Pediatric Emergency Care[JOURNAL]
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200 papers
Letter to the Editor Regarding Comparison of Adenosine Administration Utilizing a Single-Syringe Versus a Double-Syringe Method in a Simulated Pediatric Patient.
Özkaya AK, İldeş EN
Pediatr Emerg Care · 2026 May · PMID 42050966 · Publisher ↗
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The Use of Point-of-Care Lung Ultrasound in the Diagnosis of Pneumonia in Pediatric Patients.
Marzook N
Pediatr Emerg Care · 2026 May · PMID 42050965 · Publisher ↗
Traditional methods to evaluate for pediatric pneumonia include clinical examination and chest radiography (CXR). Point-of-care lung ultrasound (LUS) has emerged as a promising, noninvasive alternative for diagnosing ped...
Traditional methods to evaluate for pediatric pneumonia include clinical examination and chest radiography (CXR). Point-of-care lung ultrasound (LUS) has emerged as a promising, noninvasive alternative for diagnosing pediatric pneumonia. This review highlights the diagnostic accuracy, benefits, and limitations of LUS compared with clinical assessment and CXR in pediatric patients with suspected pneumonia. Multiple meta-analyses demonstrate that LUS offers high sensitivity (up to 94%) and specificity (up to 96%) in diagnosing pediatric pneumonia, comparable to or exceeding CXR performance. LUS provides significant advantages, including no radiation, bedside applicability, and lower costs. However, challenges remain in standardizing LUS interpretation, particularly distinguishing bacterial pneumonia from viral illness and asthma, where overlapping ultrasound findings are common and require careful clinical correlation. Standardized protocols, clinician training, and diagnostic algorithms are essential to optimize LUS utility in pediatric respiratory care. Further research is warranted to refine differentiation between bacterial and viral etiologies and effectively integrate LUS into routine clinical pathways.
Patient-Provided Video Footage of Injuries in the Pediatric Emergency Department: A Novel Adjunct to Patient History.
Lee L, Yoo P, Bullaro F … +3 more , Golden J, Cerise J, Williamson K
Pediatr Emerg Care · 2026 Apr · PMID 42048353 · Publisher ↗
OBJECTIVE: To evaluate the impact of viewing video footage during a pediatric emergency department (ED) encounter on the medical assessment of children with traumatic injuries, specifically its influence on clinical deci...
OBJECTIVE: To evaluate the impact of viewing video footage during a pediatric emergency department (ED) encounter on the medical assessment of children with traumatic injuries, specifically its influence on clinical decision-making and management. METHODS: Data was collected over 35 months at a pediatric level 1 trauma center. Pediatric emergency medicine (PEM) providers completed a survey after evaluating patients presenting with an injury and reviewing video footage shown to them depicting what happened to the child. The survey included basic video information and whether video footage influenced the providers' approach to patient care. RESULTS: Fifty-one surveys were completed after families voluntarily showed PEM providers video footage of the patient's mechanism of injury. In 27 cases (53%), ED providers reported that observing the video influenced management. Review of footage influenced providers' decision regarding radiologic imaging in 18 cases (35%); providers performed imaging in 11 cases where they would not have otherwise, and did not perform imaging in 7 cases where they would have otherwise. Review of footage influenced providers' decision regarding laboratory studies in 5 cases (10%). Six (12%) providers indicated they consulted specialists after viewing the video footage when they otherwise would not have. CONCLUSION: The study findings indicate that viewing video footage related to the mechanism of injury affected the clinical decision-making processes of PEM providers in more than half of the observed instances (53%). This suggests that video surveillance footage has potential utility as an adjunct to traditional history-taking in the trauma evaluation of patients presenting to the ED.
Clinical Phenotypes and Early Risk Stratification in Pediatric Acute Myocarditis: A Single-Center Experience in the Postpandemic Context.
Pasquinucci M, Scaglione M, Caratozzolo D … +11 more , Siboldi A, Meneghesso D, Morelli E, Trocchio G, Bondanza S, Arcidiacono CM, Formigari R, Caorsi R, Volpi S, Gattorno M, Derchi ME
Pediatr Emerg Care · 2026 Apr · PMID 42046445 · Publisher ↗
OBJECTIVES: Pediatric acute myocarditis presents with a heterogeneous clinical spectrum. The primary aim of this study was to identify early clinical and laboratory predictors of severe disease requiring intensive care u...
