Pediatric Emergency Care[JOURNAL]
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200 papers
Establishment of a Mandatory National Simulation Program for Pediatric Emergency Medicine Fellowship Training.
Rosenbloom E, Feldman O, Jacob R … +4 more , Chayen G, Capua T, Takagi D, Friedman N
Pediatr Emerg Care · 2025 Nov · PMID 40847185 · Publisher ↗
BACKGROUND: In 2020, the scientific council of the Israeli Medical Association approved a National Simulation Program (NSP) for Pediatric Emergency Medicine (PEM) fellows as a mandatory component of their training curric...
BACKGROUND: In 2020, the scientific council of the Israeli Medical Association approved a National Simulation Program (NSP) for Pediatric Emergency Medicine (PEM) fellows as a mandatory component of their training curriculum. The study aimed to outline the NSP's development, its components, and assess PEM fellows' self-reported perception of knowledge and confidence acquisition following participation. METHODS: The NSP comprised 9 simulation days over 2.5 years, covering various PEM emergencies with 34 novel scenarios and 4 technical skill stations. After each session, PEM fellows completed a self-assessment using a 5-point Likert scale to evaluate the NSP's impact on their knowledge and confidence in managing complex PEM scenarios. RESULTS: From July 2020 to February 2023, 197 participants attended 9 simulation days, representing 59 PEM fellows from all 14 different PEM departments across Israel offering PEM fellowship programs. PEM fellows rated the NSP's contribution to improving abilities and confidence in leading resuscitation teams according to Crisis Resource Management (CRM) principles with an average of 4.7/5 (±0.7) and 3.9/5 (±0.6), respectively, on a 5-point Likert scale. They also rated NSP's contribution to improving clinical knowledge and scenario management abilities with averages of 4.8/5 (±0.5) and 4.7/5 (±0.6), respectively. CONCLUSIONS: We demonstrated that it is possible to successfully establish and implement an NSP in Israel. Our findings indicate that the NSP enhances PEM fellow's perception of knowledge and confidence in managing complex PEM conditions. The NSP is deemed valuable for training PEM fellows in Israel.
Characteristics Among a Pediatric Cohort Arriving Via EMS Following Nonaccidental and Accidental Trauma.
Piper K, Gabriele G, Wilkinson M … +1 more , Lawson K
Pediatr Emerg Care · 2026 Jan · PMID 40827046 · Publisher ↗
OBJECTIVES: To describe the characteristics of injured children arriving at a Pediatric Level I Trauma Center via Emergency Medical Services (EMS) and determine predictive characteristics for children injured due to nona...
OBJECTIVES: To describe the characteristics of injured children arriving at a Pediatric Level I Trauma Center via Emergency Medical Services (EMS) and determine predictive characteristics for children injured due to nonaccidental trauma (NAT). METHODS: A single-center retrospective cohort study was performed for children 5 years of age and younger arriving via EMS from January 2016 through December 2018. NAT finding was made by a Multidisciplinary Child Protection Team of child abuse clinicians, representatives from Child Protective Services, law enforcement, and District Attorney's offices. The rate of NAT was determined, and prehospital (ie, demographics) and hospital (ie, highest level of care) factor differences were explored between children with injuries sustained from NAT versus accidental trauma (AT). Additional subanalyses examined those among the cohort with head injuries. RESULTS: The sample included 352 children; 8.5% were found with injuries sustained from NAT. These children were younger, needed higher levels of care (ie, admission) and more likely to have EMS scene times >15 minutes (aOR 3.46) compared with those with AT. Among the population with head injuries (n=121), 9% were sustained from NAT. Like the full cohort, children were younger and more likely to have EMS scene times >15 minutes. CONCLUSIONS: In our study, a substantial proportion of injured children arriving at the hospital via EMS were victims of NAT. These children were younger and had injuries warranting higher levels of care than those with AT. Significantly higher EMS scene times among the NAT group warrant more exploration.
A Simulation-Based Measurement of Emergency Department Readiness for Neonatal Resuscitation: Is the Staff Ready?
Bruno CJ, Balga T, Gray M … +2 more , Johnston LC, Auerbach MA
Pediatr Emerg Care · 2025 Nov · PMID 40826953 · Publisher ↗
OBJECTIVES: Few studies have evaluated the readiness of emergency departments (EDs) that care for both children and adults to perform newborn resuscitation. Little is known about the adherence to Neonatal Resuscitation P...
