and practice for 5 of the 6 AAP recommendations related to placing an infant to sleep in a region with high SUID incidence. Addressing these modifiable risk factors during emergency department visits may decrease SUID incidence.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310300","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":"Methodological Observations on the Meta-analysis by Alsabri et al Regarding Ketorolac Use in Pediatric Acute Pain.","authors":"Javier Arredondo Montero","doi":"10.1097/PEC.0000000000003424","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003424","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302715","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 National Dissemination of a Disaster Medicine Module for Pediatric Residents Through Nationally Funded Disaster Networks.","authors":"Roxanna Lefort, Rong Sang, Shana E Godfred-Cato, Yae Sul Jeong, Dennis M Ren, Myto Duong, Erica Y Popovsky, Kara B Kowalczyk, Caitlin Valentino, Nichole R Davis, Paul J Stengel, Marc A Auerbach","doi":"10.1097/PEC.0000000000003403","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003403","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate a dissemination strategy for an online pediatric disaster learning module to reach pediatric residents in programs participating in nationally funded disaster networks. A secondary aim measured the educational impacts among learners.</p><p><strong>Methods: </strong>The module included case-based scenarios, videos, interactive questions and answers with experts, and resource links. The dissemination strategy involved identifying a local champion at each of the disaster network institutions to recruit a targeted group of pediatric residents during a clinical rotation. Dissemination was evaluated using surveys of site champions and learners. The educational impact of the module was measured using retrospective pre/postsurveys.</p><p><strong>Results: </strong>Twenty-eight residency programs within the funded disaster networks were approached, and 6 additional residency programs requested to participate after learning about this project. Twenty-five programs participated with a total of 252 residents initially engaging with the module over the 2 designated dissemination weeks. Of residents, 75% started the module and completed it. Most site champions expressed interest in continuing to engage in dissemination of future modules in the curricula. A statistically significant improvement in self-reported knowledge, attitudes, and behaviors was noted for all 6 learning objectives. The mean Net Promoter Score reported by the learners was 11/100.</p><p><strong>Conclusions: </strong>Overall, the strategy of disseminating disaster curricula through the funded disaster networks with local site champions was effective, though barriers were identified for future efforts to reach all programs interested. Completion of the module was associated with self-reported achievement of all learning objectives.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310301","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 Benefits and Evolutions of Shared Research Cores: A Novel Pediatric Emergency Department Research Program.","authors":"Brandon Kappy, Bobbe Thomas, Monika Goyal, Ioannis Koutroulis","doi":"10.1097/PEC.0000000000003430","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003430","url":null,"abstract":"<p><p>Shared research cores are centralized facilities that provide investigators with advanced equipment and services under fee-for-service arrangements. By pooling costs among investigators, cores offer access to otherwise cost-prohibitive technology and allow researchers to utilize specialized staff without taking on retraining costs. The structure of shared cores promotes a team-based approach to research where users can learn technical skills and collaborate with investigators from different fields. Research cores have become an essential part of universities and academic healthcare centers, providing the infrastructure for some of the most important scientific innovations of the past decade. Recently, shared cores have expanded to include clinical research programs that offer investigators improved access to translational services and study scalability, with some cores specializing in unique patient populations and disease processes. Yet, as most clinical cores are embedded in outpatient facilities, they often exclude patients who experience trauma and acute illnesses. This article discusses a novel pediatric emergency department research core-like program and the value that such a program brings to investigators studying emergent symptoms, underserved populations, and acute presentations of chronic diseases. As emergency departments are always open, they offer expanded recruitment windows and can embed interventions into existing patient flow processes. Housing a research core or core-like program within the department of emergency medicine also allows the program to subsidize internal projects and collaborate with other divisions across the institution.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286041","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":"Evaluating a Triage Screen in a Pediatric Emergency Department to Improve Appropriate Identification of Immigrant Populations.","authors":"Leen Bakdash, Amy Zeidan, Anna Q Yaffee","doi":"10.1097/PEC.0000000000003428","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003428","url":null,"abstract":"<p><strong>Objectives: </strong>One in 4 children in the United States is part of an immigrant family. Children in immigrant families (CIFs) experience significant disparities in health care quality and access in the pediatric emergency department (PED). Insufficient utilization of interpreters for those with non-English language preference contributes to these disparities. CIFs are often excluded from clinical research studies, impairing efforts to improve their health care access. We evaluated an immigration and language triage screen in a PED to better identify CIF.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of attitudes toward a triage screen identifying country of origin and language preference. Caregivers who entered the assessment/triage room of an urban PED were asked about the caregiver's and child's country of birth, year of arrival to the US, and preferred language. Patients who were born outside the United States or had a caregiver born outside the United States were identified as CIF. Caregivers of CIF were asked to participate in a survey to understand their attitudes toward the screen. Demographics and attitudes toward the triage screen were then analyzed using basic descriptive statistics.</p><p><strong>Results: </strong>CIF were identified in 252 or 21.9% of screened encounters. In 51.2% (n=129) of these encounters, caregivers completed a survey. Ninety-two percent of surveyed families were comfortable with the triage screen. In contrast, almost one third of families endorsed that they would have felt uncomfortable had they been asked their immigration status directly. Eighteen percent of families who needed an interpreter did not have this need identified until after the triage screen.</p><p><strong>Conclusions: </strong>Our findings suggest that a language and immigration triage screen in a PED is feasible and acceptable to improve the identification of CIF and their language needs in electronic medical records with the goal of improving the quality of health care and research for this population.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286040","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}