Pediatric emergency care最新文献

{"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}

{"title":"Accidental Toxicological Pediatric Ingestions: Disparities in the Involvement of Social Work and Child Protective Services.","authors":"Henry Nguyen, Joshua Kim, Priya Spencer, Laura Sansoterra, Kelly Levasseur, Amy M DeLaroche","doi":"10.1097/PEC.0000000000003712","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003712","url":null,"abstract":"<p><strong>Objectives: </strong>To examine sociodemographic and clinical factors associated with social work consultation and child protective services (CPS) referrals among children presenting to the pediatric emergency department (ED) after an accidental toxicological ingestion.</p><p><strong>Methods: </strong>This retrospective study included children ≤5 years of age presenting to the ED between January 1, 2021, and December 31, 2023, with a diagnostic code for poisonings. Demographic and clinical variables were recorded, and clinical severity was quantified using 2 complementary scores. Predictor variables include race, ethnicity, language, insurance, serum drug screen and urine drug screen (UDS) results, prior CPS involvement, clinical severity on presentation, and critical interventions. The primary outcome was social work involvement, while the secondary outcome was a CPS referral. Unadjusted odds ratios (OR) with 95% CI were calculated.</p><p><strong>Results: </strong>Among 569 patients, social work was involved in 26.5% (n=151) of cases, and CPS was contacted for 17.8% (n=101). Children who were Black (OR: 2.08, 95% CI: 1.38-3.13, P=0.0005), had public insurance (OR: 2.87, 95% CI: 1.59-5.22, P=0.0003), a positive UDS (OR: 17.79, 95% CI: 7.49-42.22, P<0.0001), or critical/fatal clinical severity (OR: 24.92, 95% CI: 9.55-65.05, P<0.0001) were more likely to have social work consultation. These children were also more likely to have a CPS referral.</p><p><strong>Conclusions: </strong>Race, insurance status, a positive UDS, and clinical severity were associated with social work consultation and CPS referrals among young children presenting to the ED following an accidental ingestion. Evidence-based referral guidelines are needed to promote consistent and equitable decision-making.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025873","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 Conundrum of Maintaining Pediatric Readiness at Nonpediatric Designated Trauma Centers.","authors":"Steven G Schauer, Mark Piehl, Julie A Rizzo, Michael D April","doi":"10.1097/PEC.0000000000003694","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003694","url":null,"abstract":"<p><strong>Introduction: </strong>The American College of Surgeons (ACS) has recently highlighted the need for emergency departments to maintain pediatric readiness, regardless of pediatric trauma center verification. Since sufficient emergency department volume is often required to maintain pediatric competency, a more complete understanding of pediatric trauma volume at centers without ACS verification would help inform efforts to improve pediatric trauma readiness.</p><p><strong>Methods: </strong>We conducted a retrospective descriptive analysis of public data sets from 2017 through 2023 from the Trauma Quality Improvement Program (TQIP) registry. We included encounters at non-pediatric-designated facilities with a documented age. We used deidentified facility keys to perform per-facility analyses. Based on previously published data, we used thresholds of <324, 324 to 899, 900 to 1799, and >1800 pediatric trauma encounters per year for low, medium-low, medium-high, and high volume.</p><p><strong>Results: </strong>Among 5,805,596 trauma encounters with a documented age, 291,418 patients were younger than 15 years old and presented to a trauma center without pediatric verification. During the study period, most nondesignated centers saw at least 1 pediatric trauma patient, with a yearly median of 25 to 32 pediatric trauma encounters per non-pediatric-designated facility. The majority (97%) were in the lowest category of pediatric trauma volume (<324 cases per year). The yearly median encounters per facility with a composite injury severity score >15 were 1. For adult verified level 1, level 2, level 3, and unverified trauma centers, the median visits per year were 31, 31, 22, and 31, respectively. When assessed by age groups of younger than 4, 5 to 9 years, and 10 to 14 years, the median number of visits per year was 8, 9, and 11, respectively.</p><p><strong>Conclusions: </strong>Pediatric encounters at non-pediatric-designated trauma centers were very low, with few trauma centers having sufficient volume to sustain system-level readiness through patient care only. Our findings highlight ongoing challenges with maintaining pediatric readiness and point to the need for innovative methods to ensure a high level of pediatric readiness.