Pediatric emergency care最新文献

{"title":"Spinal Anatomy Ultrasound in Young Infants With Implications for Lumbar Puncture.","authors":"Margaret B Rinaldi, Matthew Lipton, Rebecca Kidd, Donald H Arnold, Marla C Levine","doi":"10.1097/PEC.0000000000003313","DOIUrl":"10.1097/PEC.0000000000003313","url":null,"abstract":"<p><strong>Background: </strong>Lumbar puncture (LP) in young infants may challenge clinicians due to the infrequency of the procedure and anatomic variability. The use of ultrasound (US) to characterize young infant spinal anatomy prior to performing an LP may help determine the most favorable site for intervention.</p><p><strong>Objectives: </strong>1) Evaluate potential sites for LP in young infants with US at L2/L3 through L5/S1 to determine differences in needle insertion depth (NID), spinal canal width (SCW), and subarachnoid fluid width (SAW).2) Describe the location of the conus medullaris.3) Predict NID of L2/L3 through L5/S1 based on variables including age, gestational age, height, and weight.</p><p><strong>Methods: </strong>We studied a convenience sample of participants aged 0-6 months in a tertiary children's emergency department. We recorded characteristic data and used a Sonosite PX US with a linear 15-MHz transducer to image each participant's spine. We used the paired t -test to examine univariate differences in NID, SCW, and SAW and multiple linear regression models to derive predictive equations for NID.</p><p><strong>Results: </strong>Among 50 participants, the mean NID for sites L2/L3 through L5/S1 did not differ significantly; however, at sites L2/L3 through L5/S1, there were statistically significant differences in the mean SCW and mean SAW, which were both consistently measured to be larger the more cephalad the site. Weight was the only statistically significant variable associated with NID after adjusting for other covariates.</p><p><strong>Conclusions: </strong>Spinal canal width and SAW were consistently measured to be larger at more cephalad sites, suggesting there is a larger target fluid volume available at higher interspaces. Subarachnoid fluid width was measured to be small, highlighting the importance of precise movements. Location of the needle site did not change expected needle depth (approximately 1 cm across all sites). The conus medullaris was not often visualized while scanning the L2/L3-L5/S1 interspaces. Weight can be used to estimate optimal NID; although, it is unclear such small differences would have clinical significance.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"203-207"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813967","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":"Incidence of Sexually Transmitted Infections and Pregnancy Among Adolescents Experiencing Sex Trafficking.","authors":"Whitney Ficker, Lauren Ehrhardt-Humbert, Stacy Reynolds","doi":"10.1097/PEC.0000000000003317","DOIUrl":"10.1097/PEC.0000000000003317","url":null,"abstract":"<p><strong>Objective: </strong>There is a lack of data regarding the incidence of sexually transmitted infections (STIs) and pregnancy among adolescents experiencing sex trafficking. This study aimed to determine the incidence proportion of STIs and pregnancy among adolescents evaluated for sex trafficking at an urban tertiary children's hospital compared to the community adolescent population.</p><p><strong>Methods: </strong>This retrospective, cross-sectional study looked at adolescents aged 11 to 21 years experiencing sex trafficking from March 2019 to March 2022. Data were abstracted from the hospital's human trafficking advocacy team database and the electronic medical record (EMR), including demographics, type and setting of trafficking, presenting complaints, and STI and pregnancy test results. Using Fisher's exact test, the incidence of STIs and pregnancy among adolescents experiencing sex trafficking was compared to adolescents in the community using local county health department data.</p><p><strong>Results: </strong>Fifty-four patients met the eligibility criteria. Females comprised 93% (n = 50) of the group. The average age was 16 years. The racial demographics most represented were African American at 56% (n = 30) and White at 30% (n = 16). History of abuse prior to trafficking was found in 78% (n = 42). Incidence proportions of STIs, compared to county health data, are as follows: 64.8% for Chlamydia trachomatis (CT) versus 7.8% (OR, 22; 95% CI, 12-40), 51.9% for Neisseria gonorrhoeae (GC) versus 2.2% (OR, 47; 95% CI, 26-83), 9.3% for syphilis versus 0.1% (OR, 111; 95% CI, 34-283), and 5.6% for HIV versus 0.1% (OR, 83; 95% CI, 16-261). There was a high individual cumulative incidence of STIs among patients over time, and patients presented with a variety of presenting complaints. The incidence proportion for pregnancy was 11.1% compared to 1.3% (OR, 10; 95% CI, 3-22).</p><p><strong>Conclusions: </strong>Adolescents experiencing sex trafficking have a significantly higher rate of STIs and pregnancy than the community adolescent population.