OBJECTIVES: Few studies have evaluated the readiness of emergency departments (EDs) that care for both children and adults to perform newborn resuscitation. Little is known about the adherence to Neonatal Resuscitation Program (NRP) guidelines or availability of necessary equipment in this setting. We sought to address these knowledge gaps. METHODS: This is an observational pilot cohort study of 3 emergency departments, 1 underresourced and urban and 2 suburban and resource rich, to assess readiness to perform newborn resuscitation. A systems assessment at each site involved a before and after simulation survey, completion of an adapted Pediatric Readiness Equipment Checklist specific for neonatal care and a Critical Action Checklist measured during an in situ simulated case. RESULTS: Thirty-five providers participated, including nurses (42%), physicians (18%), advanced practice providers (17%), emergency medical services (EMS) providers/paramedics (11%), and emergency medicine technicians (11%). All EDs had the majority of equipment items for newborn resuscitation (94%, 30/32 items). Laryngeal mask airways, plastic wrap for preterm newborn thermoregulation, and endotracheal tube tape were not available at one or more EDs. Only 40% to 50% of critical actions were performed. All teams performed cardiac compressions before establishing effective ventilation. Most participants reported an improvement in perceived abilities to manage a neonate requiring resuscitation postsimulation. CONCLUSIONS: EDs had most of the equipment required for newborn resuscitation. There were significant deviations from evidence-based NRP guidelines, specifically not prioritizing effective ventilation and starting chest compressions prematurely. There is continued need to develop and sustain NRP skills in EDs, in addition to ensuring that appropriate equipment is readily available.
Impact of Race and Ethnicity, Income, Language, and Insurance on Timeliness of Pediatric Emergency Department Sepsis Care.
Ha L, Fullerton L, Swenson K … +1 more , Tuuri R
Pediatr Emerg Care · 2025 Nov · PMID 40820288 · Publisher ↗
OBJECTIVE: This study aimed to measure the association of race and ethnicity, preferred language, income, and insurance status on process and outcomes measures of sepsis care in a pediatric emergency department (PED). ME...
OBJECTIVE: This study aimed to measure the association of race and ethnicity, preferred language, income, and insurance status on process and outcomes measures of sepsis care in a pediatric emergency department (PED). METHODS: A single-center, retrospective cohort study was conducted at the only tertiary-care children's urban hospital with a PED in New Mexico. Children aged 2 months to younger than 18 years old who were evaluated in the PED from July 2020 to July 2023 and met sepsis criteria by ICD-10 codes were screened for inclusion. Demographic data and outcomes including median time to fluid bolus, time to antibiotics, PED length of stay (LOS), and hospital LOS were collected from the electronic medical records. RESULTS: There was no significant difference in time to sepsis interventions by demographic factors studied. Patients who reported preferring a language other than English had longer PED LOS (350 min, P = 0.024) compared with English speakers (245 min), but there were no other significant differences in PED and hospital LOS by demographic factors. CONCLUSIONS: There were no associations between race and ethnicity, income, preferred language, insurance status, and time to sepsis interventions. PED LOS was significantly different by reported preferred language. This overall lack of differences may be attributed to the local context of the study, which may not be generalizable to other areas. Further research is warranted to investigate processes that lead to similar care and barriers to timely interventions.
POCUS for Pulled Elbow Due to Trauma: A Retrospective Review and Case Series.
Arnowitz E, Scheier E
Pediatr Emerg Care · 2025 Nov · PMID 40820279 · Publisher ↗
INTRODUCTION: Radial head subluxation (RHS) can result from a traumatic mechanism such as a fall, and these children often receive radiography. Point-of-care ultrasound (POCUS) can identify RHS. Here, we review 2 years o...
INTRODUCTION: Radial head subluxation (RHS) can result from a traumatic mechanism such as a fall, and these children often receive radiography. Point-of-care ultrasound (POCUS) can identify RHS. Here, we review 2 years of RHS at our facility and show a decrease in length of stay (LOS) for children receiving POCUS. METHODS: This is a retrospective chart review at a tertiary care pediatric emergency department (PED). We used keyword searches of our facility's electronic medical records to identify children treated in the PED for RHS from January 2023 to January 2025. RESULTS: Over the study period, 291 children presented to the PED on 348 occasions with RHS. Of the 348 visits due to RHS, 74 (21%) presented with a traumatic mechanism. Of the 74 children presenting with a history of trauma, 39 (53%) received radiography, versus 22 of 208 (11%) presenting with a history of axial traction and 8 of 66 (12%) presenting with no history. Children with a traumatic mechanism had LOS of 82 minutes versus 62 for children with an axial traction mechanism ( P <0.05). Children with RHS receiving POCUS had an LOS of 61 minutes compared with 103 minutes for children who received radiography ( P < 0.05). When looking specifically at children with a traumatic mechanism, those receiving POCUS only had LOS of 69 minutes versus 92 minutes for children with a traumatic mechanism receiving x-ray ( P < 0.05). CONCLUSIONS: Children with RHS frequently present with a history of traumatic injury. POCUS identification of RHS can decrease radiography and LOS in the PED.
Risk Factors for Recurrence of Primary Spontaneous Pneumothorax in Adolescents.
Lin CH, Chen CH, Lin WC … +4 more , Tseng TY, Chao HH, Soong WJ, Hong SY
Pediatr Emerg Care · 2025 Oct · PMID 40797365 · Publisher ↗
OBJECTIVES: The recurrence of primary spontaneous pneumothorax (PSP) is common among adolescents. This study investigated the recurrence rate and the risk factors of PSP in adolescents. METHODS: A total of 103 (aged 12-1...