OBJECTIVES: Pediatric acute myocarditis presents with a heterogeneous clinical spectrum. The primary aim of this study was to identify early clinical and laboratory predictors of severe disease requiring intensive care unit (ICU) admission. A secondary aim was to describe the clinical characteristics of cases diagnosed in the postpandemic context. METHODS: We conducted a retrospective cohort study of children admitted to a tertiary center with acute myocarditis between 2012 and 2024. Patients requiring ICU admission were compared with those managed in standard wards to identify risk factors for severity. Data were analyzed using descriptive statistics, nonparametric tests, and effect size calculations. RESULTS: Thirty-eight cases were identified, with 76% of diagnoses occurring after 2020. The median age was 12.5 years. Two distinct clinical phenotypes emerged: patients with chest pain (59%) and those with cardiogenic shock (15%). Admission to the ICU was strongly associated with hemodynamic instability (P < 0.001), lower left ventricular ejection fraction (P < 0.001), and the absence of reported chest pain (P < 0.001). Among biomarkers, higher levels of NT-pro-BNP (P = 0.005) and elevated Procalcitonin (P = 0.02) were associated with severe disease. Parvovirus B19 was the most frequently detected pathogen in the recent period. CONCLUSIONS: In our cohort, pediatric myocarditis presented with increased frequency in the postpandemic years. Risk stratification remains crucial: "infarct-like" chest pain was associated with a milder course in older children. Conversely, severe cases, often occurring in younger patients unable to report pain, were identified by hemodynamic stress (shock, elevated NT-pro-BNP) and systemic inflammation (procalcitonin).
Managing and Communicating Diagnostic Uncertainty in Pediatric Emergency Care: National Insights and Opportunities for Intervention.
Geanacopoulos AT, Totman MS, Miller KA … +2 more , Neuman MI, Peltz A
Pediatr Emerg Care · 2026 Apr · PMID 42021594 · Publisher ↗
BACKGROUND: Effective management and communication of diagnostic uncertainty are critical, yet understudied, drivers of patient safety in pediatric emergency care. We explored how clinicians manage and communicate diagno...
BACKGROUND: Effective management and communication of diagnostic uncertainty are critical, yet understudied, drivers of patient safety in pediatric emergency care. We explored how clinicians manage and communicate diagnostic uncertainty and identified opportunities for intervention. METHODS: Four 1-hour-long focus groups were conducted with 19 geographically diverse emergency medicine physicians. Discussions focused on clinical vignettes with diagnostic uncertainty. Reflexive thematic analysis was used to generate themes. RESULTS: Participants described diagnostic uncertainty as a multidimensional experience involving complex interactions between the clinician, caregiver, and context. We identified 3 distinct themes: (1) Intersection of clinician's usual practice pattern with caregiver and contextual factors: Within the guardrails of safety and evidence-based care, clinicians adjust management and communication to caregiver expectations, health literacy, resources, acuity, and volume. (2) Synergies at the clinician, caregiver, and context interfaces: Shared decision-making, decision support tools, and primary care continuity facilitate clinician-caregiver alignment and safety. (3) Tensions at the interfaces: Perceived misaligned clinician-caregiver expectations, space constraints, and limited access to care promote additional work-up and hinder communication. Participants highlighted intervention opportunities to promote patient safety in uncertainty and reduce ED work-up: (1) standard tools to communicate uncertainty, (2) disease-specific risk prediction models with visual aids to effectively communicate risk, (3) improvements to the physical space, and (4) interventions to streamline access to primary care. CONCLUSION: Diagnostic uncertainty in pediatric emergency care is a multidimensional experience influenced by synergies and tensions between the clinician, caregiver, and context. Communication tools, decision-support strategies, and systems-level interventions can strengthen diagnostic safety in pediatric emergency care.
Enhancing Prehospital Care for Medically Complex Children: The Evolution of the STARS Program.
Pintea M, Finney J, Salzman N … +4 more , Clukies L, Miljkovic M, Ahmad FA, Laffey S
Pediatr Emerg Care · 2026 Apr · PMID 42021582 · Publisher ↗
OBJECTIVES: The population of children and youth with special health care needs (CYSHCN) has grown significantly. This includes children with medical complexity (CMC), those with chronic conditions, functional limitation...
OBJECTIVES: The population of children and youth with special health care needs (CYSHCN) has grown significantly. This includes children with medical complexity (CMC), those with chronic conditions, functional limitations, or reliance on medical technology. Due to advances in medical care, these children are now able to live at home, making encounters with emergency medical services (EMS) more likely. EMS clinicians receive limited pediatric training and have infrequent encounters with this population, resulting in variable comfort and preparedness. Utilization of emergency care among CMC is further influenced by social determinants of health, with disadvantaged communities experiencing higher emergency department use and increased child mortality. To bridge these gaps, the Special Needs Tracking and Awareness Response System (STARS) was developed to enhance EMS readiness, promote health equity, and improve prehospital care for CMC. METHODS: Launched in 2014 as an EMS-driven initiative, STARS has evolved into a hospital-based, physician-led program with individualized emergency care plans stored in a secure electronic system. A major focus of STARS is to create and provide emergency care education to EMS and community EDs in their catchment area regarding STARS. RESULTS: As of 2025, STARS has enrolled 2424 patients. The program has reduced unnecessary transports, strengthened disaster response, and offered an opportunity to address health inequities in CMC. CONCLUSIONS: STARS provides a scalable and collaborative model that prioritizes medically complex, high-risk pediatric populations through targeted EMS training, interdisciplinary care coordination, and real-time access to patient-specific plans. This approach offers a unique opportunity to advance prehospital care and improve health outcomes for CMC.
Performance of Open-Source LLMs in Identifying Pediatric Pneumonia From Free-Text Chest Radiograph Reports.
