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The Paediatric Research in Emergency Departments International Collaborative (PREDICT) released the Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children in 2021. We describe innovative and practical methods used to develop this guideline. Informed by GRADE‐ADOLOPMENT and ADAPTE frameworks, we adopted or adapted recommendations from multiple high‐quality guidelines or developed de novo recommendations. A Guideline Steering Committee and a multidisciplinary Guideline Working Group of 25 key stakeholder representatives formulated the guideline scope and developed 33 clinical questions. We identified four relevant high‐quality source guidelines; their recommendations were mapped to clinical questions. The choice of guideline recommendation, if more than one guideline addressed a question, was based on its appropriateness, currency of the literature, access to evidence, and relevance. Updated literature searches identified 440 new studies and key new evidence identified. The decision to develop adopted, adapted or de novo recommendations was based on the supporting evidence‐base and its transferability to the local setting. The guideline underwent a 12‐week consultation period. The final guideline consisted of 35 evidence‐informed and 17 consensus‐based recommendations and 19 practice points. An algorithm to inform imaging and observation decision‐making was also developed. The resulting process was an efficient and rigorous way to develop a guideline based on existing high‐quality guidelines from different settings. [ABSTRACT FROM AUTHOR]

This review paper summarises the key changes made to the resuscitation guidelines used in Australia and New Zealand. They were released by the Australian and New Zealand Committee on Resuscitation in January 2016. These are local adaptations of the evidence previously published in October 2015 by the International Liaison Committee on Resuscitation (ILCOR). They are presented across the main working groups in ILCOR: ALS, BLS, paediatrics, neonates, acute coronary syndromes, first aid and 'Education, Implementation and Teams'. [ABSTRACT FROM AUTHOR]

Objective: The prevalence of paediatric anaphylaxis is rising in Australia. Treatment requires timely administration of intramuscular (IM) adrenaline. Study goals included utilising in situ simulation (ISS) within a translational simulation (TS) programme as a diagnostic tool to identify the frequency and cause of IM adrenaline errors in a paediatric ED, and utilising ISS to evaluate multidisciplinary emergency team response to anaphylaxis. Methods: A prospective observational study was conducted in the Royal Children's Hospital Melbourne ED utilising an ISS anaphylaxis scenario with a debrief pro forma within an established ISS/TS programme. Results: Twenty‐three anaphylaxis ISS were delivered over 16 months. One hundred and sixty‐four multidisciplinary staff participated (mean of 8 per session). Median times (in minutes) for the total ISS were 12:33 (interquartile range [IQR] 9:06–15:19), consisting of the scenario 4:07 (IQR 3:33–4:44) and debriefing 9:00 (IQR 5–11). IM adrenaline was administered in all ISS within 5 min, median 2:57 (IQR 2:30–3:40). Adrenaline medication errors occurred in 30% ISS (7/23). Errors included three (13%) administrations and four (17%) potential or 'near misses' associated with a verbal order or medication preparation error. A weight‐based medication cognitive aid was utilised in 56% (13/23) ISS but was not utilised in all three administration errors. Conclusions: ISS within TS programmes was successfully utilised as a diagnostic tool in identifying that medication errors were common during anaphylaxis management in the ED. Improving access to adrenaline in dosing boxes and promoting the utilisation of weight‐based cognitive aids alongside ISS education will likely reduce errors and improve patient safety. [ABSTRACT FROM AUTHOR]

Objective: Anecdotal reports indicate an increase in mental health presentations and acuity to EDs during the COVID‐19 pandemic and associated stay at home restrictions. Paediatric and adolescent data to confirm this are unavailable in the Australian setting. Methods: Retrospective electronic medical record review of all ED patients with mental health discharge codes at a large tertiary children's hospital in Australia during the period of stay at home restrictions from 1 April to 30 September 2020 compared with the same dates in 2019. Results: We found a 40% decrease in ED presentations (18 935–11 235) with a concurrent 47% increase in mental health presentations (809–1190) to ED during the study periods between 2019 and 2020. This resulted in an increase of 100 mental health admissions from ED. Diagnoses with greatest percentage increases were eating disorders, social issues and suicidality. We found suicidality presentation numbers were highest in June to September 2020 compared with 2019. Patients with a diagnosis of suicidality had a higher rate of re‐presentation in 2020 (1.83 presentations per patient) compared to 2019 (1.38 presentations per patient). Conclusions: Despite an overall decrease in ED presentations, the absolute increase in mental health presentations for children and adolescents during the stay at home restriction period was pronounced. It is unclear how sustained this change and the impact on mental health resource use will be post‐pandemic. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including Australi's reopening after lockdown, coronavirus disease 2019 (COVID-19) and emergency department nursing, and asthma in Queensland.