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012838","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 With Epidermolysis Bullosa in the Emergency Department.","authors":"Paula García-Sánchez, Beatriz Jiménez de la Jara, Rocío Maseda Pedrero, Raúl de Lucas Laguna, Rosario López López, María de Ceano-Vivas la Calle","doi":"10.1097/PEC.0000000000003703","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003703","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the clinical characteristics, reasons for consultation, management, and outcomes of patients with epidermolysis bullosa (EB) presenting to a pediatric emergency department (PED).</p><p><strong>Methods: </strong>We conducted a retrospective, observational study in a tertiary-care PED in Spain, designated as a national reference center for EB. All visits by patients with a confirmed diagnosis of EB between 2011 and 2025 were included. Demographic, clinical, and management data were collected.</p><p><strong>Results: </strong>Twenty-nine patients accounted for 169 PED visits (median age: 8.1 y; 62% female). Recessive dystrophic EB was the most frequent subtype (72.4%). The median number of visits per patient was 2 (IQR: 1 to 9). Most visits were triaged as level 3 (68%). The leading reasons for consultation were infections (42.6%), gastrointestinal complications (22.5%), particularly esophageal involvement, and gastrostomy-related problems (14.2%). Additional tests were required in 57.4% of visits. Wound/skin cultures were positive in 83.3% of cases in which they were obtained, most commonly isolating Gram-negative organisms and Staphylococcus species. Anemia was present in 83.3% of cases in which hemoglobin was measured. In patients with sepsis, both C-reactive protein and procalcitonin levels were significantly higher compared with non-sepsis cases. Venous access was required in 33.1% of visits and was difficult in 23.2%. Systemic antibiotics were administered in 35.5% of episodes, frequently intravenously. Hospital admission was required in 31% of visits, including 4.7% to the pediatric intensive care unit. Two deaths were recorded.</p><p><strong>Conclusions: </strong>Pediatric patients with EB frequently present to the PED with complex and potentially severe conditions, particularly infections and gastrointestinal complications. High rates of anemia, need for intravenous therapy, and difficulties in vascular access highlight the challenges of acute management. Improved clinician training and standardized care pathways may enhance the safety and quality of emergency care for this vulnerable population.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991139","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":"Identifying Opportunities to Strengthen Alignment Between Educational Mission and Faculty Effort in Pediatric Emergency Medicine.","authors":"Christopher E Gaw, Delia L Gold, Charmaine B Lo, Courtney Coyle, David B Kling, H Michelle Greene, Anne P Runkle, Sarah M Chen, Yamini Jadcherla, Rachel M Stanley, Maya S Iyer","doi":"10.1097/PEC.0000000000003701","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003701","url":null,"abstract":"<p><strong>Objectives: </strong>Pediatric emergency medicine (PEM) clinician educators (CEs) face challenges in balancing clinical, educational, and scholarship expectations. We describe an early-stage, Division-level program evaluation to support CE faculty in teaching and advancement.</p><p><strong>Methods: </strong>From August 2025 to April 2026, an Education Faculty Task Force (EFTF) was convened within an academic emergency department at a freestanding quaternary care children's hospital. The EFTF conducted a program evaluation incorporating (1) Division-level governance and College of Medicine promotion documents; (2) trainee evaluations; (3) a Division-wide survey; (4) a PEM fellow listening session; (5) a focused search of the external literature on education value unit models; and (6) an environmental scan of Division-level education structures within the Department of Pediatrics. We synthesized these data using concepts from complex adaptive systems and professional identity formation theories to identify areas of evidence convergence and inform implementation recommendations.</p><p><strong>Results: </strong>The Division appointed 22 new CE faculty since 2020 and trains ~300 learners annually. Division educational governance was organized around programmatic roles with reporting lines directly to the Division Chief. A focused literature search on educational value units identified both benefits and barriers to sustained educator engagement. Within the Department of Pediatrics, heterogeneity existed in Division-level educational tracking and faculty engagement, reflecting local needs with no easily replicable model. Division-level programs involving simulation, interprofessional education, and procedural teaching demonstrated programmatic strengths but fragmentation. Strengthening educational infrastructure was deemed essential to support learners and sustainable CE scholarship. From these findings, the EFTF identified 5 priority implementation recommendations.</p><p><strong>Conclusions: </strong>As academic medical centers grow in scale and complexity, thoughtful institutional support of PEM CEs is imperative. We utilized a systems-oriented approach to identify opportunities for improving educational infrastructure while accounting for structural barriers, local communities of practices, and professional identity, with the goal of supporting an engaged and sustainable academic workforce.