Pediatric emergency care最新文献

{"title":"Pediatric Emergency Care Coordinator-Facilitated Education Curriculum in Community Emergency Departments: A Multisite Evaluation.","authors":"Snimarjot Kaur, Carlee Lenehan, Erin Montgomery, Kamal Abulebda, Theresa Walls, Robert A Dudas, Jason Crellin, Arushi Manga, Lynda Knight, Daniel Scherzer, Elizabeth Sanseau, Sofia G Athanasopoulou, Marc Auerbach","doi":"10.1097/PEC.0000000000003638","DOIUrl":"10.1097/PEC.0000000000003638","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate a Pediatric Emergency Care Coordinator (PECC)-facilitated curriculum in Community Emergency Departments (CEDs). The objectives were to (1) increase CED staff engagement with pediatric education, (2) improve learners' pediatric knowledge and self-efficacy, and (3) explore PECCs' perceptions of the curriculum.</p><p><strong>Methods: </strong>A prospective study evaluated a 12-week curriculum focused on the topics of pediatric status epilepticus and newborn resuscitation. The curriculum consisted of 10 weeks of brief asynchronous online weekly assignments (articles, videos, and podcasts), with in situ simulations in the first and last weeks. Engagement was measured by tracking learners' access to the content. Simulation performance was measured via case-specific checklists. Online surveys measured learners' pediatric knowledge and self-efficacy, and learners'/PECCs' satisfaction and perceptions.</p><p><strong>Results: </strong>Twenty-one CED sites started the project, with 14 (67%) completing the curriculum. One hundred seventeen learners (53% nurse, 28% physician, 19% other staff) participated in the initial simulation, while 71 (61%) learners completed the follow-up simulation. Learners reported improvements in case-based pediatric knowledge and self-efficacy ( P <0.001). No change was noted in simulation performance scores. The Net Promoter Score, indicating overall satisfaction with the curriculum, was high at 82%.</p><p><strong>Conclusions: </strong>A PECC-facilitated curriculum in CEDs was associated with an increase in pediatric educational activities as well as improved pediatric knowledge and self-efficacy, but not simulation performance. Learners and PECCs expressed a high level of satisfaction.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"e141-e148"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252775","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 Mortality Rate of Eczema Herpeticum Is Lower Than What Is Commonly Cited.","authors":"Loren G Yamamoto, Bao Xin Liang, Kevin Liu","doi":"10.1097/PEC.0000000000003593","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003593","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":"42 10","pages":"e138-e139"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081827","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":"Establishing Age-Specific and Sex-Specific Norms for Mitral Valve E-Point Septal Separation (EPSS) Measurements in Pediatric Patients.","authors":"Jaya C Ruffin, Christopher T Stem, Scott Pletzer, Mathew J Gregoski, Asha Kumar-Veeraswamy, Matthew M Moake","doi":"10.1097/PEC.0000000000003625","DOIUrl":"10.1097/PEC.0000000000003625","url":null,"abstract":"<p><strong>Objective: </strong>Pediatric heart failure is a rare condition with significant morbidity that requires timely diagnosis and treatment. Mitral valve E-point septal separation (EPSS) may be used as an estimate of systolic function in this evaluation. Although well studied in adults, there is limited literature looking at pediatric EPSS values. The goal of this study was to establish normal pediatric EPSS values that can serve as a reference in this evaluation.</p><p><strong>Methods: </strong>This was a single-center retrospective study of 455 pediatric patients aged 17 years or younger, who had an outpatient transthoracic echocardiogram performed from January 1, 2020, until June 26, 2023. Those with reduced ejection fraction and cardiac abnormalities were excluded. EPSS measurements were taken from parasternal long-axis B-mode views. Relationships between EPSS and patient biometric and echo measurements were evaluated. Consistency of EPSS measurement between independent reviewers was also evaluated.</p><p><strong>Results: </strong>Across all patients, the median EPSS for all measurements was 2.25 mm (IQR 2.06 mm). When looking specifically at the lowest 3 EPSS measurements for each patient, the median EPSS was 1.33 mm (IQR 2.56 mm). EPSS demonstrated statistically significant ( P <0.05) but low magnitude ( R <0.3) correlations with several patient biometric and echo measurements, including a negative correlation with ejection fraction and a positive correlation with age, height, weight, and body surface area. There was no significant correlation with sex. Interclass correlation by Cronbach Alpha was 0.951.</p><p><strong>Conclusions: </strong>EPSS measurements observed in this large pediatric patient sample are lower than those reported in both adults and children. Differences in imaging and measurement technique may explain these observed differences. Future prospective studies are needed to explore these differences and better define reference EPSS values and their clinical implications.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"729-737"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964609","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":"Multicenter Insights into Pediatric Extreme Leukocytosis: A 5-Year Retrospective Study.","authors":"Noa Guzner, Saar Hashavya, Yuval Barak-Corren, Eyal Heiman, Zimmerman Deena, Oren Gordon, Giora Wieser, Roni Sedakah, Itai Gross","doi":"10.1097/PEC.0000000000003636","DOIUrl":"10.1097/PEC.0000000000003636","url":null,"abstract":"<p><strong>Objective: </strong>This study compared the clinical outcomes of pediatric emergency department (PED) patients with extreme leukocytosis (EL; WBC >25,000/µL) to those with moderate leukocytosis (ML; WBC 15,000 to 25,000/µL).