Pediatric emergency care最新文献

{"title":"Detection of Traumatic Knee Arthrotomy in Children Using Point-of-Care Ultrasound, a Review of 2 Cases.","authors":"Blake Nowakowski, Antonio Riera","doi":"10.1097/PEC.0000000000003661","DOIUrl":"10.1097/PEC.0000000000003661","url":null,"abstract":"<p><p>These 2 cases involved children who suffered traumatic penetrating injuries to the knee and were ambulatory after the event. Point-of-care ultrasound (POCUS) performed on both patients revealed findings consistent with trapped air in the suprapatellar bursa. Both patients were evaluated with additional imaging and were treated by pediatric orthopedic surgeons for urgent operative irrigation and debridement. There is limited data on the use of POCUS for traumatic knee arthrotomy, especially among pediatric populations. Ultrasound has been well established as a safe and timely imaging modality in a variety of other conditions. In these cases, POCUS represented a low-risk and efficient approach for the diagnosis of traumatic knee arthrotomy in the pediatric emergency department.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"797-800"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592971","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":"Shyam Sundar Sah, Abhishek Kumbhalwar","doi":"10.1097/PEC.0000000000003539","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003539","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":"42 10","pages":"e137"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081792","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":"One-Hour Simulation Curriculum Improves Neonatal Resuscitation Skills of Emergency Medicine Residents.","authors":"Rachel Reed, Michael Thompson, Aneury Hernandez, Guillaume Stoffels, Jo Hsuan Lee, Sushma Krishna","doi":"10.1097/PEC.0000000000003710","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003710","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether a 1-hour neonatal resuscitation (NR) simulation curriculum improves emergency medicine (EM) resident skills, competency, and level of comfort in NR.</p><p><strong>Methods: </strong>NR skills were assessed during a 7-minute simulation conducted before and after a 45-minute educational session. Performance was assessed using the validated Neonatal Resuscitation Performance Evaluation (NRPE) tool. Time to each successful intervention during the simulation was recorded. Residents completed surveys at 3 time points: before the session (pre), immediately after (post), and at the end of the year (post-post). Surveys assessed baseline NR experience, knowledge, and self-reported competency in NR skills.</p><p><strong>Results: </strong>Fourteen third-year EM residents participated. There was a significant median improvement in total NRPE scores and in the subset scores of the bag-mask ventilation, intubation, and chest compressions skills. There was a significant decrease in the median time to obtaining initial heart rate, starting positive pressure ventilation, and to successful intubation. There was no significant difference in the time to initiating chest compressions. All 4 self-reported competency measures showed significant median improvement immediately postintervention. This improvement was maintained for 2 items in the post-post survey. Knowledge assessment scores improved significantly from pre- to postintervention.</p><p><strong>Conclusions: </strong>A 1-hour, NR skill-based simulation curriculum significantly improved NR skills, knowledge, and confidence among senior EM residents. This curriculum could serve as a valuable intervention to address gaps in NR training and can help fulfill proposed Accreditation Council for Graduate Medical Education requirements.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081811","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 Death in the Emergency Department: Qualitative Insights From Physicians' Experiences.","authors":"Ji Young Lee, Jamie Pattee, Christine Aspiotes, Maren M Lunoe, Traci M Kazmerski, Danielle S Harvey, Noel B Spears, Kathleen A Noorbakhsh","doi":"10.1097/PEC.0000000000003707","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003707","url":null,"abstract":"<p><strong>Objective: </strong>To explore pediatric emergency medicine (PEM) physician perspectives on the death of a child in the emergency department (ED) to identify key lessons learned and areas for improvement in care and provider support.</p><p><strong>Methods: </strong>We conducted a 5-year review of PEM physicians' experiences after the death of a child at a single urban pediatric ED. Qualitative thematic analysis was performed on questionnaire responses regarding the resuscitation, debrief, overall support, and opportunities for improvement.