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9. Predicting Adverse Outcomes for Shiga Toxin–Producing Escherichia coli Infections in Emergency Departments

Author

Rominger, Annie, Beer, Darcy, Pruitt, Christopher M., Abramo, Thomas J., Schuh, Abigail, Kanegaye, John T., Jones, Nicholas E., Lin, Chu Yang, Xie, Jianling, Freedman, Stephen B., McKee, Ryan S., Schnadower, David, Tarr, Phillip I., Finkelstein, Yaron, Desai, Neil M., Lane, Roni D., Bergmann, Kelly R., Kaplan, Ron L., Hariharan, Selena, Cruz, Andrea T., Cohen, Daniel M., Dixon, Andrew, Ramgopal, Sriram, Powell, Elizabeth C., Kilgar, Jennifer, Michelson, Kenneth A., Bitzan, Martin, Yen, Kenneth, Meckler, Garth D., Plint, Amy C., Balamuth, Fran, Bradin, Stuart, Gouin, Serge, Kam, April J., Meltzer, James A., Hunley, Tracy E., Avva, Usha, Porter, Robert, Fein, Daniel M., Louie, Jeffrey P., and Tarr, Gillian A.M.

Published
2021
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12. 2021 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19

Author

Hsu, Antony, Sasson, Comilla, Kudenchuk, Peter J., Atkins, Dianne L., Aziz, Khalid, Becker, Lance B., Berg, Robert A., Bhanji, Farhan, Bradley, Steven M., Brooks, Steven C., Chan, Melissa, Chan, Paul S., Cheng, Adam, Clemency, Brian M., de Caen, Allan, Duff, Jonathan P., Edelson, Dana P., Flores, Gustavo E., Fuchs, Susan, Girotra, Saket, Hinkson, Carl, Joyner, Benny L., Jr, Kamath-Rayne, Beena D., Kleinman, Monica, Lasa, Javier J., Lavonas, Eric J., Lee, Henry C., Lehotzky, Rebecca E., Levy, Arielle, Mancini, Mary E., McBride, Mary E., Meckler, Garth, Merchant, Raina M., Moitra, Vivek K., Morgan, Ryan W., Nadkarni, Vinay, Panchal, Ashish R., Peberdy, Mary Ann, Raymond, Tia, Roberts, Kathryn, Sayre, Michael R., Schexnayder, Stephen M., Sutton, Robert M., Terry, Mark, Walsh, Brian, Wang, David S., Zelop, Carolyn M., and Topjian, Alexis

Published
2021
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21. The impact of pediatric emergency department crowding on patient and health care system outcomes: a multicentre cohort study

Author

Doan, Quynh, Wong, Hubert, Meckler, Garth, Johnson, David, Stang, Antonia, Dixon, Andrew, Sawyer, Scott, Principi, Tania, Kam, April J., Joubert, Gary, Gravel, Jocelyn, Jabbour, Mona, and Guttmann, Astrid

Subjects
Ontario. Ministry of Health and Long-Term Care -- Analysis, Hospital emergency services -- Analysis, Emergency medicine -- Analysis, Pediatric emergencies -- Analysis, Death, Hospital admission and discharge, Pediatrics, Children, Health
Abstract

BACKGROUND: Emergency department overcrowding has been associated with increased odds of hospital admission and mortality after discharge from the emergency department in predominantly adult cohorts. The objective of this study was to evaluate the association between crowding and the odds of several adverse outcomes among children seen at a pediatric emergency department. METHODS: We conducted a retrospective cohort study involving all children visiting 8 Canadian pediatric emergency departments across 4 provinces between 2010 and 2014. We analyzed the association between mean departmental length of stay for each index visit and hospital admission within 7 days or death within 14 days of emergency department discharge, as well as hospital admission at index visit and return visits within 7 days, using mixed-effects logistic regression modelling. RESULTS: A total of 1931465 index visits occurred across study sites over the 5-year period, with little variation in index visit hospital admission or median length of stay. Hospital admission within 7 days of discharge and 14-day mortality were low across provinces (0.8%-1.5% and INTERPRETATION: Emergency department crowding was not significantly associated with hospital admission within 7 days of the emergency department visit or mortality in children. However, it was associated with increased hospital admission at the index visit for the sickest children, and with return visits to the emergency department for those less sick., Emergency department overcrowding is a complex systems problem and an important health services and public health concern. Although the magnitude of emergency department overcrowding varies regionally, the Canadian Association of [...]