</p><p><strong>Methods: </strong>We conducted a retrospective analysis using the MALRADI database, which includes pediatric visits to Jerusalem's 3 major hospitals, the largest urgent care network, TEREM. Demographics, clinical data, lab results, and outcomes were analyzed for culture positivity and WBC trends over time.</p><p><strong>Results: </strong>Among 125,471 pediatric records, 19,955 (15.9%) had EL and 105,516 (84.1%) had ML. EL patients were younger (mean age 3.4 vs. 4.2 y, P <0.00001), had higher inflammatory markers (CRP 12.1 vs. 7.8 mg/L; ESR 46.6 vs. 34.6 mm/h; P <0.0001), and more frequently positive cultures (3% vs. 1.5%; P <0.0001). A rapid decline in WBC count within 24 hours was observed in EL patients, compared with a slight increase in the ML group. Malignancy was rare (0.06%) in EL cases, indicating that EL is generally infection-related in this population.</p><p><strong>Conclusion: </strong>Extreme leukocytosis in pediatric patients is more frequently associated with infections requiring targeted monitoring but rarely indicates malignancy. These findings highlight the clinical importance of extreme leukocytosis and support the need for careful evaluation and monitoring in affected patients.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"776-780"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148219108","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":"Detection of Traumatic Knee Arthrotomy in Children Using Point-of-Care Ultrasound, a Review of 2 Cases.","authors":"Blake Nowakowski, Antonio Riera","doi":"10.1097/PEC.0000000000003661","DOIUrl":"10.1097/PEC.0000000000003661","url":null,"abstract":"<p><p>These 2 cases involved children who suffered traumatic penetrating injuries to the knee and were ambulatory after the event. Point-of-care ultrasound (POCUS) performed on both patients revealed findings consistent with trapped air in the suprapatellar bursa. Both patients were evaluated with additional imaging and were treated by pediatric orthopedic surgeons for urgent operative irrigation and debridement. There is limited data on the use of POCUS for traumatic knee arthrotomy, especially among pediatric populations. Ultrasound has been well established as a safe and timely imaging modality in a variety of other conditions. In these cases, POCUS represented a low-risk and efficient approach for the diagnosis of traumatic knee arthrotomy in the pediatric emergency department.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"797-800"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor Regarding \"Selective Use of Magnetic Resonance Imaging for Facial Palsy in the Pediatric Emergency Department\".","authors":"Shyam Sundar Sah, Abhishek Kumbhalwar","doi":"10.1097/PEC.0000000000003539","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003539","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":"42 10","pages":"e137"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-Hour Simulation Curriculum Improves Neonatal Resuscitation Skills of Emergency Medicine Residents.","authors":"Rachel Reed, Michael Thompson, Aneury Hernandez, Guillaume Stoffels, Jo Hsuan Lee, Sushma Krishna","doi":"10.1097/PEC.0000000000003710","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003710","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether a 1-hour neonatal resuscitation (NR) simulation curriculum improves emergency medicine (EM) resident skills, competency, and level of comfort in NR.</p><p><strong>Methods: </strong>NR skills were assessed during a 7-minute simulation conducted before and after a 45-minute educational session. Performance was assessed using the validated Neonatal Resuscitation Performance Evaluation (NRPE) tool. Time to each successful intervention during the simulation was recorded. Residents completed surveys at 3 time points: before the session (pre), immediately after (post), and at the end of the year (post-post). Surveys assessed baseline NR experience, knowledge, and self-reported competency in NR skills.</p><p><strong>Results: </strong>Fourteen third-year EM residents participated. There was a significant median improvement in total NRPE scores and in the subset scores of the bag-mask ventilation, intubation, and chest compressions skills. There was a significant decrease in the median time to obtaining initial heart rate, starting positive pressure ventilation, and to successful intubation. There was no significant difference in the time to initiating chest compressions. All 4 self-reported competency measures showed significant median improvement immediately postintervention. This improvement was maintained for 2 items in the post-post survey. Knowledge assessment scores improved significantly from pre- to postintervention.</p><p><strong>Conclusions: </strong>A 1-hour, NR skill-based simulation curriculum significantly improved NR skills, knowledge, and confidence among senior EM residents. This curriculum could serve as a valuable intervention to address gaps in NR training and can help fulfill proposed Accreditation Council for Graduate Medical Education requirements.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Death in the Emergency Department: Qualitative Insights From Physicians' Experiences.","authors":"Ji Young Lee, Jamie Pattee, Christine Aspiotes, Maren M Lunoe, Traci M Kazmerski, Danielle S Harvey, Noel B Spears, Kathleen A Noorbakhsh","doi":"10.1097/PEC.0000000000003707","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003707","url":null,"abstract":"<p><strong>Objective: </strong>To explore pediatric emergency medicine (PEM) physician perspectives on the death of a child in the emergency department (ED) to identify key lessons learned and areas for improvement in care and provider support.</p><p><strong>Methods: </strong>We conducted a 5-year review of PEM physicians' experiences after the death of a child at a single urban pediatric ED. Qualitative thematic analysis was performed on questionnaire responses regarding the resuscitation, debrief, overall support, and opportunities for improvement.