</p><p><strong>Results: </strong>Twenty-two PEM physicians provided questionnaire responses to 34 deaths, with no difference in the distribution of number of deaths, sex, or clinical experience between questionnaire respondents and nonrespondents. Six key themes were identified from 34 questionnaire responses: (1) Physicians expressed confidence in the medical aspects of pediatric resuscitation but acknowledged a lack of prehospital information and deliberated airway management. (2) Most physicians found it helpful to have multidisciplinary providers with diverse expertise present during the resuscitation, emphasizing clear leadership and crowd control. (3) Family involvement and communication were crucial during a child's death. (4) Legal and administrative tasks after the death of a child can be burdensome, serving as possible barriers to completing other essential duties. (5) Continued support during and after the death of a child required significant staffing and was essential for resuming ED operations. (6) Staff debriefings occurred frequently and were highly valued, yet encountered challenges in implementation.</p><p><strong>Conclusions: </strong>PEM physicians highlight that leadership, multidisciplinary collaboration, communication with families, and debriefing are vital components surrounding the death of a child in the ED. Future studies should explore insights from nonphysician health care workers and family members.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070026","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":"Risk Factors for Undertriage of Children Presenting to a Pediatric Emergency Department With Abdominal Pain.","authors":"Sara Sandri, Ethan Gough, Siwei Xie, Joanna S Cohen","doi":"10.1097/PEC.0000000000003702","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003702","url":null,"abstract":"<p><strong>Objectives: </strong>To identify demographic and clinical risk factors associated with undertriage of pediatric patients presenting to the emergency department with abdominal pain.</p><p><strong>Methods: </strong>This retrospective cross-sectional study included pediatric patients who presented to the pediatric ED at an academic urban hospital between January 1, 2023, and December 31, 2023, with a chief complaint of abdominal pain and were triaged as Emergency Severity Index level 4. Undertriage was defined as a triage level 4 assignment followed by hospital admission or use of more than 1 resource category. Demographic and clinical data, including age, sex, race, ethnicity, insurance type, interpreter use, disposition, and resource utilization, were extracted from the electronic health record. Multivariable logistic regression was used to assess the association between interpreter use and undertriage, adjusting for potential confounders.</p><p><strong>Results: </strong>A total of 603 patients met the inclusion criteria, of which 198 (32.8%) were undertriaged. Undertriage was more likely among patients who required an interpreter and were 13 years or older. Undertriage was less likely among those identifying as Black or Hispanic. Presentations during overnight hours were also associated with lower odds of undertriage. No significant seasonal variation was observed. Among undertriaged patients, most patients underwent both laboratory testing (93.9%) and imaging (80.3%).</p><p><strong>Conclusions: </strong>Nearly one-third of pediatric patients with abdominal pain triaged as level 4 were undertriaged. Patients 13 and older were more likely to be undertriaged compared with those aged 1 to 12. Interpreter use was associated with higher odds of undertriage, while Hispanic ethnicity and Black race were associated with lower odds of undertriage. These findings highlight the importance of addressing language-related barriers and other factors that influence equitable triage in the pediatric emergency department.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070086","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":"Age-Associated Variation in Documented Emergency Department Analgesia Among Pediatric Trauma Patients in a Painful Injury Cohort.","authors":"Barry Hahn, Najiha Farooqi, Esther Cohen, Anna Van Tuyl, Ahmad Nama, Josh Greenstein","doi":"10.1097/PEC.0000000000003709","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003709","url":null,"abstract":"<p><strong>Objectives: </strong>Young children may be at risk for less frequent analgesic administration after injury because pain assessment and communication are more difficult. We evaluated whether age younger than 6 years was associated with less frequent ED analgesic administration among pediatric trauma registry patients with painful injuries.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of trauma registry patients aged 18 years or younger evaluated in an emergency department from May 2022 through April 2025. The primary painful injury cohort included patients with injury descriptors consistent with fracture, dislocation, burn, laceration, open wound, crush injury, amputation, degloving injury, or avulsion injury. The primary outcome was any documented administration of ED analgesics. We used modified Poisson regression with robust standard errors to estimate relative risks.