Pediatric emergency care最新文献

{"title":"Addressing Caregiver Intimate Partner Violence in the Pediatric Emergency Department.","authors":"Cheyenne Smith, Ashlee Murray","doi":"10.1097/PEC.0000000000003366","DOIUrl":"10.1097/PEC.0000000000003366","url":null,"abstract":"<p><p>Caregiver intimate partner violence (IPV) is common, with an estimated one in 4 children exposed to family violence during their lifetime. This often leads to poor physical, emotional, and cognitive outcomes for these children. Pediatric emergency departments (EDs) are critical touchpoints for addressing caregiver IPV, as these caregivers frequently seek care for their children. This CME article explores the prevalence of caregiver IPV and identifies best practices around identification, trauma-informed care, documentation, and resource provision within pediatric EDs. We highlight universal education-an approach endorsed by the American Academy of Pediatrics-which involves providing IPV-related resources to all caregivers to normalize conversations and expand access to support. Ongoing efforts to enhance caregiver IPV identification and intervention in the pediatric ED setting are crucial for addressing this widespread public health concern.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":"41 6","pages":"489-495"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply: Comparing the Use of Crotaline-Polyvalent Immune Fab (Ovine) Versus Observation in Children.","authors":"Stephen Rohl, Mark Meredith, Tucker Anderson, Mark Snider, Saralyn Williams, Elizabeth Tolley, Donna Seger","doi":"10.1097/PEC.0000000000003380","DOIUrl":"10.1097/PEC.0000000000003380","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"e33"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663484","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":"Artificial Intelligence as a Language Barrier Application in a Simulated Health Care Setting: A Proof-of-Concept Study.","authors":"Nicholas Hampers, Rita Thieme, Louis Hampers","doi":"10.1097/PEC.0000000000003369","DOIUrl":"10.1097/PEC.0000000000003369","url":null,"abstract":"<p><strong>Objective: </strong>We evaluated the accuracy of an artificial intelligence program (ChatGPT 4.0) as a medical translation modality in a simulated pediatric urgent care setting.</p><p><strong>Methods: </strong>Two entirely separate instances of ChatGPT 4.0 were used. The first served as a simulated patient (SP). The SP generated complaints and symptoms while processing and generating text only in Spanish. A human provider (blinded to diagnosis) conducted a clinical \"visit\" with the SP. The provider typed questions and instructions in English only. A second instance of ChatGPT 4.0 was the artificial medical interpreter (AMI). The AMI translated the provider's questions/instructions from English to Spanish and the SP's responses/concerns from Spanish to English in real time. Post-visit transcripts were then reviewed for errors by a human-certified medical interpreter.</p><p><strong>Results: </strong>We conducted 10 simulated visits with 3597 words translated by the AMI (1331 English and 2266 Spanish). There were 23 errors (raw accuracy rate of 99.4%). Errors were categorized as: 9 omissions, 2 additions, 11 substitutions, and 1 editorialization. Three errors were judged to have potential clinical consequences, although these were minor ambiguities, readily resolved by the provider during the visit. Also, the AMI made repeated errors of gender (masculine/feminine) and second person formality (\"usted\"/\"tu\"). None of these were judged to have potential clinical consequences.</p><p><strong>Conclusions: </strong>The AMI accurately and safely translated the written content of simulated urgent care visits. It may serve as the basis for an expedient, cost-effective medical interpreter modality. Further work should seek to couple this translation accuracy with speech recognition and generative technology in trials with actual patients.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":"41 6","pages":"481-485"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12118609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187607","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":"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":"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":"443-447"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","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":"A Descriptive Analysis of the Reliability of the Broselow Tape for Use in the US Pediatric Trauma Population: A Trauma Quality Improvement Program Study.","authors":"Ian S McCullough, Melissa L Givens, Kelli J Welter, Hannah L Gale, Ashley E Sam, Jonathan Henderson, Michael D April, Steven G Schauer","doi":"10.1097/PEC.0000000000003362","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003362","url":null,"abstract":"<p><strong>Objectives: </strong>Length-based weight estimation tools are used for estimating a pediatric patient's weight when the actual body weight is not readily available. We sought to evaluate the proportion of children that were >20% outside of the estimated weight range using data from the Trauma Quality Improvement Program (TQIP) registry.</p><p><strong>Methods: </strong>We completed a retrospective review using data from the TQIP registry from 2017 to 2022. We included patients below 15 years of age who had a documented height within the range of the Broselow tape. We excluded patients without documentation of both height and weight and those that were >2× over the upper weight limit. We define underestimated as a patient's estimated weight being lower than their measured weight and overestimated as their estimated weight being higher than the measured weight. We particularly focused on under or overestimation by >20% as our primary outcome.</p><p><strong>Results: </strong>A total of 204,097 patients met our inclusion criteria. Two percent of patient's weights were overestimated by >20%. Fourteen percent of patient's weights were underestimated by >20%.</p><p><strong>Conclusions: </strong>We found that nearly 1 in 7 patients' measured body weight was above the weight range estimated by the Broselow tape by >20%, creating the potential for medication underdosing.