False-Positive Urine Drug Screen for Benzodiazepines in a Child Taking Fluoxetine
No abstract available (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Letters to the Editors Source Type: research

Pediatric Definitions for Sepsis and Septic Shock—Are We in the Right Way?
No abstract available (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Letters to the Editors Source Type: research

A COVID-19–Positive Infant Presenting With Sudden Cardiac Arrest
No abstract available (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Letters to the Editors Source Type: research

Fatigue During Infant Cardiopulmonary Resuscitation: Is It Really a Problem for Quality Performance?
No abstract available (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Letters to the Editors Source Type: research

Comments on “Pediatric Sigmoid Volvulus”
No abstract available (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Letters to the Editors Source Type: research

Left-Sided Appendicitis: More Than Meets the Eye
We present a case of a 13-year-old previously healthy adolescent boy with acute onset of left-sided abdominal pain who was found to have appendicitis in the setting of underlying malrotation. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Clinical Suspicion and Language Translation in the Pediatric Emergency Department
We describe 2 teenage females who presented to our pediatric emergency department within 48 hours with similar presentations but no obvious organic cause or examination findings to suggest a specific diagnosis. We demonstrate how complex language translation issues in these adolescents contributed to prolonged diagnoses and advocate for independent interpreters to be available on first presentation to hospital. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Hard as Iron: A Case of Delayed Presentation of Severe Iron Toxicity With Diagnostic and Treatment Dilemmas
We present a case of an adolescent girl with metabolic acidosis, hypoglycemia, obtundation, and liver and renal failure of undifferentiated etiology who was eventually discovered to have overdosed on ferrous sulfate tablets 4 days before arrival. The diagnosis was made because the patient had an elevated transferrin concentration in the setting of a minimally elevated serum iron concentration and faint radio-opacities on abdominal plain film imaging. This case presents many diagnostic challenges and treatment dilemmas and is a rare report of survival in delayed presentation of severe toxicity. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Characteristics of Emergency Department Presentations of Pediatric Poisoning Between 2011 and 2016: A Retrospective Observational Study in South Korea
Conclusions Over 6 years, the annual number of total poisoning cases and of accidental poisoning cases in particular increased despite a lack of change in the types of causative agents related to pediatric poisoning. This phenomenon may reflect failed preventative measures. Thus, the implementation of tailored preventative measures based on epidemiological data should be accelerated. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Prediction of High-Grade Hip Joint Effusion With Simple Radiographs in Children: A Comparative Study With Magnetic Resonance Imaging
Conclusions For children 6 years and older with asymmetric hip joint space widening on simple radiographs, further evaluations for the presence of hip joint effusion should be considered because of its high specificity. The predictability can improve if both medial and superior gaps, and sex are included in the evaluation. In girls, hip joint effusion seems to widen the joint space more easily than in boys, which may be owing to the more ligamentous laxity of and less musculature around the hip in girls. However, the risk of joint effusion should not be underestimated even if a child presents symmetry on the simple rad...
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Outcomes of Short Versus Long Leg Casts for Childhood Accidental Spiral Tibial CAST Fractures
Conclusions A short leg walking cast seems to be an effective and safe method of treatment for CAST fractures and could be considered as potentially preferable to long leg casts because of the added benefits of increased mobility and function. Follow-up to this preliminary study is warranted to better elucidate any differences in benefit between these treatment options, and clinical judgment should be used when considering immobilization options. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