Amagai S, Powell EC, Alpern ER … +7 more , Florin TA, Li Y, Liebovitz D, Luo Y, Espinoza J, Wong AF, Ramgopal S
Pediatr Emerg Care · 2026 Apr · PMID 42011065 · Publisher ↗
OBJECTIVES: To develop and internally validate an automated system for classifying chest radiograph (CXR) reports for community-acquired pneumonia in children. METHODS: We performed a retrospective single-center study us...
OBJECTIVES: To develop and internally validate an automated system for classifying chest radiograph (CXR) reports for community-acquired pneumonia in children. METHODS: We performed a retrospective single-center study using 1000 pediatric emergency department encounters (2016 to 2022) with CXR. Reports were adjudicated by two physicians as positive, negative, or indeterminate for pneumonia. We evaluated five open-source LLMs (Gemma2 9B, Gemma2 27B, Falcon3 7B, DeepSeek R1 Distill Llama 8B, and Llama3.1 8B) on a 70/30 train-test split for an outcome of pneumonia. We reported performance metrics for both three-class and binary classification (pneumonia + indeterminate vs. no pneumonia). RESULTS: The median patient age was 4.2 years (IQR 1.7 to 10.5), and 54.4% were admitted from the ED. After clinician adjudication, 27.8% of reports were labeled pneumonia, 13.7% indeterminate, and 58.5% no pneumonia. Gemma2 9B achieved the best performance overall, with a pneumonia F1 score of 0.82 and no-pneumonia F1 score of 0.97 in three-class classification. Binary classification further improved performance (F1=0.97 for Gemma2 9B and 0.93 for 27B). Discrepancies between model and human labels often involved ambiguous language, highlighting interpretive subjectivity rather than model error. All LLMs substantially outperformed traditional NLP classifiers such as XGBoost, random forest, and logistic regression. CONCLUSIONS: Open-source LLMs accurately classified pediatric CXR reports for pneumonia. These findings support the feasibility of integrating LLMs into decision support and quality improvement pipelines to enhance radiographic interpretation and improve pediatric emergency care.
CT Scan Utilization Decreases With Implementation of a Clinical Pathway for Children With Suspected Acute Appendicitis.
Barricelli E, Lo Cascio JN, Noiman A … +4 more , Quintos-Alagheband L, Lala SV, Agarwalla V, Glynn L
Pediatr Emerg Care · 2026 Apr · PMID 42011037 · Publisher ↗
OBJECTIVES: The National Surgical Quality Improvement Program-Pediatric (NSQIP-P) recommends reducing computed tomography (CT) scan use to <25% in children with suspected appendicitis. Our multidisciplinary team develope...
OBJECTIVES: The National Surgical Quality Improvement Program-Pediatric (NSQIP-P) recommends reducing computed tomography (CT) scan use to <25% in children with suspected appendicitis. Our multidisciplinary team developed a pediatric appendicitis clinical pathway that emphasizes the use of ultrasound as first-line imaging and reserves CT for patients with both non-diagnostic ultrasounds and agreement from pediatric emergency medicine and surgery teams. METHODS: For this local study, all cases of patients aged younger than 19 years who were diagnosed with appendicitis from 2021 to 2023 were reviewed, with emergency department (ED) length of Stay (LOS) as a balancing measure. A series of Plan-Do-Study-Act cycles was used to implement the clinical pathway and to involve multiple teams. A Statistical Process Control chart was generated and possible special cause variations were analyzed using Six Sigma rules. RESULTS: Ultrasound was the first-line imaging in over 90% of total cases. However, CT utilization steadily decreased from 39% to 22% by the end of our initiative. This was paralleled by a sharp increase in surgical consults before CT scan order from 21% to 41%, and a decrease in non-diagnostic ultrasounds from 35% to 20% across the 3 years of the study. ED LOS decreased from 538 to 435 minutes on average. In addition, 2 patients underwent an MRI in quarter 4 of 2023, demonstrating its potential in the workflow. CONCLUSIONS: Overall, by implementing a clinical pathway this team was able to significantly reduce CT scan utilization in the diagnosis of pediatric appendicitis. STUDY TYPE AND EVIDENCE LEVEL: Cohort study, level III.
Evaluation of an Online Module for Fascia Iliaca Block Education for Pediatric Femur Fractures in the Pediatric Emergency Department.
Kangwa M, Shaahinfar A, Addo N … +1 more , Lin-Martore M
Pediatr Emerg Care · 2026 Apr · PMID 42007732 · Publisher ↗
PURPOSE: Point-of-care ultrasound-guided fascia iliaca nerve block (POCUS-FINB) is an effective method for pain control in children with femur fractures. Many pediatric emergency medicine (PEM) providers have not been tr...