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"213-218"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882074","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":"Firearm Injury Risk Prediction Among Children Transported by 9-1-1 Emergency Medical Services: A Machine Learning Analysis.","authors":"Craig D Newgard, Sean Babcock, Susan Malveau, Amber Lin, Jason Goldstick, Patrick Carter, Jennifer N B Cook, Xubo Song, Ran Wei, Apoorva Salvi, Mary E Fallat, Nathan Kuppermann, Peter C Jenkins, Joel A Fein, N Clay Mann","doi":"10.1097/PEC.0000000000003314","DOIUrl":"10.1097/PEC.0000000000003314","url":null,"abstract":"<p><strong>Objective: </strong>Among children transported by ambulance across the United States, we used machine learning models to develop a risk prediction tool for firearm injury using basic demographic information and home ZIP code matched to publicly available data sources.</p><p><strong>Methods: </strong>We included children and adolescents 0-17 years transported by ambulance to acute care hospitals in 47 states from January 1, 2014 through December 31, 2022. We used 96 predictors, including basic demographic information and neighborhood measures matched to home ZIP code from 5 data sources: EMS records, American Community Survey, Child Opportunity Index, County Health Rankings, and Social Vulnerability Index. We separated children into 0-10 years (preadolescent) and 11-17 years (adolescent) cohorts and used machine learning to develop high-specificity risk prediction models for each age group to minimize false positives.</p><p><strong>Results: </strong>There were 6,191,909 children transported by ambulance, including 21,625 (0.35%) with firearm injuries. Among children 0-10 years (n = 3,149,430 children, 2,840 [0.09%] with firearm injuries), the model had 95.1% specificity, 22.4% sensitivity, area under the curve 0.761, and positive predictive value 0.41% for identifying children with firearm injuries. Among adolescents 11-17 years (n = 3,042,479 children, 18,785 [0.62%] with firearm injuries), the model had 94.8% specificity, 39.0% sensitivity, area under the curve 0.818, and positive predictive value 4.47% for identifying patients with firearm injury. There were 7 high-yield predictors among children and 3 predictors among adolescents, with little overlap.</p><p><strong>Conclusions: </strong>Among pediatric patients transported by ambulance, basic demographic information and neighborhood measures can identify children and adolescents at elevated risk of firearm injuries, which may guide focused injury prevention resources and interventions.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"195-202"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Emergency Medicine Physicians' Perspectives of Concussion in Young Children.","authors":"Deborah A Levine, Julia Gombar, Taylor Lis, Nathalie Orr-Gaucher, Dominique Dupont, Janice Hanson, Miriam H Beauchamp","doi":"10.1097/PEC.0000000000003305","DOIUrl":"10.1097/PEC.0000000000003305","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic brain injury (TBI) during early childhood (before 6 years) is prevalent, accounting for rising rates of emergency department visits. These injuries may lead to postconcussive symptoms, which may be subtle and difficult to diagnose in young children. Inadequate discharge counseling may lead to prolonged duration of symptoms and possible developmental delays. We aimed to explore pediatric emergency medicine (PEM) physicians' perspectives on \"concussion\" terminology, diagnosis, and management, specifically in a young child with mild TBI.</p><p><strong>Methods: </strong>We conducted semistructured interviews using open-ended questions involving a hypothetical scenario. We recruited currently practicing PEM physicians by a snowball sampling method. A research team recorded, transcribed, and analyzed the interviews. Using social constructionism as the philosophical framework, we developed and refined codes and derived themes until reaching thematic saturation. Peer debriefing with an expert collaborator aided with revisions of themes.</p><p><strong>Results: </strong>A single PEM researcher interviewed 13 participants. Three primary themes emerged. Our first theme identified the role of guidelines and tools in the diagnostic workup. Most participants utilized a clinical prediction tool for neuroimaging but no clinical symptom scales. Our second theme described the difficulties and inconsistencies in the approach to diagnosis of concussion, largely due to young age, lack of verbal skills and unreliable examinations. Our last theme focused on the difficulty in providing clear discharge instructions to parents. Many participants described difficulty providing activity restrictions, instead allowing self-modulation, and lack of counseling for educational tasks.