Pediatric emergency care最新文献

{"title":"Drivers of Bronchodilator Use in Bronchiolitis: Analyzing Treatment Trends From Pediatric Emergency Department Practices.","authors":"Andrea Rivera-Sepulveda, Timothy Maul, Anna Jurlina, Kathryn V Blake, Matthew M Davis, Kenneth Alexander","doi":"10.1097/PEC.0000000000003360","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003360","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to evaluate patient characteristics associated with bronchodilator (BD) use at various stages of bronchiolitis illness and evaluate corresponding patient outcomes in the emergency department (ED).</p><p><strong>Methods: </strong>This retrospective, cross-sectional study involves secondary data analysis from a sample of 932 children ages 3 to 24 months who received a diagnosis of bronchiolitis during an ED visit (1057 cases). Predictor variables included demographics, past medical history, family history, physical findings, medication use, and disposition. Outcomes included BD use for bronchiolitis symptoms in the pre-ED and ED settings, and associated care outcomes in the ED. Predictors of BD use in the ED with statistical significance were incorporated in a predictive multivariable logistic regression model with a training-validation split of 70% to 30%.</p><p><strong>Results: </strong>Children with prior BD use were significantly more likely than children without such history to receive BD treatment during their current bronchiolitis illness before the ED [odds ratio (OR): 23.7, 95% CI: 14.4-39], in the ED (OR: 2.6, 95% CI: 1.76-3.77), and as a prescription upon discharge from the ED (OR: 3.7, 95% CI: 2.49-5.58). In multivariable regression analyses, older age, parental asthma history, and wheezes and retractions on ED physical examination were significantly associated with BD use in the ED (P<0.05). The area under the curve for the validation model with these variables was 0.826 (95% CI: 0.794-0.858).</p><p><strong>Conclusions: </strong>Prior BD use was associated with subsequent use during the current illness, during ED care, and subsequent prescription, forming a cyclical pattern. A perceived bronchospastic phenotype of bronchiolitis may influence clinical practice in ED settings.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524118","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":"Children's Emergency Department Provider Experiences With Lethal Means Restriction Counseling and Firearm Access.","authors":"Arielle Shibi Rosen, Kirsten Bechtel","doi":"10.1097/PEC.0000000000003363","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003363","url":null,"abstract":"<p><strong>Objective: </strong>Assessing firearm access and providing lethal means restriction counseling (LMRC) is paramount for harm reduction, but evidence indicates that it is not commonly provided by Children's Emergency Department (ED) providers. This study aimed to explore provider perspectives and determine avenues to increase discharge safety for patients with behavioral health emergencies.</p><p><strong>Methods: </strong>Twenty-nine Children's ED providers completed semistructured interviews which were recorded, transcribed, iteratively coded, and organized into themes.</p><p><strong>Results: </strong>We identified the following 5 themes: (1) Children's ED providers have varying experiences with firearms which could influence their clinical practices. (2) Most providers expressed knowledge of LMRC as a necessary component of safety planning for behavioral health patients. (3) The role of medical providers is commonly assumed to be only in medical clearance, with LMRC falling to social workers and psychiatrists. (4) Many Children's ED providers seem to underestimate the gravity of risk associated with firearm access for children with behavioral health complaints. (5) Training and resources could help facilitate effective LMRC and support caregiver implementation of firearm secure storage.</p><p><strong>Conclusions: </strong>Despite a wide range of perspectives and barriers that prevent the consistent provision of LMRC, we saw that providers are amenable to interventions to increase comfort, consistency, and efficacy of safety planning. Understanding these perspectives can inform future initiatives for comprehensive LMRC that include firearm secure storage and address this crucial gap in care.