PURPOSE: Point-of-care ultrasound-guided fascia iliaca nerve block (POCUS-FINB) is an effective method for pain control in children with femur fractures. Many pediatric emergency medicine (PEM) providers have not been trained in this technique, and there is no standard curriculum. While other studies have evaluated in-person POCUS-FINB didactics, assessment of online educational interventions is lacking. We created and implemented a novel online POCUS-FINB module and evaluated its efficacy in knowledge, confidence, and technical skill acquisition among PEM physicians. METHODS: This was a prospective presurvey and postsurvey study of PEM attendings and fellows. The curriculum was developed using the Kern 6-step framework and included an online module and a brief hands-on session. Confidence, knowledge, and technical skills were assessed using a Likert scale, multiple-choice tests, and an observation checklist, respectively. In addition, we reviewed the proportion of eligible patients who received POCUS-FINB at our institution precurriculum and postcurriculum implementation. RESULTS: Twenty-seven PEM physicians in 2 pediatric emergency departments participated in the study. Twenty-two completed all assessments from January 2022 to July 2023. Physicians demonstrated improved confidence with POCUS-FINB methods after completion of the online curriculum, with 4% reporting being confident or very confident before and 71% after the module (P<0.001). On the knowledge test, there was a statistically significant improvement, with mean scores from 77% premodule to 95% postmodule (P<0.001). Immediately after the module, participants scored well in technical skills with a mean score of 92%. There was a significant increase in the proportion of eligible patients with femur fractures who received blocks over the study period, 19% during the premodule period and 38% during the postmodule period (P=0.046). CONCLUSION: After completing a web-based curriculum for POCUS-FINB, PEM physicians showed improvement in confidence and knowledge and performed well in their technical skills.
Implementation of a Standardized Management Algorithm for Cannabis Hyperemesis Syndrome in a Pediatric Emergency Department.
Kelly CM, Attridge M, Katsogridakis YL … +3 more , Mrozek L, Jackson K, Hoffmann JA
Pediatr Emerg Care · 2026 Jul · PMID 42003265 · Full text
OBJECTIVES: Cannabis hyperemesis syndrome (CHS) is an increasingly common cause of pediatric emergency department (ED) visits, yet management pathways remain understudied. We evaluated clinical outcomes following the imp...
OBJECTIVES: Cannabis hyperemesis syndrome (CHS) is an increasingly common cause of pediatric emergency department (ED) visits, yet management pathways remain understudied. We evaluated clinical outcomes following the implementation of a CHS management algorithm in a pediatric ED. METHODS: We conducted a retrospective study of encounters by adolescents before and after implementation of a CHS management algorithm in an academic pediatric ED from July 2020 to July 2024. We examined medications administered, length of stay, disposition, and return visits before and after implementation using chi-square, Fisher exact, or Mann-Whitney U tests as appropriate. We used mixed-effects models to examine the association of time period and admission rates, adjusting for age, sex, and emergency severity index level. A similar model examined the association of time period and ED length of stay that was also adjusted for total daily ED arrivals. RESULTS: Of 533 screened encounters, 128 met inclusion criteria, representing 44 unique patients. Following algorithm implementation, administration rates increased for capsaicin (2.7% vs. 22.2%, P <0.001) and metoclopramide (6.8% vs. 42.6%, P <0.001). Frequency of haloperidol administration did not change significantly (20.3% vs. 9.3%, P =0.138), but mean dose decreased (2.7 mg vs. 1.0 mg, P =0.014). The adjusted odds of hospital admission (adjusted OR: 0.57, 95% CI: 0.17, 1.86) and ED length of stay (adjusted beta: -0.01, 95% CI: -0.21, 0.20) did not significantly differ. CONCLUSIONS: Algorithm implementation was associated with increased capsaicin and metoclopramide use but no change in admission rates or length of stay. Prospective studies are needed to assess optimal CHS management in children.
Determining a Consensus-Based Measure for Critical Illness and Injury for Children Cared for By Emergency Medical Services.
Ramgopal S, Hayes A, Barrera L … +4 more , Horvat CM, Martin-Gill C, Macy ML, Cash RE
Pediatr Emerg Care · 2026 Apr · PMID 42003250 · Publisher ↗
OBJECTIVES: Accurate triage of patients from the field or community EDs to higher levels of care is essential for emergency, disaster, and surge response. We sought to define a hospital-based measure of critical illness...
OBJECTIVES: Accurate triage of patients from the field or community EDs to higher levels of care is essential for emergency, disaster, and surge response. We sought to define a hospital-based measure of critical illness and/or injury to support the development of emergency medical services-based models for this outcome. METHODS: We convened a 22-member Delphi panel of clinicians with subspecialities including pediatrics, pediatric emergency medicine, pediatric surgery, trauma, prehospital medicine, and emergency medical services. We considered key diagnostic, intervention, and clinical outcome criteria for patients following arrival to the hospital to determine a consensus-based measure for critical illness and/or injury. We engaged in a modified Delphi process with sequential rounds of voting to determine consensus priorities. RESULTS: We completed 4 rounds of voting, with participation ranging between 95% and 100% on each round. We achieved consensus on 50 measures, including for 8 medical diagnoses, 14 trauma diagnoses, 1 trauma mechanism, 6 assessments, 13 interventions, 6 medications, and 2 dispositions. In the final survey, we achieved a consensus of 82%. CONCLUSIONS: We reached consensus on measures for an operational hospital-based outcome criteria for critical illness and/or injury. This approach also enables future benchmarking of EMS performance and more precise identification of at-risk children in the prehospital setting. Subsequent steps include determining the prevalence of these criteria within varying hospital-based settings and the development of prediction models to identify prehospital factors associated with these outcomes.
