Pediatric Emergency Care[JOURNAL]
Sun
200 papers
Delayed Consent for Research During the Emergent Care of Febrile Young Infants: Feasible, Acceptable, Doable.
Burstein B, Dionne KA, Yannopoulos A … +2 more , Wolek C, Goldman RD
Pediatr Emerg Care · 2026 Jun · PMID 42252979 · Publisher ↗
OBJECTIVE: To assess the feasibility and parental acceptability of delayed consent for research involving blood samples collected from febrile infants aged 60 days or younger during emergent care. METHODS: This was a sub...
OBJECTIVE: To assess the feasibility and parental acceptability of delayed consent for research involving blood samples collected from febrile infants aged 60 days or younger during emergent care. METHODS: This was a substudy of a pilot trial at a tertiary pediatric ED to detect biomarkers of serious bacterial infections among febrile young infants. Families were provided an introductory letter indicating that, after clinically necessary blood tests, a small volume of additional blood would be collected and stored for research for which they could opt out at any time. After hospital discharge, all families received telephone follow-up for a delayed consent discussion, allowing them to accept or refuse participation in the main biomarker trial. A 6-month consecutive sample of parents was invited to complete a questionnaire regarding the acceptability of research blood collection with delayed telephone consent. RESULTS: Among 345 consecutive infants, 22 (6.4%) families opted out of research blood collection during ED care, and 136 (42.1%) had research blood collected after clinical sampling. Nearly all families (333/345; 96.5%) had telephone follow-up, and questionnaires were completed by 312/333 (90.4%). Most families found delayed consent for research blood collection acceptable (271/312; 86.9%) or somewhat acceptable (34/312; 10.9%), and 81.5% provided consent to use their infants' research blood samples. CONCLUSIONS: Delayed consent for research is feasible andhighly acceptable to parents of febrile infants in the ED. This methodology may minimize stress during emergent care, enhance inclusivity, and facilitate timely, ethical pediatric research when there are barriers to standard prospective consent. Broader implementation should consider study risk, context, and ethical oversight.
Emergiquiz: Toddler With a Limp.
Hendrickson EH, Rutowicz N, Woods R
Pediatr Emerg Care · 2026 Jun · PMID 42247208 · Publisher ↗
A 22-month-old male with profound microcytic anemia presented with a limp, refusal to walk, and several days of vomiting. Dietary history and focused examination prompted further workup that revealed two rare but related...
A 22-month-old male with profound microcytic anemia presented with a limp, refusal to walk, and several days of vomiting. Dietary history and focused examination prompted further workup that revealed two rare but related diagnoses that may be easily missed in the emergency department but are treatable with early identification.
Accidental Ingestion of Highly Toxic Drugs in Young Children: A Multicenter Study From Spanish Pediatric Emergency Departments.
Ramírez-Romero J, Mintegi S, Santibañez BA … +1 more , Surveillance System of the Intoxications Working Group of the Spanish Society of Pediatric Emergencies
Pediatr Emerg Care · 2026 Jun · PMID 42231643 · Publisher ↗
OBJECTIVES: Highly toxic medications are thought to lead to fatal overdose even after single-dose ingestions. Recent evidence has questioned some of the assumptions underlying this concept. In this context, this study ai...
OBJECTIVES: Highly toxic medications are thought to lead to fatal overdose even after single-dose ingestions. Recent evidence has questioned some of the assumptions underlying this concept. In this context, this study aimed to evaluate the incidence, management, and outcomes of accidental ingestions involving highly toxic drugs in young children presenting to pediatric emergency departments (EDs). METHODS: We performed a descriptive and analytical study using a prospective, nationwide, multicenter pediatric poisoning registry including 58 Spanish EDs from 2008 to 2024. We analyzed accidental ingestions of therapeutic drugs in children under 8 years of age with a predefined subgroup of infants under 1 year. Highly toxic drugs were defined according to established pediatric toxicology criteria. Clinical presentation, ED management, hospital disposition, and outcomes were compared with other therapeutic drug ingestions. RESULTS: Among 3577 poisoning episodes, 1189 (33.2%) involved accidental ingestion of therapeutic drugs in children under 8 years; 61 cases (5.1%) involved highly toxic drugs. Median age was 3 years (interquartile range 1 to 6), and 26 children (46.6%) were under 1 year. Cardiovascular drugs (37.7%) and opioids (24.5%) were the most frequent agents. Only 4 patients (6.8%) were symptomatic at presentation. No child required advanced airway or circulatory support, and no fatalities occurred. Hospital admission was more frequent after ingestion of highly toxic drugs. CONCLUSIONS: Accidental ingestion of highly toxic medications represents a small proportion of pediatric poisonings in EDs and is generally associated with favorable short-term outcomes. This supports a more evidence-based approach to risk stratification in the management of exploratory ingestions.