OBJECTIVES: The recurrence of primary spontaneous pneumothorax (PSP) is common among adolescents. This study investigated the recurrence rate and the risk factors of PSP in adolescents. METHODS: A total of 103 (aged 12-18 years) adolescents who presented with PSP were included. The exclusion criterion was iatrogenic or secondary pneumothorax. Patients were classified into 2 groups: the nonrecurrence group and the recurrence group. RESULTS: There were 61 patients in the nonrecurrence group and 42 patients in the recurrence group. The recurrence rate was 45.8% with supplemental oxygen, 47.7% with pigtail drainage, and 28.6% with video-assisted thoracic surgery (VATS). The recurrence rates in patients who did not undergo VATS and those who did undergo VATS were 47.1% and 28.6%, respectively. In a comparison of the nonrecurrence, ipsilateral recurrence, and contralateral recurrence groups, the percentage of patients in the ipsilateral recurrence group who underwent surgery was significantly lower, and the percentage of patients with bullae found by computed tomography was significantly higher in the contralateral recurrence group. The incidence of pleural abnormalities was also found to be higher in the contralateral recurrence group. CONCLUSIONS: The recurrence rate of PSP in our study was 40.8% and higher in male patients. Surgery after the first episode of PSP appears to significantly reduce the risk of ipsilateral recurrence. Furthermore, if bullae are revealed by computed tomography or pleural abnormalities are revealed by chest radiograph, the incidence of subsequent contralateral recurrence may be higher.
A Video-Based Intervention to Assess COVID-19 and Influenza Vaccine Acceptability in a Pediatric Emergency Department.
Ebbing B, Fullerton L, Putnam S … +2 more , Kundurti N, Dehority W
Pediatr Emerg Care · 2025 Dec · PMID 40790526 · Publisher ↗
INTRODUCTION: Children have unacceptably low rates of COVID-19 and influenza vaccine uptake. Given limited access to primary care for many children, pediatric emergency departments (PEDs) are novel settings for COVID-19...
INTRODUCTION: Children have unacceptably low rates of COVID-19 and influenza vaccine uptake. Given limited access to primary care for many children, pediatric emergency departments (PEDs) are novel settings for COVID-19 and influenza vaccine administration. OBJECTIVE: Our study tested whether viewing a brief educational video would be associated with an increase in COVID-19 and influenza vaccine readiness among adult caregivers for themselves and their children. METHODS: This study consisted of a convenience sample of 339 caregivers accompanying pediatric patients to a university-based PED from 1/13/2022 to 5/11/2022. Participants completed a pre-intervention survey through iPad that gathered information concerning demographics, COVID-19 beliefs, and vaccine attitudes and readiness. Participants watched a novel 3-minute educational video created by the study team addressing risks and benefits of vaccine-preventable illnesses and immunizations. Information in the video was delivered by local medical professionals and tailored to our community. Participants were then resurveyed with only the questions about vaccine attitudes and vaccine readiness. Pre-intervention/post-intervention attitude changes were assessed using the Wilcoxon signed-rank test. RESULTS: Participants were 69% Hispanic and 16% Native American, with a median age of 34 years; 30% resided in rural areas. Post-intervention, COVID-19 vaccine acceptability as reported by caregivers increased on a 5-point agreement scale for both themselves ( P =0.0017) and their children ( P =0.0038). Participants were also more likely to be willing to talk to a pediatric emergency medicine doctor about influenza vaccine administration for their children after the intervention ( P =0.012). CONCLUSIONS: A brief video-based intervention featuring locally relevant content in a PED targeted at caregivers was associated with improvement in some measures of vaccine readiness as reported by caregivers for both themselves and their children. Similar interventions could be modeled specifically for individual community characteristics and combined with vaccine administration to substantially impact morbidity and mortality from vaccine-preventable diseases.
Learning Curve for Point-of-Care Ultrasonography for Pediatric Skin and Soft Tissue Infections.
Neal JT, Miller AF, Gravel CA … +5 more , Levy JA, Neuman MI, Monuteaux MC, Rempell RG, Pusic MV
Pediatr Emerg Care · 2025 Dec · PMID 40776413 · Publisher ↗
OBJECTIVES: Point-of-care ultrasonography (POCUS) for skin and soft tissue infections (SSTIs) has been integrated into routine clinical care in pediatric emergency medicine (PEM). Despite its widespread utilization, empi...
OBJECTIVES: Point-of-care ultrasonography (POCUS) for skin and soft tissue infections (SSTIs) has been integrated into routine clinical care in pediatric emergency medicine (PEM). Despite its widespread utilization, empirical data on skill development are required to inform standards of care. We sought to evaluate the accuracy of POCUS for the detection of SSTIs, and to estimate a learning curve as providers gained experience. METHODS: A database was created at a single urban pediatric emergency department (ED) for all POCUS studies performed for cellulitis and abscess among children from August 2009 to January 2020. Providers who completed at least 10 total studies were included. The accuracy of each study was asynchronously rated by 6 POCUS experts. We report each provider's learning curve. Within the provider, the studies were ordered temporally. Mixed-effect logistic regression was used to model study accuracy with study accuracy as the dependent variable, within-provider examination temporal order as a fixed effect, and random effects for provider-level intercept and longitudinal slope. RESULTS: A total of 3408 ultrasounds by 87 providers were included. The median number of ultrasounds per provider was 32 (range: 10 to 184). Accuracy increased significantly with each additional scan [odds ratio: 1.02 (1.01, 1.03)]. Significant variability was found across provider-level intercepts ( P < 0.001) but not across slopes ( P = 0.215). To reach mean accuracy levels of 90% and 95%, averages of 29 and 80 scans were required, respectively. CONCLUSIONS: POCUS accuracy for detecting pediatric SSTIs improved with experience, with a mean of 29 scans required to reach 90% accuracy.
