Pediatric emergency care
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Pediatric emergency care · Jun 2022
External Validation of the PediBIRN Screening Tool for Abusive Head Trauma in Pediatric Emergency Department Settings.
We conducted a retrospective, secondary analysis of an existing, deidentified, prospective data set captured to derive a bruising CDR. Subjects were patients under 3 years with bruising and confirmed acute head trauma. An expert medical panel had previously identified patients with AHT. Measures of the CDR's AHT screening performance (sensitivity, specificity, likelihood ratios) were calculated with 95% confidence intervals (CIs). ⋯ The PediBIRN 4-variable CDR demonstrated AHT screening sensitivity in the pediatric ED equivalent to pediatric intensive care unit and other inpatient settings, but lower specificity. Further study of a simplified 3-variable PediBIRN AHT screening tool for the ED setting is warranted.
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Pediatric emergency care · Jun 2022
Identification of Initial and Subsequent Injury in Young Infants: Opportunities for Quality Improvement in the Evaluation of Child Abuse.
Six children's hospitals identified infants with an initial injury and recurrent injury over a 1-year period using 2 methods: (1) diagnostic code method - infants 6 months or younger presenting with at least 1 diagnostic code for injury were tracked for 12 months to determine the frequency of recurrent injury, and (2) consult method - all available medical records of children 18 months or younger seen for an inpatient consultation for suspected child abuse were reviewed to identify history of a first injury at 6 months or younger. ⋯ Our study demonstrates that young infants who experience 1 injury often experience a second injury. There exists significant variability in the identification of injury and the completion of skeletal surveys across a network of 6 children's hospitals. A standardized quality improvement approach may improve identification of injury and reduce the variability in practice observed.
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Pediatric emergency care · Jun 2022
Randomized Controlled TrialSingle-Dose Dexamethasone Is Not Inferior to 2 Doses in Mild to Moderate Pediatric Asthma Exacerbations in the Emergency Department.
The purpose of this study was to compare the efficacy of a single dose of dexamethasone to 2 doses of dexamethasone in treating mild to moderate asthma exacerbations in pediatric patients. We anticipated that there would not be a difference in the rate of return visits to the emergency department (ED), urgent care, or primary care physician for continued asthma symptoms. ⋯ In this single-center, unblinded randomized trial of children and adolescents with mild to moderate acute exacerbations of asthma, there was no difference in the rate of return visits for continued or worsened symptoms between patients randomized to 1 or 2 doses of dexamethasone.
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Pediatric emergency care · Jun 2022
Multicenter StudyValue of Temperature for Predicting Invasive Bacterial Infection in Febrile Infants: A Spanish Pediatric Emergency Research Group (RISeuP-SPERG) Study.
This study aimed to analyze the prevalence of invasive bacterial infection (IBI) among infants younger than 90 days with fever without source according to the degree of fever. ⋯ Performing blood tests should be recommended in infants 90 days or younger with temperature ≥38°C without source regardless of the degree of fever.
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Pediatric emergency care · Jun 2022
The Initial Approach to the Multisystem Pediatric Trauma Patient.
Trauma remains the leading cause of morbidity and mortality in children and youth 1 to 19 years old in the United States. Providing timely care with a systematic approach is essential for emergently addressing life-threatening injuries and ongoing assessment. The primary survey is focused on identifying and managing life-threatening injuries. ⋯ Over the past decade, there have been important advances in the evidence supporting the management of multisystem trauma in the pediatric patient by the emergency medicine clinician. In addition, the emergence of diagnostics, such as point-of-care ultrasound, aids decision making in the evaluation and management of the pediatric trauma patient. The purpose of this article is to review the initial systematic diagnostic approach and the emergent management of multisystem injuries from blunt force trauma in children in the emergency department and provide insight into the aspects of care that are still evolving.