Objective: To explore trends in presentation and key performance indicators with respect to children seeking mental health services at The Prince Charles Hospital Children's Emergency Department (TPCH‐CED), Brisbane. Methods: A retrospective audit was performed utilising data obtained from the local Emergency Department Information System for all mental health presentations between 1 January 2013 and 1 January 2018 to TPCH‐CED. Results: A total of 1078 children presented to TPCH‐CED requiring mental health review between 2013 and 2018. Mental health presentations almost doubled over the 5 years (185 attendances in 2013; 342 in 2017); however, as a proportion of overall presentations, there was no significant increase. The percentage of mental health presentations meeting the National Emergency Access Target criteria dropped from 63% in 2013 to 39% in 2017 (P < 0.0001). Those requiring a mental health inpatient stay were more likely to have very extended length of stay within the CED. Suicidal ideation was the most common presenting complaint (72% of mental health presentations). Violence and aggression were noted in a consistent proportion of mental health presentations (4.4–12%). Conclusions: Despite failing to demonstrate an interval increase in the proportion of children presenting to TPCH‐CED requiring mental health services, it is clear that children with mental health needs, like their adult counterparts, disproportionately experience delays to appropriate care when compared with children presenting with other emergency conditions. Ongoing research is warranted to assess standards of care and the impact of mental health presentations on CEDs. [ABSTRACT FROM AUTHOR]

Objectives: To investigate patient‐level factors predictive for computed tomography of the brain (CTB) use and abnormality in head injured children in Australia and New Zealand. Methods: Retrospective data from tertiary, urban/suburban and regional/rural EDs including factors predictive for CTB use and abnormality. Results: Of 3072 children at 31 EDs, 212 (6.9%) had a CTB scan, of which 66 (31%) were abnormal. Increasing age, serious mechanisms of injury and decreasing Glasgow Coma Score were predictive for ordering CTB. Decreasing age was predictive for CTB abnormalities. Other factors were not. Conclusion: Patient‐level drivers of CTB use in children in Australia and New Zealand are consistent with international data. [ABSTRACT FROM AUTHOR]

Objective: Fluid bolus therapy (FBT) is recommended as the initial form of acute circulatory support for many disease processes. The epidemiology of its use in the ED is unknown. The aim of this study was to assess indications, use patterns and short‐term effects of FBT in a paediatric ED. Methods: Retrospective observational study in the ED of the Royal Children's Hospital, Melbourne, Australia (annual census >90 000) using hospital electronic medical record data for all patients who received an i.v. fluid bolus in the ED over the calendar year 2018 were included in the study. We extracted demographics, indications, volume, content of FBT as well as subsequent vital sign and biochemical changes. Results: One thousand five hundred and thirty‐nine fluid boluses were administered to 1343/90 000 children (1.5%), 1185 received 1, 123 received 2, 32 received 3, and 3 received 4 boluses. Fluid bolus volume of 10 mL/kg was used in 45.3%, 20 mL/kg in 35.7%, 500 mL in 6.4% and 1000 mL in 7.1%. The fluid content was 0.9% saline in 99.9% of cases. The most common indications for FBT were: vomiting/diarrhoea (23%), acute febrile illness (11%) and pneumonia or sepsis (10% each). FBT was associated with a reduction in median heart rate by 6 beats per minute (P < 0.01), reduction in mean blood pressure by 3 mmHg (P < 0.01), and reduction in venous lactate by 0.2 mmol/L (P < 0.01). Conclusions: Fluid bolus therapy is a commonly used intervention in the paediatric ED, most often for dehydration. Variability in indications, dose and effects of FBT warrant further exploration. [ABSTRACT FROM AUTHOR]

Objective This study examines clinical characteristics and helmet use of children presenting to the ED with a recreational vehicle (RV)-related head injury (HI). Methods Observational retrospective study of children <18 years presenting with a RV-related HI to the ED of a state-wide paediatric trauma centre in Australia between April 2011 and January 2014. Results In the 647 presentations identified, corresponding to 7.5% (95% CI 7.0-8.1) of all HI presentations, RVs involved were bicycles (36.3%), push scooters (18.5%), motorcycles (18.4%), horses (11.7%), skateboards (11.6%), quadbikes (2.8%) and go-karts (0.6%). Recorded helmet use was the highest in motorcycle, horse and bicycle riders (83.2%, 82.9% and 65.1%, respectively), and the lowest for push scooter (25.8%) and skateboard riders (17.3%). Overall 23% underwent a CT scan, 8.8% had intracranial injuries on CT, 30.6% were admitted, and 2.2% underwent neurosurgery. Push scooter-related HIs were the least severe. Age (in years), riding a motorised vehicle and not wearing a helmet were independently associated with intracranial injuries on CT on multiple logistic regression (OR 1.1, 95% CI 1.0-1.2; OR 2.4, 95% CI 1.3-4.6 and OR 6.0, 95% CI 3.2-11.2, respectively). Conclusions RV-related HIs accounted for a non-negligible proportion of paediatric HIs presenting to the ED and for significant morbidity and use of hospital resources. Interventions such as introduction of mandatory helmet use for off-road motorised vehicle riding and skateboard riding in children, enhanced injury prevention campaigns, and strict adult supervision during motorised vehicle riding may reduce the morbidity and health care costs associated with paediatric RV-related HIs. [ABSTRACT FROM AUTHOR]

The Paediatric Acute Care Conference (PACC) is an annual conference organised by Advanced Paediatric Life Support Australia to advance paediatric acute care topics for clinicians in pre-hospital medicine, EDs, acute paediatrics, intensive care and anaesthesia. The PACC 2016 was held at Glenelg, Adelaide, Australia. We provide a summary of some of the presentations. [ABSTRACT FROM AUTHOR]

The article discusses headache in children. Topics discussed include the Home, Education, Alcohol, Drugs, Smoking, Sex (HEADSS) screen that should be undertaken in all adolescent patients as a screening tool that provides a framework for conducting a psychosocial assessment, treatment for headache suggesting simple analgesia for headaches secondary to upper respiratory tract infections, and diagnosis for viral upper respiratory tract infection.