Pediatric Emergency Care[JOURNAL]
Sun
200 papers
Cannabinoid Hyperemesis Syndrome in Adolescents: A Single Institution Case Series.
Vega Castellvi C, Jennings NF, Clemente Fabrega M … +2 more , Gamboa H, Li BUK
Pediatr Emerg Care · 2026 Apr · PMID 41744458 · Publisher ↗
Cannabinoid hyperemesis syndrome (CHS), a recurring vomiting disorder triggered by long-term, frequent cannabis use, remains underdiagnosed and often leads to unnecessary diagnostic evaluations, increased health care uti...
Cannabinoid hyperemesis syndrome (CHS), a recurring vomiting disorder triggered by long-term, frequent cannabis use, remains underdiagnosed and often leads to unnecessary diagnostic evaluations, increased health care utilization, and mental health burden. We present a large case series of CHS in pediatrics that includes data on treatment efficacy, health care utilization, and comorbidities.
A Clinical Scoring Tool for Predicting Epilepsy in Children With First-Onset Afebrile Seizure in the Emergency Department: A Retrospective Observational Study.
Choi S, Nah S, Lee JW … +2 more , Kim M, Han S
Pediatr Emerg Care · 2026 Jul · PMID 41714864 · Publisher ↗
OBJECTIVES: This study developed and validated a clinical scoring tool for predicting epilepsy development in pediatric patients with first-onset afebrile seizures using easily accessible clinical and laboratory paramete...
OBJECTIVES: This study developed and validated a clinical scoring tool for predicting epilepsy development in pediatric patients with first-onset afebrile seizures using easily accessible clinical and laboratory parameters. METHODS: We conducted a retrospective, multicenter study involving pediatric patients aged 1 month to 18 years who presented to the EDs of 3 university hospitals in Korea with first-onset afebrile seizures between March 2018 and March 2021. Stepwise multivariable logistic regression analysis was performed to identify predictors of epilepsy. A point-based risk score was derived from the regression coefficients, and the performance of the prediction model was evaluated using a receiver operating characteristic (ROC) curve. RESULTS: In total, 328 children were included, of whom 132 (40.2%) developed epilepsy. Five variables remained significant in the final multivariable model: age group at onset, 2 or more seizures within 24 hours, lactate >2.27 mg/dL, total calcium <9.25 mg/dL, and abnormal brain imaging findings. The area under the ROC curve (AUROC) was 0.813 [95% confidence interval (CI): 0.763-0.859], and the mean AUROC from 5-fold cross-validation was 0.810 (95% CI: 0.760-0.857). CONCLUSIONS: This clinical scoring tool may help stratify epilepsy risk in children with first-onset afebrile seizures in the ED. If prospectively validated, it could help identify high-risk patients early for appropriate referral and follow-up without requiring specialized equipment such as electroencephalography, thereby supporting clinical decision-making.
Two Years or Three? Rethinking the Ideal PEM Training Timeline.
Jain PG, Wilson PM, Baghdassarian AA … +6 more , Bailey JA, Caglar D, Nagler J, Ngo TL, Roskind CG, Langhan ML
Pediatr Emerg Care · 2026 May · PMID 41714847 · Publisher ↗
Concerns about the pediatric subspecialty workforce and financial impacts of subspecialty training have prompted national conversations regarding the optimal duration of pediatric subspecialty training. It is unknown whe...
Concerns about the pediatric subspecialty workforce and financial impacts of subspecialty training have prompted national conversations regarding the optimal duration of pediatric subspecialty training. It is unknown whether accrediting bodies will change duration of training, and if so, which data/influences/drivers will inform those decisions. This special feature, assembled by a national group of pediatric emergency medicine educational leaders, compares the current 3-year training model with a shortened 2-year training duration for pediatric emergency medicine fellows. We discuss the rationale and potential impacts of each of these models in regard to recruitment, clinical competency, scholarly activity, and career preparation for fellows in this subspecialty. A balanced look at aspects of each model can help guide the national conversation and serve as a starting point to explore experiences and perceptions of key stakeholders-trainees and program leadership-in an effort to better inform future decisions about subspecialty training.
Pediatric Emergency Department Research Participation: The Influence of Study Design Across Race and Ethnicity.
Jaafar H, Catlin PA, Davis AP … +4 more , Doucas A, Visotcky A, Erpenbach H, Thomas D
Pediatr Emerg Care · 2026 May · PMID 41709446 · Publisher ↗
OBJECTIVES: The underrepresentation of racial and ethnic minorities in clinical research limits the generalizability of findings. This study examined how specific study design elements, such as follow-up requirements, st...