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983384","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":"Duration of Resuscitation and Survival of Pediatric Traumatic Cardiac Arrest: A Systematic Review of the Literature and Meta-Analysis.","authors":"Romana Erblich, Marius Knöll, Brigitte Wildner, Dominik Jenny, Matthias Noitz, Bernhard Eichler, Mervyn Mer, Jens Meier, Martin W Dünser","doi":"10.1097/PEC.0000000000003706","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003706","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the association between resuscitation duration and survival from pediatric traumatic cardiac arrest (TCA).</p><p><strong>Methods: </strong>A meta-analysis was conducted. CENTRAL, MEDLINE, and EMBASE were searched from January 1, 2000, to January 31, 2026. Eligible studies included English-language original research involving children (<18 y) undergoing resuscitation for TCA.</p><p><strong>Results: </strong>Thirteen studies were included, comprising 28 survivors, 21 survivors with favorable outcomes, and 281 nonsurvivors or patients with unfavorable outcomes. The pooled mean resuscitation duration was 5.9 (95% CI: 2.5-9.2) minutes among survivors, 7.7 (95% CI: 0.1-17.7) minutes among survivors with favorable outcomes, and 44.8 (95% CI: 33.0-56.6) minutes among nonsurvivors or those with unfavorable outcomes. Resuscitation duration was significantly shorter in survivors than nonsurvivors (P=0.0002) and in patients with favorable versus unfavorable outcomes (P=0.0293). Individual patient data showed that 50% of survivors achieved return of spontaneous circulation (ROSC) within 13 minutes, 77.8% within 23 minutes, 88.9% within 30 minutes, and all survivors within 45 minutes. Among survivors with favorable outcomes, 87.5% achieved ROSC within 30 minutes, and all within 45 minutes.</p><p><strong>Conclusions: </strong>Evidence regarding the association between resuscitation duration and survival after pediatric TCA remains highly limited. Available data suggest that survivors of predominantly blunt pediatric TCA generally achieve ROSC early during resuscitation, with pooled mean resuscitation durations of ~6 minutes in all survivors and 8 minutes in survivors with favorable outcome. Resuscitation efforts in nonsurvivors are continued for a pooled mean duration of ~45 minutes. No survivor was identified after resuscitation >45 minutes.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977524","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":"Comparing Oscillometric and Manual Mean Arterial Pressure Measurements Among Children in the Emergency Department.","authors":"Abidatou Diasso-Adamou, Cristina Payan, Danielle Cory, Sriram Ramgopal","doi":"10.1097/PEC.0000000000003696","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003696","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate agreement among three approaches to mean arterial pressure (MAP) measurement in children.</p><p><strong>Methods: </strong>We performed a single-center prospective study of a convenience sample of children (<18 y) presenting to a pediatric emergency department. We compared MAP agreement using the intraclass correlation coefficient (ICC) measured in three ways: calculated via auscultation, calculated from oscillometric systolic and diastolic measurements, and measurement via oscillometry.</p><p><strong>Results: </strong>We included 347 patients (median age 8 y, IQR: 4 to 13). The highest ICC was observed between calculated and device-reported oscillometric MAP measurements (0.83, 95% CI: 0.79-0.86), indicating good agreement. Agreement was poor between manual and device-reported oscillometric MAP (ICC: 0.33, 95% CI: 0.22-0.43) and between manual and calculated oscillometric MAP (ICC: 0.38, 95% CI: 0.20-0.52). The median difference between calculated oscillometric and device-reported oscillometric MAP was 1.0 mm Hg (IQR: 0.0 to 2.3), compared with -3.3 mm Hg (IQR: -8.3 to 2.0) between manual and device-reported oscillometric MAP and -4.0 mm Hg (IQR: -9.3 to 0.3) between manual and calculated oscillometric MAP. Bland-Altman plots suggested that manual MAP measurements were slightly lower than both device-reported oscillometric and calculated oscillometric MAP measurements. Agreement between calculated oscillometric and device-reported oscillometric MAP was highest among children <2 years and lowest among children 12 to <18 years. Agreement involving manual MAP remained poor across most age groups. Similar patterns were observed when stratified by weight and patient state.</p><p><strong>Conclusions: </strong>Calculated oscillometric MAP had good agreement with device-reported oscillometric MAP, while manual MAP had poorer agreement with either oscillometric measure. Further study is needed to determine the clinical implications of these differences across age, weight, and patient-state subgroups.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977465","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}