Pediatric Emergency Transfers Following Virtual Urgent Care Visits.
Kim JW, Hancock D, Levine D … +2 more , Platt S, Lame M
Pediatr Emerg Care · 2025 Dec · PMID 40775677 · Publisher ↗
OBJECTIVES: Telemedicine use has surged since the COVID-19 pandemic, offering patients access to remote health care and the potential to reduce nonemergent emergency department (ED) visits. This study aims to describe po...
OBJECTIVES: Telemedicine use has surged since the COVID-19 pandemic, offering patients access to remote health care and the potential to reduce nonemergent emergency department (ED) visits. This study aims to describe postpandemic virtual urgent care (VUC) utilization, including VUC-to-ED referral rates and outcomes in children. METHODS: We performed a retrospective cohort study of patients under 21 years presenting to the ED within 72 hours following a VUC visit from March 1, 2021, through February 28, 2023, using the electronic medical record. We reviewed demographic data and examined ED care and disposition for patients VUC physician-referred compared with those who self-referred. RESULTS: We analyzed 4676 completed VUC patient visits. Patients who preferred English, were non-Hispanic, and had commercial insurance were more likely to complete their VUC visit, with a rate of 72%. Among all patients who completed a VUC visit, 5.9% were referred to the ED by a VUC physician with a 19% admission rate, whereas 5% of patients self-referred with a 6% admission rate. On logistic regression analysis, only insurance status was significant; patients with Medicaid had twice the odds of a self-referred visit. CONCLUSIONS: This study demonstrated low referral rates from VUC to ED. Despite modifications to improve VUC access, disparities in VUC utilization persist. Patients with Medicaid are more likely to self-refer to the ED, although they have lower rates of admission when self-referred. Future qualitative studies are needed to optimize VUC as an equitable health care resource.
Retrospective Evaluation of Pediatric Emergency Department Visits of Children With Medical Complexity in a Tertiary Care Center in Italy.
Zanin A, La Piana C, Brigiari G … +6 more , Gregori D, Divisic A, Bressan S, Zangardi T, Masiero S, Benini F
Pediatr Emerg Care · 2025 Dec · PMID 40770933 · Full text
OBJECTIVE: Children with medical complexity are a growing population with multiple conditions, medical device dependency and frequent need for emergency department (ED) visits; their care and management in an emergency s...
OBJECTIVE: Children with medical complexity are a growing population with multiple conditions, medical device dependency and frequent need for emergency department (ED) visits; their care and management in an emergency setting may be challenging. The pediatric palliative care (PPC) network aims to address the needs of these children and their families to improve their quality of life.The purpose of this retrospective single-center study was to determine the prevalence and reasons for visiting the ED, the management, outcome, and quality of care received in a Tertiary Care Pediatric Hospital, where the PPC facility is strongly integrated and cooperating with the ED. METHODS: We collected data on the 775 pediatric ED visits performed in Padua Pediatric ED between 2006 and 2023 by 85 children under the care of the regional center for PPC in Veneto, Italy. RESULTS: Median number of visits per patient was 2.0 per year, 33.4% resulting in hospital admissions. Most frequent reasons for ED visits were respiratory conditions (28.9%), followed by medical device malfunctions (18.3%). Other data included PPC specialist involvement, ED referral, time of arrival, color code, and type of assistance required. Over the years, there has been an increased number of ED visits, admissions, medical device malfunctions, hours spent in the ED, and involvement of PPC specialists. No significant influences were noted during the COVID-19 pandemic period. CONCLUSION: These data highlight potential areas of intervention to enhance emergency care management for CMC, such as early PPC specialist involvement with the home care network activation, a specific training of ED providers, and a dedicated service for the management of device malfunctions.
Nurse-Performed Bladder Ultrasound Effect on Pediatric Bladder Catheterization Success.
Ng C, Promer G, Troy B … +11 more , Lewis A, Hoyos A, Covelo L, Carlson O, Reddy NR, Abdallah C, Sarnaik A, Ling J, Jergel A, Morris CR, Berkowitz TE
Pediatr Emerg Care · 2025 Dec · PMID 40770366 · Full text
BACKGROUND AND OBJECTIVES: Bladder catheterization (BC) is a routine procedure, but unsuccessful attempts due to inadequate bladder volume are common and stressful for children and caregivers. Physician-performed bladder...