A Pragmatic Study to Evaluate the Use of a Rapid Diagnostic Test to Detect Group A Streptococcal Pharyngitis in Children With the Aim of Reducing Antibiotic Use in a UK Emergency Department
Conclusions Despite poor RDT sensitivity and the McIsaac score's poor specificity in children, their use in combination decreased antibiotic prescribing rates in a children's ED setting. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Implementing the 2016 American Academy of Pediatrics Guideline on Brief Resolved Unexplained Events: The Parent's Perspective
Conclusions Successful implementation of the 2016 guideline will require close attention to the parent's point of view. Otherwise, parental resistance is likely to compromise clinicians' best efforts. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Resuscitation With Ringer's Lactate Compared With Normal Saline for Pediatric Diabetic Ketoacidosis
Conclusions Ringer's lactate was infrequently used for resuscitation of pediatric DKA patients. However, resuscitation with LR compared with NS was associated with lower total cost and rates of CE. Further investigation using patient-level clinical and laboratory data is needed to evaluate factors that drive cost and risk of CE development with each fluid. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Providers' Ability to Identify Sentinel Injuries Concerning for Physical Abuse in Infants
Conclusions Sentinel injuries are not uniformly recognized as potential signs of child abuse requiring further evaluation by pediatric health care providers. Additional evidence and education are needed regarding sentinel injuries. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Test Characteristics of Cerebrospinal Fluid Gram Stain to Identify Bacterial Meningitis in Infants Younger Than 60 Days
In our cohort of 20,947 infants aged 60 days or younger, cerebrospinal fluid Gram stain had a sensitivity of 34.3% (95% confidence interval, 28.1%–41.1%) and a positive predictive value of 61.4% (95% confidence interval, 52.2%–69.8%) for positive cerebrospinal fluid culture, suggesting that Gram stain alone may lead to both underdiagnosis and overdiagnosis of bacterial meningitis. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Radiographic Pneumonia in Febrile Infants 60 Days and Younger
Conclusions Radiographic pneumonias were uncommon, often had viruses detected, and were associated with ill appearance, but few other predictors, in febrile infants 60 days or younger. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

“PEM Pals”—Cultivating a Learning Community During the Pandemic
Conclusions The goal of our curriculum was to supplement an anticipated knowledge gap. Through use of a wellness “check-in,” we elicited important themes for PEM educational leaders to consider as they mentor pediatric residents toward a career in PEM during the pandemic. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Special Features Source Type: research

Simulation as a Dynamic Tool to Reorganize Pediatric Emergency Department Resuscitation During the Coronavirus Disease 2019 Pandemic and Beyond
Conclusions Simulation can be an effective and agile tool in restructuring patient workflow and care of the most critically ill or injured patients in a PED during a novel pandemic. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Special Features Source Type: research

Point-of-Care Ultrasound Facilitates Management of Ruptured Ectopic Pregnancy
We present a case where point-of-care ultrasound was used to facilitate diagnosis and expedite lifesaving management of a ruptured ectopic pregnancy. We further review the technique and literature for first-trimester transabdominal point-of-care ultrasound. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Ultrasound Case Review Source Type: research

Diagnosis and Management of Pediatric Venous Thromboembolism: New Therapies on the Horizon
No abstract available (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: CME Review Article Source Type: research

Diagnosis and Management of Pediatric Venous Thromboembolism: New Therapies on the Horizon
The incidence of venous thromboembolism (VTE) is increasing in pediatric patients. Prompt recognition and evaluation of VTE in young patients could prevent significant morbidity or mortality. In contrast to VTE in adults, current treatment guidelines are largely based on expert opinion as limited randomized controlled trial data exist about the appropriate management in pediatric patients with traditional anticoagulants. However, recently approved direct-acting oral anticoagulants in adults are also being investigated in pediatric VTE and these data could inform future evidence-based treatment principles. Thus, healthcare ...
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: CME Review Article Source Type: research

When Parents Hit: Providing Education to Physician Trainees About Corporal Punishment Through a Pilot Simulation and Debriefing
Conclusions The educational experience provided physicians in training with the opportunity to participate in or observe a situation in which CP occurs in the medical setting. The simulation and debriefing were an innovative approach to providing an educational opportunity for physicians to learn from difficult situations and discussions surrounding CP with caregivers. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Original Research-QI Source Type: research