OBJECTIVES: The underrepresentation of racial and ethnic minorities in clinical research limits the generalizability of findings. This study examined how specific study design elements, such as follow-up requirements, stipends, and research procedures, were associated with participation refusal rates across racial and ethnic groups in a pediatric emergency department setting. METHODS: This retrospective cohort study analyzed recruitment outcomes from prospective studies conducted between 2012 and 2022 in a pediatric emergency department with approximately 70,000 annual visits. Studies requiring informed consent were included, excluding those targeting specific racial or ethnic groups. Demographic data were abstracted from the electronic health record using standard categories obtained by self-report during ED registration. Logistic regression assessed associations between study design elements and consent likelihood across racial and ethnic subgroups. RESULTS: Among 14,500 encounters, the median age was 12 years; 14.0% identified as Hispanic, 41.6% as Black, 55.7% as White, and 2.0% as Asian. Recruitment was successful in 71.5% of cases, with a 25.4% refusal rate. Moderate enrollment procedure time (6 to 15 min) were associated with higher consent odds for all groups, while very short (<6 min) or prolonged durations (>30 min) were linked to lower consent odds. High stipends (>$135) were associated with reduced likelihood of consent across all groups. Requirements for biobanking and lab work were more likely to be linked with refusal among Black and Asian participants. Hispanic participants were more likely to consent to medication trials (OR: 1.74, P =0.003). Follow-up requirements were associated with lower consent odds among Hispanic and White participants, with a stronger association for Hispanic participants (OR: 0.39, P =0.002). CONCLUSIONS: Study design elements were significantly associated with recruitment outcomes, with notable variation across racial and ethnic groups. Transparent communication, culturally responsive engagement, and logistical flexibility may help reduce participation barriers and promote equity in pediatric clinical research.
Wounding Patterns in Fatal and Nonfatal Pediatric Firearm Injuries.
Matecki M, Walker M, Corbett J … +8 more , Donnelly KA, Shapiro G, Smith ER, Diaz F, Davenport M, Mitstifier P, Streit S, Sarani B
Pediatr Emerg Care · 2026 Jul · PMID 41703420 · Publisher ↗
OBJECTIVES: Gunshot wounds (GSWs) are the leading cause of death in children. This study defines pediatric firearm wound patterns and fatal organ injury to identify salvageability of injuries. METHODS: Survivor data were...
OBJECTIVES: Gunshot wounds (GSWs) are the leading cause of death in children. This study defines pediatric firearm wound patterns and fatal organ injury to identify salvageability of injuries. METHODS: Survivor data were collected from an urban Level I pediatric trauma center and nonsurvivor data were collected from the medical examiner. All GSW patients aged 14 years and younger from 2011 to 2021 were included. Both survivors and nonsurvivors were analyzed for body area wounds. For nonsurvivors, trauma surgeons and medical examiners determined fatal organ injury. Wound patterns and fatal organ injury were compared with existing data on adult wound patterns and fatal organ injury. RESULTS: A total of 165 patients were analyzed, including 148 (90%) survivors. Nonsurvivors were younger (8 ± 4 vs. 10 ± 4 years old, P =0.04). Only 5% of survivors had a tourniquet placed, but none required operative control of hemorrhage. All nonsurvivors suffered head wounds, chest wounds, or both. Nonsurvivors had significantly more head wounds (71%) compared with survivors (9%) ( P <0.001). Survivors had significantly more extremity wounds than nonsurvivors (68% vs. 12%, P <0.001). Nonsurvivors had significantly more brain (71% vs. 3%, P <0.001) and heart injuries (24% vs. 1%, P <0.001). No deaths were caused by exsanguination from peripheral vascular injury. CONCLUSIONS: Pediatric firearm deaths are largely due to nonsurvivable brain injury. The best opportunity to lower pediatric firearm mortality is to prevent the injury itself, although this needs to be assessed in other cities and settings as well.
Digital Otoscopy in the Pediatric Emergency Department: Can It Limit Repeat Ear Exams?
Keane-Bisconti C, Akabas L, Meltzer JA … +1 more , Chamdawala H
Pediatr Emerg Care · 2026 Jun · PMID 41699436 · Publisher ↗
BACKGROUND/OBJECTIVES: Otoscopy is a fundamental yet challenging skill for pediatric trainees. Otoscopy can be uncomfortable for children, particularly if repeat examinations are required. Digital otoscopy (DO) allows cl...
BACKGROUND/OBJECTIVES: Otoscopy is a fundamental yet challenging skill for pediatric trainees. Otoscopy can be uncomfortable for children, particularly if repeat examinations are required. Digital otoscopy (DO) allows clinicians to record and review otoscopic images. This study evaluated whether trainees' use of DO could reduce repeat examinations by supervisors, and its perceived educational value to trainees. METHODS: We conducted a prospective observational study in a pediatric emergency department in New York City. Pediatric, emergency medicine, and pediatric nurse practitioner trainees used DO to record ear exams in children presenting with fever, upper respiratory symptoms, or otalgia. Trainees presented all cases to a pediatric emergency medicine attendings or fellows who served as supervisors. Trainees completed pre- and postrotation surveys assessing confidence in otoscopy, ability to diagnose acute otitis media (AOM), and satisfaction with otoscopy education. The primary outcome was "first examine success" defined as the supervisor not needing to repeat the examination of the patient's tympanic membranes (TM). Logistic regression was used to identify factors associated with first-exam success. Ratings of DO's value as a diagnostic and teaching tool were also collected. RESULTS: Sixty-seven trainees and 368 patients were included. In 276 (75%) encounters, no repeat exam by the supervisor was needed. First-exam success was independently associated with age ≥2 years, higher training level, and >50% TM visualization. Trainee confidence in performing otoscopy, diagnosing AOM, and educational satisfaction increased significantly postrotation. Of all trainees, 66 (97%) and 57 (85%) agreed that DO was a superior teaching and diagnostic tool, respectively. CONCLUSION: DO eliminated the need for repeated exams in the majority of patients. Trainees considered it a superior teaching and diagnostic tool compared with conventional otoscopy.