Published
2019
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22. Evaluating the psychosocial status of BC children and youth during the COVID-19 pandemic: A MyHEARTSMAP cross-sectional study

Author

Woodward, Melissa L., primary, Hossain, Abrar, additional, Chun, Alaina, additional, Liu, Cindy, additional, Kilyk, Kaitlyn, additional, Bone, Jeffrey N., additional, Meckler, Garth, additional, Black, Tyler, additional, Stewart, S. Evelyn, additional, Samji, Hasina, additional, Barbic, Skye, additional, and Doan, Quynh, additional

Published
2023
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23. Psychosocial Care for Injured Children: Worldwide Survey among Hospital Emergency Department Staff

Author

Osmond, Martin, Plint, Amy, Freedman, Stephen, Johnson, David, Murray, Diana, Williamson-Urquhart, Sarah, Curran, Janet, Dixon, Andrew, Meckler, Garth, Bialy, Liza, Doan, Quynh, Stang, Antonia, Mater, Ahmed, Beer, Darcy, Joubert, Gary, Crocco, Anthony, Davis, Adrienne, Moore, Andrea, Alqurashi, Waleed, Dubrovsky, Sasha, Trottier, Evelyne, Blanchet, Mathieu, Hurley, Katrina, Porter, Robert, Auerbach, Marc, Chang, Todd, Cruz, Andrea, Macias, Charles G., Florin, Todd A., Kharbanda, Anupam B., Mahajan, Prashant, Mistry, Rakesh, Schnadower, David, Stanley, Rachel, Nigrovic, Lise, Michelson, Kenneth, Zorc, Joe, Lyttle, Mark, Maconochie, Ian, Hartshorn, Stuart, Foster, Steven, Bevan, Cath, O'Sullivan, Ronan, Mitchelson, Mark, Maney, Julie-Ann, Potter, Sarah, Younge, Paul, Powell, Colin V.E., Robinson, Gisela, Blackburn, Carol, Bolger, Turlough, McNamara, Roisin, Leonard, Paul, Reuben, Adam, Choudhery, Vince, Mulligan, Joanne, Alcock, Roger, Davies, Ffion, Mehta, Bimal, Parikh, Ami, Ross, James, Criddle, John, Sutherland, Emer, Sajjanhar, Tina, Wong, Shye, Thiagarajan, Jai, Rowland, Andrew, Potier, Katherine, Dieppe, Clare, Thomas, Lucy, Smith, Jason, Vorwerk, Chris, Lenton, Kate, Burke, Derek, Barling, Jason, Mullen, Niall, Dickson-Jardine, Kirsty, Mintegui Raso, Santiago, Gómez, Borja, Da Dalt, Liviana, Gervaix, Alain, Moll, Henriette, Waisman, Yehezkel, Parri, Niccolò, Titomanlio, Luigi, Benito, Javier, Yilmaz, Hayri Levent, Teksam, Ozlem, Srivastava, Geetanjali, Bognar, Zsolt, Moldovan, Diana, Luaces-Cubells, Carles, Qureshi, Nadeem, Cheron, Gerard, Kreier, Felix, Velasco, Roberto, Leroy, Sandrine, Simon, Gabor, Van de Voorde, Patrick, Mintegi, Santiago, Ruddy, Richard, Dayan, Peter, Hickey, Robert, Kuppermann, Nathan, Chamberlain, James, Dean, J. Michael, Lerner, E. Brooke, Rogers, Alexander, Cohen, Daniel, Babcock, Lynn, Brousseau, David, Kwok, Maria, Macias, Charles, Bajaj, Lalit, Chun, Thomas, Bennett, Jonathan, Tzimenatos, Leah, Nelson, Douglas, Brown, Kathy, Powell, Elizabeth, Cheng, Nicholas, Zhang, Michael, Craig, Simon, Babl, Franz E., Dalziel, Stuart, Sinn, Kam, McCaskill, Mary, George, Shane, Jocelyn Neutze, Phillips, Natalie, Borland, Meredith, Barrow, Lisa, Rao, Arjun, Furyk, Jeremy, Kochar, Amit, Chamberlain, Jim, Kharbanda, Anupam, Babl, Franz, Alisic, Eva, Hoysted, Claire, Kassam-Adams, Nancy, Landolt, Markus A., Curtis, Sarah, and Lyttle, Mark D.

