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Pediatric Emergency Care

Christina Conrad, Parita Soni, Vasanth Coorg, Benjamin Thompson, Jared Muenzer, Zebulon Timmons, Blake Bulloch
PURPOSE: Undertreatment of pain by caregivers before presentation to the pediatric emergency department (ED) has been well documented. What has yet to be elucidated are the reasons why caregivers fail to adequately treat pain before arrival in the ED and whether there are differences based on ethnic background or age of the child. The objectives of this study were to determine the barriers to giving pain medication for injuries before ED arrival and to determine if there are any ethnic- or age-related variations to giving pain relief at home...
October 2, 2018: Pediatric Emergency Care
Woo Sung Jung, Sun Hyu Kim, Hyeji Lee
OBJECTIVES: This study was to determine the characteristics of missed diagnosis of pediatric anaphylaxis that were registered as urticaria only at the emergency department (ED) by comparing those who had only urticaria symptoms with those who had both anaphylaxis and urticaria symptoms. METHODS: Subjects were classified into missed anaphylaxis and urticaria group according to whether satisfied anaphylaxis diagnostic criteria or not. Anaphylaxis group, those who were initially registered as anaphylaxis with urticaria and anaphylaxis symptoms simultaneously, were further investigated...
October 2, 2018: Pediatric Emergency Care
Gillian Currie, Jennifer Crotts, Alberto Nettel-Aguirre, David Johnson, Antonia Stang
OBJECTIVES: This study aimed to elicit pediatric emergency physician's treatment choices for preschool-aged children with wheeze, determine the characteristics of the presenting child that influence treatment choices, and determine whether there is clinical equipoise by eliciting physician willingness to enroll these children in a placebo-controlled trial of corticosteroids. METHODS: Discrete choice experiments varying the characteristics of the presenting child were designed to elicit Canadian emergency physician's treatment choices, both in the emergency department (ED) and at discharge, for young children presenting with wheeze and their willingness to enroll in a randomized controlled trial (RCT)...
October 2, 2018: Pediatric Emergency Care
Judith W Dexheimer, Huaxiu Tang, Andrea Kachelmeyer, Melanie Hounchell, Stephanie Kennebeck, Imre Solti, Yizhao Ni
OBJECTIVE: Challenges with efficient patient recruitment including sociotechnical barriers for clinical trials are major barriers to the timely and efficacious conduct of translational studies. We conducted a time-and-motion study to investigate the workflow of clinical trial enrollment in a pediatric emergency department. METHODS: We observed clinical research coordinators during 3 clinically staffed shifts. One clinical research coordinator was shadowed at a time...
October 2, 2018: Pediatric Emergency Care
Hoon Jang, Mustafa Ozkaynak, Turgay Ayer, Marion R Sills
OBJECTIVES: Acute asthma exacerbations are among the most common reasons for childhood emergency department (ED) visits and hospitalizations. Although early ED administration of asthma medication has been shown to decrease hospitalizations, studies of factors associated with early ED asthma medication delivery have been limited. The objective of our study was to identify patient- and ED-related factors associated with early medication delivery among children treated in the ED for asthma exacerbations...
October 2, 2018: Pediatric Emergency Care
Alison Gardner, Alison Ruch
BACKGROUND: Emergency providers often attribute stridor to croup in pediatric patients. However, even in children who are having other symptoms of a viral etiology, several other causes need to be considered. CASE: A 6-month-old term male without significant past medical history presented to the emergency department with stridor with likely underlying laryngospasm. He was initially ascribed the diagnosis of croup and was discharged home after receiving steroids and racemic epinephrine...
September 25, 2018: Pediatric Emergency Care
Nathalie Gaucher, Nago Humbert, France Gauvin
OBJECTIVES: The objective of this study was to describe the characteristics of pediatric palliative care (PPC) patients presenting to a pediatric emergency department (ED) and these patients' ED visits. METHODS: This retrospective chart review was conducted from April 1, 2007, to March 31, 2012, in a tertiary care pediatric university-affiliated hospital. Eligible patients had initial PPC consultations during the study period; all ED visits by these patients were included...