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516300","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":"POCUS Standoff: Comparing Ultrasound Interfaces for Soft Tissue Foreign Body Imaging.","authors":"Carolina Vega, Robert Lindsay, Keyon Shokraneh, Celia S Willard, Timothy Gleeson, Monica Kapoor, Ari Nalbandian, Zachary Binder","doi":"10.1097/PEC.0000000000003359","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003359","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound can be used to identify foreign bodies (FBs) in soft tissue. Imaging interfaces such as standoff pads and water baths can improve image resolution for superficial soft tissue structures. Our objective was to determine the optimal interface for FB detection. We hypothesized that water baths would be associated with the greatest FB detection accuracy and image quality.</p><p><strong>Methods: </strong>Prospective analysis of ultrasound imaging interfaces to detect FBs. 18 emergency physicians in training were enrolled: 8 interns, 8 senior residents, and 2 fellows. Four imaging interfaces were compared: gel, saline bag standoff, water bath, and a novel proposed interface: water-filled patient belongings bag (PBB). Standardized FBs (wood, plastic, and metal) were inserted into porcine models, which were imaged by participants using the interfaces. The primary outcome was the accuracy of FB detection for the interfaces. Secondary outcomes included time to FB detection, image quality, and impact of training level. Ultrasounds were reviewed by 2 blinded ultrasound fellowship-trained emergency physicians to determine FB visibility and image quality. Data analysis was performed using the χ2 test and Kruskal-Wallis test with GraphPad Prism Software.</p><p><strong>Results: </strong>Eighteen participants completed 16 stations. Two hundred eighty-eight ultrasounds total. Interface types demonstrated a trend of greatest accuracy for PBB, followed by water bath, gel, and saline bag. Gel was significantly more accurate than saline bag (P=0.0120). Gel did not have a significant difference from PBB (P=0.1425) or water bath (P=0.125). As training level increased, time to FB detection significantly decreased (P=0.02), and accuracy increased. Accuracy for fellows was significantly greater than for senior residents (P=0.0473) and interns (P=0.0027). There was a trend of greater accuracy in senior residents from interns.However, there was no significant difference (P=0.0729).</p><p><strong>Conclusions: </strong>PBBs may be a viable alternative interface for soft tissue FB detection. PBBs, water baths, and gel should be considered prior to saline standoffs.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493199","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":"Oxygen Saturation Sub-analyses Errors in the Dominant Meta-analysis Used to Deimplement Albuterol as a Therapeutic Option for Bronchiolitis.","authors":"Larry Mellick, Gabriella Weston, Paul Walsh, Shane McKinney, Hongyan Xu","doi":"10.1097/PEC.0000000000003352","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003352","url":null,"abstract":"<p><strong>Objective: </strong>Clinical experience and patient-level physiological studies indicate that albuterol transiently reduces oxygen saturation, irrespective of the underlying respiratory condition causing the wheezing. Three revisions of the Cochrane review, Bronchodilators for Bronchiolitis (Review), have found that albuterol temporarily increases oxygen saturation. Rarely, these findings were even statistically significant, but the direction of effect is consistently opposite from physiological studies. In this study, we attempted to resolve this apparent paradox.</p><p><strong>Methods: </strong>The original trial publications included in multiple oxygen saturation sub-analyses in the 2006, 2010, and 2014 updates of the Cochrane review were assessed for appropriate study inclusion, correctness of calculations, and correct analysis with respect to direction of effect. The studies were also reviewed to assess whether the data was correctly transferred to the meta-analysis software. We repeated the meta-analyses calculations after correcting for suspected errors and plotted the results of the meta-analyses as originally reported and in their corrected form on an albatross plot.</p><p><strong>Results: </strong>We found data miscalculations, errors of transposition of albuterol and placebo data, the inclusion of inpatient data in outpatient analyses, and questionable study inclusions in the 3 Cochrane review updates. After corrections were made, the direction of effect of albuterol switched negative, albeit nonsignificantly, a finding most consistent with clinical and physiological observations. In addition, the very wide heterogeneity between the original meta-analyses disappeared.</p><p><strong>Conclusion: </strong>After multiple suspected data flaws were corrected our reanalyses of the reported data confirmed that decreased oxygen saturation can be expected following administration of albuterol to infants presenting with bronchiolitis syndrome, thereby resolving the apparent paradox in favor of clinical observation and research physiology.