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Pediatric emergency

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https://www.readbyqxmd.com/read/29775132/evaluation-of-lateral-atlantodental-interval-asymmetry-in-the-pediatric-age-group-normative-values
#1
Stephen K Mendenhall, Andrew Huh, Janit Pandya, Vincent Alentado, Karl Balsara, Chang Ho, Andrew Jea
OBJECTIVE The revelation of normative radiographic measurements for the developing pediatric spine is incomplete. The purpose of this analysis was to determine the normal range of asymmetry of the lateral atlantodental interval (LADI) and define age- and sex-related differences. METHODS A total of 3072 children aged 0-18 years who underwent CT scanning of the cervical spine were identified at Riley Hospital for Children between 2005 and 2017. Patients were stratified by sex and age (in years) into 36 cohorts...
May 18, 2018: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/29774760/safety-of-nonsteroidal-anti-inflammatory-drugs-in-copperhead-snakebite-patients
#2
Hoang X Pham, Michael E Mullins
INTRODUCTION: Current management guidelines for pit viper envenomations recommend against the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control due to concern for platelet dysfunction and resulting coagulopathy. However, prior research suggests that copperhead snakes generally do not cause coagulopathy and they are responsible for most of the venomous snakebites in the USA. Thus, we compared the occurrences of clinically apparent bleeding and most abnormal laboratory values of coagulation between copperhead envenomation patients who received NSAIDs and those who did not...
May 18, 2018: Clinical Toxicology
https://www.readbyqxmd.com/read/29774106/hematopoietic-restricted-ptpn11e76k-reveals-indolent-mpn-progression-in-mice
#3
Stefan P Tarnawsky, Wen-Mei Yu, Cheng-Kui Qu, Rebecca J Chan, Mervin C Yoder
Juvenile Myelomonocytic Leukemia (JMML) is a pediatric myeloproliferative neoplasm (MPN) that has a poor prognosis. Somatic mutations in Ptpn11 are the most frequent cause of JMML and they commonly occur in utero . Animal models of mutant Ptpn11 have probed the signaling pathways that contribute to JMML. However, existing models may inappropriately exacerbate MPN features by relying on non-hematopoietic-restricted Cre-loxP strains or transplantations into irradiated recipients. In this study we generate hematopoietic-restricted models of Ptpn11E76K-mediated disease using Csf1r-MCM and Flt3Cre...
April 24, 2018: Oncotarget
https://www.readbyqxmd.com/read/29771953/mitochondrial-disease-patient-motivations-and-barriers-to-participate-in-clinical-trials
#4
Zarazuela Zolkipli-Cunningham, Rui Xiao, Amy Stoddart, Elizabeth M McCormick, Amy Holberts, Natalie Burrill, Shana McCormack, Lauren Williams, Xiaoyan Wang, John L P Thompson, Marni J Falk
BACKGROUND: Clinical treatment trials are increasingly being designed in primary mitochondrial disease (PMD), a phenotypically and genetically heterogeneous collection of inherited multi- system energy deficiency disorders that lack effective therapy. We sought to identify motivating factors and barriers to clinical trial participation in PMD. METHODS: A survey study was conducted in two independent mitochondrial disease subject cohorts. A discovery cohort invited subjects with well-defined biochemical or molecularly- confirmed PMD followed at a single medical center (CHOP, n = 30/67 (45%) respondents)...
2018: PloS One
https://www.readbyqxmd.com/read/29771871/trends-in-antiretroviral-therapy-eligibility-and-coverage-among-children-aged-15-years-with-hiv-infection-20-pepfar-supported-sub-saharan-african-countries-2012-2016
#5
Amanda Burrage, Monita Patel, Kelsey Mirkovic, Eric Dziuban, Wondimu Teferi, Laura Broyles, Emilia Rivadeneira
Rapid disease progression and associated opportunistic infections contribute to high mortality rates among children aged <15 years with human immunodeficiency virus (HIV) infection (1). Antiretroviral therapy (ART) has decreased childhood HIV-associated morbidity and mortality rates over the past decade (2). As accumulating evidence revealed lower HIV-associated mortality with early ART initiation, the World Health Organization (WHO) guidelines broadened ART eligibility for children with HIV infection (2)...