Diagnostic Value of the Systemic Immune-Inflammation Index in Differentiating Acute Appendicitis From Familial Mediterranean Fever in Children.
Şahin C, Tunce E, Gül C … +6 more , Gülçin N, Mirapoğlu SL, Arpacık M, Tekin T, Sözeri B, Kaymakcı A
Pediatr Emerg Care · 2026 Jul · PMID 41680108 · Publisher ↗
OBJECTIVES: Acute appendicitis and Familial Mediterranean Fever attacks are among the leading causes of acute abdominal pain in children and often present with overlapping clinical features. This study aimed to evaluate...
OBJECTIVES: Acute appendicitis and Familial Mediterranean Fever attacks are among the leading causes of acute abdominal pain in children and often present with overlapping clinical features. This study aimed to evaluate the diagnostic utility of the systemic immune-inflammation index in differentiating acute appendicitis from Familial Mediterranean Fever attacks and to assess whether combining this index with other hematological parameters improves diagnostic discrimination. METHODS: A retrospective diagnostic accuracy study was conducted at a tertiary pediatric surgery center between January 2019 and December 2024. Pediatric patients aged 1 to 18 years with histopathologically confirmed acute appendicitis or clinically defined Familial Mediterranean Fever attacks were included. Demographic characteristics and complete blood count parameters were recorded. The systemic immune-inflammation index was calculated using neutrophil, platelet, and lymphocyte counts. The neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were also calculated. Group comparisons were performed using nonparametric tests. Diagnostic performance was evaluated using receiver operating characteristic curve analysis, including a combined hematological model. RESULTS: A total of 90 patients were included, comprising 44 with acute appendicitis and 46 with Familial Mediterranean Fever attacks. Age and sex distributions were comparable between groups. Median systemic immune-inflammation index values were significantly higher in patients with acute appendicitis than in those with Familial Mediterranean Fever attacks. The neutrophil-to-lymphocyte ratio was also significantly higher in the acute appendicitis group, whereas the platelet-to-lymphocyte ratio did not differ significantly between groups. The combined hematological model demonstrated improved discriminative performance compared with the systemic immune-inflammation index alone. CONCLUSIONS: The systemic immune-inflammation index is significantly elevated in pediatric patients with acute appendicitis compared with those experiencing Familial Mediterranean Fever attacks and shows good diagnostic performance in this differential setting. The combined use of hematological indices may further enhance diagnostic discrimination and serve as a supportive tool in the evaluation of children presenting with acute abdominal pain.
Impalement Injuries in Children: Patterns, Management, and Outcomes From a 10-Year Single-Center Review.
Pandey V, Tiwari P, Marripati BK … +4 more , Srivastava V, Khobragade M, Dwivedi AND, Gangolli CK
Pediatr Emerg Care · 2026 Jul · PMID 41671267 · Publisher ↗
BACKGROUND: Impalement injuries in children, though rare, pose unique diagnostic and surgical challenges due to unpredictable trajectories and frequent involvement of multiple organ systems. Literature is limited to isol...
BACKGROUND: Impalement injuries in children, though rare, pose unique diagnostic and surgical challenges due to unpredictable trajectories and frequent involvement of multiple organ systems. Literature is limited to isolated reports and small series, with few comprehensive analyses from pediatric populations. METHODS: We conducted a retrospective review of pediatric impalement injuries managed at a tertiary children's hospital over 10 years (July 2015-June 2025). These patients were first encountered by the general surgery and critical care team in the trauma center initially and were subsequently referred to Pediatric Surgery and respective specialities. Patients 12 years or below with impaled objects in situ or requiring operative exploration were included; minor punctures not requiring surgery were excluded. Data regarding demographics, mechanisms, injury sites, operative management, complications, and outcomes were analyzed descriptively. RESULTS: Twenty-one children (median age: 7 y; range 4 to 12; 13 males, 8 females) were managed. Mechanism was accidental in all, most commonly falls onto fixed objects (81%). Injury distribution was oral cavity (7, 33.3%), abdomen (5, 23.8%), thorax/thoracoabdominal (4, 19.0%), perineum (4, 19.0%), and neck (1, 4.8%). Eleven children required major operative intervention (6 laparotomies, 4 thoracotomies, 1 tracheostomy); the remainder underwent wound repair or examination under anesthesia. Gastrointestinal involvement occurred in 9 patients, with 5 requiring fecal diversion. Blood transfusions were needed in 52%, and massive transfusions in 3 cases. Complications were observed in 8 patients (38.1%), including intra-abdominal/pelvic abscess, salivary leak, atelectasis, wound infection, and urethral stricture. Three patients (14.3%) died, all with major thoracic or abdominal injuries. Among 18 survivors, follow-up (median 12 mo) demonstrated complete functional recovery, including continence after stoma reversal and preserved urinary/gynecologic function in pelvic injuries. CONCLUSIONS: Pediatric impalement injuries, though infrequent, demand meticulous multidisciplinary management. Outcomes are favorable with adherence to trauma principles, delayed removal of impaled objects until surgical control, and judicious fecal diversion in anorectal or contaminated injuries. Mortality is concentrated in thoracic and complex abdominal impalements, underscoring the need for early resuscitation, controlled extraction, and prompt surgical expertise.