Characteristics of Pediatric Visits to the Emergency Department With Dermatological Complaints.
Homme K, Leng T, Homme JJL
Pediatr Emerg Care · 2026 Jun · PMID 42227175 · Publisher ↗
OBJECTIVES: Dermatological diseases constitute 4% to 12% of all emergency department (ED) visits and may contribute to high health care costs. However, little is known about pediatric visits. The aim of this study was to...
OBJECTIVES: Dermatological diseases constitute 4% to 12% of all emergency department (ED) visits and may contribute to high health care costs. However, little is known about pediatric visits. The aim of this study was to determine characteristics, photo app utilization, and diagnostic concordance at follow-up of pediatric visits to the ED with dermatological complaints. METHODS: This was a retrospective study conducted in the ED at an academic medical center. Patients younger than or equal to 18 years of age who presented with a dermatologic concern between May 2022 and April 2023 were included. The association between clinical characteristics and the use of a photo application in the ED was evaluated using logistic regression. RESULTS: In 380 patients who met inclusion criteria, the most common final diagnoses were rash (30%, N=115), burn (10%, N=39), and cellulitis (9%, N=35). Fourteen patients (4%) had an emergent triage category (ESI 2). Photo app was used in 38% (N=143) encounters. Factors associated with the photo app use in multivariate analysis included ESI category 2 (odds ratio [OR]: 4.08, 95% CI: 1.17-14.18, P=0.027), ESI category 3 (OR: 1.74, 95% CI: 1.07-2.82, P=0.025), and duration of illness >1 week (OR: 3.50, 95% CI: 1.54-7.96, P=0.003). The diagnosis at follow-up was identical in 68% (N=78) of cases; clarified for 22% (N=25) and altered in 11 patients (10%). CONCLUSIONS: Most pediatric visits presenting to the ED with dermatological complaints are non-urgent and ER physicians can accurately diagnose the majority of these cases. Triage category ESI 2, ESI 3, and illness duration >1 week were associated with the photo app use.
Factors Associated With Reports to Child Protective Services Following Unintentional Ingestions in Children Younger Than Age 6.
Irgens-Moller N, Shea C, Kazmir S … +3 more , Dodington J, Gaither JR, Tiyyagura G
Pediatr Emerg Care · 2026 Jun · PMID 42226541 · Publisher ↗
OBJECTIVE: Unintentional ingestions in children are a common presenting chief complaint in the emergency department (ED). The decision to consult social work or report to Child Protective Services (CPS) relies on the pro...