May 18, 2018: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/29771826/pediatric-nasal-traumas-contribution-of-epidemiological-features-to-detect-the-distinction-between-nasal-fractures-and-nasal-soft-tissue-injuries
#6
Taliye Cakabay, Selin Ustun Bezgin
OBJECTIVES: Nasal bone is prone to injury due of its prominent position on the face. Epidemiologic surveys are necessary to investigate nasal traumas. The aim of the present study is to examine the distribution of trauma etiologies according to age, sex, and seasonality in pediatric patients who present with nasal trauma, and to classify the pathologies according to their etiology as nasal fractures or nasal soft tissue injuries. METHODS: A total of 200 pediatric patients aged between 0 and 18 years who were admitted to the emergency room with sustained nasal trauma between September 1, 2015 and August 1, 2016 and who were diagnosed with an either nasal fracture or nasal soft tissue injury were retrospectively analyzed...
May 15, 2018: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29771758/opportunistic-fungal-infection-in-children-and-management
#7
Joseph M Lam
PURPOSE OF REVIEW: An opportunistic mycosis is a fungal agent of low pathogenicity that specifically infects immunocompromised hosts. Advances in transplantation, preterm care, immunosuppressive therapies and intensive care, have lead to the emergence of pediatric patients with serious immunodeficiency who are vulnerable to nonpathogenic fungi. RECENT FINDINGS: The advent of the use of biologic agents in pediatric disease as well as the advances in care of preterm and immunosuppressed patients opens up a new cohort of patients at risk of opportunistic mycotic infections...
May 15, 2018: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/29771484/management-of-multiply-injured-pediatric-trauma-patients-in-the-emergency-department
#8
Andria Tatem, Rupa Kapoor
Management of the child with multiple traumatic injuries can be challenging, and important injuries may not be readily recognized. Early recognition of serious injuries, initiation of appropriate diagnostic studies, and rapid stabilization of injuries are key to decreasing morbidity and mortality in the multiply injured pediatric trauma patient. The differential diagnosis for these patients is wide, and treatment is targeted to the specific injuries. In this issue, a systematic approach to the multiply injured pediatric patient will be reviewed, with specific attention to commonly missed injuries and those injuries that may cause significant morbidity or mortality...
June 2018: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/29771396/lyme-arthritis-of-the-pediatric-elbow-a-case-series
#9
David Gendelberg, William L Hennrikus
Most patients with untreated Lyme disease will experience joint symptoms. Owing to their resemblance in clinical presentation, Lyme arthritis and septic arthritis are often difficult to differentiate. However, their treatment is different. The elbow is rarely the first joint to present with symptoms. Therefore, Lyme disease is not commonly included in the differential diagnosis for children presenting with isolated elbow pain. The authors report 4 cases of monoarticular Lyme arthritis presenting in the elbow...
May 16, 2018: Orthopedics
https://www.readbyqxmd.com/read/29770975/regulation-of-access-to-the-hospital-care-network-for-children-in-cear%C3%A3-brazil
#10
Maria de Fátima Vasques Monteiro, Maria Auxiliadora F Vertamatti, Maria Nina Morais Alves, Amanda Cordeiro de Oliveira Carvalho, Maria Nizete Tavares Alves, Caio Parente Barbosa
Regulation is a state management tool to ensure that networked health services and goods comply with the principles of universality of access and integrality of care in the Unified Health System. To describe the regulatory actions of access to children's health services in the hospital setting, a descriptive, documentary study was performed to address data on the regulation of access to hospital health-care points for children from January to October 2015. The sample consisted of 2485 hospitalization procedures and regulated transfers in children between 0 and 15 years old living in the Juazeiro do Norte Health Region in the State of Ceará...