</p><p><strong>Results: </strong>ED analgesia was recorded in 54 of 126 younger children (42.9%) compared with 133 of 193 older children (68.9%), an absolute difference of 26.1 percentage points. In unadjusted analysis, age younger than 6 years was associated with a lower likelihood of ED analgesia (RR: 0.62; 95% CI: 0.50-0.78). After adjustment for Injury Severity Score, sex, mechanism, transport mode, trauma activation level, and ED disposition, age younger than 6 years remained associated with a lower likelihood of ED analgesia (adjusted relative risk: 0.66; 95% CI: 0.53-0.83).</p><p><strong>Conclusions: </strong>Children younger than 6 years with painful injuries had less frequent ED analgesic administration than older children.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070053","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":"Diagnostic Utility of the Albumin-to-Globulin Ratio for Kawasaki Disease in Children Presenting to the Emergency Department.","authors":"Soo-Young Lim, Seung Jun Choi, Jun Sung Park, Jeeho Han, Dahyun Kim, Min Kyo Chun, Jeong-Yong Lee, Jong Seung Lee","doi":"10.1097/PEC.0000000000003705","DOIUrl":"10.1097/PEC.0000000000003705","url":null,"abstract":"<p><strong>Objectives: </strong>Early diagnosis of Kawasaki disease (KD) is essential to prevent coronary artery complications but may be challenging in the emergency department (ED), particularly in patients who do not meet the complete clinical criteria. Although hypoalbuminemia is commonly used as a supportive marker, albumin levels may be influenced by various clinical factors. Therefore, we aimed to evaluate the diagnostic performance of the albumin-to-globulin (A/G) ratio in children with prolonged fever presenting to the ED.</p><p><strong>Methods: </strong>This retrospective case-control study included pediatric patients who presented to a tertiary ED between January 2022 and July 2023. Children diagnosed with KD were compared with febrile controls (fever ≥5 d) diagnosed with other illnesses. The A/G ratio was calculated as albumin/(total protein - albumin). Receiver operating characteristic curve analysis was performed, and areas under the curve (AUCs) were compared using the DeLong test.</p><p><strong>Results: </strong>A total of 134 children with KD and 141 febrile controls were included. Using a cutoff value of ≤1.0, the A/G ratio demonstrated a sensitivity of 82.1% and was associated with an increased likelihood of KD (OR: 5.06; 95% CI: 2.92-8.79). The A/G ratio showed superior discriminatory performance compared with albumin alone (AUC: 0.691 vs. 0.611; P =0.004). No significant differences in the A/G ratio were observed between complete and incomplete KD.</p><p><strong>Conclusions: </strong>An inverted A/G ratio (≤1.0) demonstrated better diagnostic performance than hypoalbuminemia alone and may serve as a simple adjunctive marker for suspected KD in children with prolonged fever presenting to the ED.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977470","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":"Access to Care as Predictors of Emergency Department Utilization: A Cross-Sectional National Study.","authors":"Catherine G Coughlin, Michael C Monuteaux, Rebekah Mannix","doi":"10.1097/PEC.0000000000003704","DOIUrl":"10.1097/PEC.0000000000003704","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between caregiver-reported access to care and children's emergency department (ED) utilization using the 2023 National Survey of Children's Health (NSCH).</p><p><strong>Methods: </strong>We conducted a cross-sectional study using the 2023 NSCH. Access-to-care measures included having a personal doctor or nurse, a usual place for sick care, difficulty seeing specialists, caregiver frustration obtaining services, presence of a medical home, receipt of family-centered care, effective care coordination, and care in a well-functioning system. The primary outcome was number of ED visits in 1 year. Multivariable Poisson regression models were estimated for each access measure, adjusted for child age, race and ethnicity, sex, insurance type, poverty level, household language, and presence of special health care needs.</p><p><strong>Results: </strong>The sample included 55,162 participants representing 72 million US children. ED visits were higher among American Indian or Alaska Native; Black, non-Hispanic; and Hispanic children compared with White children, and among those with public insurance, lower income, or special health care needs. Among access-to-care measures, the strongest associations were seen for unmet care-coordination needs: children requiring care coordination had roughly double the rate of ED visits compared with those who did not. Increased ED use was also associated with caregiver frustration obtaining services, lack of a medical home, and fragmented systems of care.