OBJECTIVE: Unintentional ingestions in children are a common presenting chief complaint in the emergency department (ED). The decision to consult social work or report to Child Protective Services (CPS) relies on the provider's discretion. We sought to investigate the association between race or insurance status and providers' decisions. METHODS: A retrospective cross-sectional study of children younger than 6 years of age presenting to 1 of 6 hospitals within the Yale New Haven Health system in 2013 to 2021 with an ICD-9/10 code of poisoning or accidental ingestion. Multivariable logistic regression was used to assess factors associated with social work and CPS consults. RESULTS: Among 759 children with unintentional ingestions, there were 467 (48.4%) ingestions of over-the-counter substances, 359 (47.3%) ingestions of prescription medications and 24 (3.2%) ingestions of illicit substances. Medication error by caregiver accounted for 46 cases (6.1%). Social work was consulted in 23% of cases. Factors associated with social work consults were changes in baseline mental status and vital signs (adjusted odds ratio [aOR]=3.35 [95% CI: 1.62-6.92]), requiring inpatient care (aOR=14.3 [8.04-25.6]), PICU admission (aOR=24.5 [5.57-107.9]), and having toxicology tests ordered (aOR=3.2 [1.85-5.51]). Presentation to a general ED decreased the odds of a social work consult (aOR=0.14 [0.08-0.24]). CPS reports were filed in 6.7% of cases. Factors associated with CPS reports were ingestion type (prescription aOR=2.73 [95%CI 1.19-6.27]; substances illegal for a minor [eg, alcohol, nicotine, THC-containing products] aOR=21.8 [6.76-70.4]), change in mental status or vital signs from baseline (aOR=3.18 [1.39-7.26]), requiring inpatient care (aOR=4.17 [1.95-8.91]) PICU (aOR=6.23 [95%CI 1.67-23.3]) and having toxicology tests ordered (aOR=3.6 [1.71-7.57]). CONCLUSIONS: In children presenting after unintentional ingestion, involvement of social work or CPS was associated with clinical severity and substance type but not with race or insurance status.
Response to Letter to the Editor: The Critical Importance of a Standardized Definition of Severe Pneumonia in Prognostic Research.
Samuel N, Lipsky AM
Pediatr Emerg Care · 2026 Jun · PMID 42223200 · Publisher ↗
Abstract loading — click title to view on PubMed.
The Critical Importance of a Standardized Definition of Severe Pneumonia in Prognostic Research.
Wang Y, Yang Z, Tian M
Pediatr Emerg Care · 2026 Jun · PMID 42223199 · Publisher ↗
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Update on the Clinical Management of Atopic Dermatitis in the Pediatric Emergency Department.
Ch'en PY, McQueen A, Lio PA
Pediatr Emerg Care · 2026 Jun · PMID 42223198 · Publisher ↗
Atopic dermatitis, the most common inflammatory skin disease of childhood, affects up to 20% of US children and frequently prompts emergency department (ED) visits. Clinicians must distinguish uncomplicated flares from s...
Atopic dermatitis, the most common inflammatory skin disease of childhood, affects up to 20% of US children and frequently prompts emergency department (ED) visits. Clinicians must distinguish uncomplicated flares from secondary infections or treatment complications and initiate appropriate acute interventions. Evidence supports the judicious use of topical corticosteroids, with systemic therapy reserved for severe or refractory cases. The therapeutic landscape has expanded to include biological and targeted agents, which, while generally initiated in specialty settings, influence long-term care and require awareness in the ED. Families benefit from structured, actionable discharge planning, including provision of an "Eczema Action Plan," clear instructions on topical regimens, moisturizer use, and guidance on follow-up with primary care and dermatology. Emphasis on communication and education helps prevent recurrence, reduces unscheduled visits, and fosters adherence to outpatient management.
Examining Rates of Burnout Among Emergency Medicine and Pediatric Emergency Medicine Physicians.
Alhaddad Z, Gill AM, Parker J … +3 more , Felt J, Benner C, Arora B
Pediatr Emerg Care · 2026 May · PMID 42198916 · Publisher ↗
BACKGROUND: Approximately 2 in 3 physicians experience burnout at any given time. The field of emergency medicine (EM) has notably high burnout rates; however, research on burnout specifically among pediatric emergency m...
BACKGROUND: Approximately 2 in 3 physicians experience burnout at any given time. The field of emergency medicine (EM) has notably high burnout rates; however, research on burnout specifically among pediatric emergency medicine (PEM) physicians is more limited. The aim of this study is to examine burnout rates and contributing factors in both PEM and EM physicians, including the impact of the COVID-19 pandemic. METHODS: We conducted an online convenience survey of EM and PEM physicians practicing in the United States in 2021, utilizing email listservs. We adapted the Copenhagen Burnout Inventory (CBI) scale to examine 5 burnout domains: personal, work-related, patient-related, perceived contributing factors, and perceived burnout/stress due to COVID-19. RESULTS: We had a total of 453 respondents. The data were divided into 3 main groups: EM, PEM, and combined EM/PEM physicians. Burnout rates, on average, were 43.28%, 44.1%, and 43.23% for EM, PEM, and combined EM/PEM physicians, respectively. Post hoc analysis found that patient-related burnout score was, on average, higher in EM physicians (35) than in EM/PEM (31) and PEM (29) physicians (P = 0.02). Fewer EM physicians (22.8%) reported pandemic-related job security stress compared with EM/PEM (33.3%) and PEM (41.5%) physicians (P = 0.001). No other differences in burnout outcomes were statistically significant. CONCLUSION: Our study suggests that there are differences in patient-related burnout and COVID-related job security across EM categories. Therefore, further research is needed to identify specific factors contributing to burnout among EM/PEM physicians. This, in turn, will help guide targeted solutions to combat physician burnout and promote their well-being.