September 25, 2018: Pediatric Emergency Care
Oren Feldman, Najib Nasrallah, Yuval Bitterman, Roni Shavit, Dana Marom, Zofia Rapaport, Shauli Kabesa, Michael Benacon, Itai Shavit
BACKGROUND: No study has examined the performance of emergency department (ED) nurses in establishing intraosseous access (IO) access. This study aimed to evaluate ED nurses' success rate in establishing pediatric IO access using semiautomatic devices. METHODS: A randomized crossover simulation study was conducted. The success rates of ED nurses were compared with those of paramedics with similar years of experience. The study instruments were the new spring-loaded injector (NIO) and the battery power drill (EZ-IO)...
September 25, 2018: Pediatric Emergency Care
Onyinyechi I Ukwuoma, Veerajalandhar Allareddy, Veerasathpurush Allareddy, Sankeerth Rampa, Jerri A Rose, Steven L Shein, Alexandre T Rotta
OBJECTIVES: Although closed head injuries occur commonly in children, most do not have a clinically important traumatic brain injury (ciTBI) and do not require neuroimaging. We sought to determine whether the utilization of computed tomography of the head (CT-H) in children presenting to an emergency department (ED) with a closed head injury changed after publication of validated clinical prediction rules to identify children at risk of ciTBI by the Pediatric Emergency Care Applied Research Network (PECARN)...
September 25, 2018: Pediatric Emergency Care
Chelsea R Majerus, Trevor L Tredway, Nicole K Yun, James M Gerard
OBJECTIVES: Previous studies have not evaluated the utility of obtaining chest radiographs (CXR) in patients with acute asthma exacerbation reporting chest pain. The aims of this study were to evaluate the symptom of chest pain as a predictor for clinicians obtaining a CXR in these patients and to evaluate chest pain as a predictor of a positive CXR finding. METHODS: This was a retrospective chart review of patients, ages 2 to 18 years, presenting for acute asthma exacerbation to the emergency department from August 1, 2014, to March 31, 2016...
September 25, 2018: Pediatric Emergency Care
Aaron Donoghue, Mary Kate Abbadessa, Ting-Chang Hsieh, Warren Frankenberger, Sage Myers
OBJECTIVES: We aimed to quantify time performing chest compressions (CCs) per year of individual providers in a pediatric ED and to project a rate of opportunity for CC based on median clinical hours per provider category. METHODS: This was an observational study of video-recorded resuscitations in a pediatric ED over 1 year. Events where CCs were performed for more than 2 minutes were included. Identification of providers and duration of CCs per provider were determined by video review...
September 21, 2018: Pediatric Emergency Care
Tara Cristallo, Michelle Walters, James Scanlan, Ian Doten, Theresa Demeter, David Colvin
OBJECTIVES: Emergency department (ED) caregivers have reported feeling uncomfortable performing emergency pediatric procedures, likely because of either a lack of training or infrequent exposure to these events. To address these gaps, ongoing education for experienced ED caregivers must aim to improve caregiver confidence with high-risk, low-volume pediatric emergency care. This study used multidisciplinary, in situ simulations to facilitate improved caregiver confidence when treating pediatric emergencies in an ED setting...
September 21, 2018: Pediatric Emergency Care
Shiu-Lin Tsai, Elena Reynoso, Da Wi Shin, James W Tsung
OBJECTIVES: With epidemic opioid deaths and abuse in the United States, government agencies recommend nonpharmacological treatments for pain. However nonopioid treatment options for moderate to severe pain in the pediatric emergency department (PED) are limited. Acupuncture has been shown to be effective for pain. The objective of this study was to evaluate the feasibility of using traditional acupuncture (TA) and battlefield acupuncture (BFA) in the treatment of pain in the PED. METHODS: A pediatric cohort treated with acupuncture for pain in an urban PED was assessed...
September 21, 2018: Pediatric Emergency Care
Esma Altinel Acoglu, Melahat Melek Oguz, Eyup Sari, Husniye Yucel, Meltem Akcaboy, Pelin Zorlu, Sanliay Sahin, Saliha Senel
OBJECTIVES: Lumbar puncture (LP) is fundamental for diagnosis and treatment; however, some parents do not provide consent for their children to undergo the procedure, which can make diagnosis and determination of the optimal treatment difficult. The present study aimed to describe the level of knowledge and attitudes toward LP of parents whose children were scheduled to undergo the procedure. METHODS: A prospective cross-sectional descriptive study of a convenience sample of parents of 84 children aged 2 months to 17 years scheduled for LP at a single academic children's hospital between 2015 and 2017...
