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We previously developed and retrospectively validated the estimated percentage of heart rate variation (EHRV) as a predictor of the composite outcome of ≥ 5% dehydration and/or acute kidney injury (AKI) in non-febrile children. The current study aimed to prospectively validate EHRV as a predictor for dehydration or AKI in a different cohort of children attending the Pediatric Emergency Department. From July 2022 to August 2023, 256 pediatric patients aged 0–18 years attending the Pediatric Emergency Department were enrolled. EHRV was calculated as follows: [(HR at admission − 50th percentile of HR for age and sex)/HR at admission] × 100. Dehydration was categorized as < 5% or ≥ 5% fluid deficit. AKI was defined according to KDIGO creatinine criteria. Statistical analyses included receiver-operating characteristic (ROC) curves and logistic regression analysis. Among enrolled patients, 52 had ≥ 5% dehydration, 50 had AKI, and 16 had both conditions. EHRV demonstrated significant predictive ability for both ≥ 5% dehydration (AUROC = 0.71; 95% confidence interval (CI), 0.63–0.78; p < 0.001) and AKI (AUROC = 0.78; 95% CI, 0.71–0.84; p < 0.001). An EHRV > 24.5% was associated with an increased odds ratio (OR), adjusted for confounders, of ≥ 5% dehydration (OR = 3.5; 95% CI, 1.6–8.0; p = 0.003) and AKI (OR = 3.4; 95% CI, 1.6–7.3; p = 0.002). The sensitivity and specificity of this cut-off were 34% and 83% for ≥ 5% dehydration and 36% and 84% for AKI, respectively. Conclusions: This study prospectively validates the clinical utility of EHRV in predicting dehydration and AKI in a pediatric emergency care setting. An EHRV > 24.5% could serve as a marker for suspecting dehydration or AKI. Further validation across diverse patient populations and settings is needed. What is Known: • An increased heart rate (HR) is a readily detectable sign of dehydration in children. • In a retrospective validation cohort, an estimated HR variation (EHRV) greater than 24.5% compared to the 50th percentile of HR was predictive of ≥ 5% dehydration and/or acute kidney injury (AKI) in non-febrile patients. What is New: • We prospectively validated the clinical utility of EHRV in predicting dehydration and AKI in a pediatric emergency care setting. • We confirmed that an EHRV greater than 24.5% is associated with increased odds of ≥ 5% dehydration and AKI. [ABSTRACT FROM AUTHOR]

Ileocolic intussusception, a major cause of acute intestinal obstruction in young children, necessitates rapid diagnosis and a multidisciplinary treatment approach. A recent large study identified variations in pain management, sedation, and non-operative reduction methods in these patients. We aimed to explore variability within the diagnostic and treatment pathways of ileocolic intussusception. A narrative review of the literature was conducted for peer-reviewed articles published in English between 2004 and 2024. We searched the electronic databases Ovid, Embase, Scopus, PubMed, and the Cochrane Database. Google Scholar was searched using the search terms "intussusception," "triage," "diagnosis," emergency department," "radiology," "ultrasound," "POCUS," "reduction," "air-enema," "fluid-enema," "pneumatic," "hydrostatic," "pain," "sedation," "operating-room," "laparoscopy," and "surgery" to identify articles published in electronic journals, books, and scientific websites. Data were analyzed by a multidisciplinary team of specialists in pediatric emergency medicine, pediatric radiology, and pediatric surgery. Fifty-six papers were included in this review. Six areas of practice variation were found: pain management in triage, the use of point-of-care ultrasound in the emergency department, the use of pneumatic versus hydrostatic technique for the reduction procedure, performing the reduction procedure under sedation, patient observation after an uncomplicated reduction, and the use of open surgery or laparoscopy for patients who underwent unsuccessful reduction. Conclusion: This review has identified practice variations in several key areas of ileocolic intussusception management. The findings underscore the need for further research in these areas and the establishment of uniform standards aimed at improving the care of children with ileocolic intussusception. What is Known: • Ileocolic intussusception necessitates rapid diagnosis and a collaborative treatment approach involving emergency medicine, radiology, surgery, and often anesthesia. • A previous study reported variations in the practice of pain management and sedation among these patients. What is New: • This narrative review identified practice variations in several key areas within the diagnostic and treatment pathways of ileocolic intussusception. [ABSTRACT FROM AUTHOR]

Objectives: Point‐of‐care‐ultrasound (POCUS) is increasingly used by pediatric emergency medicine (PEM) fellows, but scant data exists on the accuracy of exam interpretations. Our goal was to determine whether agreement on exam interpretation between quality assurance (QA) faculty (reference standard) and PEM fellows varied by fellowship year or exam type. Methods: Retrospective review of fellow‐performed POCUS exams between January 2019 and June 2022. Negative binomial (NB) random effects regression was used to account for longitudinal measurement of individual fellow performance across 3 years. Fixed effects were exam type and fellowship year. To assess between‐ and within‐user variability across time, a random intercept and slope were included for each fellow. Results: Exactly 3032 exams, performed by 24 fellows, were included. Raw proportion agreement by fellowship year was high for all exam types (≥88%). From the NB model, there was no statistically significant effect of fellowship year on the mean count of agreement. The relative risk (RR) of agreement for exam types was greatest for cardiac vs other types. The standard deviations for the random intercept and random slope were 0.09 and 0.04, respectively, with a correlation of −0.94. Conclusions: PEM fellows generally interpret exams correctly, with little variation through fellowship, although those who began with more basic skills showed more progress over time. Fellowship year did not influence the likelihood of correct interpretation but there was variation across exam type, with the best agreement for cardiac exams. The extent to which disagreements between fellows and QA faculty represent clinically significant errors requires further study. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions To describe sources of advice and the recommendations given to parents/guardians prior to attending ED with their child.This was a prospective observational study of patients presenting to two EDs of a multi‐centre Victorian Health service in June 2016. Data collection involved surveying all parents/guardians attending paediatric ED during a 1‐week period by trained research assistants. We determined the proportion of eligible respondents who sought advice before attending ED, the source of advice, and the type of advice provided.One thousand sixty‐nine patients presented to ED over the 1‐week period. There were 730 responses to the survey, of which 65% (477/730) had received a total of 620 recommendations prior to ED attendance. Seventy‐six per cent (362/477) had received advice from a single source, 19% (90/477) had received advice from 2 sources, and 5% (25/477) from 3 or more sources. The most common sources of advice were general practice consultations (49%), friends/family (13.5%), and NURSE‐ON‐CALL (11%). Fifty‐four per cent (335/620) of the recommendations were to attend ED immediately and 12% (77/620) were to attend if their child was getting worse.Most parents and guardians sought advice from a single source prior to attending an ED. The most common source of advice was consultation with a general practitioner and the most common recommendation was to attend ED immediately, or if their child's condition worsened. [ABSTRACT FROM AUTHOR]

