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OBJECTIVE: To establish, in children aged from 3 months to less than 13 years with a febrile illness, caregiver medication usage patterns and drivers. Secondary objectives assessed caregiver knowledge and concern about fever. METHODOLOGY: This was a prospective, observational study of a convenience sample of 147 children presenting to a tertiary Paediatric Emergency Department, where the caregivers reported a concern of fever within the preceding 48 h. A paper-based survey was completed by the caregivers, and the results analysed both qualitatively and quantitatively. RESULTS: Caregivers of 92.4% had administered medication for fever in the 48 h prior to presentation. Dual therapy of paracetamol and ibuprofen was used by 45.8%, with paracetamol used more frequently as monotherapy (35.4%). Almost one-third of caregivers woke their child to administer medication. Just over one-third of respondents stated that a temperature of less than 38.0°C is a fever. The majority of caregivers (67.6%) said that fever is bad for their child, with 97.9% being concerned by fever. Almost half the children (46.8%) were given medication purely to treat the degree of the temperature. General practitioners were reported as the strongest influence on medication decision (60%). CONCLUSIONS: This study provides insight into current knowledge and practices of parents regarding fever and its treatment. The results of this study may be used to direct future interventions to educate caregivers on this topic.

Background: Sports-related head injuries (HIs) are frequent in children. There are few large-scale assessments correlating type of sport and severity of injury in Emergency Department (EDs) presentations. Objective(s): To describe the outcomes of sports-related HIs in a large cohort of patients presenting to EDs in Australia and New Zealand. Method(s): Planned secondary analysis of a prospective observational study of children who presented with a sports-related HIs at 10 Australian/New Zealand paediatric EDs. We assessed epidemiology, clinical characteristics, and outcome of clinically important traumatic brain injury (ciTBI) (death, neurosurgery, intubation > 24 h and admission >2 d with abnormal CT). Relative risk (RR) for ciTBI was calculated for individual sports. Result(s): Of 9,199 patients with HIs aged 5 to <18 years, 3,177 (34.5%) had sports related HIs. 2482 (78.0%) were male. 524 (16.5%) underwent neuroimaging, 64 (2.0%) had traumatic brain injury on CT and 45 (1.4%) ciTBI. Sports categories were high speed (1088, 34.3%), contact (1032, 32.5%), ball sports (495, 15.6%), club/bat (239, 7.5%), water (230, 7.2%), dance related (63, 2.0%) and racket sports (30, 0.9%) with ciTBI in 36 (3.3%) high speed, 6 (2.5%) club/bat and 3 (0.3%) contact sports and none in other sports. For individual sports RRs for ciTBI were horse riding 5.9 (2.5-14.1), bike riding 4.4 (2.6-7.7), skateboarding 3.8 (1.7-8.5), hockey 2.1 (0.5-8.9), football 0.3 (0.0-2.4), rugby 0.23 (0.0-1.7). Conclusion(s): Paediatric sports-related HIs frequently present to EDs. However, ciTBIs are rare with higher rates in horse riding, bike riding and skateboarding.

BACKGROUND AND OBJECTIVES: Identifying international differences in the management of acute pediatric poisonings may help improve the quality of care. The objective of this study was to assess the international variation and appropriateness of gastrointestinal decontamination (GID) procedures performed in children and adolescents who present with acute poisonings to emergency departments. METHOD(S): This was an international, multicenter, cross-sectional prospective study including children <18 years with poisoning exposures presenting to 105 emergency departments in 20 countries from 8 global regions belonging to the Pediatric Emergency Research Networks. Data collection started between January and September 2013 and continued for 1 year. The appropriateness of GID procedures performed was analyzed using the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists' recommendations. Multivariate logistic regression was performed to identify independent risk factors for performing GID procedures. RESULT(S): We included 1688 patients, 338 of whom (20.0%, 95% confidence interval 18.1%-22.0%) underwent the following GID procedures: activated charcoal (166, 49.1%), activated charcoal and gastric lavage (122, 36.1%), gastric lavage (47, 13.9%), and ipecac (3, 0.9%). In 155 (45.8%, 40.5%-51.2%), the GID procedure was considered appropriate, with significant differences between regions. Independent risk factors for GID procedures included age, toxin category, mechanism of poisoning, absence of symptoms, and the region where the intoxication occurred (P < .001). CONCLUSION(S): Globally, there are substantial differences in the use and appropriateness of GID procedures in the management of pediatric poisonings. International best practices need to be better implemented.Copyright © 2017 by the American Academy of Pediatrics.