Past, Present, and Future: The Legacy of the Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC).
Touzinsky SM, Coughlin C, Harries M … +2 more , Nigrovic LE, Aronson PL
Pediatr Emerg Care · 2026 May · PMID 42178842 · Publisher ↗
The Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC) is the research subcommittee of the American Academy of Pediatrics (AAP) Section on Emergency Medicine. Volunteer-led, the committee has a long...
The Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC) is the research subcommittee of the American Academy of Pediatrics (AAP) Section on Emergency Medicine. Volunteer-led, the committee has a long history of supporting and facilitating high-impact multicenter pediatric emergency medicine research as well as nurturing future pediatric emergency medicine researchers. Currently, the 76 contributing sites across the United States, Canada, and Spain provide an avenue to investigate topics related to the emergency care of children with adequately powered, generalizable studies. We describe the history of PEM CRC, the impact on the field of pediatric emergency medicine, and future goals.
Factors Associated With Use of Procedural Sedation in Pediatric Facial Laceration Repair in the Emergency Department: A Retrospective Cross-Sectional Study.
Steidley IG, Mills D, Waltman E … +8 more , Monuteaux MC, Lyons T, Miller A, Rees CA, Landschaft A, Stewart A, Fleegler EW, Kimia A
Pediatr Emerg Care · 2026 May · PMID 42144930 · Publisher ↗
OBJECTIVE: To identify factors associated with the utilization of procedural sedation during pediatric facial laceration repair. METHODS: We performed a retrospective cross-sectional study at a tertiary care pediatric ED...
OBJECTIVE: To identify factors associated with the utilization of procedural sedation during pediatric facial laceration repair. METHODS: We performed a retrospective cross-sectional study at a tertiary care pediatric ED from 2016 to 2020 of patients aged 0 to 18 with facial lacerations repaired with sutures. Our primary outcome was utilization of procedural sedation (ketamine, propofol alone or plus fentanyl or ketamine, midazolam plus fentanyl), with a secondary outcome of utilization of anxiolysis (intranasal midazolam). We measured the association of covariates, including provider subspecialty and patient age, sex, race and ethnicity, insurance status, time and day, laceration characteristics, mechanism, and layers of repair in a multivariate analysis and multinomial logistic regression. RESULTS: We identified 4943 patient visits, with 3859 (78.8%) laceration repairs performed by emergency medicine providers and 1084 (21.9%) performed by plastic surgery. Procedural sedation was used in 373 (7.6%) visits. Lacerations repaired by plastic surgery were 25 times more likely to involve procedural sedation compared with those repaired by emergency medicine providers [adjusted odds ratio (aOR): 25.0, 95% CI: 17.1-36.5]. Additional factors included: laceration length (≥5 vs. <2.5 cm, aOR: 3.87, 95% CI: 1.88, 7.94), laceration complexity (complex vs. simple aOR: 2.50, 95% CI: 1.75, 3.57), and time of presentation (overnight vs. day, aOR: 2.58, 95% CI: 1.36, 4.91). CONCLUSION: Provider specialty was the strongest independent predictor of procedural sedation use, even after adjustment for wound characteristics. These findings highlight substantial practice variation and suggest an opportunity to develop standardized, clinically driven approaches to sedation decision-making for pediatric facial lacerations.
Establishing Age-Specific and Sex-Specific Norms for Mitral Valve E-Point Septal Separation (EPSS) Measurements in Pediatric Patients.
