Pediatric emergency care
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Pediatric emergency care · Jul 2023
ReviewDe-escalation Techniques for the Agitated Pediatric Patient.
The emergency department can be a particularly challenging environment for the care of pediatric patients presenting with acute agitation. Agitation is a behavioral emergency requiring prompt intervention. Timely recognition of agitation and proactive implementation of de-escalation strategies are critical for safe and effective management of agitation, as well as prevention of recurrent episodes. This article reviews the definition of agitation, explores the domains of verbal de-escalation, and considers multidisciplinary management strategies for children with acute agitation.
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Pediatric emergency care · Jul 2023
Multicenter StudyWhich Trauma Severity Scores Are Useful in Predicting Pediatric Mortality?
Trauma is the leading cause of death in children. Several trauma severity scores exist: the shock index (SI), age-adjusted SI (SIPA), reverse SI (rSI), and rSI multiplied by Glasgow Coma Score (rSIG). However, it is unknown which is the best predictor of clinical outcomes in children. Our goal was to determine the association between trauma severity scores and mortality in pediatric trauma. ⋯ Several trauma scores may help predict mortality in children with trauma, the best being rSIG. Introduction of these scores in algorithms for pediatric trauma evaluations can impact clinical decision-making.
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Pediatric emergency care · Jul 2023
Randomized Controlled TrialA Randomized Trial of Incentivization to Maximize Retention for Real-Time Symptom and Activity Monitoring Using Ecological Momentary Assessment in Pediatric Concussion.
The aims of this study were to determine the incentivization strategy that maximizes patient adherence to report symptoms and activity via ecological momentary assessment (EMA) after pediatric concussion, and assess the feasibility of tracking concussed youth using EMA from the emergency department (ED) setting. ⋯ Dynamic incentivization showed higher rates of response to tridaily symptom prompts compared with flat-rate incentivization. These data show tracking concussed youth using EMA from the ED is feasible using a dynamic incentivization strategy, with improved ability to discern outcomes compared with prospective monitoring using follow-up clinical visits.
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Pediatric emergency care · Jul 2023
Effect of Prearrival Orders on Time to Antibiotics for Immunocompromised Oncology Patients Presenting to the Emergency Department With Fever.
Pediatric cancer patients with fever are at risk for invasive bacterial infection. The administration of antibiotics to these patients within the first hour of evaluation is viewed as a quality of care metric with potential to improve outcome. We sought to evaluate the impact of prearrival patient orders on the timeliness of antibiotic administration for this patient population presenting to the emergency department (ED) because of fever. ⋯ Standardizing elements of prehospital communication and ED-based care using PAO sets resulted in significant improvements in time to antibiotics and in the proportion of febrile immunocompromised oncology patients receiving antibiotics within 60 minutes of ED arrival.
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Pediatric emergency care · Jul 2023
Clinical Utility and Patient Distribution of Brief Resolved Unexplained Event Classification for Apparent Life-Threatening Events.
In 2016, brief resolved unexplained events (BRUEs) were proposed as alternative concepts to apparent life-threatening event (ALTE). The clinical utility of managing ALTE cases according to the BRUE classification is controversial. To verify the clinical utility of the BRUE criteria, we evaluated the proportion of ALTE patients who met and those who did not meet the BRUE criteria and assessed the diagnoses and outcomes of each group. ⋯ Many of the patients with ALTE were classified into the ALTE-not-BRUE group, suggesting that replacing ALTE with BRUE is difficult. Although patients classified as lower-risk BRUE showed no adverse outcomes, there were only a few of them. In the pediatric emergency medicine setting, the BRUE risk classification may be beneficial for certain patients.