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174451","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":"Point-of-Care Ultrasound Detection of Pseudoaneurysms in Pediatric Patients: A Multicenter Case Series.","authors":"Jaron A Smith, Kaitlyn M Boggs, Allie A Grither, Kathryn E Kasmire, Anelah McGinness, Veronica Renov, Oren Tamary, Inbal Kestenbom, Boris Azis Mirch, Bethsabee S Stone","doi":"10.1097/PEC.0000000000003416","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003416","url":null,"abstract":"<p><p>Pseudoaneurysms are a relatively rare presentation in the pediatric emergency department with considerable implications. Ultrasonography is commonly employed in identifying pseudoaneurysms and distinguishing them from true aneurysms. Reports of detecting pseudoaneurysms by point-of-care ultrasound (POCUS) are abundant in adults, yet scant in children. We present a multi-institutional 8-case series of POCUS used in pediatric patients to identify pseudoaneurysms in 6 different anatomic locations.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174452","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":"Variable Yet Distinctive: Revisiting Radiographic Features of Mycoplasma pneumoniae Pneumonia.","authors":"Yanzhi Wang, Man Tian","doi":"10.1097/PEC.0000000000003420","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003420","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151332","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 \"Honey, I Shrank the Beads: Water Bead Growth and Shrinking in Different Solutions In Vitro\".","authors":"Ashley Haugen","doi":"10.1097/PEC.0000000000003419","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003419","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151328","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 Eliminating Oral Contrast on Computed Tomography Abdomen/Pelvis Throughput in the Pediatric Emergency Setting: A Multisite Analysis.","authors":"Farid Hajibonabi, Ashishkumar Parikh, Erica Riedesel, Geetika Khanna","doi":"10.1097/PEC.0000000000003418","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003418","url":null,"abstract":"<p><strong>Objective: </strong>Historically, oral contrast has been considered essential for the evaluation of abdominal pathology on computed tomography (CT). With advances in CT technology, the need for oral contrast has decreased. Many pediatric studies have shown that lack of oral contrast has no impact on the diagnostic accuracy of CT abdomen/pelvis for evaluation of acute abdominal pain. This study evaluates the impact of updated oral contrast guidelines on patient throughput in a large multisite children's health care system.</p><p><strong>Methods: </strong>This is a single pediatric health care system multisite retrospective study. Guidelines for abdominopelvic CT scans from pediatric emergency departments at 2 free-standing children's hospitals were modified to limit the use of oral contrast in 2021. Interrupted time series analysis was performed, evaluating the use of oral contrast before and after targeted intervention during 2019 and 2023, and the impact of guidelines on turnaround time for performance of CT examinations.</p><p><strong>Results: </strong>A total of 2259 abdominopelvic CT examinations from the emergency department (ED) were evaluated, 48.7% (1101/2259) before intervention and 51.3% (1158/2259) following intervention. Sex was similar during the 2 periods [females: 47.6% (524/1101) and 48.9% (566/1158) respectively; P = 0.54]. Median (IQR) age was 10 years old (7 to 14) and 12 years old (7 to 15) in 2019 and 2023, respectively (P = 0.001). Before intervention, oral contrast was used in 32.7% (278/851) examinations at hospital 1 and 41.6% (104/250) examinations at hospital 2. Following intervention, oral contrast use decreased at hospital 1 to 5.4% (45/835) and at hospital 2 to 2.5% (8/323) (all P < 0.001). After intervention, mean time from CT order to examination completion at hospital 1 changed from 129 to 100 minutes (P < 0.001) and at hospital 2 changed from 152 to 76 minutes(P < 0.001).</p><p><strong>Conclusion: </strong>Changes to oral contrast guidelines successfully decreased the use of oral contrast in abdominopelvic CT scans from the pediatric ED, resulting in significantly improved examination throughput.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142992","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":"Racial and Ethnic Differences in ED Analgesia Among Injured Children Transported Via EMS.","authors":"Sarahjean Kerolle, Lorin R Browne, Ruta Brazauskas, Kathleen M Adelgais, Kunal Chadha, Todd P Chang, Matthew I Harris, E Brooke Lerner, Julie C Leonard, Geoffrey S Lowe, Christyn F Magill, Daniel K Nishijima, Manish I Shah, Hamilton P Schwartz, Corrie E Chumpitazi","doi":"10.1097/PEC.0000000000003389","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003389","url":null,"abstract":"<p><strong>Objectives: </strong>Pain management remains suboptimal across the prehospital and the emergency department (ED) settings. Racial and ethnic disparities in the timing of analgesia among children transported to EDs via emergency medical services (EMS) are not known. We investigated disparities in the timing of ED pain management for injured children transported by EMS.</p><p><strong>Methods: </strong>We conducted a secondary analysis of a multicenter prospective observational study of children transported via EMS to 10 pediatric EDs. We analyzed the timing of ED analgesia for injured children by race and ethnicity: non-Hispanic White (NH-White), non-Hispanic Black (NH-Black), Hispanic, and Other or Multiracial. We stratified doses of ED analgesia by opioids, nonopioids, nonsteroidal anti-inflammatory drugs, and other analgesic medications regardless of routes of administration.</p><p><strong>Results: </strong>Among 480 eligible injured children, 353 (73.5%) received ED analgesia and 150 (31.3%) received opioid analgesia in the ED after EMS transport. The median time to first administration of any ED analgesia was 39 minutes (range, 2 min to 6 h). Hispanic children received their first dose of any ED analgesia 55 minutes (minimum-maximum, 2 to 369) into their ED care, compared with 38 minutes (4 to 379) for NH-Black, 37 minutes (4 to 345) for NH-White, and 32 minutes (9 to 188) for children of Other or Multiracial groups (P=0.0148). There were no statistical differences in the time to first ED opioid analgesia by race and ethnicity (P=0.3270). Patients with long bone fractures (hazard ratio: 1.56, 1.18-2.06) and those who had received EMS opioids (1.43, 1.07-1.91) were more likely to receive both any analgesia and opioid analgesia in the ED.</p><p><strong>Conclusions: </strong>Among injured children across the country transported by EMS to pediatric EDs, there were race and ethnicity differences with respect to time to any ED analgesia; however, no delay for ED opioids. Further research is needed to understand and mitigate potential root causes of these disparities.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120566","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}