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483883","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":"Emergency Management of Animal-Related Injuries in Children: An Observational Multicenter Italian Study.","authors":"Onorina Di Mita, Margherita Rosa, Laura Ruggiero, Vincenzo Tipo, Fabio Savoia, Claudio Fiorilla, Ilaria Liguoro, Paola Cogo, Elena Bozzola, Francesco La Penna, Fabio Cardinale, Francesco La Torre, Federico Marchetti, Angela Troisi, Andrea Cella, Giacomo Biasucci, Nadia Rossi, Roberta Rossi, Caterina Pacenza, Sergio Manieri, Giuseppe Di Cara, Francesca Corrias, Giuseppe Patano, Marco Maglione","doi":"10.1097/PEC.0000000000003358","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003358","url":null,"abstract":"<p><strong>Objectives: </strong>Animal-related injuries (ARIs) represent a common reason for emergency department (ED) visits in children. Limited data regarding treatment in Italian EDs are available. The aims of the study were to assess the epidemiological features of these patients and to investigate the association between their characteristics and therapeutic approaches, particularly antibiotic prescription.</p><p><strong>Materials and methods: </strong>Patients presenting to 13 pediatric EDs from 11 Italian regions because of ARIs were prospectively enrolled for 20 months. Patients' clinical data, injury characteristics, and performed treatment were recorded.</p><p><strong>Results: </strong>We enrolled 442 patients aged 6.1 years (3.9) who were grouped in non-insect-related injuries (non-IRIs, n=236) and insect-related injuries (IRIs, n=206). Most injuries occurred in an outdoor setting during the afternoon. Except for IRIs, the most frequently involved animals were pets, mostly dogs (91.5%). In 59.1% of cases, the injury extent was <15 mm. The antibiotic prescription was more likely in children presenting with a lesion by a wild animal [odds ratio (OR): 5.8 (CI 95%: 1.27-26.57), P=0.02], in those with lacerations [OR: 2.90 (CI 95%: 1.13-6.54), P=0.01], and in those with larger injuries [OR: 2.66 (CI 95%: 1.49-4.76), P<0.01]. Antibiotics were more frequently prescribed in non-IRIs compared with IRIs (P<0.001), whereas IRIs more commonly received oral or topical steroids, topical antibiotics, or antihistamines (P<0.001).</p><p><strong>Conclusions: </strong>Most pediatric ARIs require limited emergency management. Antibiotic prescriptions are more likely in large lesions determined by wild animals. Monitoring non-IRIs and IRIs may provide useful information to improve and uniform therapeutic management and to plan public health preventive interventions.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483882","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":"Dieulafoy Lesion in a Pediatric Patient.","authors":"Meylakh Barshay, Maiya Cowan, Meghan Beucher","doi":"10.1097/PEC.0000000000003347","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003347","url":null,"abstract":"<p><strong>Objective: </strong>Our aim is to describe a rare etiology of an upper gastrointestinal bleeding (UGIB) to help pediatric emergency medicine clinicians improve their understanding of its presentation as well as the standard therapeutic approach to UGIB.</p><p><strong>Methods: </strong>This is a retrospective case report of a patient who presented to the Pediatric Emergency Department of Hasbro Children's Hospital and who was found to have a UGIB secondary to a Dieulafoy lesion.</p><p><strong>Results: </strong>The etiology of UGIBs varies by geography and patient age but includes esophagitis, Mallory-Weiss tears, gastritis, peptic ulcers, and foreign body ingestion. Given the overlapping presenting symptoms, history and physical are critical to identifying likely etiology and guiding treatment. This patient improved after definitive treatment with endoscopy and hemo-clips.</p><p><strong>Conclusions: </strong>Children with symptoms of UGIB should receive prompt resuscitation and stabilization, and clinicians should maintain an index of clinical suspicion for less common pediatric pathologies, such as malignancy or arterial bleeding.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468527","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":"Cardiac Point-of-Care Ultrasound Findings in Multisystem Inflammatory Syndrome in Children in the Pediatric Emergency Department.","authors":"Inbal Kestenbom, Eric Scheier, Bat-Hen Annie Daviko, Ron Berant, Nachshon Buchshtav, Natalia Sheinberg, Nir Friedman","doi":"10.1097/PEC.0000000000003351","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003351","url":null,"abstract":"<p><strong>Objectives: </strong>Multisystem inflammatory syndrome in children (MIS-C) is a potentially life-threatening condition associated with cardiac involvement. Cardiac point-of-care ultrasound (POCUS) can be performed at the bedside in the pediatric emergency department (PED) to identify cardiac pathology. There is limited data on cardiac POCUS findings in children with MIS-C in the PED. The main outcome objective of our study was to describe the cardiac POCUS findings in MIS-C patients in the PED.