Keywords: Pediatric trauma, blood transfusion, ratios (PubMed Search)
Akl M, Anand T, Reina R et al. Balanced hemostatic resuscitation for bleeding pediatric trauma patients: A nationwide quantitative analysis of outcomes. Journal of Pediatric Surgery 2022. epub ahead of print.
Keywords: intuccesption, air enema, reduction timing (PubMed Search)
Keywords: pediatrics, moderate sedation, airway, laryngospasm. (PubMed Search)
Cosgrove P, Krauss B, Cravero J and Fleegler E. Predictors of Laryngospasm During 276,832 Episodes of Pediatric Procedural Sedation. Annals of Emergency Medicine 2022. epub ahead of print
Keywords: COVID, kids, masking, school (PubMed Search)
This was a multistate, prospective, observational cohort of children and teachers attending in person schools in kindergarden through 12th grade where the school districs had the ability to perform contact tracing and determine primary vs secondary infections. During the study period (6/21-12/21) 46 districts had universal masking policies and 6 districts had optional masking policies.
Districts that optionally masked had 3.6x the rate of secondary transmission compared to universally masked school districts. Optionally masked districts had 26.4 cases of secondary transmission per 100 community acquired cases compared to only 7.3 cases in universally masked districts.
Bottom line: Universial masking was associated with reduced secondary transmission of SARS-CoV2 compared with optional masking policies.
Boutzoukas AE, Zimmerman KO, Inkelas M, et al. School Masking Policies and Secondary SARS-CoV-2 Transmission. Pediatrics. 2022;149 (6):e2022056687.
Keywords: trauma informed care, pediatric resuscitation (PubMed Search)
Beaulieu-Jones BR, Bingham S, Rhynhart KK, Croitoru DP, Singleton MN, Rutman MS, Baertschiger RM. Incorporating a Trauma-Informed Care Protocol Into Pediatric Trauma Evaluation: The Pediatric PAUSE Does Not Delay Imaging or Disposition. Pediatr Emerg Care. 2022 Jan 1;38(1):e52-e58. doi: 10.1097/PEC.0000000000002278. PMID: 33181796.
Keywords: PNA, pediatrics, duration of treatment (PubMed Search)
Williams DJ, Creech CB, Walter EB, Martin JM, Gerber JS, Newland JG, Howard L, Hofto ME, Staat MA, Oler RE, Tuyishimire B, Conrad TM, Lee MS, Ghazaryan V, Pettigrew MM, Fowler VG Jr, Chambers HF, Zaoutis TE, Evans S, Huskins WC; The DMID 14-0079 Study Team. Short- vs Standard-Course Outpatient Antibiotic Therapy for Community-Acquired Pneumonia in Children: The SCOUT-CAP Randomized Clinical Trial. JAMA Pediatr. 2022 Mar 1;176(3):253-261. doi: 10.1001/jamapediatrics.2021.
Keywords: motrin, narcotics, oxycodone, fracture care (PubMed Search)
Ali et al. An observational cohort study comparing ibuprofen and oxycodone in children with fractures. PLos ONE 16(9): e0257021.
Keywords: abdominal trauma, MVC, CT scans, radiation (PubMed Search)
Fornari M and Lawson S. Pediatric Blunt Abdominal Trauma and Point of Care Ultrasound. Pediatric Emergency Care 2021. 37 (12): 624-629.
Keywords: peds, chest xray, pneumonia. (PubMed Search)
Lipsett, Susan C. MD*,†,‡; Hirsch, Alexander W. MD*,†; Monuteaux, Michael C. ScD*,†; Bachur, Richard G. MD*,†,‡; Neuman, Mark I. MD, MPH*,†,‡ Development of the Novel Pneumonia Risk Score to Predict Radiographic Pneumonia in Children, The Pediatric Infectious Disease Journal: January 2022 - Volume 41 - Issue 1 - p 24-30.
Keywords: pediatric trauma, complications (PubMed Search)
Khalil M, Alawwa G, Pinto F, O'Neill PA. Pediatric Mortality at Pediatric versus Adult Trauma Centers. J Emerg Trauma Shock. 2021 Jul-Sep;14(3):128-135. doi: 10.4103/JETS.JETS_11_20. Epub 2021 Sep 30. PMID: 34759630; PMCID: PMC8527062.
Keywords: pediatrics, COVID, vaccination, hospitalization (PubMed Search)
Woodruff RC, Campbell AP, Taylor CA, et al. Risk Factors for Severe COVID-19 in Children. Pediatrics. 2022;149(1):e2021053418.
Keywords: orthopedics, upper extremity fractures, playgrounds (PubMed Search)
Curnow H and Millar R. Too far to fall: Exploring the relationship between playground equipment and paediatric upper limb fractures. Journal of Pediatrics and Child Health. 2021.
Keywords: seizure, status epilepticus, midazolam (PubMed Search)
This was a retrospective, noninferiority analysis looking at patients 14 years old and younger treated for nontraumatic seizures by EMS with a midazolam dose of 0.1 mg/kg (regardless of route). There were just over 2000 patients with a median age of 6 years included in the study. Midazolam redosing occurred in 25% of patients who received intranasal midazolam versus only 14% who received midazolam via intramuscular, intravenous, or intraosseous routes.
Bottom line: In the prehospital setting, intranasal midazolam at a dose of 0.1 mg/kg was associated with an increased need to redose compared to other routes. This dose may be subtherapeutic for intranasal administration.