Association of Serum Eosinophilic Cationic Protein With Disease Severity in Infant Bronchiolitis.
Bedir S, Seçilmiş Y
Pediatr Emerg Care · 2026 Apr · PMID 41992838 · Publisher ↗
OBJECTIVES: This study aimed to evaluate serum eosinophilic cationic protein (ECP) levels in young children with acute bronchiolitis compared with healthy controls and to investigate their association with clinical sever...
OBJECTIVES: This study aimed to evaluate serum eosinophilic cationic protein (ECP) levels in young children with acute bronchiolitis compared with healthy controls and to investigate their association with clinical severity and tobacco smoke exposure. We hypothesized that ECP would not function as a diagnostic biomarker but might reflect inflammatory phenotypes associated with severe disease. METHODS: In this prospective cross-sectional study, 96 children aged 1 to 24 months with acute bronchiolitis and 96 age-matched and sex-matched healthy controls were enrolled. Serum ECP levels and routine laboratory parameters were measured at presentation. Within the bronchiolitis cohort, associations between serum ECP levels and clinical severity indicators-including oxygen requirement, ICU admission, mechanical ventilation, and prenatal or passive tobacco smoke exposure-were evaluated. Correlations between ECP and systemic inflammatory markers were analyzed using Spearman correlation analysis. Multivariable binary logistic regression was performed to identify independent predictors of severe bronchiolitis. RESULTS: Serum ECP levels did not differ significantly between young children with bronchiolitis and healthy controls, indicating limited diagnostic utility. However, within the bronchiolitis group, significantly higher ECP levels were observed in young children requiring ICU admission or mechanical ventilation and in those with prenatal or passive tobacco smoke exposure. Serum ECP levels demonstrated significant positive correlations with total leukocyte count and leukocyte subpopulations, including neutrophils, monocytes, and eosinophils, as well as with serum glucose levels. Age-stratified analyses revealed distinct leukocyte profiles across infancy, whereas serum ECP concentrations remained comparable between age groups. In multivariable analysis adjusting for age and tobacco smoke exposure, serum ECP was not independently associated with severe disease, whereas tobacco smoke exposure emerged as a strong independent predictor of severe bronchiolitis. CONCLUSIONS: Although serum ECP does not seem to have independent prognostic utility, its elevation in severe and smoke-exposed cases suggests that it may reflect distinct inflammatory phenotypes in bronchiolitis rather than function as a direct clinical risk stratification tool.
Tranexamic Acid Use for Posttonsillectomy Hemorrhage Across US Children's Hospitals.
Bergmann KR, Hall M, Ramgopal S … +11 more , Badaki-Makun O, Chaudhari PP, Eltorki M, Geanacopoulos AT, Gonzalez F, Keating EM, Phamduy TT, Rees CA, Shapiro DJ, Chinnadurai S, Neuman MI
Pediatr Emerg Care · 2026 Apr · PMID 41992793 · Publisher ↗
OBJECTIVES: To determine trends and variation in tranexamic acid (TXA) use and to determine whether treatment with TXA is associated with reoperation or hospital admission for children with posttonsillectomy hemorrhage....
OBJECTIVES: To determine trends and variation in tranexamic acid (TXA) use and to determine whether treatment with TXA is associated with reoperation or hospital admission for children with posttonsillectomy hemorrhage. METHODS: We conducted a retrospective, cross-sectional study of children (<18 y old) with an emergency department encounter for posttonsillectomy hemorrhage from January 1, 2016, to December 31, 2024, using Pediatric Health Information System data. The primary outcome was treatment with TXA. Secondary outcomes included reoperation, hospital admission, and patient factors. We calculated annual hospital-level median percentages and used the Cochran-Armitage test to assess for trends in TXA use when ranked by quartile. We assessed the encounter-level association between secondary outcomes and TXA administration. RESULTS: A total of 19,572 encounters were included. The median age was 7 years (IQR: 4 to 11 y). TXA was used in 1892 (9.7%) encounters. TXA use ranged from 1.0% to 67.1% across hospitals. Median annual TXA use increased from 0.0% in 2016 to 30.6% in 2024. At the hospital level, we observed no difference in reoperation (P=0.941) or hospital admission (P=0.060) by hospital quartile of TXA use. At the encounter level, treatment with TXA was associated with lower adjusted odds of reoperation (aOR: 0.66, 95% CI: 0.56-0.77) but not hospital admission (aOR: 0.93, 95% CI: 0.83-1.04). CONCLUSIONS: We observed a significant increase in TXA use for posttonsillectomy hemorrhage, with substantial hospital-level variation. TXA use was associated with lower odds of reoperation but not hospital admission.
Digital Media and Device-Related Conflicts During Pediatric Mental Health Boarding.