Factors Influencing Pediatric Emergency Department Visits for Low-Acuity Conditions
Conclusions There appears to be a common misperception that PCPs do not offer extended hours. In addition, the parent or guardian's perception of severity was oftentimes more serious than perceived by medical staff. These results suggest that improving health literacy among our patient population by educating them on PCP availability and capability, ancillary services offered by PCP, and appropriate usage of the ED could potentially reduce nonurgent ED visits. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Maternal Confidence and Emergency Department Utilization Among Infants
Conclusions Low maternal confidence did not correlate with frequent ED visits or nonurgent visits. Medicaid status was the main factor associated with any ED visit. Hispanic or Latino mothers had higher maternal confidence scores, were more likely to have Medicaid and more likely to bring their child to the ED. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Effects of Glucocorticoids on Hospitalized Children With Anaphylaxis
Conclusions We observed increasing trends of H1- and H2-receptor antagonist use. Length of hospital stay and total hospitalization cost were greater in the steroid group than in the nonsteroid group, whereas readmission risks were similar between the 2 groups. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Analgesic Efficacy of Intranasal Ketamine Versus Intranasal Fentanyl for Moderate to Severe Pain in Children: A Prospective, Randomized, Double-Blind Study
Conclusions There was insufficient power to support the analgesic noninferiority of IN ketamine at a dose of 1 mg/kg compared with IN fentanyl at a dose of 1.5 μg/kg in children experiencing painful conditions at 20 minutes after administration. Intranasal ketamine was found to be inferior to IN fentanyl in relieving pain at 10 minutes and was found to have significantly greater rates of sedation and dizziness. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Adherence to Guidelines in the Treatment of Diabetic Ketoacidosis in Children: An Austrian Survey
Background The aim of this study is to assess the adherence of Austrian physicians to International Society for Pediatric and Adolescent Diabetes guidelines 2009 concerning treatment in diabetic ketoacidosis and whether there is a difference between specialty (endocrinologists or intensivists) or clinical experience. Patients and Methods An online questionnaire was sent to members of the working groups of the Austrian Society of Pediatric and Adolescent Medicine. Results Of 106 questionnaires, 56 were included in the analysis. The mean ± SD overall adherence was 60 ± 23.5%. Endocrinologists ...
Source: Pediatric Emergency Care - May 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

“Second Wave” of COVID-19 Pandemic: Admittance on Pediatric Emergency Department of a Regional Hospital From North of Spain During State of Alarm
No abstract available (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Letters to the Editors Source Type: research

Statistics Should Be Carefully Interpreted: Vitamin K for Newborn Hemorrhages and Steroids for COVID-19
No abstract available (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Letters to the Editors Source Type: research

Coccygodynia Due to a Sacrococcygeal Anomaly: A Rare Cause of Constipation
We report a case of an uncommon sacrococcygeal anomaly in a healthy girl initially presenting to the emergency department with coccygodynia and a past history of longstanding constipation. The clinical evolution was satisfactory once the bony anomaly was removed (coccygectomy). This unusual case exemplifies the importance of the medical history and physical examination to make an accurate diagnosis. An inadequate intervention may result in persistent pain, worsening longstanding constipation, and psychosocial and medical consequences. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

UnBeelievable: A Case of Pediatric Myocarditis After Insect Envenomation
We report a unique case of a 14-year-old adolescent boy who developed acute myocarditis after a bee sting. The pathophysiology involving envenomation and myocarditis remains poorly understood. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Lazarus Syndrome — Challenges Created by Pediatric Autoresuscitation
We report a previously well 18-month-old who attended the emergency department after an unexplained cardiac arrest. After 10 cycles of CPR, resuscitation was stopped; 6 minutes later, the patient had a return of spontaneous circulation and was transferred to the pediatric intensive care unit. The patient remains alive but with significant neurological impairment. There are a variety of theories regarding the pathology of pediatric autoresuscitation. The most commonly accepted model is that there is a degree of autopositive end-expiratory pressure impending venous return as a consequence of vigorous ventilation during CPR. ...
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

“That's Not His Regular Formula”: A Case of Organophosphate Poisoning in an Infant
Conclusions This case highlights the importance of safety education for families. It also demonstrates how to recognize and treat OP toxicity in an infant. It emphasizes starting treatment early to avoid complications secondary to aging. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