</p><p><strong>Conclusions: </strong>Variability exists among PEM physicians in diagnosis and management of concussions in young children. Discomfort with lack of reliability of symptoms and underappreciation of typical early childhood characteristics may account for findings. Educational initiatives, age-appropriate clinical tools and treatment-guided outcomes research are needed to guide PEM physicians in the care of young children with head injuries.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"159-164"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801972","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":"External Validation of the Surgical Intervention for Traumatic Injuries Scale in Children.","authors":"Bergthor Jonsson, Manu Madhok, Shea Lammers, Paige Reimche, Meghan McClure, Andrew W Kiragu, Meysam A Kebriaei, Kelly R Bergmann","doi":"10.1097/PEC.0000000000003309","DOIUrl":"10.1097/PEC.0000000000003309","url":null,"abstract":"<p><strong>Objectives: </strong>The Surgical Intervention for Traumatic Injuries (SITI) scale is intended to predict the likelihood of needing surgical decompression among patients with traumatic brain injury (TBI). We sought to examine the performance of the SITI score to predict likelihood of acute neurosurgical intervention for children with TBI.</p><p><strong>Methods: </strong>We conducted a cross-sectional, retrospective, observational study of children diagnosed with TBI as determined by International Classification of Diseases codes, presenting to a single level 1 pediatric trauma center, between June 1, 2003, and May 31, 2018. The main outcome was decompressive craniotomy or craniectomy within 24 hours of arrival. Data for SITI scoring were abstracted by research assistants, and all cases were scored by a physician who was blinded to the outcome. The SITI scale performance was evaluated using receiver operating characteristic curve and by calculating the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).</p><p><strong>Results: </strong>There were 656 encounters with TBI, of which 39 (5.9%) underwent surgical decompression. The mean SITI scores were 4.15 for the operative group and 0.40 for the nonoperative group ( P  < 0.001). A cutoff of 2 or greater for a positive score gave the best performance with a sensitivity of 0.79, specificity of 0.90, PPV of 0.34, and NPV of 0.99. The area under the receiver operating characteristic curve was 0.89 (95% confidence interval, 0.83-0.96). In sensitivity analysis excluding 75 cases with depressed skull fractures, a score of 2 or greater had a sensitivity of 0.96, specificity of 0.91, PPV of 0.31, and NPV of 1.00. The area under the receiver operating characteristic curve was 0.98 (95% confidence interval, 0.97-1.00).</p><p><strong>Conclusions: </strong>A SITI score of less than 2 is associated with nonoperative management. However, clinicians should not be falsely reassured by a low score in patients with depressed skull fractures.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"183-189"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789541","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":"Understanding Strategies to Reduce the Impact of Non-urgent Visits to the Pediatric Emergency Department: A Scoping Review.","authors":"Erica Qureshi, Kelly Nguyen, Brett Burstein, Jessica Moe, Steven P Miller, Garth Meckler, Quynh Doan","doi":"10.1097/PEC.0000000000003306","DOIUrl":"10.1097/PEC.0000000000003306","url":null,"abstract":"<p><strong>Context: </strong>The pediatric emergency department (PED) is increasingly being used for non-urgent reasons. This impacts PED input and throughput, and contributes to overcrowding. To identify solutions, it is essential to identify and describe the approaches that have been trialed.</p><p><strong>Objective: </strong>We completed a scoping review to identify and then describe the design and outcomes of all initiatives undertaken to reduce the impact of non-urgent visits on the PED.</p><p><strong>Data sources: </strong>We searched 4 databases (MEDLINE, EMBASE, EBM, and CINAHL) to identify research published from the database inception until March 31, 2024.</p><p><strong>Study selection: </strong>Studies met our inclusion criteria if they focused on the pediatric ED, defined non-urgent visits, described an intervention (hypothesizing it would reduce the impact of non-urgent visits on the PED), and reported on the interventions impact.</p><p><strong>Data extraction: </strong>The title and abstract of each study were independently screened for inclusion by 2 reviewers (E.Q., K.N.), and disagreements were resolved by deliberation until consensus was achieved. This process was then repeated for the full text of all articles.