This study aims to provide a national overview of procedural sedation and analgesia practices within Pediatric Emergency Departments in Switzerland, focusing on the availability of pharmacologic agents, the presence of safety protocols, the utilization of non-pharmacological interventions, and to identify specific local limitations. We conducted a detailed subgroup analysis of Swiss data from a European cross-sectional survey on emergency department pediatric Procedural Sedation and Analgesia (PSA) practice, isolating data from Swiss sites. The survey, conducted between November 2019 and March 2020, covered various aspects of procedural sedation and analgesia practices. The survey included nine Swiss sites, treating a total of 252,786 patients in 2019. Topical analgesia, inhaled equimolar nitrous oxide-oxygen mixture, and ketamine were largely available. All sites had nurse-directed triage protocols in place; however, opioid administration was included in the protocols in only 66% of sites. Only 33% of hospitals reported common use of intravenous sedation. Barriers to procedural sedation and analgesia implementation included staffing shortages (89% of sites) and lack of dedicated spaces (78%). Conclusions: Despite a broad array of pharmacological and options available in Swiss Pediatric Emergency Departments, challenges remain in standardizing practices across the country. Limited space and staffing and enhancing training on non-pharmacological interventions were identified as potential areas for improving pain and anxiety management in pediatric emergency care. This study underscores the need for national guidelines to harmonize emergency department PSA practices across Switzerland, ensuring all children have access to effective and evidence-based procedural comfort. What is Known: • Recent research, conducted in European emergency departments, suggests that in pediatric Procedural Sedation and Analgesia (PSA) resources are limited, and practice is heterogeneous What is New: • Swiss pediatric hospitals offer a wide range of pharmacological options for pain and anxiety management. However, significant barriers to PSA were identified. These include external control of intravenous sedation and insufficient integration of non-pharmacological interventions, such as child life specialists and procedural hypnosis. National guidelines are needed to harmonize PSA practices [ABSTRACT FROM AUTHOR]

Conducting research in ED is important and necessary to improve emergency care. Effective recruitment is an essential ingredient for the success of a research project and must be carefully monitored. Research coordinators are focused on optimising recruitment to research studies while also ensuring that the needs of participants and their families are met, and the research is acceptable to ED staff. In this paper, a group of experienced research coordinators from Australia and New Zealand have shared their strategies to engage staff and enhance recruitment of participants in emergency research. Although this paper is from a paediatric research network, the findings are applicable for EDs in general, both in Australasia and elsewhere. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion The aim of this study is to describe circumstances, management and short‐term outcomes of neonatal head trauma, and adherence to the Paediatric Emergency Care Applied Research Network (PECARN) head trauma prediction rule for children under 2 years.Multicentre retrospective cohort study of neonates (<29 days) with head trauma across 25 emergency departments (ED) from January 2017 to June 2021.A total of 492 neonates (median age 17 days, range 0–28 days) with non‐trivial head trauma were enrolled. Falls were the most common injury mechanism (375/492, 76.2%). Imaging was performed in 150/492 (30.5%) neonates.Clinically important traumatic brain injury (ciTBI), defined as death, neurosurgery, prolonged intubation, or extended hospitalisation from injury, occurred in 7/492 (1.4%) cases. Notably, 286/492 (58.1%) neonates were managed by short‐term observation (<48 h), and 126/492 (25.6%) were admitted.Among high‐risk neonates per PECARN criteria, 17/21 (80.9%) did not undergo recommended head CT scans but were observed within ED short observation units or underwent alternative imaging, with no ciTBI diagnoses among those discharged without CT.Severe neonatal head injuries are rare, and most neonatal head injuries have a favourable outcome, making observation a suitable approach, while remaining vigilant for signs of non‐accidental injuries. [ABSTRACT FROM AUTHOR]

Background: Length of stay in the emergency department is used as a quality indicator to gauge the overall efficiency of emergency care. The performance measure was used to evaluate the quality of care provided in the emergency department. Objective: To assess the length of stay and associated factors among pediatric patients admitted to the pediatric emergency unit of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. Methods: An institution-based prospective cross-sectional study design was employed. A systematic random sampling technique was used to select the study participants. Data were collected via semi-structured, interviewer-administered questionnaires and chart reviews. Analysis was performed via the Statistical Package for Social Science software version 27. Binary logistic regression analysis was conducted to identify variables associated with the length of stay. The study was conducted in the Pediatric Emergency Unit of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, from March 15 to April 15, 2023. Results: A total of 268 patients participated in the study, with a response rate of 97.81%. The majority of the participants were male (157, 58.6%), with a median age of 3 years. The study revealed that 180 participants (67.2%) experienced a prolonged length of stay. The variables significantly associated with prolonged length of stay included residency (AOR = 2.04, CI: 1.03, 4.025), triage category (AOR = 3.25, CI: 1.08, 5.974), number of investigations (AOR = 2.381, CI: 1.038, 5.462), and waiting for imaging (AOR = 4.230, CI: 1.638, 10.93). Conclusion: Many pediatric patients stayed in the emergency room for more than 24 h because of factors such as residency, triage category, number of investigations, and the need for imaging. To address this, we recommend streamlining triage processes, increasing imaging resources, providing additional staff training, developing integrated care pathways, and advocating for policy changes to increase emergency room efficiency and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion The aim of this study is to investigate the utility of interleukin‐6 (IL‐6) in the early diagnosis of serious bacterial infections (SBI) in febrile infants and to compare it with C‐reactive protein (CRP).Retrospective study conducted in the paediatric emergency department in Gothenburg, Sweden, on previously healthy, full‐term infants aged ≤60 days with fever without a source (FWS) from 2014 to 2017.We included 536 infants with FWS, of whom IL‐6 was analysed in 364 (68%) and CRP was analysed in 494 (92%). Approximately 70% of the infants presented with a fever duration of less than 12 h. The prevalence of SBIs was 14.8% (95% CI,11.3–18.9) in the IL‐6 group and 17.8% (95% CI,14.5–21.5) in the CRP group. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of IL‐6 ≥50 ng/L were 93%, 66%, 98% and 33%, respectively. For CRP ≥20 mg/L, the sensitivity, specificity, NPV, and PPV were 76%, 89%, 95%, and 55%, respectively. Logistic regression analysis showed that CRP was significantly associated with SBI (p < 0.0001) in the entire population, whereas IL‐6 was not.Interleukin‐6 showed high sensitivity and NPV, which might assist in identifying SBIs early in febrile infants. However, IL‐6 was not shown to be superior to CRP and further studies are needed to investigate whether IL‐6 should be incorporated in clinical management. [ABSTRACT FROM AUTHOR]

Background: Neurological emergencies are one of the major diagnosis groups in the Emergency Medical Services (EMS) with the highest rate of misdiagnosis. Despite the knowledge of time sensitivity and the importance of prehospital factors, prehospital delay is common. Although several stroke triage scales have been developed, a gold standard in the prehospital setting is lacking. Objectives: Our aim was to evaluate the perception of neurological emergencies by EMS personnel and to identify current problems, difficulties and opportunities for improvement in the prehospital management of stroke, seizure, non-specific neurological symptoms, and paediatric neurological emergencies. Methods: The study was conducted as an online survey through SoSci Survey and was made available from March 1st to June 30th 2023 to all personnel working in emergency medical services. The access link was distributed through snowballing, social media, and through a QR code on a promotional poster. The survey was completed anonymously. The final survey consisted of 30 questions in German on the topics of neurological emergencies, general neurological assessment, specific neurological examination including paediatric assessment, stroke, and seizures, and finally suggestions for improvement. Results: The largest group of participants were paramedics, who estimated to encounter neurological emergencies at a general rate of 20–60%. When unease was felt, the main reasons were ambiguity of symptoms and insufficient admission capacity of hospitals. The biggest challenges were highly varied. Almost 80% of participants assumed that the neurological assessment would be omitted in difficult patient groups such as demented, intoxicated or children. 75% felt uncomfortable making a paediatric assessment, 50% were unfamiliar with the Paediatric Glasgow Coma Scale. Conclusions: Support through more standardized practical training and defined, uniform guidelines is needed. There was also a clear need for peer collaboration, feedback and case sharing. Digitalization, the usage of telemedicine and updated versions of the documentation protocols including paediatric adaptations to current guidelines could further improve current neurological assessment in the prehospital setting. [ABSTRACT FROM AUTHOR]