Impact of Virtual Reality Technology on Pediatric Patients During Venous Access in the Emergency Department: A Meta-Analysis.
Lin L, Zhu C, Liu L
Pediatr Emerg Care · 2026 May · PMID 41665660 · Publisher ↗
OBJECTIVE: To systematically evaluate the impact of virtual reality (VR) technology on pediatric patients during venous access in the emergency departments (EDs). METHODS: Randomized controlled trials (RCTs) investigatin...
OBJECTIVE: To systematically evaluate the impact of virtual reality (VR) technology on pediatric patients during venous access in the emergency departments (EDs). METHODS: Randomized controlled trials (RCTs) investigating the effects of VR technology on pediatric patients during venous access in the EDs were retrieved from databases including CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, Embase, and Web of Science, with the search period spanning from inception to July 2025. Data analysis was performed using RevMan 5.2 software. RESULTS: A total of 8 RCTs involving 629 pediatric patients in the EDs were included. The analysis revealed that the VR technology group showed significantly better outcomes in pain scores compared with the control group (SMD=-0.73, 95% CI=-1.42 to -0.04, P =0.04). However, no significant differences were observed between the 2 groups in fear scores ( SMD =-0.94, 95% CI=-2.13 to 0.26, P =0.12) or first-attempt success rate (OR=1.01, 95% CI=0.60-1.72, P =0.96). CONCLUSION: VR technology may help alleviate pain in pediatric patients during venous access in the EDs, but no significant improvements were found in reducing fear or increasing the first-attempt success rate.
Predictive Value of ROX and ROX-HR for Care Escalation in Infants With Bronchiolitis Initiated on High-Flow Nasal Cannula.
Kannikeswaran N, Lorenz D, Hintz LK … +4 more , Miller C, Lipshaw MJ, Zorc JJ, Florin TA
Pediatr Emerg Care · 2026 Jun · PMID 41661547 · Publisher ↗
OBJECTIVE: Current scoring tools are suboptimal to predict care escalation in infants with bronchiolitis. Single-center studies suggest that respiratory oxygenation index (ROX) and ROX-heart rate (ROX-HR) may have predic...
OBJECTIVE: Current scoring tools are suboptimal to predict care escalation in infants with bronchiolitis. Single-center studies suggest that respiratory oxygenation index (ROX) and ROX-heart rate (ROX-HR) may have predictive value. We evaluated the ability of these measures to predict care escalation in a multicenter cohort of infants with bronchiolitis initiated on high-flow nasal cannula (HFNC). METHODS: We performed a secondary analysis of a retrospective multicenter cohort study of infants with bronchiolitis initiated on HFNC at 3 pediatric emergency departments (EDs) between February 1, 2018 and March 1, 2020. ROX [(SpO2/FiO2)/RR] and ROX-HR (ROX/HR × 100) were calculated at triage and pre-HFNC initiation. We defined care escalation as the need for positive pressure ventilation or ICU care. RESULTS: Of 738 infants, 73 (9.9%) required care escalation. These infants had higher maximum heart and respiratory rate, greater proportion were hypoxemic and required higher HFNC support. While there were no significant differences in mean initial ROX [9.4 (3.1) vs 9.4 (3.0); P = 0.81], pre-HFNC ROX [9.4 (3.0) vs 9.0 (2.9); P = 0.24] and initial ROX-HR [6.4 (2.7) vs 6.4 (2.5); P = 0.94], there was a small difference in pre-HFNC ROX-HR (5.7±2.0 vs 5.4±2.0; P = 0.048) between those who did and did not require care escalation. AUROCs for initial and pre-HFNC ROX were 0.51 (95% CI, 0.43-0.58) and 0.54 (95% CI, 0.47-0.61), and initial and pre-HFNC ROX-HR were 0.50 (95% CI, 0.43-0.58) and 0.57 (95% CI, 0.49-0.64), respectively. CONCLUSION: ROX and ROX-HR showed poor ability to predict care escalation in infants with bronchiolitis initiated on HFNC.