Published
2016
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26. Epinephrine metered‐dose inhaler for pediatric croup

Author

Meckler, Garth D., primary, Alqurashi, Waleed, additional, Eltorki, Mohamed, additional, Curtis, Sarah J., additional, Doyle, Elisabete, additional, Kam, April J., additional, Lim, Rodrick, additional, MacPhee, Shannon, additional, Schuh, Suzanne, additional, Wright, Bruce, additional, and Johnson, David W., additional

Published
2022
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27. 61 Analgesia and sedation for pediatric ileocolic intussusception: a global, multicenter, cross-sectional study (PAINT)

Author

Poonai, Naveen, primary, Cohen, Daniel M, additional, MacDowell, Doug, additional, Mistry, Rakesh, additional, Craig, Simon, additional, Ali, Samina, additional, Thompson, Graham, additional, Roland, Damian, additional, Gravel, Jocelyn, additional, Sabhaney, Vikram, additional, Meckler, Garth, additional, Jain, Rini, additional, Miller, Michael, additional, Davis, Adrienne, additional, Shavit, Itai, additional, and Mintegi, Sa, additional

Published
2022
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29. Guidance for Cardiopulmonary Resuscitation of Children With Suspected or Confirmed COVID-19

Author

Morgan, Ryan W., primary, Atkins, Dianne L., additional, Hsu, Antony, additional, Kamath-Rayne, Beena D., additional, Aziz, Khalid, additional, Berg, Robert A., additional, Bhanji, Farhan, additional, Chan, Melissa, additional, Cheng, Adam, additional, Chiotos, Kathleen, additional, de Caen, Allan, additional, Duff, Jonathan P., additional, Fuchs, Susan, additional, Joyner, Benny L., additional, Kleinman, Monica, additional, Lasa, Javier J., additional, Lee, Henry C., additional, Lehotzky, Rebecca E., additional, Levy, Arielle, additional, McBride, Mary E., additional, Meckler, Garth, additional, Nadkarni, Vinay, additional, Raymond, Tia, additional, Roberts, Kathryn, additional, Schexnayder, Stephen M., additional, Sutton, Robert M., additional, Terry, Mark, additional, Walsh, Brian, additional, Zelop, Carolyn M., additional, Sasson, Comilla, additional, and Topjian, Alexis, additional

Published
2022
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42. randomized controlled pilot study of intranasal lidocaine in acute management of paediatric migraine and migraine-like headache.

Author

Maki, Kate, Doan, Quynh, Sih, Kendra, Stillwell, Karly, Chun, Alaina, and Meckler, Garth

Subjects
LIDOCAINE, PILOT projects, LENGTH of stay in hospitals, SAMPLE size (Statistics), HOSPITAL emergency services, CONFIDENCE intervals, MIGRAINE, RANDOMIZED controlled trials, BLIND experiment, HEADACHE, STATISTICAL sampling, DRUG side effects, PHYSIOLOGIC salines
Abstract

Objectives This study was aimed to determine the sample size required to conduct an efficacy randomized controlled trial (RCT) to evaluate superiority of intranasal (IN) lidocaine to placebo as an analgesic option for children presenting to the paediatric emergency department (PED) with migraine or posttraumatic headache with migraine features and to evaluate study protocol feasibility. Study Design This study is a double-blind RCT of children aged 7 to 16 years at a single-centre PED. Thirty-two participants were randomized to receive either IN 2% lidocaine or 0.9% sodium chloride. The primary outcome measure was the proportion of subjects with a Verbal Numeric Rating Scale pain score of <4 at 30 and 60 minutes post-IN therapy. Primary outcome data were analyzed using a test of differences between proportions. Secondary objectives included assessing the feasibility of our study protocol by evaluating recruitment rates, adverse drug events, and PED length of stay (LOS). Results Six of 17 participants in the lidocaine group and 2 of 15 in the placebo group were treated successfully. Using these proportions with 95% confidence intervals and 80% power, the sample size required to find a significant difference between proportions would be 67 participants per arm. Our enrolment rate was 55% and there were no serious adverse drug events. The median PED LOS was similar between groups. Conclusion We determined the sample size required to conduct a definitive RCT to evaluate the superiority of IN lidocaine to placebo and found the study protocol is feasible but identified important considerations in PED migraine trial design. [ABSTRACT FROM AUTHOR]