Background: We conducted a scoping review of the evidence for the use of the Pediatric Assessment Triangle (PAT) tool in emergency pediatric patients, in hospital and prehospital settings. We focused on the psychometric properties of the PAT, the reported impact, the setting and circumstances for tool implementation in clinical practice, and the evidence on teaching the PAT. Methods: We followed the Joanna Briggs Institute methodology for scoping reviews and registered the review protocol. We searched MEDLINE, PubMed Central, the Cochrane Library, Epistemonikos, Scopus, CINAHL, Grey literature report, Lens.org, and the web pages of selected emergency pediatrics organizations in August 2022. Two reviewers independently screened and extracted data from eligible articles. Results: Fifty-five publications were included. The evidence suggests that the PAT is a valid tool for prioritizing emergency pediatric patients, guiding the selection of interventions to be undertaken, and determining the level of care needed for the patient in both hospital and prehospital settings. The PAT is reported to be fast, practical, and useful potentially impacting overcrowded and understaff emergency services. Results highlighted the importance of instruction prior using the tool. The PAT is included in several curricula and textbooks about emergency pediatric care. Conclusions: This scoping review suggests there is a growing volume of evidence on the use of the PAT to assess pediatric emergency patients, some of which might be amenable to a systematic review. Our review identified research gaps that may guide the planning of future research projects. Further research is warranted on the psychometric properties of the PAT to provide evidence on the tool's quality and usefulness. The simplicity and accuracy of the tool should be considered in addressing the current healthcare shortages and overcrowding in emergency services. Review registration: Open Science Framework; 2022. https://osf.io/vkd5h/ [ABSTRACT FROM AUTHOR]

Background: COVID-19 is a global pandemic that has highly impacted the healthcare system and patients, especially patients with epilepsy, due to the fact that the success of their treatment depends on obtaining sustainable access to medical professions, diagnostic services, facilities, and medications. The epidemiology and presence of neuro-pediatric emergencies in the setting of COVID-19 in XXX have not been thoroughly described. This is a barrier to planning and providing quality emergency care within the local health systems. The objective of this study is to provide a comprehensive description of the epidemiology of neurological cases encountered in the pediatric emergency unit. Methods: This is a retrospective study to analyze the flow pattern of Emergency Department (ED) visits among pediatric patients with neuro-related complaints. Participants were filtered, and a total of 108,000 visits were reduced to 960 patients with a neurological provisional diagnosis. Patients were grouped into pre- and post-pandemic visits according to their age group. We identified demographic and clinical variables. Results: The study included 960 patients with a provisional neurological diagnosis, consisting of 542 (56.5%) males and 418 (43.5%) females. The mean age of admission was 5.29 ± 4.19 years. The majority of patients were triaged as "priority 1—resuscitation" (n = 332, 34.6%), and seizures were the most frequent chief complaint (n = 317, 33.0%). Statistical significance was observed for patients with vascular issues (p = 0.013) during the pre-COVID-19 period after adjusting for odds ratio. The most common outcome was discharge (n = 558, 58.1%). The mean length of stay during the pre-COVID-19 pandemic was 16.48 ± 33.53 h, which was significantly longer compared to a mean length of stay of 7.76 ± 7.27 h during the COVID-19 pandemic (P < 0.001). Conclusion: We presented a new epidemiology of pediatric patients with neuro-related ED visits. An increase in seizure diagnosis was observed, as were significant shifts in the length of stay. Demographic changes were less evident in the two periods. Understanding such variation aids in managing this vulnerable population during critical periods. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is the commonest paediatric surgical emergency. Adult studies suggest non‐operative management (NOM) may have a place in care. There have been no adequately powered randomized controlled trials in children. Objective: to determine the safety and efficacy of NOM for paediatric simple appendicitis. Methods: A non‐inferiority randomized controlled trial was conducted comparing operative (OM) to NOM of SA in children aged five‐15 years. Primary outcome was treatment success (no unplanned or unnecessary operation, or complication) at 30 days and 12 months, with a non‐inferiority margin of 15%. (anzctr.org.au: ACTRN12616000788471). Results: From 11 June 2016 to 30 November 2020, 222 children were randomized: 94 (42.34%) to OM and 128 (57.66%) to NOM. Non‐inferiority of NOM was not demonstrated at either time point, with 45.67% of NOM patients subsequently undergoing operation. There was no significant difference in complications. Conclusions: While noninferiority was not shown, NOM was safe, with no difference in adverse outcomes between the two groups. Further research to refine the place of NOM of simple appendicitis in children is required, including nuanced patient selection, longer term evaluation, the place of choice, and the acceptability of the treatment for children and their carers. [ABSTRACT FROM AUTHOR]

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Copyright of Bagcilar Medical Bulletin / Bağcılar Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pediatric procedural sedation (PPS), formerly known as conscious sedation, is often used outside the operating room for various procedures. Twenty years ago, nearly all cases of PPS were performed by pediatric intensivists, dentists, emergency medicine physicians, and anesthesiologists, due to the urgent nature of procedures in their settings. However, with the emergence of pediatric hospital medicine as a board-certified subspecialty, many children's hospitals have created dedicated PPS teams. These teams, composed of highly trained physicians and ancillary staff, are well-suited for procedures, quality measures, and multidisciplinary care. The wider availability of sedation outside the operating room allows other pediatric subspecialties, such as surgery and oncology, to use PPS in ensuring safe and timely interventions for their patients. This article will cover PPS as an alternative to anesthesia for otherwise healthy children and aim to answer frequent questions that arise regarding medications, risks, and candidacy for PPS. [Pediatr Ann. 2024;53(9):e324–e329.] [ABSTRACT FROM AUTHOR]

Measles is a viral illness considered eliminated in the United States; however, outbreaks still occur even in this modern era where vaccines are readily available for every child under government-sponsored financing programs. The most recent measles outbreak was reported in March 2024 in Chicago, Illinois. Many of these patients were children younger than age 5 years with unvaccinated or unknown vaccine status, and this outbreak was associated with a migrant shelter. Measles bears a resemblance to other exanthemic diseases of childhood. In populations where there is high vaccine coverage, measles is less likely to be in the differential diagnosis for most physicians; however, cases of vaccine failure have been described, and populations have risk factors for developing complications associated with measles. Therefore, this quick review aims to describe an illustrative case, followed by epidemiology, clinical manifestations, complications, diagnosis, and vaccines associated with measles. By the end of this article, clinicians should be able to recognize a potential measles case, select the most appropriate test to confirm the diagnosis, and thus, prevent the spreading of this highly contagious disease. [Pediatr Ann. 2024;53(9):e345–e350.] [ABSTRACT FROM AUTHOR]

New American Academy of Pediatrics (AAP) guidelines were published in 2021 for the evaluation and management of well-appearing febrile infants from age 8 to 60 days. This first guideline of its kind from the AAP brings together increasing evidence from the last 20 years and replaces the varied protocols previously used (eg, Rochester, Philadelphia, Boston). The guideline also incorporates lessons from newer studies, such as the work of the Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network. This article will explain the motivation for the guideline, summarize its recommendations, and fill in some details about how to evaluate and manage infants that fall out of the guideline's scope of the well-appearing febrile infant age 8 to 60 days (ill-appearing infants and early-onset infections in newborns younger than age 8 days). [Pediatr Ann. 2024;53(9):e314–e319.] [ABSTRACT FROM AUTHOR]

