Pediatric emergency care最新文献

{"title":"Orotracheal Intubation With 3D-Printed Videolaryngoscope, Commercially Available Videolaryngoscope, and Direct Laryngoscopy: Comparative Study in a Pediatric Manikin.","authors":"Vitória Silva Souza Dias, Lucas Guimarães Ferreira Fonseca, José Eduardo Corrente, Norma Sueli Pinheiro Módolo, José Roberto Fioretto, Joelma Gonçalves Martin","doi":"10.1097/PEC.0000000000003407","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003407","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the first attempt orotracheal intubation success rate and time to intubation using a 3D-printed videolaryngoscope (3DVL), a commercially available videolaryngoscope (VL), and direct laryngoscopy (DL) in a pediatric manikin, simulating normal airway, and difficult airway.</p><p><strong>Methods: </strong>Randomized crossover manikin study performed at a tertiary care hospital in Brazil, with the participation of 60 medical professionals with varying levels of experience in pediatric intubation. After explanation and training, participants performed orotracheal intubation in a pediatric manikin with and without a cervical collar using 3DVL, VL, and DL for a total of 6 intubations per participant. Variables recorded included first-attempt intubation success rates, the primary outcome, as well as the time to glottic visualization, the time to successful intubation, the need for external manipulation, Cormack-Lehane grade, and the preferred device in simulated difficult and normal airway scenarios.</p><p><strong>Results: </strong>There was no statistically significant difference in first-attempt success rate between 3DVL, VL, and DL for simulated normal (100%, 100%, and 100%, respectively) and difficult airways (100%, 98.3%, and 100%, respectively). For the analysis using a gamma distribution, time to intubation was significantly shorter with DL than 3DVL and VL in simulated normal and difficult airways (P=0.0002 and 0.0104, respectively). For a subsequent analysis comparing mean differences, time to intubation was significantly shorter with DL than 3DVL in both normal and difficult airways simulations (normal: mean difference 2.66 s, 95% CI: 1.27-4.05; difficult: mean difference 1.88 s, 95% CI: 0.49-3.27). Although intubation time was also shorter with DL than VL, the differences were not statistically significant (normal: mean difference 1.29 s, 95% CI: -0.09 to 2.68; difficult: mean difference 1.22 s, 95% CI: -0.17 to 2.61).</p><p><strong>Conclusions: </strong>In a simulated pediatric setting, 3DVL demonstrated comparable success rates and time to orotracheal intubation as VL. Intubation times with DL were shorter than 3DVL, while gamma distribution analysis showed equivalent intubation times between 3DVL and VL.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993366","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 Firearm Injury: Comparing age-Adjusted Shock Indices for Prediction of Emergency Interventions.","authors":"Jung Heon Kim, Nathan J White","doi":"10.1097/PEC.0000000000003405","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003405","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize pediatric firearm injury (PFI) and identify predictors of outcomes relevant to emergency care interventions.</p><p><strong>Methods: </strong>We conducted a retrospective registry review of pediatric patients (below 18 y) presenting to a single level-1 trauma center located in Seattle, Washington, from 2018 through 2023. PFI patients were compared with the otherwise injured patients by anatomic or physiological severity indices, such as injury severity score (ISS) and 3 types of age-adjusted shock index. The shock indices included shock index pediatric age-adjusted, pediatric shock index, and Advanced Trauma Life Support-based shock index (ATLS-SI). Multivariable logistic regression was performed to identify predictors of the need for transfusion or surgical intervention.</p><p><strong>Results: </strong>Of 2610 total trauma patients, 230 (8.8%) were injured by firearms with a median age of 16.0 years (interquartile range: 14.0 to 17.0) and a male proportion of 80.4%. When compared with other injury mechanisms, PFI was associated with more frequent vascular injuries (PFI, 19.1% vs. others, 4.3%), transfusions (31.7% vs. 10.2%), and surgical interventions (23.5% vs. 6.7%). Among the age-adjusted shock indices, an elevated value of ATLS-SI showed the highest specificities for both outcomes [transfusion, 91.7% (95% CI: 86.3-95.5); surgical intervention, 83.5% (77.2-88.7)] and the strongest association with transfusion at an adjusted odds ratio of 4.84 (1.94-12.06).</p><p><strong>Conclusions: </strong>From this single-center experience, PFI patients are typically male adolescents, more frequently sustain major vascular injuries, and are more likely to require transfusion or surgery. An elevated ATLS-SI at emergency department (ED) arrival is specific for and predictive of the need for emergency care interventions.