Use of Machine Learning to Predict Hospital Admission for EMS-Treated Infants After a Suspected BRUE.
Toy J, Claudius I, Gausche-Hill M … +3 more , Pham P, Chang TP, Saidinejad M
Pediatr Emerg Care · 2026 Jun · PMID 41661244 · Publisher ↗
OBJECTIVES: This study explored the use of different applied machine learning (ML) classification algorithms to predict hospital admission for infants treated by emergency medical services (EMS) after a suspected brief r...
OBJECTIVES: This study explored the use of different applied machine learning (ML) classification algorithms to predict hospital admission for infants treated by emergency medical services (EMS) after a suspected brief resolved unexplained event (BRUE). METHODS: Data from a large regionalized pediatric care system were obtained for infants in which paramedic suspected a BRUE and who were transported between July 2017 and February 2021. After data pre-processing, a random 80%/20% split for training and testing was performed. First, a random forest ML classification model was used to identify and select the most important variables influencing the prediction of hospital admission. Then, multiple ML-based models and a statistical model were trained with this subset of variables and evaluated the performance of each to predict hospital admission. Model performance characteristics including the area under the receiver operator curve (AUROC) were reported. RESULTS: A total of 508 infants were included; 300 (59%) were admitted and 76 (15%) required critical care. The most important variables in predicting hospital admission were age, history of bystander interventions (ie, cardiopulmonary resuscitation and back blows), presence of past medical history, and a normal appearing examination. In the prediction of hospital admission, the support vector machine model achieved the highest AUROC of 0.85, with a sensitivity of 0.88 (95% CI: 0.80-0.96) and specificity of 0.71 (95% CI: 0.57-0.85). The predictive performance of the extreme gradient boosting, RF, and logistic regression models were similar (AUROC: 0.83 to 0.84). CONCLUSIONS: The applied ML models demonstrated good predictive performance for hospital admission for EMS-treated infants with a paramedic suspected BRUE. ML and statistical models had similar predictive performance.
Optic Nerve Sheath Diameter in Pediatric Populations: Establishing Reference Intervals and Anthropometric Correlations.
Erkan M, Tolu Kendir Ö, Gürlü R … +1 more , Erkek N
Pediatr Emerg Care · 2026 Jun · PMID 41661226 · Publisher ↗
OBJECTIVES: Ultrasonographic measurement of optic nerve sheath diameter (ONSD) is emerging as a noninvasive method for assessing intracranial pressure (ICP) in children. However, its practical application is limited by t...
OBJECTIVES: Ultrasonographic measurement of optic nerve sheath diameter (ONSD) is emerging as a noninvasive method for assessing intracranial pressure (ICP) in children. However, its practical application is limited by the lack of adequate age-specific normative data for healthy children. This study aimed to establish age-specific reference ranges for ONSD in healthy children aged 4 to 18 years and assess how anthropometric factors such as body mass index (BMI), height, and weight affect ONSD measurements. METHODS: This cross-sectional study included 150 healthy children aged 4 to 18 years, with no suspicion of increased ICP or chronic illness. ONSD was measured bilaterally using standardized transorbital ultrasonography. Anthropometric z -scores were calculated and correlations and percentile-based reference intervals were determined. RESULTS: The mean ONSD was 3.67±0.50 mm, with higher values in the 11 to 18 years group compared with the 4 to 10 years group (3.80±0.45 mm vs. 3.51±0.51 mm, P <0.001). ONSD positively correlated with age, height, weight, and BMI in the overall sample. Subgroup analyses revealed that BMI was significantly associated with ONSD only in the 11 to 18 years group. The age-specific 97th percentile upper limits were 4.33 mm (4 to 10 y) and 4.40 mm (11 to 18 y). CONCLUSIONS: This study provides age-specific normative reference intervals for ONSD in healthy children and shows the impact of BMI on ONSD measurements in adolescents. These findings enhance the clinical interpretation of ONSD in pediatric settings and support its integration into noninvasive ICP assessment protocols. Further multicenter studies are required to validate the reference values.
External Validation of Diagnosis Codes to Identify Pediatric Mental Health Emergency Department Visits for Aggression.
Wnorowska JH, Harmon A, Lorenz D … +1 more , Hoffmann JA
Pediatr Emerg Care · 2026 May · PMID 41661220 · Full text
OBJECTIVE: To externally validate a set of 9 ICD-10-CM billing diagnosis codes to identify pediatric ED encounters with agitation and aggression by determining their sensitivity and specificity compared with electronic h...