May 17, 2018: International Journal of Health Planning and Management
https://www.readbyqxmd.com/read/29769243/hospitalization-for-suicide-ideation-or-attempt-2008-2015
#11
Gregory Plemmons, Matthew Hall, Stephanie Doupnik, James Gay, Charlotte Brown, Whitney Browning, Robert Casey, Katherine Freundlich, David P Johnson, Carrie Lind, Kris Rehm, Susan Thomas, Derek Williams
OBJECTIVES: Suicide ideation (SI) and suicide attempts (SAs) have been reported as increasing among US children over the last decade. We examined trends in emergency and inpatient encounters for SI and SA at US children's hospitals from 2008 to 2015. METHODS: We used retrospective analysis of administrative billing data from the Pediatric Health Information System database. RESULTS: There were 115 856 SI and SA encounters during the study period...
May 16, 2018: Pediatrics
https://www.readbyqxmd.com/read/29768298/orbital-cellulitis-when-computed-tomography-imaging-is-falsely-reassuring
#12
Arsany Basily, Sasha Mansukhani, Andrew Anzeljc, Peter Gutierrez
An 8-year-old male presented to the pediatric emergency department with subjective fever, blurry vision, and left eye pain. On physical examination, there was mild left lower lid erythema and a subtle left eye elevation deficit. Computed tomography demonstrated preseptal soft tissue swelling without orbital involvement; however, there was varying amounts of paranasal sinus opacification. Despite the negative scan, a diagnosis of orbital cellulitis associated with sinusitis was made and treatment with intravenous antibiotics was initiated...
May 15, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29768297/pediatric-esophageal-foreign-body-possible-role-for-digital-tomosynthesis
#13
Andrew Johansen, Gregory P Conners, Jacob Lee, Amie L Robinson, William L Chew, Sherwin S Chan
OBJECTIVES: Foreign body (FB) ingestion is a common reason for emergency department visits, affecting more than 80,000 children in the United States annually. Whereas most ingested FBs are coins or other radiopaque objects, some are radiolucent FBs such as food. Digital tomosynthesis (DTS) is a radiographic technique that produces cross-sectional images with in-plane resolution similar to that of traditional radiographs. Our pilot study evaluated the sensitivity and specificity of DTS to detect FB in comparison to esophagram and clinical impression...
May 15, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29768296/pediatric-diabetic-ketoacidosis-with-hypotensive-shock-and-rash-an-unusual-presentation
#14
Yehonatan Pasternak, Omer Niv, Yehezkel Hezi Waisman
We describe a previously healthy adolescent boy who presented with respiratory distress, hypotensive shock, and a diffuse erythematous rash. The final diagnosis was diabetic ketoacidosis. Caregivers should be alert to this unusual combination of symptoms in the emergency department setting in order to improve the recognition and management of children with new-onset diabetes.
May 15, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29768295/requirement-for-head-magnetic-resonance-imaging-in-children-who-present-to-the-emergency-department-with-acute-nontraumatic-visual-disturbance
#15
Jeong-Yong Lee, Jung-Heon Kim, Hyung-Rae Cho, Jong-Seung Lee, Jeong-Min Ryu, Mi-Sun Yum, Tae-Sung Ko
OBJECTIVES: This study aimed to investigate the clinical features and head magnetic resonance imaging (MRI) findings in children who presented to the emergency department with acute nontraumatic visual disturbance and to study related clinical factors for discovering positive lesions on head MRI. METHODS: We performed a retrospective study of 1-month to 15-year-old children who underwent head MRI as an evaluation for acute nontraumatic visual disturbance as a chief complaint in our pediatric emergency department between March 2010 and March 2015...