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987399","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":"When a Horseshoe Is Not a Lucky Find.","authors":"Wesley Yim, Sathyaseelan Subramaniam","doi":"10.1097/PEC.0000000000003303","DOIUrl":"10.1097/PEC.0000000000003303","url":null,"abstract":"<p><strong>Abstract: </strong>Identification of a neonatal horseshoe kidney in the emergency department is uncommon but has implications for future healthcare planning for patients. We present a case of a neonate with bloody diapers who was evaluated with renal point-of-care ultrasound (POCUS) that identified a horseshoe kidney. The ultrasound was remarkable for its clear visualization of the isthmus of the horseshoe kidney in the midline abdomen. Midline interrogation is not part of the routine technique for ultrasound imaging of the kidney but should be considered when the limits of the lower pole of bilateral kidneys are difficult to visualize. This case highlights the importance of understanding normal anatomical landmarks when performing renal POCUS to identify renal anomalies.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"395-396"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789630","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 Golf Cart Injuries and Morbidity: A Single-Center Trauma Experience.","authors":"Kaitlyn Boggs, Andrew Wortham, Mathew J Gregoski, Christopher M Pruitt, Lucas A McDuffie","doi":"10.1097/PEC.0000000000003350","DOIUrl":"10.1097/PEC.0000000000003350","url":null,"abstract":"<p><strong>Objective: </strong>The primary aim of this study was to characterize pediatric golf cart injuries at our center including demographic, clinic, and outcome data. The secondary outcomes explored were associations between patient and driver age and mechanism of injury with hospital admission, length of stay, and surgical interventions.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of golf cart injuries at a pediatric American College of Surgeons Level I trauma center (2013-2023). Demographic information, mechanism of injury, location in the cart, driver age, injury locations and types, and other clinical factors were assessed. Possible differences in hospital admission, length of stay, and surgical intervention were assessed.</p><p><strong>Results: </strong>There were 156 patients who sustained golf cart injuries, with 39% requiring trauma activation upon initial presentation. The majority of patients were 13 years old or younger (75.6%), injured from a fall from the cart (55.8%), and admitted to the hospital (51.9%). Over half of the patients had more than one injury type, most commonly affected areas were head, neck, or face (61.5%) and extremities (66.7%). There was a disproportionate number of privately insured patients who presented with golf cart-related injuries compared with the general emergency department population (64.1 vs. 18.5%, 45.6% difference, 95% CI: 37.8%-52.7%, P <0.0001). Over half (63%) of patients with a documented driver age were in golf carts driven by a minor, with a median driver age of 13 years old. Patients in accidents where the drivers were minors were more likely to be admitted to the hospital ( P <0.001).</p><p><strong>Conclusions: </strong>Golf carts are a considerable source of injury for our pediatric population, with some accidents leading to serious morbidity. There is a need for consistent safety regulation of golf carts and increased public knowledge of the hazards they pose to children.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"383-387"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256297","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":"Changes in Care in Spanish Pediatric Emergency Departments After the First Immunization With Nirsevimab.","authors":"Paula Vazquez-Lopez, Aristides Rivas-Garcia, Carles Luaces-Cubells, Elena Perez-Gonzalez, María Luisa Ales-Palmer, Nuria Cahis-Vela, Esther Lera-Carballo, Carmen Solano-Navarro, Estefanía Romero-Castillo, Eva Patricia Torres-Begara, Maria Jesus Sanchez-Alvarez, Javier Benito-Fernandez, Laura Sanz-Rueda, María Angeles Garcia-Herrero, Alba Henares-Rodriguez, Sandra Yañez-Mesia, Antonio de Francisco-Profumo, Abel Martinez-Mejias, Maria Elena May-Llanas, Sofia Mesa-Garcia, Alejandro Aranda-Mora, Concepcion Baquero-Gomez, Daniel de la Rosa-Sanchez, Maria de Ceano-Vivas, Mercedes de la Torre Espí, Silvia Oliva-Rodriguez-Pastor, Jo Se Lorenzo Guerra-Diez, Sara Pons-Morales, Arantxa Gomez-Carabaza, Carmen Campos-Calleja, Antonio Ramon Torres-Torres","doi":"10.1097/PEC.0000000000003339","DOIUrl":"10.1097/PEC.0000000000003339","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study is to assess the changes in the pediatric care of patients seen in the Pediatric Emergency Departments (PED) during the bronchiolitis season following the introduction of immunization with a monoclonal antibody against RSV (nirsevimab).