Published
2022
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46. Part 4: Pediatric Basic and Advanced Life Support 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Author

Topjian, Alexis A., Raymond, Tia T., Atkins, Dianne, Chan, Melissa, Duff, Jonathan P., Joyner, Benny L., Lasa, Javier J., Lavonas, Eric J., Levy, Arielle, Mahgoub, Melissa, Meckler, Garth D., Roberts, Kathryn E., Sutton, Robert M., Schexnayder, Stephen M., Bronicki, Ronald A., de Caen, Allan R., Guerguerian, Anne Marie, Kadlec, Kelly D., Kleinman, Monica E., Knight, Lynda J., McCormick, Taylor N., Morgan, Ryan W., Roberts, Joan S., Scholefield, Barnaby R., Tabbutt, Sarah, and Thiagarajan, Ravi

Subjects
Resuscitation, medicine.medical_specialty, medicine.medical_treatment, Respiratory arrest, Return of spontaneous circulation, Targeted temperature management, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, medicine, Humans, Intubation, Cardiopulmonary resuscitation, Cricoid pressure, business.industry, American Heart Association, Cardiopulmonary Resuscitation, United States, Advanced life support, Cardiovascular Diseases, Practice Guidelines as Topic, Pediatrics, Perinatology and Child Health, Emergency medicine, medicine.symptom, Emergency Service, Hospital, business
Abstract

1. High-quality cardiopulmonary resuscitation (CPR) is the foundation of resuscitation. New data reaffirm the key components of high-quality CPR: providing adequate chest compression rate and depth, minimizing interruptions in CPR, allowing full chest recoil between compressions, and avoiding excessive ventilation. 2. A respiratory rate of 20 to 30 breaths per minute is new for infants and children who are (a) receiving CPR with an advanced airway in place or (b) receiving rescue breathing and have a pulse. 3. For patients with nonshockable rhythms, the earlier epinephrine is administered after CPR initiation, the more likely the patient is to survive. 4. Using a cuffed endotracheal tube decreases the need for endotracheal tube changes. 5. The routine use of cricoid pressure does not reduce the risk ofd regurgitation during bag-mask ventilation and may impede intubation success. 6. For out-of-hospital cardiac arrest, bag-mask ventilation results in the same resuscitation outcomes as advanced airway interventions such as endotracheal intubation. 7. Resuscitation does not end with return of spontaneous circulation (ROSC). Excellent post–cardiac arrest care is critically important to achieving the best patient outcomes. For children who do not regain consciousness after ROSC, this care includes targeted temperature management and continuous electroencephalography monitoring. The prevention and/or treatment of hypotension, hyperoxia or hypoxia, and hypercapnia or hypocapnia is important. 8. After discharge from the hospital, cardiac arrest survivors can have physical, cognitive, and emotional challenges and may need ongoing therapies and interventions. 9. Naloxone can reverse respiratory arrest due to opioid overdose, but there is no evidence that it benefits patients in cardiac arrest. 10. Fluid resuscitation in sepsis is based on patient response and requires frequent reassessment. Balanced crystalloid, unbalanced crystalloid, and colloid fluids are all acceptable for sepsis resuscitation. Epinephrine or norepinephrine infusions are used for fluid-refractory septic shock. More than 20 000 infants and children have a cardiac arrest per year in the …