Ruffin JC, Stem CT, Pletzer S … +3 more , Gregoski MJ, Kumar-Veeraswamy A, Moake MM
Pediatr Emerg Care · 2026 May · PMID 42144922 · Publisher ↗
OBJECTIVE: Pediatric heart failure is a rare condition with significant morbidity that requires timely diagnosis and treatment. Mitral valve E-point septal separation (EPSS) may be used as an estimate of systolic functio...
OBJECTIVE: Pediatric heart failure is a rare condition with significant morbidity that requires timely diagnosis and treatment. Mitral valve E-point septal separation (EPSS) may be used as an estimate of systolic function in this evaluation. Although well studied in adults, there is limited literature looking at pediatric EPSS values. The goal of this study was to establish normal pediatric EPSS values that can serve as a reference in this evaluation. METHODS: This was a single-center retrospective study of 455 pediatric patients aged 17 years or younger, who had an outpatient transthoracic echocardiogram performed from January 1, 2020, until June 26, 2023. Those with reduced ejection fraction and cardiac abnormalities were excluded. EPSS measurements were taken from parasternal long-axis B-mode views. Relationships between EPSS and patient biometric and echo measurements were evaluated. Consistency of EPSS measurement between independent reviewers was also evaluated. RESULTS: Across all patients, the median EPSS for all measurements was 2.25 mm (IQR 2.06 mm). When looking specifically at the lowest 3 EPSS measurements for each patient, the median EPSS was 1.33 mm (IQR 2.56 mm). EPSS demonstrated statistically significant (P<0.05) but low magnitude (R <0.3) correlations with several patient biometric and echo measurements, including a negative correlation with ejection fraction and a positive correlation with age, height, weight, and body surface area. There was no significant correlation with sex. Interclass correlation by Cronbach Alpha was 0.951. CONCLUSIONS: EPSS measurements observed in this large pediatric patient sample are lower than those reported in both adults and children. Differences in imaging and measurement technique may explain these observed differences. Future prospective studies are needed to explore these differences and better define reference EPSS values and their clinical implications.
Evaluating the Impact of Respiratory Pathogen Testing on Pediatric Emergency Department Return Visits and Management.
Stephan AM, Pérez-Lizardi JY, Stern LM … +5 more , Jonas JA, Thomas C, Gerber N, Acker KP, Levine DA
Pediatr Emerg Care · 2026 May · PMID 42138070 · Publisher ↗
OBJECTIVES: To determine whether limited versus comprehensive respiratory pathogen panel (RPP) testing in children discharged from the pediatric emergency department (PED) with a viral respiratory illness is associated w...
OBJECTIVES: To determine whether limited versus comprehensive respiratory pathogen panel (RPP) testing in children discharged from the pediatric emergency department (PED) with a viral respiratory illness is associated with 7-day PED return visit rate and return visit management and disposition. METHODS: We conducted a retrospective cohort study of children 61 days to 18 years of age discharged from a large urban PED between June 1, 2023 to August 31, 2023 and December 1, 2023 to February 29, 2024, who received either limited (SARS-CoV-2, influenza A/B, respiratory syncytial virus) or comprehensive (22 pathogens) RPP testing for a clinically diagnosed viral respiratory illness. We recorded basic demographics, RPP test results, 7-day PED returns, and interventions and disposition during return visits. RESULTS: Of 2346 eligible patients, 1417 (60.4%) received limited RPP testing and 929 (39.6%) received comprehensive RPP testing. No difference was found in the 7-day PED return visit rate for limited testing compared with comprehensive testing after controlling for age, sex, race/ethnicity, insurance, Emergency Severity Index level, and visit season (aOR: 0.96, 95% CI: 0.67-1.38). On return visits, patients who had received limited testing were more likely to undergo additional urine studies (aOR: 2.70, 95% CI: 1.16-6.84); no differences were found in additional blood tests, throat swabs, chest radiographs, IV placements, medication administration, antibiotic prescribing, or disposition. CONCLUSIONS: Limited RPP testing is likely sufficient for children with a viral respiratory illness in the outpatient setting, as comprehensive RPP testing was not associated with a reduction in 7-day return visits or return visit interventions.