</p><p><strong>Methods: </strong>An observational, retrospective, multicenter study was conducted, analyzing the Bronchiolitis Registry of the Spanish Society of Pediatric Emergency Medicine. This registry, containing data on bronchiolitis cases, was initiated in December 2022. A total of 30 hospitals participated, all of which are members of the Spanish Society of Pediatric Emergency Medicine. Data from a 26-day period in 2 bronchiolitis seasons (2022: preimmunization and 2023: postimmunization) were included. Variables regarding health care burden were recorded for both periods. Quantitative variables were described using mean and SD, and the Student t test was used for comparisons between the 2 periods.</p><p><strong>Results: </strong>Twenty-five hospitals from 11 autonomous communities were included with a mean of 47,811 PED visits/year (SD: 26,675). The number of bronchiolitis cases presenting to the PED and bronchiolitis-related admissions decreased by 41.6%(95% CI: 34.9%-48.2%) and 55.4% (95% CI: 46.6%-64.2%), respectively, while admissions for RSV bronchiolitis decreased by 60.3% (95% CI: 51.9%-68.7%). Admissions to pediatric intensive care units decreased by 81.3% (95% CI: 57.9%-100%). Furthermore, the occupancy rate in the pediatric intensive care units decreased by 30% (95% CI: 22.8%-37.3%), while a reduction of 22.4% (95% CI: 13.2%-31.5%) was observed in the occupancy rate of observation units. The number of bronchiolitis cases transferred to other hospitals decreased by 73.4% (95% CI: 29.0%-100%). Finally, there was a 60.9% (95% CI: 26.5%-95.3%) reduction in the need for high-flow oxygen therapy among bronchiolitis patients.</p><p><strong>Conclusions: </strong>After the introduction of nirsevimab, a large portion of indicators related to the burden of care associated with bronchiolitis during its epidemic season decreased significantly.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"365-371"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365028","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 Need to Screen and Treat Iron Deficiency in Women.","authors":"Toby Richards","doi":"10.1097/PEC.0000000000003356","DOIUrl":"10.1097/PEC.0000000000003356","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"e29"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557670","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":"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":"336-340"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","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":"Comparison of Outcomes for Emergency Medical Services-Transported Infants With Suspected Brief Resolved Unexplained Events Before and After the Coronavirus Disease 2019 Pandemic.","authors":"Jake Toy, Rishi Bhargava, Calvin G Lowe, Phung K Pham, Nishelle Shepard, Myrna Aboudiab, Mohsen Saidinejad, Jessica Chow, Todd P Chang, Caroline Altergott, Ekra Rai, Ilene Claudius, Gabriela Moriel, Ellie Conser, Marianne Gausche-Hill","doi":"10.1097/PEC.0000000000003346","DOIUrl":"10.1097/PEC.0000000000003346","url":null,"abstract":"<p><strong>Objectives: </strong>This study compares care-seeking behavior, care delivery, and outcomes for infants with suspected brief resolved unexplained events (BRUEs) who were treated by emergency medical services (EMS) and emergency department clinicians before and after the onset of the coronavirus disease 2019 (COVID-19) pandemic and stay-at-home mandates.</p><p><strong>Methods: </strong>This multicenter, retrospective observational study uses prehospital and hospital data on EMS-treated infants (age ≤12 months) with a primary paramedic impression of BRUE. We evaluated interventions, management, and outcomes, including transports and admissions, before (April 2019 to February 2020) and after (April 2020 to February 2021) the start of the pandemic and stay-at-home mandates in March 2020. We also characterized longitudinal trends in transports and hospital admissions for BRUE infants between July 2017 and February 2021. Data were analyzed using descriptive statistics and interrupted time series modeling.</p><p><strong>Results: </strong>There were no significant differences in demographic characteristics or infant presentations before and after the beginning of the pandemic and stay-at-home mandates. We noted an increase in transports during the before period, but transports plateaued in the after period. There was no significant difference in admissions between the before and after periods.</p><p><strong>Conclusions: </strong>For EMS-treated infants with paramedic-suspected BRUE, presentations and hospital admissions were similar before and after the beginning of the COVID-19 pandemic and stay-at-home mandates. There was a longitudinal increase in EMS transports for infants with suspected BRUE before the COVID-19 pandemic and stay-at-home mandates, which then leveled off in the after period.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"329-335"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123405","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":"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":"341-347"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","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}

{"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":"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":"388-394"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","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}