</p><p><strong>Methods: </strong>This is a multicenter, retrospective, cohort study between February 15, 2021 and March 31, 2022, during the alpha, delta, and omicron severe acute respiratory syndrome coronavirus 2 waves in 6 PEDs in Israel. We included patients diagnosed with MIS-C who received a cardiac POCUS examination in the PED. All POCUS clips were analyzed by a PED POCUS expert.</p><p><strong>Results: </strong>We included 32 MIS-C patients who underwent cardiac POCUS during the study period. The median age was 8 years (interquartile range = 6 to 10 y), and 20 (63%) were males. The median time from onset of symptoms upon PED visit was 5 days (interquartile range = 4 to 5 d). Overall, 27 patients (84%) were diagnosed with normal cardiac function and 5 patients with decreased cardiac function (16%). No patients were diagnosed with pathologic cardiac effusion. Three patients were diagnosed with plethoric inferior vena cava. Among the patients, 17 (53%) were admitted to the pediatric wards and 15 (47%) to the pediatric intensive care unit. There was no mortality.</p><p><strong>Conclusion: </strong>Cardiac POCUS by PEM physicians is an applicable tool for the evaluation of MIS-C patients in the PED. In our study, 16% of MIS-C patients who underwent POCUS had decreased cardiac function per POCUS on their PED presentation. Future studies are needed to evaluate the impact of cardiac POCUS in the PED of patients with MIS-C.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458976","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":"A Prediction Rule to Identify Children and Young Adults at Low Risk for Myocarditis.","authors":"Katia C Genadry, Michael C Monuteaux, Kenneth A Michelson, Emily M Bucholz, Rebekah Mannix","doi":"10.1097/PEC.0000000000003354","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003354","url":null,"abstract":"<p><strong>Objective: </strong>(1) To derive a prediction rule for pediatric myocarditis that distinguishes low-risk patients for whom additional work-up, including venipuncture or cardiac imaging, may be avoided, (2) to assess the test characteristics of troponin in our study population.</p><p><strong>Methods: </strong>This retrospective case-control study included all patients who presented to a pediatric emergency department between 2010 and 2021 and underwent troponin testing for suspected myocarditis. Myocarditis cases (identified using American Heart Association criteria) and controls were to approximate a 1:2 ratio. Logistic regression with forward selection was used to derive a prediction rule for myocarditis. As the goal was to derive a rule for low-risk children, in whom venipuncture would be unnecessary, laboratory results were analyzed separately.</p><p><strong>Results: </strong>We identified 93 case patients and 202 control patients. The final prediction rule included chest pain [adjusted odds ratio (aOR): 3.5, 95% CI: 1.8 to 7.0], reported or measured fever (aOR: 1.7, 95% CI: 1.0 to 3.1,) and atrioventricular conduction delays or ST segment changes (aOR: 2.6, 95% CI: 1.4 to 4.7). Sensitivity, calculated as the proportion of cases with at least one of the 3 predictors was 99% (95% CI: 0.94 to 0.99), and specificity was 14% (95% CI: 0.09 to 0.20). With at least 2 predictors, sensitivity was 60% (95% CI: 0.50 to 0.71) and specificity was 72% (95% CI: 0.65 to 0.78).</p><p><strong>Conclusion: </strong>The prediction rule developed can help identify children at low risk for myocarditis and, therefore, avoid troponin testing and/or further evaluation including cardiology consult or cardiac imaging. Specificity was insufficient to rule in myocarditis without additional investigation.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458960","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":"Practice Variation in Urine Collection Among Emergency Department Providers in Pre-toilet-trained Children With Suspected Urinary Tract Infection.","authors":"Lucy M Wilson, Terry P Klassen, Tighe Crombie, Apoorva Gangwani, Veronica Ka Wai Lai, Karen Gripp, Elisabete Doyle, Darcy Beer, Kaitlin Hogue, Oana Florescu, Lisa Knisley, Alex Aregbesola","doi":"10.1097/PEC.0000000000003337","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003337","url":null,"abstract":"<p><strong>Background: </strong>Urinary tract infections are a common cause of acute illness among children presenting to the emergency department (ED). Many techniques exist to collect urine specimens in pre-toilet-trained children. There is wide practice variation regarding the most appropriate collection method. This variation also appears to exist across national health organizations and societies. To date, little is known about the extent of practice variation in urine collection methods or the influence of patient and health care provider characteristics on the choice of collection method.