May 15, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29768294/a-pilot-study-to-reduce-computed-tomography-utilization-for-pediatric-mild-head-injury-in-the-emergency-department-using-a-clinical-decision-support-tool-and-a-structured-parent-discussion-tool
#16
Rakesh S Engineer, Seth R Podolsky, Baruch S Fertel, Purva Grover, Heather Jimenez, Erin L Simon, Courtney M Smalley
INTRODUCTION: The American College of Emergency Physicians embarked on the "Choosing Wisely" campaign to avoid computed tomographic (CT) scans in patients with minor head injury who are at low risk based on validated decision rules. We hypothesized that a Pediatric Mild Head Injury Care Path could be developed and implemented to reduce inappropriate CT utilization with support of a clinical decision support tool (CDST) and a structured parent discussion tool. METHODS: A quality improvement project was initiated for 9 weeks to reduce inappropriate CT utilization through 5 interventions: (1) engagement of leadership, (2) provider education, (3) incorporation of a parent discussion tool to guide discussion during the emergency department (ED) visit between the parent and the provider, (4) CDST embedded in the electronic medical record, and (5) importation of data into the note to drive compliance...
May 15, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29768293/seasonality-of-common-pediatric-infectious-diseases
#17
Susan C Lipsett, Michael C Monuteaux, Andrew M Fine
BACKGROUND/OBJECTIVE: Traditional sources cite seasonal patterns for common infectious diseases, often based on microbiologic data, but little is known about cyclical trends in clinically diagnosed infectious conditions in the emergency department (ED). We leveraged the publicly available Nationwide Emergency Department Sample database to measure the seasonality of the most common pediatric infectious diseases diagnosed in US EDs. METHODS: We searched the Nationwide Emergency Department Sample database to identify infectious diagnoses comprising at least 1% of all diagnosis codes ascribed to patients 21 years and younger in US EDs from 2009 to 2013...
May 15, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29768291/quality-of-the-triage-of-children-with-anaphylaxis-at-the-emergency-department
#18
Esozia Arroabarren, Jorge Alvarez-Garcia, Marta Anda, Montserrat de Prada, Maria Carmen Ponce, Miriam Palacios
OBJECTIVE: Early recognition of symptoms is essential in anaphylaxis management. The Canadian Paediatric Emergency Triage and Acuity Scale prioritizes anaphylaxis to level I or II (resuscitation or emergency). We analyzed the accuracy of pediatric anaphylaxis triage. METHODS: This was a retrospective review of the triage charts (adaptation of the Canadian Paediatric Emergency Triage and Acuity Scale) of 137 children attended for anaphylaxis at our pediatric emergency department...
May 15, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29768181/description-of-hot-debriefings-after-in-hospital-cardiac-arrests-in-an-international-pediatric-quality-improvement-collaborative
#19
Todd Sweberg, Anita I Sen, Paul C Mullan, Adam Cheng, Lynda Knight, Jimena Del Castillo, Takanari Ikeyama, Roopa Seshadri, Mary Fran Hazinski, Tia Raymond, Dana E Niles, Vinay Nadkarni, Heather Wolfe
BACKGROUND: The American Heart Association recommends debriefing after attempted resuscitation from in-hospital cardiac arrest (IHCA) to improve resuscitation quality and outcomes. This is the first published study detailing the utilization, process and content of hot debriefings after pediatric IHCA. METHODS: Using prospective data from the Pediatric Resuscitation Quality Collaborative (pediRES-Q), we analyzed data from 227 arrests occurring between February 1, 2016, and August 31, 2017...
May 13, 2018: Resuscitation
https://www.readbyqxmd.com/read/29766326/the-change-in-management-of-bronchiolitis-in-the-intensive-care-unit-between-2000-and-2015
#20
Minna Mecklin, Paula Heikkilä, Matti Korppi
This case-control study evaluated interventions for bronchiolitis in relation to time in the pediatric intensive care unit (PICU) during a 16-year surveillance period. Together, 105 infants aged < 12 months were treated for bronchiolitis in the PICU, and for them, we selected 210 controls admitted for bronchiolitis closest to cases. We collected data on treatments in the PICU, at the ward and in the emergency department for three periods: years 2000-2005, 2006-2010, and 2011-2015. Median hospital length of stay for PICU patients were 7 days (interquartile range 5-12), 5 days (4-8) and 8 days (4-12...
May 15, 2018: European Journal of Pediatrics
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