BACKGROUND AND OBJECTIVES: Bladder catheterization (BC) is a routine procedure, but unsuccessful attempts due to inadequate bladder volume are common and stressful for children and caregivers. Physician-performed bladder point-of-care ultrasound (POCUS) improves BC success rates, but the effect of nurse-performed POCUS remains understudied. METHODS: We randomized children under 24 months of age to receive either nurse-performed POCUS before BC or standard blind BC in the pediatric emergency department to compare dry catheterization rates. A simplified POCUS technique using a single bladder measurement was employed to enhance efficiency and feasibility for nursing staff. We also compared caregiver satisfaction and procedural time between groups. Statistical comparisons used the Pearson χ 2 test for categorical variables and the Wilcoxon rank sum test for continuous variables. A P value of <0.05 was considered statistically significant. Univariate logistic regression estimated the odds of outcomes with POCUS versus standard care. RESULTS: In the POCUS group, the dry catheterization rate was 5% compared with 17% in the standard group (odds ratio=0.24, 95% CI=[0.09, 0.72]), indicating fewer dry BCs in the POCUS group. Caregivers of children in the POCUS group reported higher satisfaction ( P =0.02). There was no significant difference in the time from BC orders to initial BC attempt between groups. CONCLUSIONS: Nurse-performed POCUS before BC reduces dry BCs and improves caregiver satisfaction without causing procedural delays. Incorporating nurse-performed POCUS into standard BC workflows may enhance patient care.
Racial Differences in the Identification of Seat Belt Signs Among Pediatric Motor Vehicle Crash Occupants.
Gakwaya RB, Zonfrillo MR, Ellison AM … +3 more , Holmes JF, Kuppermann N, Ruest SM
Pediatr Emerg Care · 2025 Nov · PMID 40767271 · Full text
OBJECTIVE: To determine if there are racial differences in the identification of seat belt signs (SBS) among children with motor vehicle crash (MVC)-related blunt torso trauma. METHODS: This was a secondary analysis of a...
OBJECTIVE: To determine if there are racial differences in the identification of seat belt signs (SBS) among children with motor vehicle crash (MVC)-related blunt torso trauma. METHODS: This was a secondary analysis of a de-identified, public-use data set from a Pediatric Emergency Care Applied Research Network (PECARN) prospective cohort study of children with blunt torso trauma between May 2007 and January 2010. Children <18 years in MVCs were included. Patient demographics, documentation of an abdominal SBS presence, MVC crash speed, and restraint status were analyzed. Descriptive statistics, χ 2 analyses, and the Cochran-Armitage test for trend were performed. RESULTS: There were 3832 children in MVCs. The mean age was 10.6 years (SD: 5.5), 52.6% of patients were White, 31.1% Black, 16.3% other/unknown, and 2.3% Asian. Restraint status differed significantly by race ( P <0.001), with 74.1% of White children (95% CI: 72.2%-76.0%), 64.5% of Black children (95% CI: 61.7%-67.2%), 83.0% of Asian children (95% CI: 75.1%-90.8%), and 68.3% of other/unknown race children (95% CI: 64.4%-72.3%) reported as restrained. There was a significant difference in the proportion of restrained Black children with SBS (7.2% [95% CI: 5.3%-9.0%]) compared with White children (27.0% [95% CI: 24.7%-29.2%]) ( P <0.001) and Asian children (26.0% [95% Cl: 16.0%-36.1%]). When adjusting for age, MVC speed, and restraint status, Black patients were 74% less likely than White patients to have SBS observed (OR: 0.26, 95% CI: 0.18-0.36). CONCLUSIONS: There were significant differences in SBS identification among Black children compared with other race children after MVCs. Prospective studies accounting for skin tone are necessary to further investigate these findings.
An Evaluation of Enteropathogen-Specific Disease Severity and Duration in Children With Acute Gastroenteritis.
Roskind CG, Schnadower D, Rogers AJ … +17 more , Casper TC, Tarr PI, Levine AC, Bhatt SR, Gouin S, Mahajan P, Vance C, Hurley KF, Norris JG, Powell EC, Farion KJ, Sapien RE, O'Connell KJ, Poonai N, Schuh S, Freedman SB, Pediatric Emergency Research Canada (PERC) and the Pediatric Emergency Care Applied Research Network (PECARN)
Pediatr Emerg Care · 2025 Dec · PMID 40762219 · Publisher ↗
OBJECTIVES: Our primary objectives were to describe pathogen-specific symptom severity and duration in a prospective cohort study of children with acute gastroenteritis (AGE). Our secondary objective was to quantify heal...