</p><p><strong>Results: </strong>In total, we screened 11,600 articles and 20 were included. Nine interventions focused on PED input, 10 on PED throughput, and 1 on both PED input and throughput. Definitions of non-urgent visits and outcomes measures used to assess the effectiveness of an intervention differed between studies. Three types of strategies employed to reduce the impact of non-urgent visits on the PED were identified, these include (1) engaging nonpediatric emergency medicine clinicians by including them into the PED or connecting non-urgent patients to community locations for care, (2) reorganizing PED operations in anticipation of non-urgent visits, and (3) providing education to prevent future non-urgent visits.</p><p><strong>Conclusions: </strong>Consistent definitions of non-urgent visits and standardized outcome measures may allow for more precise comparisons between studies. We identify 3 commonly employed strategies that may help reduce the impact of non-urgent visits on the PED.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"233-244"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789626","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":"\"Room of Horrors\": A Proof-of-Concept Simulation Model for Error Reduction Training in the Emergency Department.","authors":"Tali Capua, Maya Arnon, Moriya Rozenberg, Efrat Perets, Nir Samuel, Dana Adatto Levy, Nadav Elmaliach, Hagit Padova, Ayelet Rimon","doi":"10.1097/PEC.0000000000003310","DOIUrl":"10.1097/PEC.0000000000003310","url":null,"abstract":"<p><strong>Objective: </strong>This pilot study aimed to assess the effectiveness of a \"room of horrors\" (RoH) simulation in identifying patient safety threats in a pediatric emergency department (PED) and to evaluate health care workers' (HCWs') perceptions of the experience.</p><p><strong>Methods: </strong>We developed an RoH simulation featuring 25 potential safety hazards derived from actual PED incidents and \"never events.\" The teams of physicians and nurses who participated in the simulation identified as many hazards as they could within a 10-minute window followed by a debriefing session during which errors were corrected and missed hazards were pointed out. The participants' perceptions were measured on a 5-point Likert scale of a questionnaire.</p><p><strong>Results: </strong>Twenty sessions that included a total of 45 participants were conducted. The teams identified an average of 23 of 25 safety threats, yielding a mean detection rate of 86% for electronic medical record errors, 95% for physical space errors, and 97% for communication errors. The simulation received high ratings for overall positive experience (4.88/5) and impact on daily activities (4.68/5).</p><p><strong>Conclusion: </strong>The RoH simulation experience was effective in evaluating the level of retention of earlier training and the ability of multidisciplinary teams to correctly identify major safety threats in a PED setting. The participants found the experience valuable and engaging. Future research should focus on other means by which the retention of learned skills can be reinforced and new safety threats can be identified with a high level of alertness.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"172-175"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789597","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":"Code Milk: Finding the Pulse of Lactation Culture, Practices, and Preferences of Pediatric Emergency Medicine Fellows.","authors":"Shubhi G Goli, Stefanie S Sebok-Syer, Bonnie Halpern-Felsher, Shuchi Goyal, N Ewen Wang, Andrea Fang","doi":"10.1097/PEC.0000000000003272","DOIUrl":"10.1097/PEC.0000000000003272","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study is to characterize the lactation goals and practice of pediatric emergency medicine (PEM) fellows and to identify areas of improvement related to 1) policy awareness, 2) departmental culture and accommodations, and 3) lactation space and time.</p><p><strong>Methods: </strong>This study is a national, cross-sectional survey study of PEM fellows and program directors (PDs). Two surveys were developed via iterative review and distributed by the PEM-PD Survey Committee. Responses were collected anonymously via the Qualtrics survey platform. Data were summarized using descriptive statistics.</p><p><strong>Results: </strong>Survey responses from 60 PEM PDs (71%, 60/84) estimated that 67% (310/461) of their fellows had the ability to lactate. One hundred fifteen study-eligible fellows (37%) completed the survey. Most fellows (57%, 66/115) reported having lactated or expected to lactate during fellowship. Fellows reported an ideal lactation time of 11.5 months. Sixty-two percent (8/13) met their lactation goal and 42% (22/66) did not or did not know if they would meet their goal. Forty-three percent (50/115) of fellows and 57% (34/60) of PDs were aware of workplace lactation policies. Sixty-one percent (38/62) of fellows discussed a lactation plan with their PDs and 18% (7/39) reported their rotations upon returning to work were scheduled with lactation needs in mind. A dedicated lactation space was available to 67% (43/64) of fellows but used by 29% (11/28). Fellows lactated on average twice during an 8-hour shift, spending 7 minutes walking to and from their chosen lactation space and 21-minute pumping per session.