OBJECTIVE: To externally validate a set of 9 ICD-10-CM billing diagnosis codes to identify pediatric ED encounters with agitation and aggression by determining their sensitivity and specificity compared with electronic health record (EHR) review. METHODS: We performed a retrospective cross-sectional single-test diagnostic accuracy study of mental health encounters in the pediatric ED of an academic urban children's hospital, utilizing EHR data for mental health encounters by children 6 to 18 years old from April 12, 2023, to December 30, 2023. The index test was the presence of any of 9 aggression-related diagnosis codes as utilized by Peleggi et al The reference test consisted of a structured EHR review to confirm that agitation/aggression was a reason for the visit. Sensitivity, specificity, positive predictive value and negative predictive value were calculated with 95% CIs. RESULTS: We identified 855 pediatric mental health encounters (63%, 13 to 18 y old, 59% female). The diagnosis code set identified agitation/aggression in 62 encounters (7%), compared with 118 encounters (14%) confirmed to have agitation/aggression based on clinician notes. The 9 diagnosis codes yielded a sensitivity of 40% (95% CI: 31%, 49%) and specificity of 98% (95% CI: 97%, 99%) compared with EHR review, with a positive predictive value of 76% (63%, 85%) and a negative predictive value of 91% (89%, 93%). CONCLUSIONS: Upon external validation, a set of 9 billing diagnosis codes had poor sensitivity and excellent specificity for the identification of pediatric ED visits with agitation/aggression. Novel methods such as natural language processing may be needed to accurately identify pediatric ED visits with aggression/agitation.
Risk Factors for Invasive Infection in Febrile Oncology Patients Related to Cancer Type.
Gomez B, Quintana O, Moreno M … +3 more , López-Almaraz R, Almarza F, Mintegi S
Pediatr Emerg Care · 2026 Jun · PMID 41661178 · Publisher ↗
OBJECTIVE: To identify clinical and laboratory risk factors for invasive infection in febrile oncology patients seen in the Pediatric Emergency Department, depending on the type of cancer. METHODS: We conducted a prospec...
OBJECTIVE: To identify clinical and laboratory risk factors for invasive infection in febrile oncology patients seen in the Pediatric Emergency Department, depending on the type of cancer. METHODS: We conducted a prospective observational study of febrile oncology patients seen between 2016 and 2023 at the Pediatric Emergency Department of a tertiary teaching hospital. Invasive infection was defined microbiologically (isolation of a bacterial pathogen in sterile fluid or a commensal bacterial species in 2 different blood cultures) or clinically (death, meeting Phoenix criteria for sepsis, receiving inotropic support, or developing acute complications or sequelae). We performed separate multivariate analyses for hematologic cancers and solid tumors. Hematologic cancers were further classified considering the myelotoxicity of the chemotherapy received. We classified the following as high-risk hematologic cancers: acute lymphoblastic leukemia and non-Hodgkin lymphoma in the induction, reinduction, or consolidation phase or relapse, and acute myeloid leukemia in any phase. RESULTS: We included 471 episodes: 306 hematologic cancers and 165 solid tumors. The median age was 4 years (interquartile range: 2 to 10) and the median duration of fever was 2 hours (interquartile range: 1 to 3). Invasive infections were diagnosed in 69 cases (14.6%). The rate was higher among patients with high-risk hematologic cancers (n=45, 23.2%), than among those with solid tumors (n=18, 10.9%; P =0.002) or with low-risk hematologic cancers (n=6, 5.4%; P <0.001). Among patients with hematological cancers, presenting a high-risk cancer (OR: 6.006; 95% CI: 2.459-18.200) and elevated procalcitonin levels (OR: 1.668; 95% CI: 1.205-2.571) were predictors of invasive infection [AUC for the model: 0.718 (95% CI: 0.640-0.795)]. Only age (OR: 1.145; 95% CI: 1.036-1.267) was found to be an independent risk factor in patients with solid tumors. CONCLUSIONS: In patients with hematologic cancers and very recent onset fever, the type of cancer and procalcitonin level are useful for predicting the risk of invasive infection.
Outcomes of Children Discharged from the Emergency Department With a Pending Blood Culture.
Colgan JY, Michelson KA, Corboy J … +3 more , Soni PP, Alpern ER, Ramgopal S
Pediatr Emerg Care · 2026 Jun · PMID 41639570 · Publisher ↗
OBJECTIVE: To evaluate rates of critical illness and significant infection among children discharged from the emergency department (ED) with a pending blood culture. METHODS: We conducted a cross-sectional study of child...
OBJECTIVE: To evaluate rates of critical illness and significant infection among children discharged from the emergency department (ED) with a pending blood culture. METHODS: We conducted a cross-sectional study of children 90 days to 18 years old discharged from one of 37 pediatric EDs between 2016 and 2024 with a complete blood count or C-reactive protein performed. Our primary outcome was a diagnosis of specific bacteremia on representation to the ED within 3 days. Secondary outcomes on 3-day return visit included: (1) sepsis, (2) intensive care unit admission, and (3) receipt of ≥3 days of systemic antibiotics. We evaluated for differences in outcomes based on the performance of a blood culture on the index visit. RESULTS: We included 416,357 discharges (median encounter age 6.3 y, IQR: 2.1 to 12.7). Of these, 229,269 (55.1%) had a blood culture collected. Among encounters with a blood culture, 0.1% (n = 151; 95% CI: 0.1-0.1) had specific bacteremia on return visit. Encounters with a blood culture at the index visit had higher odds of specific bacteremia [odds ratio (OR) 10.86, 95% CI: 5.8-20.34], sepsis (OR: 3.16, 95% CI: 1.88-5.30), intensive care unit admission (OR: 2.82, 95% CI: 1.94-4.12), and ≥3 days of systemic antibiotics (OR: 4.77, 95% CI: 4.17-5.46). CONCLUSIONS: Children discharged with a pending blood culture have higher rates of significant bacteremia and other clinically important return visits than children discharged without a blood culture, though absolute rates of these outcomes were low. Improved guidelines are needed to better identify children who require blood cultures.