It has long been established that the environment in which a child grows and develops shapes their social and health outcomes. After all, collecting social history is a key component of a health care visit. In recent decades, the importance of social determinants of health (SDOH) has been rediscovered, and the impact of adverse childhood experiences has garnered great attention. Estimates show that health outcomes are influenced more by factors outside of health care, such as our patients' SDOH. Addressing SDOH is fundamental for improving health and reducing longstanding inequities in health. While understanding that SDOH needs to be addressed through the continuum of pediatric care, this article will focus on SDOH in the pediatric inpatient setting. [Pediatr Ann. 2024;53(9):e337–e344.] [ABSTRACT FROM AUTHOR]

There has been an overall increase in the number of suspected suicide attempts by self-poisoning among the adolescent population. Incidences of self-poisoning have increased since the coronavirus 2019 pandemic, particularly among patients age 10 to 19 years. Common agents used in self-poisoning include over-the-counter and prescription medications. It is crucial to identify adolescent patients with risk factors and provide appropriate resources to reduce the likelihood of intentional toxic ingestion. This article aims to summarize the current state of intentional toxic ingestions by adolescents, provide an overview of the most common agents implicated in self-poisoning, and discuss the best practices in screening patients. [Pediatr Ann. 2024;53(9):e330–e336.] [ABSTRACT FROM AUTHOR]

Background: Rapid Cycle Deliberate Practice (RCDP) has gained prominence in recent years as an innovative teaching method in simulation-based training for adult and pediatric emergency medical skills. However, its application in the training of forceps delivery skills among obstetrics and gynecology residents remains unexplored. This study aimed to assess the impact of RCDP in this domain. Methods: Conducted in March 2021, this randomized controlled study involved 60 second-year obstetrics and gynecology residents undergoing standardized training. Participants were randomly assigned to the RCDP group or the traditional teaching method (TTM) group, each comprising 30 residents. The RCDP group followed the RCDP practice mode, while the TTM group adhered to conventional simulation teaching. Post-training assessment of operational proficiency was conducted immediately and after one year. Independent operational confidence and training satisfaction were evaluated through questionnaire surveys and the Satisfaction with Simulation Experience (SSE) scale. Data analysis utilized SPSS 23.0. Results: The RCDP group displayed significantly higher immediate post-training forceps operation scores compared to the TTM group (92.00 [range: 90.00-94.00] vs. 88.00 [range: 86.75-92.00]; z=3.79; p < .05). Importantly, the RCDP group reported higher satisfaction scores, particularly in the Debriefing and Reflection subscale (44.00 [range: 43.00-45.00] vs. 41.00 [range: 41.50-43.00]; z=5.24; p < .001), contributing to an overall superior SSE score (z=4.74; p < .001). Conclusions: RCDP exhibits immediate efficacy in elevating forceps delivery skills among residents. However, sustained skill enhancement necessitates innovative approaches, while RCDP's value lies in tailored feedback and reflection for enriched medical education. [ABSTRACT FROM AUTHOR]

Background: Crowding has been a longstanding issue in emergency departments. To address this, a fast-track system for avoidable patients is being implemented in the Paediatric Emergency Department where our study is conducted. Our goal is to develop an optimized Decision Support System that helps in directing patients to this fast track. We evaluated various Machine Learning models, focusing on a balance between complexity, predictive performance, and interpretability. Methods: This is a retrospective study considering all visits to a university-affiliated metropolitan hospital's PED between 2014 and 2019. Using information available at the time of triage, we trained several models to predict whether a visit is avoidable and should be directed to a fast-track area. Results: A total of 507,708 visits to the PED were used in the training and testing of the models. Regarding the outcome, 41.6% of the visits were considered avoidable. Except for the classification made by triage rules, i.e. considering levels 1,2, and 3 as non-avoidable and 4 and 5 as avoidable, all models had similar results in model's evaluation metrics, e.g. Area Under the Curve ranging from 74% to 80%. Conclusions: Regarding predictive performance, the pruned decision tree had evaluation metrics results that were comparable to the other ML models. Furthermore, it offers a low complexity and easy to implement solution. When considering interpretability, a paramount requisite in healthcare since it relates to the trustworthiness and transparency of the system, the pruned decision tree excels. Overall, this paper contributes to the growing body of research on the use of machine learning in healthcare. It highlights practical benefits for patients and healthcare systems of the use ML-based DSS in emergency medicine. Moreover, the obtained results can potentially help to design patients' flow management strategies in PED settings, which has been sought as a solution for addressing the long-standing problem of overcrowding. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion After the relaxation of COVID‐19 mitigation measures, we observed a dramatic increase in pyogenic infections. Based on this observation, we retrospectively analysed all cases of invasive bacterial infections of brain, lung and complicated ear–nose–throat (ENT) infections, in the period from 1 August to 31 March from the years 2018–2019 to 2022–2023.The study was conducted in two Paediatric Emergency Departments, at IRCCS ‘Burlo Garofolo’ of Trieste and at Treviso Hospital. Electronic medical records were searched for all cases with a definitive diagnosis at discharge of mastoiditis, suppurative cervical lymphadenitis, retropharyngeal, parapharyngeal and peritonsillar abscess (ENT group), bacterial brain abscesses, epidural empyema, subdural empyema (central nervous system group), thoracic empyema and necrotising pneumonia (lung group).In 2022–2023, we observed an increase in infections compared to the previous years. Total number of cases were 22, 29, 8, 27 and 63 in 2018–2019, 2019–2020, 2020–2021, 2021–2022 and 2022–2023, respectively. The greater increase occurred in thoracic empyema, with a peak incidence of +120% in 2022–2023 in respect of 2021–2022.We reported an important increase in paediatric bacterial complicated infections in two North East Italian regions, possibly correlated with the relaxation of COVID‐19 social distancing measures. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions Although it is the most performed invasive procedure, peripheral intravenous catheter (PIVC) insertion in children can be difficult. The primary objective of the study was to identify the factors associated with difficult intravenous access (DIVA) in the paediatric ED, including patient, proceduralist and situational factors.This was a single‐centre prospective observational cohort study conducted over 28 consecutive days. Research assistants observed PIVC insertion attempts for children under 16 years of age and recorded data for variables relating to the patient, proceduralist and event. Univariate logistic regression modelling was performed to identify factors associated with DIVA, defined as unsuccessful PIVC insertion on the first attempt.A total of 134 participants were recruited; 66 were male (49%) with a median age of 5.7 years. Fifty‐two (39%) were classified as having DIVA. There was a total of 207 PIVC insertion attempts with two or more attempts needed for 48 children (36%). Patient factors associated with DIVA included age of 3 years or less and limited vein options. Proceduralist factors included gestalt of 50% or less chance of success, use of a larger gauge (smaller bore) PIVC and less PIVC insertion experience. Situational factors included a combative child, higher pain score and loud ambient noise.The present study identified multiple patient, proceduralist and situational factors that were associated with DIVA in the paediatric ED. Future studies should explore the development and implementation of a package to address DIVA in children, with the patient‐centred goals of reducing pain and improving success. [ABSTRACT FROM AUTHOR]