A Traumatic Quinceañera: Acute Superior Mesenteric Artery Syndrome in an Adolescent Girl
A 15-year-old girl presented with 3 days of progressive abdominal distention, pain, and bilious hematemesis. Her symptoms began after her quinceañera, during which she wore a tight corset. On examination, she was thin and had significant abdominal distention and pain. A computed tomography revealed a massively dilated stomach and proximal duodenum to the region of the superior mesenteric artery (SMA) with distal decompression. An upper gastrointestinal fluoroscopy demonstrated marked dilation of the stomach through the mid third portion of the duodenum with distal decompression and an associated linear compression o...
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Epidemiology of Critical Interventions in Children With Traumatic Intracranial Hemorrhage
Objective To estimate rates of critical medical and neurosurgical interventions and resource utilization for children with traumatic intracranial hemorrhage (ICH). Methods This was a retrospective study of children younger than 18 years hospitalized in 1 of 35 hospitals in the Pediatric Health Information System from 2009 to 2019 for ICH. We defined critical intervention as a critical medical (hyperosmotic agents and intubation) or neurosurgical intervention. We determined rates of critical interventions, intensive care unit (ICU) admission, and repeat neuroimaging. We used hierarchical logistic regression to id...
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Prognostic Factors of Children Admitted to a Pediatric Intensive Care Unit After an Episode of Drowning
Conclusions The need for advanced CPR with epinephrine administration on the scene predicts poor neurological outcome (severe encephalopathy or death) in drowned children. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Elevated Heart Rate and Risk of Revisit With Admission in Pediatric Emergency Patients
Conclusions Last recorded ED HR discriminates poorly between children who are and are not at risk of revisit with admission in a pediatric ED. The use of single-parameter HR in isolation as an automated trigger for mandatory reevaluation prior to discharge may not improve revisit outcomes. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Care Coordination in Emergency Departments for Children and Adolescents With Behavioral Health Conditions: Assessing the Degree of Regular Follow-up After Psychiatric Emergency Department Visits
Conclusions It is of concern that fewer than half of patients received care coordination following an ED visit. Factors such as behavioral health workforce shortages, wait times for an appointment with a provider, and lack of reimbursement for care coordination may help explain these results. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Current Practices in Pediatric Emergency Medicine Fellowship Trauma Training
Conclusions There is considerable variability in how PEM fellows are trained to care for injured children. Most PDs do not realistically expect fellows to be able to perform all recommended trauma skills after graduation. Our findings highlight the need for further research and efforts to standardize the training of PEM fellows in pediatric trauma. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Decline in Pediatric Emergency Department Behavioral Team Activations After Institution of an Agitation Protocol
Conclusions A decrease from a baseline of 2.4 to 1.3 behavioral response team activations per month, or a 46% decline, was noted following the institution of a clinical protocol for pediatric agitation. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Do Social and Environmental Factors Affect the Emergency Service Admission Characteristics of Preschool-Aged Pediatric Trauma Patients?: A Prospective Study
Conclusions Our results suggest that both in-hospital and social/environmental aspects should be improved to reduce the clinical and social burden of trauma. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Substance Use in a Domestic Minor Sex Trafficking Patient Population
Substance use and abuse have been documented as both a risk factor in and consequence of involvement in domestic minor sex trafficking (DMST). Domestic minor sex trafficking is defined as the commercial sexual exploitation of children in exchange for money, food, shelter, or any other valued entity. The current investigation sought to describe substance use in a cohort of DMST patients who present for medical evaluation. Findings revealed that 68 patients referred for DMST involvement reported high rates of alcohol/substance use and parental substance abuse. Further, many patients who had a urine toxicology screen had a po...
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Adverse Drug Event–Related Admissions to a Pediatric Emergency Unit
Conclusions A high frequency of ADE-related admissions to the pediatric emergency unit was observed. The risk of being admitted to the pediatric emergency unit for any ADE increased in cases of neurological, dermatological, and respiratory disorders. Clinical pharmacists play an important role in the identification of ADEs and the education of child caregivers and health care providers concerning pediatric medication. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Pediatric Emergency Medicine Fellowship Programs
No abstract available (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Special Features Source Type: research

Acute Hemorrhagic Edema of Infancy With Associated Hemorrhagic Lacrimation: Erratum
No abstract available (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Erratum Source Type: research

Risk of Serious Bacterial Infections in Young Febrile Infants With COVID-19
Conclusions These results suggest that febrile infants younger than 90 days with COVID-19 have lower rates of SBI than their matched SARS-CoV-2–negative controls. These data are consistent with previous studies describing lower risks of SBI in febrile infants with concomitant viral respiratory tract infections. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Special Features Source Type: research

Pediatric Emergency Telemedicine: An Untapped Resource for Vulnerable Populations During COVID-19
No abstract available (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Special Features Source Type: research

Pediatric Abdominal Tuberculosis With Calcified Intra-abdominal Lymph Nodes Identified by Point-of-Care Ultrasound
Conclusions In the right clinical setting, the concurrent presence of intra-abdominal lymphadenopathy, ascites, mesenteric thickening, ileocecal thickening, and splenic microabscesses on ultrasound imaging should lead to consideration of the diagnosis of intra-abdominal tuberculosis. Although typically diagnosed on computed tomography or magnetic resonance imaging, in our case, POCUS helped facilitate the bedside diagnosis of abdominal tuberculosis in the emergency department. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: Ultrasound Case Review Source Type: research

Recognition, Evaluation, and Management of Pediatric Hereditary Angioedema
No abstract available (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - April 1, 2021 Category: Emergency Medicine Tags: CME Review Article Source Type: research