September 21, 2018: Pediatric Emergency Care
Shelease C O╩╝Bryant, Jonathan D Lewis, Andrea T Cruz, Brent A Mothner
The last 3 decades have seen a shift in the epidemiology of epiglottitis. Epiglottitis was once most commonly associated with Haemophilus influenzae type B. However, with the implementation of the H. influenzae type B vaccine in 1985, the incidence has drastically declined. There are now new emerging pathogens-bacteria, viruses, and fungi-causing epiglottitis. Here, we report the first case of epiglottitis secondary to influenza A in a former full-term, vaccinated infant who presented with cough, fever, stridor, pursed lip breathing, and progressive respiratory distress and eventual respiratory failure...
September 21, 2018: Pediatric Emergency Care
Guylaine Larose, Arielle Levy, Benoit Bailey, Barbara Cummins-McManus, Denis Lebel, Jocelyn Gravel
OBJECTIVE: The objective of this study was to evaluate whether residents can accurately estimate children's weight using the Broselow tape. METHOD: We conducted a preplanned secondary analysis from an experimental trial. Participants were residents in pediatrics, family medicine, and emergency medicine rotating in the ED. Residents were randomly assigned to 2 sets of paired scenarios during 2 sessions. They were asked to estimate the weight of a manikin using the Broselow tape at the beginning of each scenario...
September 21, 2018: Pediatric Emergency Care
Ali Aledhaim, Jennifer N Fishe, Jon Mark Hirshon, Jennifer F Anders
OBJECTIVES: Pediatric care is increasingly regionalized, increasing rates of interfacility transport (IFT). However, it is unknown what conditions most frequently require IFT. This study's objective was to identify high-frequency pediatric conditions requiring IFT. METHODS: This is a statewide retrospective observational study from 2010 to 2012 of pediatric patients (<18 years of age) who underwent IFT in Maryland. Patients were identified from the Health Care Utilization Project's database using probabilistic linkage...
September 11, 2018: Pediatric Emergency Care
Natan Cramer, Carmen Coombs
Classic appendicitis is a common condition easily diagnosed by emergency care providers. However, atypical cases represent a diagnostic challenge and can contribute to increased morbidity from a delay in definitive care. It is important to recognize that atypical presentations have an increased risk for underlying anatomic variants, which may require additional imaging as part of management. We present a case of a 13-year-old previously healthy adolescent boy with acute onset of left-sided abdominal pain who was found to have appendicitis in the setting of underlying malrotation...
September 11, 2018: Pediatric Emergency Care
Glyndwr W Jenkins, Darren Bresnen, Elizabeth Jenkins, Niall Mullen
OBJECTIVES: Neglect is defined as the persistent failure to meet a child or young person's basic physical or psychological needs. Dental caries is explicitly mentioned in guidance on child maltreatment. We discuss the link between dental caries and child abuse in patients presenting to the emergency department. METHODS: A review of patient medical records was undertaken within the Paediatric Emergency Department at Sunderland Royal Hospital, with the aim to determine whether neglect was considered as a possible contributory factor when a child or young person presented at triage with an "oral cavity" problem...
September 11, 2018: Pediatric Emergency Care
Yuki Enomoto, Asuka Tsuchiya, Yusuke Tsutsumi, Hitoshi Kikuchi, Koji Ishigami, Junpei Osone, Masahito Togo, Susumu Yasuda, Yoshiaki Inoue
OBJECTIVES: The effectiveness of Japanese helicopter emergency medical services (HEMS) and interventions at the scene is not clear as regard children. For effective use of HEMS at the clinical scene, we need to clarify the characteristics of pediatric patients cared for by HEMS. Therefore, the objective of this study was to describe the characteristics of pediatric scene flights and to describe the procedures performed on the patients. METHODS: This was a retrospective cohort study based on the database for children aged younger than 18 years who were cared for by physician-staffed HEMS of Ibaraki prefecture, in Japan...
September 11, 2018: Pediatric Emergency Care
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