Racial Disparity and Disproportionality Among Emergency Department Visits for Child Maltreatment: Evidence From the Nationwide Emergency Department Sample (NEDS): 2019 to 2020.
Wanner C, Hunter AA, Fish M … +1 more , Livingston N
Pediatr Emerg Care · 2026 May · PMID 42132098 · Publisher ↗
BACKGROUND: Each year in the US, approximately 600,000 (8.1 per 1000 child population) children are victims of maltreatment. In 2023, rates among Black/African American children were 47% higher than the overall national...
BACKGROUND: Each year in the US, approximately 600,000 (8.1 per 1000 child population) children are victims of maltreatment. In 2023, rates among Black/African American children were 47% higher than the overall national rate. It is unclear whether similar disparities exist in national emergency department (ED) data, as the Nationwide Emergency Department Sample (NEDS) just began including race and ethnicity in data in 2019. OBJECTIVE: To evaluate racial disparity and disproportionality among a nationally representative sample of ED visits involving child maltreatment concerns. METHODS: International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes were used to identify ED visits for confirmed (T74) and suspected (T76) child maltreatment concerns in patients under 18 years old from 1/1/2019 to 12/31/2020. NEDS sampling weights were applied to produce national estimates. Racial disparity and disproportionality were calculated using the Disparity Index (DI) and the Disproportionality Representation Index (DRI), respectively. RESULTS: A total of 29,667 ED visits (130,981 weighted) involving child maltreatment concerns were identified. The DRI revealed that non-Hispanic Black children had maltreatment codes applied at a rate that was 1.8 greater times what was expected given their proportion in the general population. The DI showed that non-Hispanic Black children were twice as likely to have a maltreatment-related diagnosis code applied when compared with their non-Hispanic White counterparts. CONCLUSIONS: This research exposes racial differences in the application of diagnosis codes for child maltreatment concerns in a nationally representative ED sample. Future research should explore factors which may influence the application of maltreatment-related diagnosis codes.
Pediatric Cardiac Standstill Assessment by Pediatric Emergency Medicine Physicians With Point-of-Care Ultrasound: A Simulation-Based Skill Assessment.
Barbera NL, Ekpenyong A, Hollenbach KA … +2 more , Pade KH, Nguyen MT
Pediatr Emerg Care · 2026 May · PMID 42129600 · Publisher ↗
OBJECTIVES: The objective of this study was to determine the ability of pediatric emergency medicine (PEM) physicians to use cardiac POCUS for the evaluation of cardiac standstill by obtaining cardiac POCUS images on hea...
OBJECTIVES: The objective of this study was to determine the ability of pediatric emergency medicine (PEM) physicians to use cardiac POCUS for the evaluation of cardiac standstill by obtaining cardiac POCUS images on healthy model pediatric patients in ≤10 seconds before and after a brief training video and then interpreting prerecorded cardiac POCUS images for cardiac standstill versus organized cardiac activity as quickly as possible. METHODS: This was a single-center, prospective, simulation-based study. During simulated pediatric cardiac arrest scenarios, PEM physicians performed cardiac POCUS, reviewed a training video, and then reperformed cardiac POCUS. Subjects then interpreted 12 prerecorded cardiac POCUS video images as cardiac activity or standstill. The time to perform cardiac POCUS and to interpret images was recorded. RESULTS: Twenty PEM physicians participated. There was no change in median time, 10 seconds, to obtain cardiac POCUS images before and after the training video ( P =0.44). When data were dichotomized by ≤10 or >10 seconds, the odds of obtaining the image in ≤10 seconds were 3.5 times higher after viewing the video (95% CI=0.7, 34.5). When interpreting cardiac images, 40% (n=8) interpreted all of the images correctly; however, only 10% (n=2) did so in ≤10 seconds. CONCLUSIONS: The majority of PEM physicians can obtain cardiac POCUS images for the evaluation of cardiac standstill in ≤10 seconds. The ability to interpret cardiac POCUS images for cardiac activity or standstill in ≤10 seconds is variable; further research is needed to determine whether additional training could improve overall precision and timeliness.
Improving Appropriateness and Timeliness of Antibiotic Delivery in Pediatric Intestinal Failure.