Fever is a common presenting complaint to the pediatric emergency department (PED), especially among oncology patients. While bacteremia has been extensively studied in this population, pneumonia has not. Some studies suggest that chest X-ray (CXR) does not have a role in the investigation of neutropenic fever in the absence of respiratory symptoms, yet non-neutropenic pediatric oncology patients were excluded from these studies. We aimed to determine the incidence of CXRs ordered for febrile pediatric oncology patients, irrespective of their absolute neutrophil count (ANC), and to evaluate the rates of radiographic pneumonia as well as predictors of the latter in this group. This study was conducted in the PED at the American University of Beirut Medical Center (AUBMC), an Eastern Mediterranean tertiary-care hospital. We conducted a retrospective cohort study of acutely febrile pediatric cancer patients, younger than 18 years, presenting to a tertiary center from 2014 to 2018. We included one randomly selected febrile visit per patient. Fever was defined as a single oral temperature ≥38 °C within 24 h of presentation. We collected data on patient characteristics and outcomes. Our primary outcome was radiographic pneumonia; our secondary outcome was whether a CXR was done or not. We defined radiographic pneumonia as a consolidation, pleural effusion, infiltrate, pneumonia, "infiltrate vs. atelectasis," or possible pneumonia mentioned by the radiologist. SPSS was used for the statistical analysis. We reviewed a total of 664 medical charts and included data from 342 febrile pediatric patients in our analysis. Of these, 64 (18.7%) had a CXR performed. Overall, 16 (25%) had radiographic pneumonia while 48 (75%) did not. Patients were significantly more likely to have a CXR performed if they presented with upper respiratory tract symptoms, cough (p < 0.001 for both), or abnormal lung auscultation at the bedside (p = 0.004). Patients were also less likely to have a CXR done if they were asymptomatic upon admission to the PED (p < 0.001). However, neither cough nor shortness of breath nor abnormal lung examinations were significant predictors of a positive CXR (p = 0.17, 0.43, and 0.669, respectively). Patients with radiographic pneumonia were found to be significantly younger (4.29 vs. 6 years, p = 0.03), with a longer time since their last chemotherapy (15 vs. 7 days, p = 0.005), and were given intravenous (IV) bolus in the PED (87.5% vs. 56.3%, p = 0.02). Interestingly, patients with higher white blood cell (WBC) counts were more likely to have radiographic pneumonia (4850 vs. 1750, p = 0.01). Having a cough and an abnormal lung examination on presentation increased the odds of having a CXR (adjusted odds ratio [aOR]: 6.6; 95% confidence interval [CI]: 3.4–12.8 and aOR: 4.5; 95% CI: 1.1–18.3, respectively). Returning to the PED for the same complaint within 2 weeks was associated with lower odds of a CXR at the index visit (aOR: 0.3; 95% CI: 0.1–0.6). For every year the child is older, the odds of having radiographic pneumonia decreased by 0.8 (95% CI: 0.6–0.98). However, for every day since the last chemotherapy session, the odds increased by 1.1 (95% CI: 1.01–1.12). In our sample, CXR was not commonly performed in the initial assessment of febrile cancer patients in the PED, unless respiratory symptoms or an abnormal lung examination was noted. However, these were not significant predictors of radiographic pneumonia. Further studies are needed to identify better predictors of pneumonia in this high-risk population. [ABSTRACT FROM AUTHOR]

Manual detorsion is infrequently performed in pediatric emergency medicine, particularly in centers with urology coverage. In no other emergency condition does an emergency physician not take immediate action to alleviate pain and damage, even if definitive care is close by. A small number of case reports exist in which pediatric emergency physicians have performed manual detorsion. This review the literature presents the case for routine manual detorsion prior to definitive orchiopexy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Suicide and self-injurious behavior (SSIB) in youth 10 to 14 years old has rapidly increased, with suicide rates for youth 10 to 18 years being the second leading cause of death. Youth with SSIB seen in the Emergency Department (ED) are often discharged to the community, yet less than 40% receive subsequent mental health (MH) care within 30 days. This open pilot study examined the feasibility, acceptability, and sample characteristics of a two-component Family Navigator with text messaging intervention, ED REaCH, for caregivers of youth with SSIB discharged from the ED. METHODS: Sixteen dyads of youth (M=12.67; SD=1.09) seeking emergency care for SSIB and their caregivers were enrolled from the ED of a pediatric hospital in the northeast US from November 2023 to March 2024. Dyads were enrolled in the ED REaCH intervention consisting of navigation procedures to promote linkage to care, engagement in community-based MH care for youth with SSIB, and a digital platform to extend purported mechanisms underlying the intervention's efficacy (MH literacy, MH communication, and MH engagement). Data was collected on measures of social identities, demographics, functioning, MH services, and intervention satisfaction. RESULTS: All (100%) caregivers accepted the text messages. Most (75%) utilized the Family Navigator and completed the intervention feedback interviews. Overall, caregivers endorsed positive experiences and satisfaction with the two-component intervention. All caregivers who utilized the Family Navigator reported that 100% of youth attended MH care. CONCLUSION: Preliminary findings suggest that the content and delivery methods of this intervention are perceived by caregivers as feasible and acceptable. As such, next steps include the evaluation of the ED REaCH intervention in a randomized clinical trial design. Future directions need to focus on intervention scalability, adaptability, personalization, and sustainability. [ABSTRACT FROM AUTHOR]

Cardiac point-of-care ultrasound (POCUS) has the ability to rapidly assess function and identify systolic heart failure (HF), an often-missed diagnosis. POCUS has the potential to expedite medical intervention, improving overall outcomes. There have been limited studies describing pediatric emergency center (EC) utilization of cardiac POCUS and its impact on outcomes in pediatric patients. Authors performed a retrospective chart review at a tertiary children's hospital to identify all patients admitted from the EC to the Cardiac Intensive Care Unit (CICU) with acute systolic HF between January 2017 and August 2019. Outcome measures included EC length of stay (LOS), CICU LOS, and time until first IV HF medicine was administered. A total of 21 patients and 24 encounters meeting criteria were identified. Cardiac POCUS agreed with standard echocardiography in 8 of 9 cases. Patients who had a cardiac POCUS in the EC seemed more likely to receive their first dose of intravenous heart failure medication while in the Emergency Center (70% vs 43%). There was a trend toward significance, but it did not reach statistical significance (p = 0.1). EC and CICU LOS were not significantly different between POCUS and non-POCUS groups. Cardiac POCUS has the potential to have a valuable role in the early diagnosis of acute systolic HF in children. However, early diagnosis by POCUS did not translate into shorter EC or CICU LOS. This pilot data serves as a baseline for efforts to promote earlier clinical recognition of acute HF and more efficient collaboration between clinical services. [ABSTRACT FROM AUTHOR]

Background: Recent advances in non-invasive physiologic monitoring leverage machine learning to provide unobtrusive, real-time assessments of a learner's cognitive load (CL) as they engage in specific tasks. However, the performance characteristics of these novel composite physiologic CL measures are incompletely understood. Objectives: We aimed to 1) explore the feasibility of measuring CL in real time using physiologically-derived inputs; 2) evaluate the performance characteristics of a novel composite CL measure during simulated virtual reality resuscitations; and 3) understand how this measure compares to traditional, self-reported measures of CL. Methods: Novice (PGY1-2 pediatric residents) and expert (pediatric emergency medicine fellows and attendings) participants completed four virtual reality simulations as team leader. The scenario content (status epilepticus versus anaphylaxis) and level of distraction (high versus low) were manipulated. Cognitive load was measured in all participants using electroencephalography and electrocardiography data ("real-time CL ") as well as through self-report (NASA-TLX). Scenario performance also was measured. Results: Complete data were available for 6 experts and 6 novices. Experts generally had lower CL than novices on both measures. Both measures localized the most significant differences between groups to the anaphylaxis scenarios (real-time CL [low-distraction] Cohen's d -1.33 [95% CI -.2.56, -0.03] and self-reported CL [high-distraction] Cohen's d -1.41 [95% CI -2.67, -0.10]). No consistent differences were seen with respect to level of distraction. Performance was similar between the two groups, though both exhibited fewer errors over time (F(3,48) = 5.75, p =.002). Conclusion: It is feasible to unobtrusively measure cognitive load in real time during virtual reality simulations. There was convergence between the two CL measures: in both, experts had lower CL than novices, with the most significant effect size differences in the more challenging anaphylaxis scenarios. [ABSTRACT FROM AUTHOR]