Keywords: roller coasters, summer, death (PubMed Search)
Keywords: hyperthermia, pediatrics, car (PubMed Search)
Keywords: Bradycardia, intubation, RSI, atropine (PubMed Search)
Kovacich et al. Incidence of bradycardia and the use of atropine in pediatric rapid sequence intubation in the emergency department. Pediatric emergency care. Published online 2021.
Keywords: finger injuries, nail bed (PubMed Search)
Petruzella F, Easter JS. Pediatric emergency medicine literature 2020. The American Journal of Emergency Medicine. 2021;43:123-133
Keywords: pediatric, cardiac arrest, metabolic acidosis, sodium bicarbonate (PubMed Search)
During cardiac arrest, metabolic acidosis develops because of hypoxia-induced anaerobic metabolism and decreased acid excretion caused by inadequate renal perfusion. Sodium bicarbonate (SB) administration was considered as a buffer therapy to correct metabolic acidosis. However, SB has several side effects such as hypernatremia, metabolic alkalosis, hypocalcemia, hypercapnia, impairment of tissue oxygenation, intracellular acidosis, hyperosmolarity, and increased lactate production. The 2010 Pediatric Advanced Life Support (PALS) guideline stated that routine administration of SB was not recommended for cardiac arrest except in special resuscitation situations, such as hyperkalemia or certain toxidromes. An evidence update was conducted in the 2020 Pediatric Life Support (PLS) guideline and the recommendations of 2010 remain valid. This article was a systematic review and meta-analysis of observational studies of pediatric in hospital cardiac arrests. The primary outcome was the rate of survival to hospital discharge after in hospital cardiac arrests. The secondary outcomes were the 24-hour survival rate and neurological outcomes.
Chih-Yao Chang, Po-Han Wu, Cheng-Ting Hsiao, Chia-Peng Chang, Yi-Chuan Chen, Kai-Hsiang Wu. Sodium bicarbonate administration during in-hospital pediatric cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2021. Available on line March 1. In Press.
Keywords: stroke, altered mental status, TPA (PubMed Search)
Baldovsky MD, Okada PJ. Pediatric stroke in the emergency department. J Am Coll Emerg Physicians Open. 2020 Oct 6;1(6):1578-1586. doi: 10.1002/emp2.12275. PMID: 33392566; PMCID: PMC7771757.
Keywords: Chest pain, ischemia, pediatrics, myocarditis (PubMed Search)
Even though acute myocardial ischemia (AMI) does not present as commonly in the pediatric patient as in the adult and the literature is limited, it is reasonable to obtain a troponin when acute cardiac ischemia is suspected based on the history and physical exam.
Recreational drugs including cocaine, amphetamine, cannabis, Spice, and K2 (cannabis derivatives) have been shown to result in myocardial injury including AMI. Coronary vasospasm secondary to drug use is well documented in the pediatric population. While cocaine use is a known risk factor for coronary vasospasm, the same condition has been reported in pediatric patients after marijuana use.
In a study of pediatric patients with blunt chest trauma, 3 of 4 patients with electrocardiographic or echocardiographic evidence of cardiac injury had elevations in troponin I above 2.0 ng/mL. Cardiac troponins are an accurate tool for screening for cardiac contusion after blunt chest trauma in pediatric patients even with limited data.
Cardiac troponins are also useful in the evaluation for myocarditis. In one study, myocarditis was the most common diagnosis (27%) in pediatric ED patients presenting with chest pain and an increased troponin. Eisenberg et al showed a 100% sensitivity and an 85% specificity for myocarditis using a troponin of 0.01 ng/mL or greater as a cut off. A normal troponin using this cutoff can be used to exclude myocarditis. Abnormal troponin in the first 72 hours of hospitalization in pediatric patients with viral myocarditis is associated with subsequent need for extracorporeal membrane oxygenation and IVIg.
Bottom line: Troponin can be used in pediatric patients with clinical concern for cardiac ischemia, cardiac contusion and myocarditis
Brown JL, Hirsh DA, Mahle WT. Use of troponin as a screen for chest pain in the pediatric emergency department. Pediatr Cardiol. 2012;33(2):337-342. doi:10.1007/s00246-011-0149-8
Drossner DM, Hirsh DA, Sturm JJ, et al. Cardiac disease in pediatric patients presenting to a pediatric ED with chest pain. Am J Emerg Med. 2011;29(6):632-638. doi:10.1016/j.ajem.2010.01.011
Thankavel PP, Mir A, Ramaciotti C. Elevated troponin levels in previously healthy children: value of diagnostic modalities and the importance of a drug screen. Cardiol Young. 2014;24(2):283-289. doi:10.1017/S1047951113000231
Yolda? T, Örün UA. What is the Significance of Elevated Troponin I in Children and Adolescents? A Diagnostic Approach. Pediatr Cardiol. 2019;40(8):1638-1644. doi:10.1007/s00246-019-02198-w
Adams JE, Dávila-Román VG, Bessey PQ, Blake DP, Ladenson JH, Jaffe AS. Improved detection of cardiac contusion with cardiac troponin I. Am Heart J. 1996;131(2):308-312. doi:10.1016/s0002-8703(96)
Hirsch R, Landt Y, Porter S, et al. Cardiac troponin I in pediatrics: normal values and potential use in the assessment of cardiac injury. J Pediatr. 1997;130(6):872-877. doi:10.1016/s0022-3476(97)
Eisenberg MA, Green-Hopkins I, Alexander ME, Chiang VW. Cardiac troponin T as a screening test for myocarditis in children. Pediatr Emerg Care. 2012;28(11):1173-1178. doi:10.1097/PEC.