OBJECTIVES: Our primary objectives were to describe pathogen-specific symptom severity and duration in a prospective cohort study of children with acute gastroenteritis (AGE). Our secondary objective was to quantify health care resource utilization. METHODS: This secondary analysis of 2 trials included children aged 3 to 48 months with AGE. Children were eligible if they had ≥3 watery stools in the preceding 24 hours and were brought to the Emergency Department. Disease severity was quantified by frequency and duration of vomiting and diarrhea, and the Modified Vesikari Scale score. We used descriptive statistics to summarize severity and regression models to identify associations between pathogen type and outcomes. RESULTS: In total, 1565 trial participants had pathogen testing performed and completed follow-up. Viral pathogens were identified in 47.9% (749/1565) and bacterial pathogens in 5.9% (92/1565). Norovirus (322/1565; 20.6%) was the most frequently identified pathogen. Diarrhea duration was greatest (median 160h, IQR: 98, 216) for children with Salmonella . Vomiting (aOR: 11.02; 95% CI: 7.47, 16.26) occurred more commonly in children with viruses compared with bacteria. The mean duration of diarrhea was shorter for viruses compared with bacteria (aIRR: 0.81, 95% CI: 0.68, 0.96). Mean MVS scores were higher in children with viruses compared with those with bacteria (coefficient: 1.64, 95% CI: 0.46, 2.82). CONCLUSIONS: We describe the clinical course of viral and bacterial pathogens. Although statistically significant, differences in symptom severity across pathogens were not clinically meaningful for distinguishing between them based on symptoms alone.
Serious Video Game for Teaching Pediatric Emergency Medicine: A Randomized Controlled Noninferiority Trial of a Serious Game Versus Traditional Simulation.
Ichwan D, Cannavino C, Harvey H … +2 more , Lange A, Shah A
Pediatr Emerg Care · 2025 Nov · PMID 40762215 · Publisher ↗
OBJECTIVES: Learners' pediatric emergency medicine experiences are variable. With computer simulation modules, learners experience rare or high-stakes scenarios on their own time and pace with repetition without the reso...
OBJECTIVES: Learners' pediatric emergency medicine experiences are variable. With computer simulation modules, learners experience rare or high-stakes scenarios on their own time and pace with repetition without the resources associated with traditional simulation. This study compares third-year medical students' knowledge and confidence acquisition after participating in an author-created serious game or analogous traditional in-person simulation of a pediatric septic shock scenario. METHODS: Participants were randomized to the traditional simulation or serious game. They completed a knowledge pretest, assigned simulation with corresponding debriefing, posttest, and survey. RESULTS: Ninety students enrolled in 11 sessions. While the groups' knowledge acquisition [game mean 4.46 (standard deviation 0.38) vs traditional 3.86 (0.38)] and self-perceived confidence change in managing septic shock ( P = 0.19) were similar, knowledge acquisition did not meet the prespecified threshold proving "noninferiority." The traditional group had greater confidence change in recognizing septic shock ( P = 0.03). The traditional group had higher levels of agreement with "The simulation was realistic" ( P < 0.001). However, both groups similarly agreed with "The simulation experience was enjoyable" ( P = 0.07) and "I would be interested in doing more simulations like this in the future for other medical topics" ( P = 0.36). CONCLUSION: Third-year medical students randomized to the created serious game or traditional simulation had similar knowledge acquisition and change in self-perceived confidence for managing septic shock but not in confidence gain for recognizing septic shock. While the traditional group found the experience more realistic, both groups had comparable enjoyment and levels of interest in doing more similar simulations.
Demographic and Social Factors Associated With Pediatric Firearm Injuries: A Retrospective Review.
Cohen E, Chithra T, Siddique R … +6 more , Akkus C, Wagner B, Sheppard S, Gienapp AJ, Williams R, Snider MA
Pediatr Emerg Care · 2025 Dec · PMID 40745691 · Publisher ↗
OBJECTIVE: To identify demographic, social, and legislative risk factors that may contribute to increased incidence of ballistic injuries among children presenting to Le Bonheur Children's Hospital (LBCH) in Memphis, Ten...
OBJECTIVE: To identify demographic, social, and legislative risk factors that may contribute to increased incidence of ballistic injuries among children presenting to Le Bonheur Children's Hospital (LBCH) in Memphis, Tennessee. Memphis has the highest incidence of violent crime per capita in the United States. Tennessee, where Memphis is located, became a permit-less carry state on July 1, 2021. METHODS: We conducted a retrospective cohort study of firearm-related injuries among pediatric patients (0 to 18 y) who presented to Le Bonheur Children's Hospital (LBCH)-a tertiary care hospital and ACS-verified Level 1 Pediatric Trauma Center-from January 1, 2010, through December 31, 2023. Variables collected included age, sex, race, mortality, school zoning type (in-person, virtual, hybrid), Social Vulnerability Index (SVI) (based on patient residence), and first firearm injury (in the event patients experienced more than one). Statistical analyses were performed using the T test, χ 2 test, univariate and multivariate Poisson regression, and backward elimination. RESULTS: From 2010 to 2023, we collected 1512 charts featuring 1471 individual subjects; 79.13% were males, 78.11% were Black, and 56.8% were 14 to 18 years old. The number of pediatric firearm injuries increased from 153 patients in September 2018 to February 2020, to 377 patients between March 2020 and August 2021 during the pandemic, when schools closed and most students attended school online remotely. Black males, adolescents aged 14 to 18 years, and residing in a high-risk SVI area were associated with a higher risk of firearm injury. Passage of the permit-less carry legislation was associated with a 23.78% increase in firearm injuries. Black race and male sex were significant risk factors for firearm injury, while a low-risk SVI was protective. CONCLUSIONS: This study shows that adolescents living in areas with high SVI who are Black and male are more likely to suffer firearm injuries. Because there is widespread poverty in Memphis and increased access to guns, firearm injuries will continue to be a major public health issue for this demographic. Research on this topic should lead to tangible efforts to improve these risk factors and reduce the number of firearm injuries.