Background: Abusive head trauma (AHT) is associated with high morbidity and mortality. It may be difficult to detect in the emergency department (ED). Objective(s): To determine how cases of suspected AHT differ from non-abusive head injuries in the ED setting. Method(s): Planned secondary analysis of prospective multicentre cohort study of children aged <18 years across 10 centres in Australia and New Zealand with head injuries. We identified cases of suspected AHT when ED clinicians identified such suspicion on a clinical report form or based on research assistant assigned epidemiology codes. We compared suspected AHT cases and non-AHT cases using risk ratios with 95% confidence intervals (CIs). We assessed the rate of clinically important traumatic brain injuries [ciTBI: death; neurosurgery; intubation >1 day, admission >2 days with abnormal computed tomography (CT) scan]. Result(s): AHT was suspected in 103 of 20 137 (0.5%) headinjured children. Mean age was 2.4 years (SD 4.0). GCS was <12 in 9 (8.7%). 12 (11.7%) presented with seizures. 71 (68.9%) underwent CT head scan, of which 49 (69.0%) were abnormal. 80 (77.7%) children were admitted. Neurosurgery was performed in 3, and 2 children died. 23 (22.3%) had ciTBI. RRs (95% CI) for AHT vs. non AHT were: LOC 1.4 (0.7-2.7), vomiting 1.6 (1.2-2.2), scalp haematoma 2.3 (2.0-2.6), GCS <12 8.5 (4.5-16.0), abnormal neuroimaging 16.4 (13.2-20.4), neurosurgery 7.4 (2.4-22.9), mortality 29.9 (6.8-130.9) and ciTBI 17.4 (6.8-25.5). Conclusion(s): In the ED, clinical presentation in children with suspected AHT differs from non-AHT cases. Suspected cases of AHT are at increased risk of abnormal CT scans, ciTBI and death.

Background: While the majority of head injuries in children are non-intentional, there is limited information on intentional injuries outside abusive head trauma. Objective(s): To investigate intentional head injuries in terms of demographics, epidemiology and severity. Method(s): Planned secondary analysis of prospective multicentre cohort study of children aged <18 years across 10 centres in Australia and New Zealand. Victorian state epidemiology codes (intent, activity, place, mechanism) were used to prospectively code the injuries. Data were descriptively analysed. Result(s): Intentional injuries were found in 441 of 20 137 (2.2%) head-injured children. Injuries were caused by peers (166, 37.6%), by caregiver (103, 23.4%), by sibling (47, 10.7%), due to attack by stranger (35, 7.9%), attack by person with unknown relation to patient (19, 4.3%), intentional self-harm (7, 1.6%), other cause or undetermined (64, 28.2%). Children were <2 years old in 75.7% injuries caused by caregivers and 8.3% in other causes. Overall, 71.0% of victims were male. Admission rates varied from 77.7% for assault by caregiver, 37.1% attack by stranger, 22.3% by peer and 8.5% by sibling. Peer assaults were related to sports in 69 cases (41.6%), with highest frequency in contact sports, rugby (40.6) and Australian football (26.1%). Conclusion(s): Intentional head injuries are infrequent in children. The most frequent cause is peer assault, often during sports, and injuries caused by caregivers.

Contains fulltext : 165909.pdf (publisher's version ) (Open Access)