Pediatric Carbon Monoxide Poisoning in Southern Israel-Causality and Outcome.
Kaplan O, Kleinhaus N, Test G … +3 more , Tawatha I, Kestenbom I, Tavor O
Pediatr Emerg Care · 2026 May · PMID 41636140 · Publisher ↗
OBJECTIVES: CO intoxication is a leading cause of poisoning-related death worldwide. Little is known about the connection between the source of poisoning and the clinical outcome. Our primary goal in this study was to es...
OBJECTIVES: CO intoxication is a leading cause of poisoning-related death worldwide. Little is known about the connection between the source of poisoning and the clinical outcome. Our primary goal in this study was to establish this connection. METHODS: We conducted a retrospective cohort study using data retrieved from medical records of all cases presented to the Pediatric Emergency Department at University Medical Center (UMC), between 2016 and 2024, of children aged 0 to 18 years who were admitted with suspected CO intoxication and carboxyhemoglobin (COHb) levels exceeding 5%. "The exposure mechanisms were categorized into 3 groups: smoke inhalation by fire, intentional heating, or gas used for water heating." RESULTS: Ninety-five children had COHb levels above 5%. The mean age of patients varied across exposure groups ( P <0.001). Individuals exposed to gas were older (13.65±3.2 y), compared with smoke inhalation (6.9±5.85 y) or heating-related incidents (10.26±4.64 y). Poor outcomes (defined as death, intensive care admission, or hyperbaric chamber treatment) were most frequent in the gas group (90%, P = 0.002), followed by fire exposures (65%) and heating-related cases (49%). CONCLUSIONS: We found a strong correlation between causality (gas for water heating) and outcomes. We also showed some correlation between clinical and laboratory features that could result in severe outcomes. These findings could help guide preventive measures and further studies in the future.
Characteristics of Patient Portal Usage by Pediatric Emergency Patients.
Chen C, Kim E, Beckford ST … +1 more , Malia L
Pediatr Emerg Care · 2026 Jun · PMID 41633959 · Publisher ↗
OBJECTIVES: We aimed to describe patient and encounter characteristics of patient portal users and nonusers and to evaluate usage of specific portal functions in a pediatric emergency department (PED). METHODS: A single-...
OBJECTIVES: We aimed to describe patient and encounter characteristics of patient portal users and nonusers and to evaluate usage of specific portal functions in a pediatric emergency department (PED). METHODS: A single-center retrospective analysis of patients up to 21 years of age at an urban, tertiary care pediatric emergency department was conducted. Portal registration status of patients was analyzed. Relations between variables and usage were evaluated using logistic regression. Portal functions were analyzed for prevalence and timing of usage with respect to the PED encounter. RESULTS: Portal users made up 48.4% of 29,881 patients. Variables associated with portal usage included multiple prior PED visits (aOR 2.19, CI: 2.04-2.35), multiple admissions (aOR 2.61, CI: 2.00-3.46), PED length of stay greater than 6 hours (aOR 1.30, CI: 1.17-1.5,) and patient Hispanic ethnicity (aOR 1.24, CI: 1.13-1.36). Non-English primary language (aOR 0.64, CI: 0.60-0.70) and patient male sex (aOR 0.90, CI: 0.84-0.96) were associated with lower likelihood of usage. About 17% of users viewed laboratory and imaging results during the PED visit, and 67% within 7 days after visit. CONCLUSIONS: Between portal users and nonusers, there are differences with respect to patient sex, ethnicity, primary language, number of prior emergency visits and admissions, and length of stay in the pediatric emergency department. Portals are not commonly accessed during visits but are commonly used to view laboratory and imaging data after the emergency visit.
Point-of-Care Ultrasound Identification of Motile Enterobius vermicularis in the Appendix of a Toddler: The Youngest Reported Case and Successful Nonoperative Management of Early Appendicitis.
Vorel ES
Pediatr Emerg Care · 2026 Apr · PMID 41622431 · Publisher ↗
OBJECTIVES: To describe the youngest and second ever reported patient with real-time point-of-care ultrasound (POCUS) visualization of motile Enterobius vermicularis within the appendix and to demonstrate how real-time i...
