Pediatric emergency care
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Pediatric emergency care · Feb 2023
Observational StudyIntravenous Fluid Bolus Volume and Resolution of Acute Kidney Injury in Children With Diabetic Ketoacidosis.
To describe trends in creatinine and acute kidney injury (AKI) in children who present with diabetic ketoacidosis (DKA) and receive low versus high intravenous (IV) fluid bolus volumes. Further, to determine whether resolution of AKI is hastened by low versus high bolus volumes. ⋯ Intravenous fluid bolus volume was not associated with resolution of AKI in our cohort of children with DKA.
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Imaging algorithms for assessment of thoracic trauma in pediatric patients remain controversial, attempting to balance radiation dose and its associated risk with the need for thorough assessment of patients' injuries. This study reviewed the value of chest radiography in detecting traumatic injuries, and the impact that computed tomography (CT) had on clinical management. ⋯ Use of thoracic CT in pediatric trauma patients identifies a significantly greater number of injuries compared with than radiography but significantly increases radiation dose while changing management in only a very small proportion of cases. Despite the relatively small sample size, the findings reflect 2 years of experience at a level 1 trauma center, and this study suggests that it may be reasonable to decrease the frequency of cross-sectional imaging.
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Pediatric emergency care · Feb 2023
Observational StudyRisk Factors for Pediatric Sepsis in the Emergency Department: A Machine Learning Pilot Study.
To identify underappreciated sepsis risk factors among children presenting to a pediatric emergency department (ED). ⋯ Machine learning models trained to identify pediatric sepsis using ED clinical and sociodemographic variables confirmed well-established predictors, including heart rate and mean arterial pressure, and identified underappreciated relationships between sepsis and patient age, immunization status, and demographics.
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Pediatric emergency care · Feb 2023
It's a Hard Knock Life: How Kids With Mild Traumatic Brain Injuries Are Treated.
The diagnosis and treatment of mild traumatic brain injuries (mTBIs) by emergency medicine providers is greatly varied. Because of the frequency and long-term consequences associated with pediatric head injuries, it is crucial that adequate counseling is provided in acute care settings. The purpose of our study is to evaluate existing practices at Loyola University Medical Center emergency department to address inconsistencies in diagnostic or discharge practices and determine future quality improvement measures. ⋯ There is a lack of consistency in the evaluation and education of mTBI in pediatric patients. There is a need for personalized discharge instructions to ensure adequate patient and parent understanding and compliance. Further studies looking at long-term outcomes in these patients would also be beneficial.
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Thromboelastography's (TEG's) use in pediatric trauma patients is not widely studied. Identifying clotting cascade defects can direct decision making regarding blood product transfusion. ⋯ Coagulopathic patients based on TEG had higher mortality. All TEG values, as they moved toward transfusion-trigger cut points, were associated with increased mortality.