Perinatal Depression Screening in the Pediatric Emergency Department.
Abe N, Austin-Page L, Chang E … +4 more , Lazo-Kim A, Remnick A, Nguyen M, Pediatric Emergency Medicine Infant Health Outcome Research Group
Pediatr Emerg Care · 2025 Nov · PMID 40745556 · Publisher ↗
OBJECTIVES: The optimal approach to perinatal depression (PND) screening is poorly understood. PND is associated with increased health care utilization in children. Parental PND screening during infant pediatric emergenc...
OBJECTIVES: The optimal approach to perinatal depression (PND) screening is poorly understood. PND is associated with increased health care utilization in children. Parental PND screening during infant pediatric emergency department (PED) visits may improve detection. We aimed to identify and characterize parents in the PED with a positive PND screen and absent previous screening. METHODS: We conducted a prospective survey study on a convenience sample of parents bringing their infants (<12 mo) to our tertiary PED from September to December 2022. We included parents with English or Spanish fluency. We excluded parents of infants who required medical stabilization. Participants completed a survey that included the Edinburgh Postnatal Depression Scale, a validated PND screen. A score of 10 was considered positive. We provided resources as appropriate. We used descriptive statistics, univariate analysis, and a generalized mixed effects model to identify factors associated with a positive screen and an absent previous screening. RESULTS: Of 452 enrolled parents [387 (85.6%) females, 52 (11.5%) males], 125 (27.7%) screened positive. Gender was not associated with positive screening results. While Asian/Asian American parents and those with a history of mental health conditions or symptoms were more likely to screen positive, about 1 in 4 parents had a positive screen across all parent subgroups. One in 3 subjects reported no previous PND screening. CONCLUSIONS: PED visits offer a unique venue for PND screening, where high-risk parents who may otherwise go unscreened can be targeted. Our finding of a high proportion of positive screens across parent groups emphasizes the importance of universal screening in the PED setting. There is an urgent need to understand and improve the gaps in our current screening efforts.
Ethics in the Emergency Department: Withholding or Terminating Resuscitation.
Shapiro J, Acholonu C, Madrigal V
Pediatr Emerg Care · 2025 Aug · PMID 40742225 · Publisher ↗
Terminating cardiopulmonary resuscitation (ToR) in pediatric emergency department settings requires complicated clinical and ethical decision-making. This review focuses on providing physicians and advanced practice prov...
Terminating cardiopulmonary resuscitation (ToR) in pediatric emergency department settings requires complicated clinical and ethical decision-making. This review focuses on providing physicians and advanced practice providers with practical guidance for assessing indicators of prognosis and navigating ethical considerations during the resuscitation of pediatric patients. Clinical indicators such as physical exam findings, arrest etiology, cardiopulmonary resuscitation (CPR) duration, and end-tidal carbon dioxide levels serve as benchmarks to guide resuscitation efforts. Ethical principles, including beneficence and non-maleficence, are critical in balancing the potential benefits of resuscitation with the harms of prolonged CPR, such as dysthanasia, moral distress, and adverse neurological outcomes. Underscored is the importance of compassionate communication with families, the appropriateness of clinician directiveness in ToR decisions, and the role of "slow codes" in the emergency department setting.
Single Breath Count as a Diagnostic Tool for Children With Asthma: A Prospective Observational Study.
Nakka S, Das RR, Gulla KM … +2 more , Dwibedi B, John J
Pediatr Emerg Care · 2025 Nov · PMID 40734456 · Publisher ↗
OBJECTIVE: To determine the test characteristics of single breath count (SBC) in differentiating asthma from no asthma, exacerbations from no exacerbations, and to determine the ability of SBC to assess response to treat...
OBJECTIVE: To determine the test characteristics of single breath count (SBC) in differentiating asthma from no asthma, exacerbations from no exacerbations, and to determine the ability of SBC to assess response to treatment. METHODS: This prospective observational study was conducted in the pediatric department of a tertiary care teaching hospital over a 2-year period. Children (6 to 16 y age) were divided into 3 groups: asthma with nonsevere exacerbation (group 1), asthma without exacerbation (group 2), and healthy children (group 3). Baseline tests (spirometry and SBC) were done for all the groups, and posttreatment tests were done for groups 1 and 2. Pulmonary score (PS) was measured in group 1. Receiver operating characteristic (ROC) curves and correlation coefficients were derived. RESULTS: One hundred sixty-four children (asthma=82, healthy=82) were enrolled (male, 59.8%). The median (IQR) SBC values of the 3 groups at baseline were as follows: group 1: 27 (25-31), group 2: 32 (28-36), and group 3: 35 (31-40). Posttreatment, significant change was noted in group 1 ( P <0.05). All the spirometry parameters showed a significant positive correlation with SBC. A strong negative correlation (ρ=-0.647) was seen between SBC and PS in group 1 ( P <0.001). The area under the curve (AUC) for SBC was 0.71 (95% CI: 0.62-0.84) for differentiating between "exacerbation" and "no exacerbation" ( P =0.014). The cutoff value of SBC was 28 for this differentiation. CONCLUSIONS: SBC, like spirometry and PS, can differentiate asthma exacerbation from no exacerbation (a cutoff of 28 was suggestive). SBC can be used as a simple bedside test to monitor treatment response in children with nonsevere asthma exacerbation.