Gansner M, Nikam P, Wang W … +4 more , Huntley N, Ramrajesh S, Levy S, Schuman-Olivier Z
Pediatr Emerg Care · 2026 Apr · PMID 41992780 · Full text
OBJECTIVES: Prolonged mental health boarding can create conflict between pediatric patients reliant on digital devices to manage psychiatric distress and clinical teams seeking to enforce safe digital media/device habits...
OBJECTIVES: Prolonged mental health boarding can create conflict between pediatric patients reliant on digital devices to manage psychiatric distress and clinical teams seeking to enforce safe digital media/device habits. This study aimed to estimate the frequency of these conflicts and the characteristics of patients who may be most impacted by restrictions on digital media/device use while boarding. METHODS: Electronic medical records were reviewed for youth aged 6 to 17 years old. who presented in psychiatric crisis to a US metropolitan hospital in 2021 or 2022; all patient encounters involving mental health (MH) boarding were identified. Collected information included patient age, sex, and psychiatric diagnoses. Each encounter was reviewed as to whether it included conflict(s) related to patient digital media/device use, coded under 6 distinct categories (eg, behavioral dysregulation related to restrictions on device access). Relationships between variables of interest were assessed using t tests and logistic regression models. RESULTS: There were 2327 boarding encounters during the reviewed time period, representing 1869 unique patients. Approximately 10% of patients experienced a problem related to their use of digital media or electronic devices. Younger, male patients and those with diagnoses of autism spectrum disorder and attention deficit hyperactivity disorder were significantly more likely to have had a digital media/device-related conflict documented during MH boarding. CONCLUSION: Proactive interventions should be considered to address problematic separation from digital media/devices during pediatric MH boarding, particularly in younger, male patients.
Disparities in Admissions for RSV: A Retrospective Observational Study.
Coughlin CG, Monuteaux MC, Zhang Z … +4 more , Adelman RM, Hauptman M, Neuman MI, Horwitz BH
Pediatr Emerg Care · 2026 Apr · PMID 41978453 · Full text
OBJECTIVES: Respiratory viruses, including respiratory syncytial virus (RSV), result in many hospital admissions among young children. In this observational study, we sought to determine whether the odds of admission var...
OBJECTIVES: Respiratory viruses, including respiratory syncytial virus (RSV), result in many hospital admissions among young children. In this observational study, we sought to determine whether the odds of admission varied by race, ethnicity, and preferred language, while adjusting for disease severity and other demographic factors for children diagnosed with RSV bronchiolitis in the emergency department (ED). METHODS: We included children under 2 years of age who had a positive test for RSV in an urban freestanding children's hospital ED from 2020 to 2024. We used multivariable logistic regression to test the association between race, ethnicity, and preferred language with hospitalization and specifically ICU hospitalization, adjusting for sociodemographic factors and clinical covariates, including tachypnea, hypoxia, fever, laboratory testing, chest x-ray performance, and viral coinfection. RESULTS: A total of 2948 children were diagnosed with RSV in the ED during the study period, of which 33.8% were admitted. Decreased odds of admission were found for Black (aOR=0.53, 95% CI: 0.39-0.73) and multiracial (aOR=0.64, 95% CI: 0.47-0.87) children compared with White children. Increased odds of ICU admission were found among patients who spoke Spanish (aOR=2.00, 95% CI: 1.03-3.90) or languages other than English (aOR=2.17, 95% CI: 1.07-4.24). CONCLUSIONS: Our results revealed important disparities: Black and multiracial children with RSV had lower odds of hospital admission, while children who speak languages other than English had higher odds of ICU admission. These patterns underscore the need to better understand how clinical and structural factors shape these outcomes. Further research is essential to clarify the mechanisms driving these inequities and to advance more equitable care for all children with RSV.
Unexpected Pediatric Cardiac Arrest in a Toddler: A Case of Catecholaminergic Polymorphic Ventricular Tachycardia Presenting as Ventricular Fibrillation.
Disla Cuevas A, Tran C, Chung S … +1 more , Daya M
Pediatr Emerg Care · 2026 Apr · PMID 41968876 · Publisher ↗
INTRODUCTION: Ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) are rare causes of pediatric out-of-hospital cardiac arrest (OHCA), especially in toddlers. Within VT, catecholaminergic polymorphic...
INTRODUCTION: Ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) are rare causes of pediatric out-of-hospital cardiac arrest (OHCA), especially in toddlers. Within VT, catecholaminergic polymorphic ventricular tachycardia (CPVT) is an uncommon but potentially fatal channelopathy that may present as collapse during emotional or physical stress. CASE PRESENTATION: A previously healthy 2-year-old boy collapsed during a tantrum and became pulseless. Dispatcher-assisted CPR was limited due to a lack of bystander training, but law enforcement arrived before EMS and initiated compressions. Upon EMS arrival, the patient was found in ventricular fibrillation (VF) and promptly defibrillated with a 70-J biphasic shock (~4 J/kg), achieving return of spontaneous circulation (ROSC). Intraosseous (IO) access was obtained, and 1 mg/kg lidocaine was administered. En route, the patient developed seizure-like activity, treated with IO midazolam. In the ED, the child was hemodynamically stable but intermittently irritable. He had a normal baseline ECG showing sinus tachycardia. He continued to display episodes of seizure-like activity-characterized by decerebrate posturing and limb rigidity-and was treated with lorazepam. Cardiology and PICU teams were consulted. After admission to the PICU, a transthoracic echocardiogram (TTE) revealed no structural heart abnormalities. An epinephrine challenge provoked bidirectional VT, consistent with catecholaminergic polymorphic ventricular tachycardia (CPVT). Genetic testing later confirmed a likely pathogenic RYR2 variant. The patient was discharged on propranolol and flecainide, with a loaner AED and outpatient follow-up arranged. CONCLUSION: This case highlights the vital role of prehospital defibrillation, rapid IO access, and recognition of seizure-like activity as a potential recurrent arrhythmia in pediatric VF arrest. While definitive diagnosis, including echocardiography and genetic testing, occurs in the hospital, early EMS intervention-particularly rhythm recognition and timely shock delivery-was lifesaving in this rare pediatric case.