</p><p><strong>Conclusions: </strong>Caregiver-reported barriers to coordinated, family-centered care are strongly associated with higher pediatric ED utilization.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039992","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":"Triage Administration of Ondansetron for Gastroenteritis in Children: A Randomized Controlled Trial.","authors":"Olivia Weill, Nathalie Lucas, Benoit Bailey, Christopher Marquis, Jocelyn Gravel","doi":"10.1097/PEC.0000000000003715","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003715","url":null,"abstract":"<p><strong>Objectives: </strong>Acute gastroenteritis is a leading cause of pediatric emergency department (ED) visits. While ondansetron reduces vomiting, intravenous rehydration, and hospital admissions, its efficacy when initiated at triage remains unclear. We aimed to evaluate whether triage nurse-initiated administration of ondansetron in children with suspected gastroenteritis reduces the proportion of patients who had observation following initial physician assessment.</p><p><strong>Methods: </strong>We conducted a randomized, double-blind, placebo-controlled trial in a tertiary pediatric ED in Canada. Children aged 6 months to 17 years presenting with ≥4 episodes of vomiting in the preceding 24 hours (including ≥1 within 2 h of arrival) were eligible. At triage, we randomized participants to receive liquid ondansetron or a color- and taste-matched placebo. The primary outcome was the proportion of patients who had observation after the first physician evaluation. Secondary outcomes included postintervention vomiting, ED length of stay, patient comfort, and 48-hour return visits. The trial was registered at clinicaltrials.gov (NCT03052361).</p><p><strong>Results: </strong>Recruitment was stopped prematurely due to the coronavirus disease 2019 pandemic. Ninety-one participants were randomized to ondansetron (n = 44) or placebo (n = 47). Overall, 40 patients (45%) were discharged immediately after the initial physician assessment, with no difference between the ondansetron and placebo groups (44% vs. 45%; absolute difference: -1%, 95% CI: -20% to 19%). No significant differences were observed in any secondary outcomes.</p><p><strong>Conclusion: </strong>This trial failed to show an impact of triage nurse-initiated ondansetron administration in children with presumed gastroenteritis. Although underpowered to assess any outcome, our results could inform researchers planning larger trials.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040023","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 and Laboratory Findings When Pediatric Male Sexual Assault Survivors Present to the Emergency Department.","authors":"Marcella M Donaruma-Kwoh, Erin Thorn, Cassandra Vigil, Andrea T Cruz","doi":"10.1097/PEC.0000000000003714","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003714","url":null,"abstract":"<p><strong>Objective: </strong>The child sexual abuse (CSA) literature demonstrates that the majority of female pediatric survivors present with normal, uninjured, and uninfected anogenital examinations, yet the clinical presentation of male survivors remains underexplored. This study describes the history, clinical presentation, and medical examination findings of boys and male adolescents presenting to a large urban children's hospital emergency department (ED) seeking care for sexual assault.</p><p><strong>Methods: </strong>A retrospective cross-sectional chart review was conducted for male patients aged 0-18 years who presented to an urban pediatric ED following a chief complaint of CSA or acute sexual assault between October 2019 and March 2024. Data extracted included patient demographics, history of the present illness, elapsed time to evaluation, and documented anogenital examination and laboratory findings.</p><p><strong>Results: </strong>A total of 92 male patients with 93 system encounters met the inclusion criteria. The median age at presentation was 12.9 years. Like patterns for female counterparts, male sexual abuse survivors evaluated in the ED manifested only rare physical trauma or acute infection. Normal healthy anatomy was documented in 93% of patients who allowed physical examinations. Acute physical injury or positive laboratory findings were identified in only 7% and 3% of tested cases, respectively.</p><p><strong>Conclusions: </strong>Male pediatric CSA survivors evaluated in the ED rarely manifest anogenital trauma or acute infection upon medical examination. These findings align closely with established female pediatric cohorts and emphasize that a lack of physical or laboratory findings should be anticipated in both male and female pediatric patients disclosing sexual abuse in an acute care setting.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030997","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}