Aim: To investigate the incidence rate of urinary tract infections (UTIs) among febrile infants aged ≤60 days before, during, and after the COVID‐19 pandemic. Methods: We conducted a retrospective study in 2 Swedish paediatric emergency departments between 2014 and 2022. We included full‐term infants aged ≤60 days with fever without source. We calculated the annual incidence rate of UTI per 1000 births. Results: We included 1589 full‐term infants with fever without source. In 2020, 89 infants were evaluated in the emergency department versus 203–259 in 2017–2019. In 2020, the incidence rate of UTI was 1.43 per 1000 births/year versus 2.18–2.37 in 2017–2019. The median age, sex, fever duration, and urine testing were similar between the years 2017 and 2020. Conclusion: The number of febrile infants who presented to the paediatric emergency department and the incidence rate of UTIs decreased in 2020. This decrease might imply a systematic misdiagnosis of UTIs in infants with febrile viral infections. A more selective urine testing approach for febrile, previously healthy, infants should be considered to mitigate UTI misdiagnosis and its potential harmful effects. [ABSTRACT FROM AUTHOR]

This study aims to prospectively assess the proficiency of pediatric emergency physicians (PEPs) in interpreting non-contrast computed tomography (NCCT) brain images. A prospective investigation was conducted at the pediatric emergency unit of King Saud University Medical City (KSUMC), Saudi Arabia, over a one-year period. All patients undergoing plain brain NCCT during this period were enrolled. An independent attending neuroradiologist and two certified pediatric emergency consultants compared the interpretations of PEPs with the official final reports issued by the on-call radiologist. A total of 202 pediatric patients were examined, all under 14 years of age, with a mean age of 4.8 ± 3.6 years. Trauma was the predominant presenting complaint (127 patients, 62.9%), followed by seizures (28 patients, 13.9%). The primary indication for brain NCCT was to detect intracranial bleeding, identified in 134 patients (66.3%), followed by a space-occupying lesion in 22 patients (10.9%). Additionally, hydrocephalus with elevated intracranial pressure (ICP) was observed in 20 patients (9.9%). The overall agreement between PEPs and radiologists, based on Landis and Koch benchmark classification, was moderate (Kappa = 0.578), with an accuracy of 82.18%. The overall accuracy of brain NCCT interpretation by PEPs compared to radiologists was found to be moderate. Further multicenter studies in pediatric emergency settings with larger sample sizes are warranted to validate these findings. [ABSTRACT FROM AUTHOR]

Background A high turnover of patients is the norm at the paediatric emergency department, which inadvertently affects the documentation of patients' encounters. Methods This retrospective study involved two audit cycles, performed over six-week periods at a one-year interval, to assess discharge documentation for febrile children in the paediatric emergency department. Documentation for the following fields was assessed; diagnosis, treatment prescribed, drug doses, advice given, legibility and follow-up plan. A number of deficiencies in documentation were identified following the first cycle. Three interventions were implemented: presentation of initial audit to doctors, setting-up of a follow-up clinic for febrile children and designing a handout for carers about caring for febrile children. Chi-squared test was used, with a p-value of <0.05 considered as significant. Results 386 and 380 children were included respectively in the first and second audit. Diagnosis was documented in 84% (n=324) and 80% (n=304) respectively (p=0.09). No significant change in documentation of the prescribed treatment was noted, 73% (n=285) versus 79.4% (n=302). However, there was a significant positive trend in documentation of actual drug doses (p<0.0001). Documentation of advice given to carers rose significantly from 11% to 48.6% (p<0.0001). A significant improvement in documentation for follow-up plan was documented, 32% (n=122) to 40% (n=153) (p=0.01). Legibility was the only parameter to show a worsening trend (p<0.0001). Conclusions This study looks at the effectiveness of three interventions on the level of documentation for discharge planning of febrile children from the paediatric emergency department. In spite of the marked gains, there is room for improvement. [ABSTRACT FROM AUTHOR]

Introduction: Maintenance of procedural skills is crucial for paediatric emergency medicine (PEM) physicians to provide highquality care. A study by Lin-Martore et al. (2021) in the US identified key themes in conceptualising procedural skill maintenance (PSM), its motivations, and barriers to maintenance. However, the difference in culture brings into question the validity of their findings in other contexts. To determine its applicability specifically in an Asian context, this study aims to replicate the study at KK’s Women and Children Hospital (KKH), focusing on PEM physicians. While the findings are limited to a single hospital, they provide valuable insights into challenges encountered by PEM physicians. Methods: A general qualitative approach was used through semi-structured interviews. Participants were recruited through email. Interviews were conducted via Zoom and subsequently de-identified and transcribed. The data was coded manually through thematic analysis, identifying key themes. Results: Fifteen PEM physicians were interviewed. Participants conceptualised PSM through technical aspects and measured competence through objective and subjective measures. General motivation themes found the (1) desire to provide optimal patient care, (2) procedural competence as part of the identity of a PEM physician who teaches and performs procedures, and (3) desire for choice when alternatives are present. Barriers included limited time, support, and opportunities. Conclusion: The study found that the themes from the original study are applicable in KKH, featuring SDT concepts prominently. Practical recommendations for KKH were proposed. Future research can focus on the challenges and gaps in maintaining procedural skills and develop strategies to improve PSM in PEM physicians. [ABSTRACT FROM AUTHOR]

Transition of young people with chronic kidney disease (CKD) from paediatric to adult healthcare has been associated with poor outcomes, but few population-level studies examine trends in subgroups. We aimed to assess sociodemographic inequalities in changes in unplanned secondary care utilisation occurring across transfer to adult care for people with CKD in England. A cohort was constructed from routine healthcare administrative data in England of young people with childhood-diagnosed CKD who transitioned to adult care. The primary outcome was the number of emergency inpatient admissions and accident and emergency department (A&E) attendances per person year, compared before and after transfer. Injury-related and maternity admissions were excluded. Outcomes were compared via sociodemographic data using negative binomial regression with random effects. The cohort included 4505 individuals. Controlling for age, birth year, age at transfer, region and sociodemographic factors, transfer was associated with a significant decrease in emergency admissions (IRR 0.75, 95% CI 0.64–0.88) and no significant change in A&E attendances (IRR 1.10, 95% CI 0.95–1.27). Female sex was associated with static admissions and increased A&E attendances with transfer, with higher admissions and A&E attendances compared to males pre-transfer. Non-white ethnicities and higher deprivation were associated with higher unplanned secondary care use. Conclusion: Sociodemographic inequalities in emergency secondary care usage were evident in this cohort across the transition period, independent of age, with some variation between admissions and A&E use, and evidence of effect modification by transfer. Such inequalities likely have multifactorial origin, but importantly, could represent differential meetings of care needs. What is Known: • In chronic kidney disease (CKD), transfer from paediatric to adult healthcare is associated with declining health outcomes. • Known differences in CKD outcomes by sociodemographic factors have limited prior exploration in the context of transfer. What is New: • Population-level data was used to examine the impacts of transfer and sociodemographic factors on unplanned secondary care utilisation in CKD. • Healthcare utilisation trends may not reflect known CKD pathophysiology and there may be unexplored sociodemographic inequalities in the experiences of young people across transfer. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance is a global issue, and implementation of antimicrobial stewardship programs in outpatient settings is crucial. Japan has also focused on outpatient oral antimicrobial stewardship programs and difficulties in standardizing prescriptions have led to overprescription in primary emergency medical centers. There is a lack of research investigating the antibiotic prescription status of pediatric primary emergency medical centers and the benchmark prescription rates in pediatric outpatient settings. We conducted a multi-center, cross-sectional study of seven pediatric primary emergency medical centers located in five prefectures of Japan. We retrospectively extracted data from health claims or directly obtained them from charts at each institution and evaluated trends in the antibiotic prescription rate based on the AWaRe classification between April 2016 and December 2019. Our study included 383,525 encounters, with the most common infectious disease diagnosis being acute upper respiratory tract infection in 93,449 cases (24.4 %). The antibiotic prescription rate during the study period was 7.4 %, representing a decrease of 46 %, from 10.2 % in 2016 to 5.5 % in 2019. The percentage of prescriptions in the Access group increased at all institutions; however, it exceeded 60 % in only three facilities in 2019. The percentage of third-generation cephalosporins varied among facilities, ranging from 1.7 % to 59.4 %, as of 2019. For pediatric primary emergency medical centers where antimicrobial stewardship programs are implemented, we suggest 5 % as a reasonable benchmark level for the antibiotic prescription rate. Prescribing the antibiotics in the Access groups less frequently remains a domestic challenge in Japan. [ABSTRACT FROM AUTHOR]