Use of the Theoretical Domains Framework to Investigate Factors Influencing Pediatric Fever Management Practices and Antipyretic Use in Australian Emergency Departments.
Mutic A, Tan RZ, Tan E … +12 more , Fahey MC, Callander E, Haskell L, George S, Borland M, Loftus N, Furyk J, Phillips N, Bourke JE, Dalziel SR, Craig S, PREDICT Network
Pediatr Emerg Care · 2026 Apr · PMID 41958188 · Publisher ↗
OBJECTIVES: To examine the factors influencing paediatric fever management practices among Australian Emergency Department (ED) doctors and nurses using the Theoretical Domains Framework (TDF). METHODS: Cross-sectional s...
OBJECTIVES: To examine the factors influencing paediatric fever management practices among Australian Emergency Department (ED) doctors and nurses using the Theoretical Domains Framework (TDF). METHODS: Cross-sectional survey of doctors and nurses across 22 Australian EDs. The survey assessed 8 of the 12 domains from the TDF using 13 questionnaire items. RESULTS: A total of 472 participants [275 (58.3%) doctors, 197 (41.7%) nurses] completed the survey (overall response rate 57.7%). Of these, 286/470 (60.9%, 95% CI: 56.4%-65.2%) were familiar with clinical practice recommendations on antipyretic administration for paediatric fever (TDF domain: Knowledge). Similar proportions indicated they had been trained to ensure antipyretic use solely when febrile children appear distressed [TDF domain: Skills; 285/469 (60.8%, 95% CI: 56.3%-65.1%)] and agreed that only administering antipyretics to febrile children who seemed distressed aligned with their professional responsibilities as ED clinicians [TDF domain: Social/Professional Role and Identity; 294/467 (63.0%, 95% CI: 58.5%-67.2%)]. More than half (268/467, 57.4%, 95% CI: 52.8%-61.8%) of participants felt pressured by parents/caregivers to give antipyretics for fever reduction, irrespective of the child's discomfort level [TDF domain: Social Influences]. Just under one-third of participants (137/470, 29.1%, 95% CI: 25.2%-33.4%) aimed to reduce fever before discharge (TDF domain: Goals). CONCLUSIONS: Overall, ED clinicians showed moderate knowledge, training, and agreement with clinical practice recommendations on antipyretic administration for paediatric fever. Notably, more than half of the respondents surveyed felt pressured by parents/caregivers to use antipyretics outside of guideline recommendations. Our findings highlight the significant emotion attached to fever management and the need for clinicians to foster trust and provide tailored evidence-based information to families.
High Risk Acetaminophen Ingestion in a Nine-Month-Old Requiring Hemodialysis: A Case Report.
Mero C, Haan R, Tamimi SA … +3 more , Gonzalez VB, Penfil S, Schultz BRE
Pediatr Emerg Care · 2026 Jul · PMID 41947576 · Publisher ↗
BACKGROUND: High-risk acetaminophen (APAP) overdose in infants is rare but may result in rapid metabolic deterioration due to early mitochondrial dysfunction. Prompt recognition and aggressive intervention are essential...
BACKGROUND: High-risk acetaminophen (APAP) overdose in infants is rare but may result in rapid metabolic deterioration due to early mitochondrial dysfunction. Prompt recognition and aggressive intervention are essential for survival, yet pediatric-specific management strategies remain limited in the literature. CASE PRESENTATION: A previously healthy 9-month-old boy ingested an estimated 25 g of acetaminophen (∼2700 mg/kg by history) following an exploratory ingestion. Within 4 hours, he developed an altered mental status, severe anion-gap metabolic acidosis with lactic acidosis, early coagulopathy, and respiratory failure. He was diagnosed with high-risk acetaminophen poisoning complicated by adenovirus-associated acute respiratory distress syndrome (ARDS). MANAGEMENT AND OUTCOME: Treatment included high-dose N-acetylcysteine (NAC), adjunctive fomepizole, 2 sessions of intermittent hemodialysis (HD), followed by 16 hours of continuous renal replacement therapy (CRRT). Management also required aggressive phosphorus repletion and prolonged mechanical ventilation. The patient was extubated on day 17 and discharged on day 35 without progression to acute liver failure. CONCLUSION: This case demonstrates successful multimodal management of high-risk acetaminophen poisoning in an infant using extracorporeal toxin removal and adjunctive therapies. It highlights practical considerations for NAC dose adjustment during HD and CRRT and underscores important public health concerns regarding the accessibility and formulation of potentially lethal medications. Regulatory strategies limiting acetaminophen quantities per container and discouraging formulations attractive to young children may reduce the risk of severe exploratory ingestions.