Meenan C, Graham D, Talathi S
Pediatr Emerg Care · 2026 May · PMID 42108974 · Publisher ↗
BACKGROUND: Children with pediatric intestinal failure (PIF) on parenteral nutrition through central venous catheters are at high risk for central line-associated bloodstream infections (CLABSI), a major cause of morbidi...
BACKGROUND: Children with pediatric intestinal failure (PIF) on parenteral nutrition through central venous catheters are at high risk for central line-associated bloodstream infections (CLABSI), a major cause of morbidity and mortality. Current guidelines recommend prompt empiric antibiotic therapy, yet limited data exist on quality improvement initiatives in this population. OBJECTIVE: To increase appropriate antibiotics ordered in the emergency department (ED) for febrile PIF patients by 50% and increase antibiotics administered within 60 minutes by 50% within 2 years. METHODS: This single-center quality improvement project included PIF patients on home parenteral nutrition presenting to the ED with fever from February 2020 through August 2023. Interventions included electronic health record alerts, provider education, standardized CLABSI cards for families, antibiotic order sets, and ensuring cefepime availability in the ED. RESULTS: Ninety-five encounters were analyzed (43 preprotocol, 52 postprotocol). Postintervention, cefepime orders increased from 2.3% to 90.4% (P<0.0001), while ceftriaxone orders decreased from 88.4% to 23.1% (P<0.0001). Vancomycin orders increased from 76.7% to 98.1% (P<0.001). Both recommended antibiotics were ordered in 55.8% preintervention versus 80.8% postintervention (P<0.01). Median time to cephalosporin administration decreased 58%, from 94.5 to 39.5 minutes (P<0.05); vancomycin administration time decreased 56%, from 178 to 78 minutes (P<0.05). Cephalosporins were administered within 60 minutes in 30.2% preintervention versus 72.6% postintervention (P<0.05). CONCLUSIONS: This quality improvement initiative significantly improved appropriateness and timeliness of antibiotic delivery in children with PIF presenting with suspected CLABSI through multidisciplinary interventions targeting provider awareness, process standardization, and system-level barriers.
Inferior Vena Cava to Aorta Ratio in Children With Non-Hemorrhagic Shock After Fluid Bolus Using Point of Care Ultrasound.
Hamsika V, Batra P, Bhaskar V … +1 more , Khalil S
Pediatr Emerg Care · 2026 May · PMID 42108895 · Publisher ↗
OBJECTIVE: To compare IVC/Ao ratio, IVC collapsibility/distensibility indices before and after the administration of fluid bolus therapy in children with non-hemorrhagic shock using point of care ultrasound, and to corre...
OBJECTIVE: To compare IVC/Ao ratio, IVC collapsibility/distensibility indices before and after the administration of fluid bolus therapy in children with non-hemorrhagic shock using point of care ultrasound, and to correlate the changes in IVC/Ao ratio after fluid bolus therapy with changes in heart rate, shock index, and blood pressure. METHODS: Cross-sectional observational study was conducted in children aged 1 to 12 years with non-hemorrhagic shock requiring fluid bolus therapy. Vital parameters were recorded and IVC diameter, IVC collapsibility/distensibility, IVC/Aorta ratio were measured using point of care ultrasound before and after administration of fluid bolus. RESULTS: IVC/Aorta ratio showed a significant increase [0.79 (0.06) vs. 0.91 (0.07); P<0.001] after fluid bolus. Also, a significant decrease was observed in IVC collapsibility /distensibility indices from 58.29 (8.28) and 49.26 (15.50) to 37.39 (8.03) and 29.51 (10.55), respectively. Change in IVC/Aorta ratio showed a weak positive correlation with change in heart rate (r=0.28), and shock index (r=0.26). CONCLUSIONS: Although IVC/Aorta ratio and IVC indices reflect physiological response to fluid therapy in children with non-hemorrhagic shock, its weak correlation with other clinical parameters limits its clinical utility. Further studies with larger sample sizes are needed to validate these findings.
Prehospital Treatment of Pediatric Eye Injuries in a Multiagency Emergency Medical Services Registry.
