Pediatrics
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Bronchiolitis is the leading cause of hospitalization for infants. Our objective was to identify factors associated with safe discharge to home from the emergency department. ⋯ This large multicenter study of children presenting to the emergency department with bronchiolitis identified several factors associated with safe discharge, including cut points for respiratory rate and oxygen saturation. Although the low-risk model requires further study, we believe that it will assist clinicians evaluating children with bronchiolitis and may help reduce some unnecessary hospitalizations.
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Comparative Study
Comparison of critically ill and injured children transferred from referring hospitals versus in-house admissions.
The purpose of this work was to compare the outcomes, severity of illness, and resource use of patients transferred to PICUs from outside hospitals to patients admitted from within the same hospital. ⋯ On average, children admitted to a cohort of US PICUs from referring hospitals were more ill and required more intensive care resources than patients admitted to the same PICUs from within the institution. Hospital-level differences in PICU efficiency and severity of illness were highly variable. These data highlight the need for standardized PICU admission criteria to maximize hospital efficiency and suggest opportunities for earlier intervention and consultation by hospitals with PICU-level services to improve quality of care for critically ill children.
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The objective of this study was to describe the epidemiology of gymnastics-related injuries among children in the United States. ⋯ Gymnastics has one of the highest injury rates of all girls' sports. Establishment of a national database for gymnastics-related injuries, including exposure data for direct calculation of injury rates, would permit better identification and monitoring of risk factors for gymnastics-related injuries and aid in the development, implementation, and evaluation of injury prevention strategies based on epidemiologic evidence.
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There are few reports in children of overdoses of buprenorphine, a partial opioid agonist used in the treatment of opioid dependence and pain. The purpose of this study was to analyze buprenorphine overdoses in young children reported by US poison centers to the Researched Abuse, Diversion, and Addiction-Related Surveillance System. ⋯ Buprenorphine overdoses are generally well tolerated in children, with significant central nervous system and respiratory depression occurring in only 7%. Any child ingesting > 2 mg and children < 2 years of age ingesting more than a lick or taste should be referred to the emergency department for a minimum of 6 hours of observation. Naloxone can be used to reverse respiratory depression.
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Although nasal continuous positive airway pressure is widely used in neonatal units, its use in neonatal transport is not yet established. Previous reports have been limited to small numbers of primary road transports and larger numbers of return transports while its use in air transportation has not been reported. The aim of this study was to assess the safety and effectiveness of transporting neonates and infants by road or air while treated with nasal continuous positive airway pressure. ⋯ Nasal continuous positive airway pressure is effective and has an acceptable safety margin for the road-based transportation of infants with acute respiratory distress. Air transport is feasible but larger studies are required to assess safety.