</p><p><strong>Materials and methods: </strong>A cross-sectional survey was designed and comprised of 3 sections: pediatric emergency medicine physician demographics, pediatric ED demographics, and case scenarios designed to assess the context surrounding urine collection method choice. The survey was disseminated to pediatric emergency medicine physicians across Canada from February 2023 to April 2023. A descriptive analysis of the characteristics of pediatric emergency medicine physicians and the EDs in which they worked was performed. Multivariate logistic regression models were used to examine pediatric emergency medicine physicians and ED factors that influence urine collection methods.</p><p><strong>Results: </strong>Of 235 surveys, 96 were returned (41% participation rate). Most respondents were aged 40 to 49 (n=31, 35.6%), female (60.5%), completed residency in Ontario (18.4%) and Quebec (17.2%), and worked at the Children's Hospital of Eastern Ontario (16%). There was variation in urine collection methods among pediatric emergency medicine physicians with a preference for transurethral catheterization and bladder stimulation versus other methods. Factors such as the length of wait time of patients to be seen in the ED (odds ratio=3.03, 95% CI=1.14-8.09) and year postmedical school (odds ratio=1.67, 95% CI=1.07-2.60) were associated with increased choice of urinary catheterization when selecting a urine collection method.</p><p><strong>Conclusions: </strong>The data suggests there is practice variation in urine collection methods among Canadian pediatric emergency medicine physicians. This practice variation is influenced by both individual providers and the demographics of EDs.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441719","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 Drowning and Prehospital Predictors of Critical Illness in the United States.","authors":"Molly Greenshields, Michael C Monuteaux, Kate Dorney, Angelica Garcia, Lois K Lee, Caitlin A Farrell","doi":"10.1097/PEC.0000000000003345","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003345","url":null,"abstract":"<p><strong>Objective: </strong>Drowning is a leading cause of injury-related death for US children. The study objectives are to describe the characteristics of pediatric drowning patients receiving emergency medical services (EMS) care in the United States and to identify patient-specific and incident-specific variables associated with critical illness after drowning.</p><p><strong>Methods: </strong>This is a cross-sectional study using the 2019 National Emergency Medical Services Information System database. Children below 19 years old with international classification of diseases 10 external cause of injury (E-codes) for drowning were included. Critical illness was defined as a recorded Glasgow Coma Scale score <9 at any time during EMS care. We performed multivariable logistic regression reporting odds ratios (OR) and 95% CI for the outcome of critical illness controlling for demographic and incident characteristics.</p><p><strong>Results: </strong>Our study sample included 1052 patients, and 57% were below 5 years. Critical illness after drowning was identified in 23.9% (n=251). Most drowning patients were transported via advanced life support (88.4% for noncritically ill, 87.3% for critically ill patients). Resuscitation procedures performed by EMS for these patients included the following: 12.7% with assisted ventilation, 6.7% with advanced airway management, and 17.8% with cardiopulmonary resuscitation. There were increased odds of critical illness in males (OR 1.41, 95% CI: 1.03, 1.93) and in children below 1 year (OR 2.54, 95% CI: 1.26, 5.10) and 1 to 4 years (OR 1.61, 95% CI: 1.01, 2.56) compared with 13 to 19 years and decreased odds for urban location (OR 0.60, 95% CI: 0.39, 0.91).</p><p><strong>Conclusions: </strong>Among children receiving EMS care after drowning, 23.9% were critically ill, and predictors of critical illness included male sex, young age, and nonurban locations. Using national EMS data is a novel approach to inform prehospital and emergency department preparedness to improve care for pediatric patients after drowning including pediatric resuscitation procedures by EMS personnel.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433623","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}