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Objective: To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students. Methods: 33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge's g. Results: Both groups had an increase in self-confidence (HFS 59.1 £ 93.6, p < 0.001; CDB 50.5 £ 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 £ 63.2, p = 0.001; CDB 43.5 £ 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20). Conclusion: HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge. [ABSTRACT FROM AUTHOR]

Background: The modified Gartland classification is the most widely accepted grading method of supracondylar humeral fractures among orthopedic surgeons and is relevant to identifying fractures that may require surgery. Objective: To assess the interobserver reliability of the modified Gartland classification among pediatric radiologists, pediatric orthopedic surgeons, and pediatric emergency medicine physicians. Materials and methods: Elbow radiographs for 100 children with supracondylar humeral fractures were retrospectively independently graded by two pediatric radiologists, two pediatric orthopedic surgeons, and two pediatric emergency medicine physicians using the modified Gartland classification. A third grader of the same subspecialty served as a tie-breaker as needed to reach consensus. Readers were blinded to one another and to the medical record. The modified Gartland grade documented in the medical record by the treating orthopedic provider was used as the reference standard. Interobserver agreement was assessed using kappa statistics. Results: There was substantial interobserver agreement (kappa = 0.77 [95% CI, 0.69−0.85]) on consensus fracture grade between the three subspecialties. Similarly, when discriminating between Gartland type I and higher fracture grades, there was substantial interobserver agreement between specialties (kappa = 0.77 [95% CI, 0.66−0.89]). The grade assigned by pediatric radiologists differed from the reference standard on 15 occasions, pediatric emergency medicine differed on 19 occasions, and pediatric orthopedics differed on 9 occasions. Conclusion: The modified Gartland classification for supracondylar humeral fractures is reproducible among pediatric emergency medicine physicians, radiologists, and orthopedic surgeons. [ABSTRACT FROM AUTHOR]

Objective: Febrile seizures are common reasons for admission to paediatric emergency departments. There is evidence suggesting that the frequency, severity, and seasonal distribution of non-COVID infections have changed since the removal of measures during the COVID-19 pandemic. These changes may also impact febrile seizures, which are known to be triggered by infections. We aimed to reveal the frequency and seasonal distribution of febrile seizures during the COVID-19 pandemic and after the removal of social restrictions and measures. Methods: Patients who presented to the emergency department with a febrile seizure were grouped as having first or recurrent febrile seizure, and demographic data were reported. The patients were then grouped according to the period of the pandemic as follows; the first year of the pandemic (Group 1), the second year (Group 2), and the period after the removal of measures (Group 3). The groups were compared in terms of the number of patients, seizure age, seizure duration, seizure frequency, season of admission, seizure type, seizure status at the time of admission to the emergency department (stopped or ongoing), and electroencephalography (EEG) findings. Results: A total of 248 patients who presented with 272 febrile seizures were included. There were 34, 105, and 132 patients in Groups 1, 2, and 3, respectively. There were no significant differences among the three groups in terms of recurrent febrile seizures, continuation of seizures upon admission to the emergency department, duration of seizures, treatment requirement in the emergency department, or ratio of focal seizures (p>0,05). However, the number of febrile seizures increased in groups 2 and 3. There was seasonal variation in febrile seizures, with a decrease in autumn and an increase in winter. The majority of patients in all groups was under 3 years of age. Conclusions: In this study, we attributed the decrease in the number of febrile seizures in the first year of the pandemic period and its increase in the subsequent years to the effects of the pandemic on the course of infections. The seasonal shift observed in febrile seizures after the removal of precautions may also reflect changes in the period of infection. Understanding that pandemics cause epidemiological changes in infections and related comorbidities is important for the early prediction and management of infections and their comorbidities. [ABSTRACT FROM AUTHOR]

OBJECTIVE It is perceived by many pharmacists that inadequate training and the resulting lack of confidence hinder participation in medical emergencies. There is insufficient information detailing training programs for pharmacists responding to pediatric medical emergencies. The primary objective of this study was to compare competency scores pre and post participation in the pediatric medical emergency training (PedMET) program. The secondary objectives included comparing confidence and knowledge for participation in pediatric medical emergencies, knowledge of resources and error prevention tools, description of the median time to prepare medications, and the most common errors that occurred during simulation. METHODS A comprehensive didactic lecture and simulation-based training were designed and contained pre- and post-competencies to assess pharmacists' knowledge related to pediatric medical emergencies. Self-assessments were included to determine pharmacists' confidence levels in knowledge and preparation of medications. Feedback was solicited from participants to identify areas of improvement for the program. Standards for QUality Improvement Reporting Excellence (SQUIRE) 2.0 was used to report findings. RESULTS Twenty-nine pharmacists of diverse training (e.g., residency vs nonresidency) and experience levels completed the program between July 2021 and March 2023. Competency scores improved from a median of 86% to 97% (p value < 0.001). Significant improvement was detected in pharmacists' confidence in their ability to prepare complex medications during medical emergencies (p value = 0.001). CONCLUSIONS Following the implementation of didactic and simulation-based training, pharmacists' knowledge and confidence increased. Departments of pharmacy should consider implementing pharmacist-specific training programs for all pharmacists who respond to pediatric medical emergencies. [ABSTRACT FROM AUTHOR]