Published
2021

48. Predicting Adverse Outcomes for Shiga Toxin–Producing Escherichia coli Infections in Emergency Departments

Author

Lin, Chu Yang, primary, Xie, Jianling, additional, Freedman, Stephen B., additional, McKee, Ryan S., additional, Schnadower, David, additional, Tarr, Phillip I., additional, Finkelstein, Yaron, additional, Desai, Neil M., additional, Lane, Roni D., additional, Bergmann, Kelly R., additional, Kaplan, Ron L., additional, Hariharan, Selena, additional, Cruz, Andrea T., additional, Cohen, Daniel M., additional, Dixon, Andrew, additional, Ramgopal, Sriram, additional, Powell, Elizabeth C., additional, Kilgar, Jennifer, additional, Michelson, Kenneth A., additional, Bitzan, Martin, additional, Yen, Kenneth, additional, Meckler, Garth D., additional, Plint, Amy C., additional, Balamuth, Fran, additional, Bradin, Stuart, additional, Gouin, Serge, additional, Kam, April J., additional, Meltzer, James A., additional, Hunley, Tracy E., additional, Avva, Usha, additional, Porter, Robert, additional, Fein, Daniel M., additional, Louie, Jeffrey P., additional, Tarr, Gillian A.M., additional, Rominger, Annie, additional, Beer, Darcy, additional, Pruitt, Christopher M., additional, Abramo, Thomas J., additional, Schuh, Abigail, additional, Kanegaye, John T., additional, and Jones, Nicholas E., additional

Published
2021
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50. Hematochezia in children with acute diarrhea seeking emergency department care – a prospective cohort study.

Author

Böhrer, Madeleine, Fitzpatrick, Eleanor, Hurley, Katrina, Xie, Jianling, Lee, Bonita E., Pang, Xiao‐Li, Zhuo, Ran, Parsons, Brendon D., Berenger, Byron M., Chui, Linda, Tarr, Phillip I., Ali, Samina, Vanderkooi, Otto G., Freedman, Stephen B., Zemek, Roger, Newton, Mandi, Meckler, Garth, Poonai, Naveen, Bhatt, Maala, and Maki, Kate

Subjects
DIARRHEA, CAREGIVERS, CONFIDENCE intervals, INTRAVENOUS therapy, GASTROINTESTINAL hemorrhage, MEDICAL care use, COMPARATIVE studies, VOMITING, EMERGENCY medical services, DESCRIPTIVE statistics, VIRUS diseases, BACTERIAL diseases, ACUTE diseases, LONGITUDINAL method, SECONDARY analysis, SYMPTOMS, CHILDREN
Abstract

Objectives: Although the passage of blood in stools in children represents a medical emergency, children seeking emergency department (ED) care remain poorly characterized. Our primary objective was to compare clinical characteristics and etiologic pathogens in children with acute diarrhea with and without caregiver‐reported hematochezia. Secondary objectives were to characterize interventions and resource utilization. Methods: We conducted a secondary analysis of the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) database. Children <18 years presenting to two pediatric EDs within a 24‐hour period and <7 days of symptoms were consecutively recruited. Results: Of 1,061 participants, 115 (10.8%) reported hematochezia at the enrollment visit at which time those with hematochezia, compared to those without, had more diarrheal episodes/24‐hour period (9 vs. 6; difference: 2; 95% confidence interval [CI]: 2.0, 4.0; p < 0.001), and were less likely to have experienced vomiting (54.8% vs. 80.2%; difference: −25.4; 95% CI: −34.9, −16.0; p < 0.001). They were more likely to receive intravenous fluids (33.0% vs. 17.9%; difference: 15.2; 95% CI: 6.2, 24.1; p < 0.001) and require repeat health care visits (45.5% vs. 34.7%; difference: 10.7; 95% CI: 0.9, 20.6; p = 0.03). A bacterial pathogen was identified in 33.0% of children with hematochezia versus 7.9% without (difference: 25.1; 95% CI: 16.3, 33.9; p < 0.001); viruses were detected in 31.3% of children with hematochezia compared to 72.3% in those without (difference: −41.0%, 95% CI: −49.9, −32.1; p < 0.001). Conclusion: In children with acute diarrhea, caregiver report of hematochezia, compared to the absence of hematochezia, was associated with more diarrheal but fewer vomiting episodes, and greater resource consumption. The former group of children was also more likely to have bacteria detected in their stool. [ABSTRACT FROM AUTHOR]

Published
2022
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