Objectives To determine whether nasogastric hydration can be used in infants less than 2 months of age with bronchiolitis, and characterize the adverse events profile of these infants compared with infants given intravenous (IV) fluid hydration. Study design A descriptive retrospective cohort study of children with bronchiolitis under 2 months of age admitted for hydration at 3 centers over 3 bronchiolitis seasons was done. We determined type of hydration (nasogastric vs IV fluid hydration) and adverse events, intensive care unit admission, and respiratory support. Results Of 491 infants under 2 months of age admitted with bronchiolitis, 211 (43%) received nonoral hydration: 146 (69%) via nasogastric hydration and 65 (31%) via IV fluid hydration. Adverse events occurred in 27.4% (nasogastric hydration) and 23.1% (IV fluid hydration), difference of 4.3%; 95%CI (-8.2 to 16.9), P=.51. The majority of adverse events were desaturations (21.9% nasogastric hydration vs 21.5% IV fluid hydration, difference 0.4%; [-11.7 to 12.4], P=.95). There were no pulmonary aspirations in either group. Apneas and bradycardias were similar in each group. IV fluid hydration use was positively associated with intensive care unit admission (38.5% IV fluid hydration vs 19.9% nasogastric hydration; difference 18.6%, [5.1-32.1], P=.004); and use of ventilation support (27.7% IV fluid hydration vs 15.1% nasogastric hydration; difference 12.6 [0.3-23], P=.03). Fewer infants changed from nasogastric hydration to IV fluid hydration than from IV fluid hydration to nasogastric hydration (12.3% vs 47.7%; difference -35.4% [-49 to -22], P<.001). Conclusions Nasogastric hydration can be used in the majority of young infants admitted with bronchiolitis. Nasogastric hydration and IV fluid hydration had similar rates of complications.Copyright © 2016 Elsevier Inc.

Background: While there has been discussion in the literature about the number of "general practice" (GP) type patients presenting to emergency departments (EDs) little has been reported in the paediatric emergency medicine literature. It has been estimated that up to 50% of paediatric presentations in Victoria fall within this patient type. Some paediatric emergency departments are currently experiencing levels of access block previously seen only in adult departments. It is important to understand the reasons why parents/guardians present their children to EDs rather than see their GP and, equally as important, to determine why GPs refer children to the ED. Aim(s): The primary aim of this study is to describe the expectations of parents and doctors (ED doctors and referring GPs) regarding the type of care provided in a tertiary paediatric ED. A secondary aim is to identify factors associated with ED attendances to determine whether any processes can be implemented to improve the "appropriateness" of ED presentations in this population. Method(s): The setting is a large tertiary referral ED. Qualitative and demographic data will be collected by survey and EDIS. The survey will identify the views of parent/guardian, treating ED Doctor and referring GP (if relevant) for each paediatric presentation over a two-week period (projected 1000 attendances). Outcome(s): Descriptive statistics for survey results will be presented. A comprehensive adult and paediatric literature review on these presentation types will be undertaken.

Background: Urinary tract infection (UTI) is a common bacterial infection among young children who are febrile. The prevalence of UTI in febrile children under 2 years of age is 3.3%-7%1. It is a challenge for healthcare providers to make a diagnosis of UTI in these children as presenting symptoms and signs are non-specific, hence the need for reliable urine microscopy and culture2. There is a high contamination rate for urine collected via the clean catch method, with a contamination rate ranging from 14.7%-26%3. Objective(s): This study aims to standardise the collection method by administering a handout on technique for clean catch urine collection and to potentially decrease the contamination rate. Method(s): We conducted a single-centre prospective cohort interventional study in a tertiary Emergency Department (ED). All children below the age of 24 months who presented from April 2013-June 2014 requiring a urine sample to be obtained to test for infection were included. The intervention was provision of a pre-made urine collection pack (urine specimen jar, cleaning wipes, an underpad and a standardised information). The primary outcome measure was the difference in proportion of urine contamination in samples obtained via a clean catch pre and post intervention. Result(s): The total number of urine specimens included in the pre-intervention group was 288 and the post-intervention group was 333. Contamination rates were 14.9% in the pre-intervention group and 11.4% in the post-intervention group. There was no statistically significant reduction in contamination (p-value 0.19). The contamination rates appeared to be associated with gender, with (pooled) female contamination rates being 16.4% (44/269) and male contamination rates being 10.5% (37/352). Contamination rates in males and females were not improved by the intervention. Most specimens of urine were collected via the clean catch method (CCU) (81.2%) during the study period. This was followed by in-out cat