Background: Effective leadership of health care action teams has demonstrated positive influence on team performance and patient care, but there is no consensus on how to assess these skills. We developed a novel team leadership assessment tool for leaders of interprofessional pediatric resuscitation teams and collected validity evidence for this tool using video review. Methods: This was a prospective cohort study from November 2021 to October 2022. A novel team leadership assessment tool was developed using literature review and local expertise and then piloted and refined using medical simulation. Pediatric emergency medicine (PEM) fellows from a single tertiary care pediatric medical center were enrolled, and videos of one medical resuscitation and one trauma resuscitation were collected per fellow each month. Three reviewers underwent reviewer training and then scored the videos using the assessment tool. Raters provided feedback on feasibility and ease of use using a 5‐point Likert scale. Inter‐rater reliability for the assessment tool using Gwet's agreement coefficient and the association between performance and clinical level of training using generalized linear mixed model were calculated. Results: Twelve PEM fellows enrolled and 146 videos were reviewed. The inter‐rater reliability for each domain ranged from 0.45 (p < 0.0001) to 0.59 (p < 0.0001), with the inter‐rater reliability of the total score being 0.49 (p < 0.0001). The reviewers' mean ratings of the elements of the tool were as follows: clarity of the domains (4.6/5), the independence of each domain from each other (3.9/5), the ease of use of the 5‐point Likert scale (4.5/5), the usefulness of the provided examples for each domain (4.6/5), and the ability to assess each domain without having to rewatch (4.5/5). The tool differentiated between levels of clinical training for two of the six domains (p < 0.02). Conclusions: We developed a novel team leadership assessment tool for pediatric resuscitation team leaders that demonstrated moderate inter‐rater reliability. The tool was easy to use and feasible for educators to assess the performance of PEM trainees in complex high‐stakes clinical situations. [ABSTRACT FROM AUTHOR]

Aim: There is limited evidence on trainees' and instructors' needs and perspectives concerning interprofessional simulation-based trainings. We aimed to study task distribution among team members, profession-specific learning effects and enhancing collaboration and competencies within medical teams. Methods: This prospective study examined expectations and experiences of medical and nursing students during paediatric emergency training in a tertiary care centre with questionnaires before and after a training. Further, expert interviews were conducted to identify the needs for interprofessional training. Results were used to design a standardised checklist for structured preparation of interprofessional paediatric emergency management training. Results: Of the nursing students, 82% initially intended to assume the role of the team leader, but only 5.8% did so during training. Both professions emphasised the significance of effective communication and transparent task distribution for successful collaboration. Experts highlighted the importance of proficiency in basic technical skills and identified non-technical skills such as closed-loop communication and the 10-4-10 principle as crucial for both professions. Conclusion: The study revealed profession-specific variations in the intention of acquiring the team leader or member role. Interprofessional training emerges as a potential strategy to dismantle these structures and promote shared responsibilities. The checklist aims to facilitate structured preparation of a training. [ABSTRACT FROM AUTHOR]

Aim: This study explored whether early- life factors, such as rhinovirus- induced wheeze and allergic sensitisation, were related to asthma at 11 years of age. Methods: We focused on 107 children aged 6-48 months, who attended the paediatric emergency department at Astrid Lindgren's Children's Hospital in Stockholm, Sweden, with acute wheeze in 2008-2012. They also attended follow- up visits at 11 years of age and were compared with 46 age-matched healthy controls. Odds ratios (OR) with 95% confidence intervals (CI) were calculated with logistic regression. Results: We found that 62.6% of the acute wheeze cases had asthma at 11 years of age. Rhinoviruses at inclusion were the only common airway viruses associated with an increased asthma risk (OR 2.4, 95% CI 1.02-5.6). Other increased risks were parental heredity for asthma and/or allergies (adjusted OR 3.4, 95% CI 1.1-9.9) and allergic sensitisation at 2 years of age (adjusted OR 3.0, 95% CI 1.02-8.7). The highest prevalence of asthma was when children had both rhinovirus- induced wheeze at inclusion and allergic sensitisation at 7 years of age. Conclusion: Our findings highlight the importance of hereditary factors and allergic sensitisation on the development of asthma and suggest that rhinoviruses are associated with asthma development in predisposed children. [ABSTRACT FROM AUTHOR]

The dawn of Artificial intelligence (AI) in healthcare stands as a milestone in medical innovation. Different medical fields are heavily involved, and pediatric emergency medicine is no exception. We conducted a narrative review structured in two parts. The first part explores the theoretical principles of AI, providing all the necessary background to feel confident with these new state-of-the-art tools. The second part presents an informative analysis of AI models in pediatric emergencies. We examined PubMed and Cochrane Library from inception up to April 2024. Key applications include triage optimization, predictive models for traumatic brain injury assessment, and computerized sepsis prediction systems. In each of these domains, AI models outperformed standard methods. The main barriers to a widespread adoption include technological challenges, but also ethical issues, age-related differences in data interpretation, and the paucity of comprehensive datasets in the pediatric context. Future feasible research directions should address the validation of models through prospective datasets with more numerous sample sizes of patients. Furthermore, our analysis shows that it is essential to tailor AI algorithms to specific medical needs. This requires a close partnership between clinicians and developers. Building a shared knowledge platform is therefore a key step. [ABSTRACT FROM AUTHOR]

Intussusception is the most common paediatric abdominal emergency in young children. Even though red current jelly stool is the pathognomonic feature, it only presents in less than 15% of cases. The clinical diagnosis is often missed as the presentation can mimics others. A recurrent case within 48 hours of reduction is even rare and can be falsely suspected as a normal post-reductive presentation. We highlighted a recurrence of intussusception in a 3-year-old boy, who was initially well after being discharged to home. Medical attention was sought initially but was informed that the clinical presentation could be resolved in a few days. Nevertheless, a second opinion has been sought in view of the persistent frequency pattern. Without delay, readmission of the child was arranged for surgical reduction. Regardless of the mild severity of gastrointestinal symptoms, the possibility of recurrence of intussusception should be suspected despite the presumed success of the initial intervention. [ABSTRACT FROM AUTHOR]

Summary: Appendicectomy is a common procedure in children with a low risk of mortality, however, complication rates and risk factors are largely unknown. This study aimed to characterise the incidence and epidemiology of postoperative complications in children undergoing appendicectomy in the UK. This multicentre prospective observational cohort study, which included children aged 1–16 y who underwent surgery for suspected appendicitis, was conducted between November 2019 and January 2022. The primary outcome was 30‐day postoperative morbidity. Data collected included: patient characteristics; comorbidities; and physiological status. Multivariable regression analysis was used to identify independent risk factors for poor outcomes. Data from 2799 children recruited from 80 hospitals were analysed, of which 185 (7%) developed postoperative complications. Children from black and 'other' minority ethnic groups were at significantly higher risk of poor outcomes: OR (95%CI) 4.13 (1.87–9.08), p < 0.001 and 2.08 (1.12–3.87), p = 0.021, respectively. This finding was independent of socio‐economic status and type of appendicitis found on histology. Other risk factors for complications included: ASA physical status ≥ 3 (OR (95%CI) 4.05 (1.70–9.67), p = 0.002); raised C‐reactive protein (OR 95%CI 1.01 (1.00–1.01), p < 0.001); pyrexia (OR (95%CI) 1.77(1.20–2.63), p = 0.004); and peri‐operative oxygen supplementation (OR (95%CI) 4.20 (1.44–12.24), p = 0.009). In the UK NHS, which is a universally accessible healthcare system, ethnicity, but not socio‐economic status, was associated with an increased risk of postoperative complications in children having surgery for acute appendicitis. Further evaluations and interventions are required to address this health inequality in keeping with NHS and international priorities. [ABSTRACT FROM AUTHOR]

Foreign body ingestion is a common pediatric gastrointestinal emergency, which should be suspected in all patients who present with signs of airway obstruction or upper GI bleeding, especially if it developed after the child was left unwitnessed for a while. The most common foreign bodies identified in the literature are button batteries or coins. Early identification and management of suspected foreign body ingestion is crucial as it can lead to devastating complications including bleeding, fistula formation, perforation, mediastinitis, or abscess. Here we report a case of a peculiar foreign body ingestion resulting in esophageal perforation in a 2-year-old girl. [ABSTRACT FROM AUTHOR]