Ahmed S, Long-Mills E, Tumin D
Pediatr Emerg Care · 2026 May · PMID 42108802 · Publisher ↗
PURPOSE: Pediatric eye injuries represent a significant public health concern. This study aimed to evaluate the patterns of isolated pediatric eye injuries in the United States managed by emergency medical services (EMS)...
PURPOSE: Pediatric eye injuries represent a significant public health concern. This study aimed to evaluate the patterns of isolated pediatric eye injuries in the United States managed by emergency medical services (EMS), focusing on cases in which eye injury was the primary clinical concern, and to determine the factors linked to increased injury severity. METHODS: A retrospective analysis of data from the National EMS Information System (NEMSIS) was conducted, focusing on pediatric eye injuries between 2021 and 2023. Pediatric patients aged 18 years and younger were included if they were evaluated and transported by EMS and had a provider's primary impression indicating an eye injury based on specific ICD-10 codes, with complete data available on initial and final acuity and other study variables. RESULTS: Data from 920 cases were analyzed, examining injury types, severity, and EMS interventions. Foreign body injuries were most common. Higher acuity cases, such as open wounds and nerve injuries, often require EMS-performed procedures. Male patients and older children were more likely to sustain severe injuries. The findings demonstrated variation in prehospital procedure use across injury types and acuity levels. CONCLUSIONS: Variation in prehospital procedure use across injury types and acuity levels suggests a potential role for standardized EMS protocols to promote more consistent prehospital management.
Acute Drug-Induced Dystonia in Children: Risk Factors, Clinical Characteristics, and Emergency Management.
Akkaya B, Erdem FŞ, Öztürk B … +5 more , Yaradilmiş RM, Özcan AS, Aydin O, Güngör A, Tuygun N
Pediatr Emerg Care · 2026 Apr · PMID 42057551 · Publisher ↗
BACKGROUND: Drug-induced acute dystonia is an adverse drug reaction that is concerning in pediatric patients but resolves rapidly with appropriate treatment. In children, data on risky drugs, clinical patterns, and the m...
BACKGROUND: Drug-induced acute dystonia is an adverse drug reaction that is concerning in pediatric patients but resolves rapidly with appropriate treatment. In children, data on risky drugs, clinical patterns, and the management of dystonia in the emergency department are limited. This study aimed to evaluate the demographic and clinical findings and treatment outcomes of children presenting to the pediatric emergency department with drug-induced acute dystonia. METHODS: This retrospective observational study includes children aged 1 month to 18 years who were diagnosed with acute dystonia in a tertiary pediatric emergency department between October 2022 and March 2025. The diagnosis was made by a pediatric emergency subspecialist based on clinical findings. Patients were classified according to clinical phenotype as focal/segmental dystonia (group I) and multifocal/generalized dystonia (group II). Demographic data, drug exposures, clinical characteristics, and treatment responses were analyzed. RESULTS: A total of 79 patients were included in the study. The median age was 11 years (IQR: 7 to 16) in group I and 10 years (IQR: 6 to 16) in group II. The most commonly associated drug groups were antipsychotics (55.6%), antiemetics (26.6%), and psychostimulants (20.3%). Focal dystonia is the most common clinical pattern, affecting the head and neck muscles in 61% of cases. The use of metoclopramide was significantly higher in group I (OR: 0.21; 95% CI: 0.04-0.99). All patients were treated with parenteral biperiden. CONCLUSIONS: Antipsychotics and antiemetics are the main triggers of drug-induced acute dystonia in children. Dystonia usually appears within the first 72 hours after starting the drug. It can develop even at therapeutic doses. Dystonias associated with antiemetic drugs often show focal or segmental distribution. Parenteral biperiden is a fast and effective treatment option. Acute dystonia can mimic serious etiologies in the emergency department. Obtaining a detailed drug history can facilitate the diagnostic process.
Letter to the Editor Regarding Comparison of Adenosine Administration Utilizing a Single-Syringe Versus a Double-Syringe Method in a Simulated Pediatric Patient; Authors Response.
Steidl KE, Schafer B, Burgess JL … +4 more , Calleo V, Rose P, Su M, Seabury R
Pediatr Emerg Care · 2026 May · PMID 42050967 · Publisher ↗
Abstract loading — click title to view on PubMed.
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