Clinical Characteristics and Resource Utilization in Children Presenting to the Pediatric Emergency Department With Neck Swelling.
Cook SS, Donaldson BF, Chaudhari PP … +2 more , Pham PK, Liu DR
Pediatr Emerg Care · 2025 Oct · PMID 40734362 · Publisher ↗
OBJECTIVES: We aimed to describe patient characteristics, diagnostic imaging rates, and resource utilization in children presenting to the emergency department (ED) with neck swelling. METHODS: We conducted a single-cent...
OBJECTIVES: We aimed to describe patient characteristics, diagnostic imaging rates, and resource utilization in children presenting to the emergency department (ED) with neck swelling. METHODS: We conducted a single-center retrospective cross-sectional chart review study of children <18 years seen in a pediatric ED in the United States between January 1, 2018, and December 31, 2018, with a discharge diagnosis related to neck swelling. The primary outcome was neck imaging performed in the ED. We used descriptive statistics to describe clinical characteristics and odds ratios to compare resource utilization between ED encounters with and without imaging. RESULTS: We studied 680 ED encounters with neck swelling, 32.4% (n=220) of which involved imaging. When imaging was ordered, ultrasound, computed tomography, or plain film radiography was ordered in 79% (n=180), 18.4% (n=43), and 4.7% (n=11) of encounters, respectively. Patients with fever (OR: 1.55, 95% CI: 1.11, 2.15), recent antibiotic use (OR: 1.8, 95% CI: 1.25, 2.6), and neck tenderness on physical examination (OR: 3.01, 95% CI: 2.11, 4.3) had increased odds of undergoing imaging. A subanalysis demonstrated that 15.4% (n=37) of patients with reactive lymphadenopathy and 32.9% (n=71) of patients with adenitis were imaged, despite over 95% of these patients being discharged home. Among all patients discharged home (n=570), median [IQR] ED length of stay was 3.6 [2.7, 5.4] hours in encounters with imaging and 1.9 [1.1, 3.4] hours in encounters without imaging (OR: 1.4; 95% CI: 1.3-1.5). CONCLUSIONS: Historical characteristics and physical examination findings vary among children presenting to the ED with neck swelling, including among those who undergo imaging. Children diagnosed with reactive lymphadenopathy and adenitis are typically discharged home from the ED, whether or not imaging was performed, suggesting that imaging may not always be necessary in these patients. Future studies are needed to understand which presenting signs and symptoms should lead to neck imaging and which imaging modality is best.
Pediatric Blunt Thoracolumbar Spinal Injury: Defining the Burden of Injury and Imaging Practices.
Prabhala T, Herzog A, Ata A … +2 more , Adamo MA, Edwards M
Pediatr Emerg Care · 2025 Dec · PMID 40726177 · Publisher ↗
OBJECTIVES: Surgical intervention for thoracolumbar spinal injury (TLSI) is rare in pediatric trauma. Current guidelines recommend CT scanning of the entire spine if one spinal injury is found, and localized CT if spinal...
OBJECTIVES: Surgical intervention for thoracolumbar spinal injury (TLSI) is rare in pediatric trauma. Current guidelines recommend CT scanning of the entire spine if one spinal injury is found, and localized CT if spinal injury is suspected, likely resulting in significant radiation exposure for these injuries. This study identifies the frequency of various imaging techniques utilized across trauma centers of varied designations for confirmed pediatric TLSI. METHODS: The American College of Surgeons Trauma Quality Improvement Program Participant Use File (TQIP PUF) was queried from 2017 to 2022. Patients aged younger than or equal to 14 years with thoracic or lumbar injuries were included. ICD-10 codes for injuries, imaging, procedures, and bracing were analyzed by patient age and trauma center level. RESULTS: Thirteen thousand three hundred ten children were identified with blunt TLSI. The most common injury was thoracic spine fracture (58.23%) followed by lumbar spine fracture (45.11%). Spinal cord injuries were less common (5.8% lumbar, 7.18% thoracic), as were joint injuries (5.8% lumbar, 0.86% thoracic). The need for surgical intervention was rare (6.49%) and varied significantly with age and trauma center type. Older children were more likely to be evaluated with CT and younger children were more likely to be evaluated with MRI. Adult centers were much more likely to image with CT, and pediatric centers were much more likely to use plain film or MRI. CONCLUSIONS: Although TLSI is common in blunt pediatric trauma, intervention is rarely needed. CT imaging is liberally used, particularly in adult trauma centers. Improved guidelines for cross-sectional imaging in neurologically normal patients are needed.
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