OBJECTIVES: To describe the youngest and second ever reported patient with real-time point-of-care ultrasound (POCUS) visualization of motile Enterobius vermicularis within the appendix and to demonstrate how real-time intraluminal motion aids in distinguishing parasitic infestation from typical obstructive appendicitis. METHODS: We present the clinical course, ultrasound findings, and management of a 23-month-old girl with acute intermittent abdominal pain. RESULTS: POCUS revealed a dilated, noncompressible appendix containing multiple linear echogenic structures demonstrating serpiginous, independent motion-highly suggestive of E. vermicularis . Mild periappendiceal echogenicity suggested early acute appendicitis. The patient was successfully managed nonoperatively with albendazole and intravenous antibiotics, experiencing complete symptom resolution within 24 hours. This represents the youngest and second-ever reported patient in whom real-time sonographic visualization of live appendiceal parasites has been reported. CONCLUSIONS: True intraluminal motility is a critical sonographic discriminator of parasitic infestation and can fundamentally alter management decisions. In this case, early identification of E. vermicularis supported a safe, nonoperative strategy for early appendicitis. Incorporating POCUS early in the evaluation of atypical pediatric abdominal pain may prevent unnecessary surgical intervention.
Scene Time and Outcome in Pediatric Out-of-Hospital Cardiac Arrest: Findings From NEMSIS Data.
Chung S, Blair A, Mcgaughey S … +3 more , Hansen M, Lupton J, Lin AL
Pediatr Emerg Care · 2026 May · PMID 41622422 · Publisher ↗
BACKGROUND: Pediatric out-of-hospital cardiac arrest (P-OHCA) has a low incidence rate with a survival rate ranging from 2% to 11%. While national guidelines exist for P-OHCA management, they do not clearly address how l...
BACKGROUND: Pediatric out-of-hospital cardiac arrest (P-OHCA) has a low incidence rate with a survival rate ranging from 2% to 11%. While national guidelines exist for P-OHCA management, they do not clearly address how long EMS providers should treat on-scene and when to initiate transportation. OBJECTIVE: This study aims to explore the factors influencing scene time and its correlation with the return of spontaneous circulation (ROSC) in pediatric cases using the National Emergency Medical Services Information System (NEMSIS). METHODS: This retrospective cohort study analyzed NEMSIS data from 2019 to 2020. P-OHCA cases who received EMS treatment and were transported to the ED were included. We examined demographic and scene-related factors influencing EMS scene time and categorized interventions by scene time groups (<10, 10 to 30, >30 min). Using multivariable logistic regression, the study explored the relationship between scene time and ROSC, adjusting for various clinical and demographic predictors, and validated the model with calibration plots and sensitivity analyses. RESULTS: A total of 8467 cardiac arrest cases met the inclusion criteria for analysis. The most common EMS scene time was 10 to 30 minutes, and longer scene times were significantly associated with ROSC. ROSC was more likely with older age, public or health care arrest locations, and defibrillation use, while airway interventions and medications were associated with lower odds of ROSC. CONCLUSION: We found that younger children had shorter EMS scene times, while those who achieved ROSC had longer scene times. Further investigation is needed to clarify the underlying factors and their impact on survival and neurological outcomes.
Triage Use of the Dynamic Appraisal of Situational Aggression Score in Pediatric Emergency Care.
Costigan AD, Macnow TE, Reznek MA … +5 more , Slocum C, Canellas MM, Sanseverino AM, Kan VL, O'Connor LC
Pediatr Emerg Care · 2026 Jun · PMID 41617657 · Publisher ↗
OBJECTIVE: Aggressive behavior by pediatric patients in emergency departments (EDs) threatens safety and care delivery, yet few studies have evaluated tools to identify children at risk. We examined the association betwe...
OBJECTIVE: Aggressive behavior by pediatric patients in emergency departments (EDs) threatens safety and care delivery, yet few studies have evaluated tools to identify children at risk. We examined the association between Dynamic Appraisal of Situational Aggression (DASA) scores and the use of safety medications or physical restraints during pediatric ED encounters. METHODS: In this cross-sectional study, patients aged 5 to 17 presenting to 5 EDs from January 11 to December 31, 2023, were assigned a DASA score at triage. Clinical information was abstracted from the electronic health record, and patients were stratified into low, moderate, high, or imminent aggression risk categories. The primary outcome was the use of a behavioral intervention (physical restraint or injected safety medications). Adjusted prevalence ratios (PRs) by risk category were estimated using modified Poisson regression. RESULTS: We identified 17,482 qualifying ED encounters [median age 12 (IQR: 8-15); 49.4% female]. Higher DASA scores were strongly associated with greater use of behavioral interventions. Compared with low-risk patients, those with imminent-risk scores had an adjusted prevalence ratio (PR) of 11.45 (95% CI: 8.16-16.06; P <0.001) for any intervention, 46.67 (95% CI: 31.53-60.61; P <0.001) for physical restraint, and 11.30 (95% CI: 7.99-15.98; P <0.001) for medication administration. CONCLUSIONS: Elevated DASA scores at ED triage are associated with increased use of behavioral interventions in pediatric patients, representing the first aggression prediction tool with demonstrated value in both adult and pediatric populations. Future research should examine whether proactive, DASA-guided interventions can reduce aggression risk.
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