</p><p><strong>Conclusions: </strong>PEM fellows are likely to have lactation needs during fellowship but receive inconsistent support from their programs. Based on our findings, we advocate for the creation of more visible and PEM-specific workplace lactation policies, planning with PDs pre-return to work, and improved availability and usability of designated lactation spaces. Further optimization may help support PEM fellows' personal, clinical, and academic productivity.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"219-225"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Care Management of Brief Resolved Unexplained Events.","authors":"Amy M DeLaroche, Nassr Nama, Joel S Tieder","doi":"10.1097/PEC.0000000000003277","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003277","url":null,"abstract":"<p><strong>Abstract: </strong>A brief resolved unexplained event was defined in 2016 by the American Academy of Pediatrics in their clinical practice guideline. Since introduction of this term, research has characterized the epidemiology, clinical outcomes, and management of patients following a brief resolved unexplained event. Pediatric health care providers should be familiar with the current brief resolved unexplained event literature to minimize unnecessary health care utilization and guide shared decision-making discussions with caregivers.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":"41 3","pages":"245-250"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516303","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":"Impact of the Amount of Intravenous Glucose Administration on Hospitalization for Acute Gastroenteritis in a Pediatric Emergency Department.","authors":"Christina Santamaria, Fannie Péloquin, Sarah Mousseau, Jocelyn Gravel","doi":"10.1097/PEC.0000000000003308","DOIUrl":"10.1097/PEC.0000000000003308","url":null,"abstract":"<p><strong>Introduction: </strong>In case of failure of oral rehydration, children with acute gastroenteritis can be hydrated using intravenous (IV) solution. The choice of the intravenous solution itself (solutions containing dextrose versus crystalloids alone) and the glucose quantities to administer are not well established.</p><p><strong>Objectives: </strong>The main objective of this study was to evaluate the association between the amount of intravenous glucose provided and hospitalization for children with acute gastroenteritis. Another objective was to evaluate practice variation regarding the amount of glucose provided for IV rehydration in a pediatric emergency department (ED).</p><p><strong>Method: </strong>We conducted a retrospective cohort study from 2019 to 2022 in a Canadian pediatric ED. We included children with acute gastroenteritis undergoing IV rehydration. Patient with hypoglycemia, metabolic disease, or diabetes were excluded. The IV glucose administered during the initial 4 hours of rehydration was quantified. The primary outcome was hospitalization, and return visit within the following week was a secondary outcome. Ten percent of the charts were evaluated in duplicate to assess interrater reliability. We examined glucose distribution at 1 and 4 hours and utilized multiple logistic regression to relate glucose amounts with hospitalization and second visit, accounting for age, weight, bicarbonate levels, ondansetron use, and amount of liquid infused. It was estimated that the evaluation of 250 cases would have at least 50 admissions.</p><p><strong>Results: </strong>Among 6939 children evaluated for potential acute gastroenteritis, 250 met our inclusion/exclusion criteria. All variables included in the analysis had excellent interrater reliability. Notable variations existed in glucose quantities provided, both at 1 hour (first quartile, 87 mg/kg; third quartile, 294 mg/kg) and 4 hours (first quartile, 681 mg/kg; third quartile, 1174 mg/kg) of rehydration. Multiple logistic regression showed a negative association between hospitalization and glucose administration during the initial hour (OR for each 100 mg/kg increment, 0.60; 95% CI, 0.42-0.84) and 4 hours (OR, 0.76; 95% CI, 0.63-0.91) of rehydration. Moreover, children who received more dextrose during the first hour of rehydration were less likely of having a return visit (OR for each 100 mg/kg increment: 0.52; 95% CI, 0.35-0.78), as well as during the first 4 hours (OR for each 100 mg/kg increment, 0.83; 95% CI, 0.73-0.94).</p><p><strong>Conclusions: </strong>There was a wide practice variation in intravenous glucose provided to children with acute gastroenteritis. In this population, higher intravenous glucose amount was associated to a lower risk of hospitalization and lower risk of return visit.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"176-182"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801970","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}