Background: Limb fractures in children are a common presenting problem to emergency departments (EDs).1 Many of these are referred to fracture clinic, some unnecessarily.2-4 State-wide paediatric fracture guidelines were introduced to Victoria in October 2012, with the aim of optimising management of these conditions. Objective(s): To describe the management and referral of paediatric limb fractures presenting to our health service, and to assess outcome of fracture clinic referral. Method(s): Structured retrospective chart review of all patients aged between 0 and 18 years presenting to the 3 EDs of a single Victorian health service during a two month period. Patients were included if they had an ED discharge diagnosis of limb fracture. Data collection included x-ray findings, ED management, consultation and admission by the orthopaedic unit, referral to fracture clinic, and outcome of initial fracture clinic referral. Result(s): 489 presentations were due to limb injuries coded as fracture by emergency department staff. Of these, x-rays were available for 458 patients. 67 (14.6%) of patients did not have a fracture on formal radiology report, while the remaining 391 had a confirmed fracture. Most patients were managed by ED staff without orthopaedic consultation (Table 1), while less than a third of patients required orthopaedic consultation or admission. 31 upper limb fractures were manipulated in the ED. Of these, 4 were subsequently admitted to hospital for further treatment, while another 7 required re-manipulation after review in fracture clinic. 85 children were admitted to hospital for orthopaedic management. Of these 65 (76%) were for upper limb fractures. 288 children were referred to fracture clinic. 21 did not attend for follow-up. Of those 267 seen in fracture clinic, 22 did not have a fracture, and another 30 were discharged from the clinic on the first visit. Another 183 were booked for another review (37% of these had a change to their plaster), whi

Background: Patients and clinicians consistently rate insertion of a nasogastric tube (NGT) as one of the most painful and distressing emergency department procedures. Despite this, surveys of emergency clinicians suggest that provision of adequate procedural analgesia is often inconsistent and suboptimal. While many studies have demonstrated the effectiveness of various interventions to reduce pain and distress in adults, there have been few studies in the pediatric population. There are currently no studies comparing the effectiveness of a local anesthetic nasal spray for the prevention of the pain and distress associated with NGT insertion in children. This study aims to compare the analgesic efficacy of a proprietary preparation of lignocaine/phenylephrine nasal spray and placebo for this indication. Methods/Design: This is a prospective, randomized, controlled, double-blind superiority trial of 100 children aged 6 months to 5 years weighing at least 6 kg in whom a nasogastric tube is planned to be inserted. These children will be randomized to either intranasal lignocaine/phenylephrine or placebo. Pain severity is the primary outcome measure and will be measured utilizing the Face, Legs, Arms, Cry and Consolability (FLACC) pain severity rating scale. An independent staff member not involved in inserting the NGT and the child's parents or carer will also record pain and distress on a visual analog scale (VAS). FLACC scores and VAS scores will be presented as median and interquartile range (IQR). Non-normally distributed scores will be compared using a Wilcoxon rank-sum test. Categorical data will be analyzed using Fisher's exact test. Adverse events will be described as type and incidence. Discussion: Previous studies on NGT insertion have not focused on the pediatric population. This study aims to establish the effectiveness of a simple intranasal spray of lignocaine/phenylephrine in children undergoing NGT insertion. A positive result of this study would provi

Contains fulltext : 52541.pdf (publisher's version ) (Closed access), Isolated complex I deficiency is the most common enzymatic defect of the oxidative phosphorylation (OXPHOS) system, causing a wide range of clinical phenotypes. We reported before that the rates at which reactive oxygen species (ROS)-sensitive dyes are converted into their fluorescent oxidation products are markedly increased in cultured skin fibroblasts of patients with nuclear-inherited isolated complex I deficiency. Using video-imaging microscopy we show here that these cells also display a marked increase in NAD(P)H autofluorescence. Linear regression analysis revealed a negative correlation with the residual complex I activity and a positive correlation with the oxidation rates of the ROS-sensitive dyes 5-(and-6)-chloromethyl-2',7'-dichlorodihydrofluorescein and hydroethidine for a cohort of 10 patient cell lines. On the other hand, video-imaging microscopy of cells expressing reduction-oxidation sensitive GFP1 in either the mitochondrial matrix or cytosol showed the absence of any detectable change in thiol redox state. In agreement with this result, neither the glutathione nor the glutathione disulfide content differed significantly between patient and healthy fibroblasts. Finally, video-rate confocal microscopy of cells loaded with C11-BODIPY(581/591) demonstrated that the extent of lipid peroxidation, which is regarded as a measure of oxidative damage, was not altered in patient fibroblasts. Our results indicate that fibroblasts of patients with isolated complex I deficiency maintain their thiol redox state despite marked increases in ROS production.