A Survey of Medical Resuscitation Practices and Resources in Academic Pediatric Emergency Departments.
Shah A, Heckle T, Edmunds K … +21 more , Dean P, Geis G, Kopp T, Nagler J, Neubrand T, Donoghue A, Runkle A, Yeung C, Madhok M, Sudanagunta S, Hoehn E, Cherney K, Krack A, Bennett B, O'Connell K, Gaglani A, Popovsky E, DeLaroche AM, Greenwald E, Yoshida H, Kerrey B
Pediatr Emerg Care · 2026 Apr · PMID 41947570 · Publisher ↗
BACKGROUND: Medical resuscitation is more common than trauma in pediatric emergency departments (PEDs), yet it lacks nationally standardized programs for clinical care, education, quality improvement (QI), and research....
BACKGROUND: Medical resuscitation is more common than trauma in pediatric emergency departments (PEDs), yet it lacks nationally standardized programs for clinical care, education, quality improvement (QI), and research. We sought to describe current structures and resources as a step toward standardization. METHODS: We surveyed PEDs affiliated with the AAP Section on Emergency Medicine Special Interest Group, Pediatric Emergency Medicine Resuscitation of Children (PEM-ResCue). One physician leader per site completed a structured survey spanning clinical practice, education, research, quality assurance (QA), and QI. Items included annual counts of critical procedures (eg, tracheal intubation) and full-time equivalent (FTE) support for resuscitation leadership, plus open-ended questions on strengths and challenges. RESULTS: Twenty of 39 centers (51%) responded; 19/20 had Pediatric Emergency Medicine fellowships and 18 were level I trauma centers. Reported annual percenter averages were 79 tracheal intubations, 8 chest tubes, 4 central lines, and 20 chest compression events. Six centers had formal resuscitation leadership roles; 4 of 6 reported dedicated FTE support. Education (17 sites), QA (18), and QI (19) activities were common but varied in structure and frequency. Research activity ranged from robust to none. Reported strengths included video review and interdisciplinary collaboration; challenges included limited funding, lack of standardization, and absence of centralized data systems. CONCLUSION: Across 20 academic PEDs, medical resuscitation practices and infrastructure varied widely, with notable gaps in dedicated leadership and standardized education and QA/QI processes. Findings highlight opportunities to build coordinated, standardized systems for pediatric medical resuscitation.
Posterior Sternoclavicular Joint Dislocations in Children and Adolescents: Missed Diagnoses and Management Outcomes.
Owens SP, Grady MF
Pediatr Emerg Care · 2026 Apr · PMID 41925007 · Publisher ↗
OBJECTIVE: To evaluate pediatric and adolescent patients with posterior sternoclavicular (SC) joint dislocations, identify the prevalence of missed diagnoses at initial presentation, and determine injury features that ma...
OBJECTIVE: To evaluate pediatric and adolescent patients with posterior sternoclavicular (SC) joint dislocations, identify the prevalence of missed diagnoses at initial presentation, and determine injury features that may aid in earlier recognition. METHODS: We retrospectively reviewed patients presenting to our institution with CT-confirmed posterior SC joint dislocations between October 2015 and November 2024. Anterior dislocations, subluxations, and cases without confirmatory imaging were excluded. Demographics, injury characteristics, diagnosis timelines, management, and outcomes were recorded and analyzed using descriptive statistics. RESULTS: Thirty-six patients (median age 14.9 years, IQR 13.8 to 16.6; 91.7% male) sustained posterior SC dislocations. Thirteen (36.1%) were missed at initial presentation, with delays up to 19 days (median 7, IQR 2 to 13). Missed cases occurred in both emergency (10/30, 33.3%) and outpatient (3/6, 50.0%) settings, with similar rates in those with (9/25, 36.0%) and without (4/11, 36.4%) clavicle fractures. Injuries most often resulted from a lateral shoulder blow (28/36, 77.8%), and 83.3% of patients with documented forward flexion had pain-limited motion. Most injuries (86.1%) were sports-related. Nearly all (97.2%) underwent surgical fixation without complications, and 77.4% with follow-up returned to sports. CONCLUSIONS: Over one-third of posterior SC joint dislocations were initially missed, with similar rates in patients with and without an associated clavicle fracture. These injuries are most often seen in the emergency department, typically from contact sports and a lateral blow to the shoulder. Given the risk of neurovascular injury, timely diagnosis is critical. Clinicians should maintain a high index of suspicion in patients with anterior chest pain after a lateral shoulder impact and when full forward flexion is pain-limited. Prompt recognition, CT imaging, and early orthopedic consultation are critical to ensure proper management and optimal outcomes.
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