</p><p><strong>Results: </strong>Twenty-two PEM physicians provided questionnaire responses to 34 deaths, with no difference in the distribution of number of deaths, sex, or clinical experience between questionnaire respondents and nonrespondents. Six key themes were identified from 34 questionnaire responses: (1) Physicians expressed confidence in the medical aspects of pediatric resuscitation but acknowledged a lack of prehospital information and deliberated airway management. (2) Most physicians found it helpful to have multidisciplinary providers with diverse expertise present during the resuscitation, emphasizing clear leadership and crowd control. (3) Family involvement and communication were crucial during a child's death. (4) Legal and administrative tasks after the death of a child can be burdensome, serving as possible barriers to completing other essential duties. (5) Continued support during and after the death of a child required significant staffing and was essential for resuming ED operations. (6) Staff debriefings occurred frequently and were highly valued, yet encountered challenges in implementation.</p><p><strong>Conclusions: </strong>PEM physicians highlight that leadership, multidisciplinary collaboration, communication with families, and debriefing are vital components surrounding the death of a child in the ED. Future studies should explore insights from nonphysician health care workers and family members.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Undertriage of Children Presenting to a Pediatric Emergency Department With Abdominal Pain.","authors":"Sara Sandri, Ethan Gough, Siwei Xie, Joanna S Cohen","doi":"10.1097/PEC.0000000000003702","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003702","url":null,"abstract":"<p><strong>Objectives: </strong>To identify demographic and clinical risk factors associated with undertriage of pediatric patients presenting to the emergency department with abdominal pain.</p><p><strong>Methods: </strong>This retrospective cross-sectional study included pediatric patients who presented to the pediatric ED at an academic urban hospital between January 1, 2023, and December 31, 2023, with a chief complaint of abdominal pain and were triaged as Emergency Severity Index level 4. Undertriage was defined as a triage level 4 assignment followed by hospital admission or use of more than 1 resource category. Demographic and clinical data, including age, sex, race, ethnicity, insurance type, interpreter use, disposition, and resource utilization, were extracted from the electronic health record. Multivariable logistic regression was used to assess the association between interpreter use and undertriage, adjusting for potential confounders.</p><p><strong>Results: </strong>A total of 603 patients met the inclusion criteria, of which 198 (32.8%) were undertriaged. Undertriage was more likely among patients who required an interpreter and were 13 years or older. Undertriage was less likely among those identifying as Black or Hispanic. Presentations during overnight hours were also associated with lower odds of undertriage. No significant seasonal variation was observed. Among undertriaged patients, most patients underwent both laboratory testing (93.9%) and imaging (80.3%).</p><p><strong>Conclusions: </strong>Nearly one-third of pediatric patients with abdominal pain triaged as level 4 were undertriaged. Patients 13 and older were more likely to be undertriaged compared with those aged 1 to 12. Interpreter use was associated with higher odds of undertriage, while Hispanic ethnicity and Black race were associated with lower odds of undertriage. These findings highlight the importance of addressing language-related barriers and other factors that influence equitable triage in the pediatric emergency department.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-Associated Variation in Documented Emergency Department Analgesia Among Pediatric Trauma Patients in a Painful Injury Cohort.","authors":"Barry Hahn, Najiha Farooqi, Esther Cohen, Anna Van Tuyl, Ahmad Nama, Josh Greenstein","doi":"10.1097/PEC.0000000000003709","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003709","url":null,"abstract":"<p><strong>Objectives: </strong>Young children may be at risk for less frequent analgesic administration after injury because pain assessment and communication are more difficult. We evaluated whether age younger than 6 years was associated with less frequent ED analgesic administration among pediatric trauma registry patients with painful injuries.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of trauma registry patients aged 18 years or younger evaluated in an emergency department from May 2022 through April 2025. The primary painful injury cohort included patients with injury descriptors consistent with fracture, dislocation, burn, laceration, open wound, crush injury, amputation, degloving injury, or avulsion injury. The primary outcome was any documented administration of ED analgesics. We used modified Poisson regression with robust standard errors to estimate relative risks.</p><p><strong>Results: </strong>ED analgesia was recorded in 54 of 126 younger children (42.9%) compared with 133 of 193 older children (68.9%), an absolute difference of 26.1 percentage points. In unadjusted analysis, age younger than 6 years was associated with a lower likelihood of ED analgesia (RR: 0.62; 95% CI: 0.50-0.78). After adjustment for Injury Severity Score, sex, mechanism, transport mode, trauma activation level, and ED disposition, age younger than 6 years remained associated with a lower likelihood of ED analgesia (adjusted relative risk: 0.66; 95% CI: 0.53-0.83).</p><p><strong>Conclusions: </strong>Children younger than 6 years with painful injuries had less frequent ED analgesic administration than older children.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}