Pediatric Emergency Care[JOURNAL]
Sun
200 papers
The Power of PEERS: A Medical and Public Health Student Pilot Program to Expand Pediatric Emergency Department Capacity to Support Adolescent Health.
Frieson T, Tong L, Gandhi S … +5 more , Sunkara N, Urbach H, Finley C, Bernstein E, Thompson R
Pediatr Emerg Care · 2026 Feb · PMID 41614726 · Publisher ↗
OBJECTIVES: Adolescence is a critical period of growth and development, shaped by the social conditions in which youth are immersed. Many adolescents use emergency departments (EDs) as their primary source of care, often...
OBJECTIVES: Adolescence is a critical period of growth and development, shaped by the social conditions in which youth are immersed. Many adolescents use emergency departments (EDs) as their primary source of care, often bypassing routine health care systems where preventative screenings and counseling are provided. This may lead to missed opportunities to address social or mental health needs. Partners in Equity and Empowerment through Resources and Support (PEERS), based out of Boston Medical Center's pediatric ED, bridges the gap between patients' health-seeking behaviors and the ED's capacity to provide preventive care. PEERS engages medical and public health students to conduct social and mental health screenings, connecting adolescent and young-adult (AYA) patients with community-based resources that support their holistic health needs. METHODS: From 2021 to 2023, medical and public health students performed bedside screenings of 13- to 23-year-old pediatric ED patients using a blended survey developed from validated screening tools for social drivers of health (SDoH) (e.g., food insecurity, housing, employment, sexual health, substance use) and mental health. Following verbal consent/assent, survey screenings, and brief negotiated interviews, patients were referred to curated, need-specific resources for further support. RESULTS: During our 28-month pilot, 246 AYA patients were screened, with 97.2% reporting at least one SDoH need and 93.1% referred to at least one community-based resource. The most commonly requested resources were education (46.3%), employment (38.6%), and mental health (32.9%). Younger age was associated with higher requests for educational resources (OR: 1.38; 95% CI: 1.10-1.79), while male gender was linked to fewer mental health resource requests (OR: 0.27; 95% CI: 0.07-0.88). CONCLUSIONS: An interprofessional, student-led team can provide AYA patients with the necessary SDoH resources to bridge care gaps without disrupting ED workflow, supporting the feasibility and benefit of this innovative program to promote health.
Perspectives on the Phoenix Sepsis Criteria for the Emergency Medicine Practitioner.
Georgette N, Sheehan M, Kissoon N
Pediatr Emerg Care · 2026 Feb · PMID 41614725 · Publisher ↗
BACKGROUND: Sepsis is one of the leading causes of death among children worldwide. The Society of Critical Care Medicine Pediatric Sepsis Definition Task Force developed and validated the Phoenix sepsis criteria, new cli...
BACKGROUND: Sepsis is one of the leading causes of death among children worldwide. The Society of Critical Care Medicine Pediatric Sepsis Definition Task Force developed and validated the Phoenix sepsis criteria, new clinical criteria for pediatric sepsis and septic shock based on organ dysfunction. Although this represents a significant advancement in standardizing sepsis and septic shock definitions, its applicability in emergency department (ED) settings remains unexplored. IMPORTANCE: Given that EDs are often the first point of contact for critically ill children, we must examine the use of the Phoenix criteria in these settings and across varying resource levels. In this CME review article, we explore the evolution of pediatric sepsis definitions to the Phoenix sepsis criteria, and its utility, strengths, and limitations in emergency care in both high-resource and low-resource ED settings.
Assessing Outcomes of Point-of-Care Ultrasound Use in Testicular Torsion in a Pediatric Emergency Department.
Takadera T, Bularan C, Sarathy K … +1 more , Lee HJ
Pediatr Emerg Care · 2026 Feb · PMID 41614724 · Publisher ↗
OBJECTIVES: Testicular torsion is a surgical emergency in which a timely diagnosis under 6 hours can significantly increase the survivability of the testicle. This study aims to retrospectively analyze cases of testicula...
OBJECTIVES: Testicular torsion is a surgical emergency in which a timely diagnosis under 6 hours can significantly increase the survivability of the testicle. This study aims to retrospectively analyze cases of testicular torsion to determine whether the use of point-of-care ultrasound (POCUS) expedites care compared with radiology department ultrasound (RADUS). We evaluated POCUS effect on emergency department (ED) workflow, urological consultation time, and time to the operating room (OR). METHODS: We conducted a retrospective review of patients diagnosed with testicular torsion between January 2021 and October 2024. Inclusion criteria were patients confirmed to have testicular torsion intraoperatively. Demographics were taken of each patient as well as multiple time intervals of events such as radiologic imaging, consult time, and time to surgery. Patients were grouped into 3 cohorts, POCUS only, POCUS followed by RADUS, and RADUS only. Mann-Whitney U tests were performed for pairwise comparisons between groups. RESULTS: Sixty-five patients were eligible for the study. The time between physician initial assessment (PIA) to the OR in the subgroups of POCUS only, POCUS/RADUS, and RADUS only were 97, 141, and 195 minutes, respectively. A 98-minute difference in the PIA to OR time between POCUS-only and RADUS-only groups (P < 0.001) was found to be statistically significant. CONCLUSION: With a difference in PIA to OR time of close to 100 minutes between POCUS-only and RADUS-only groups, our findings suggest that POCUS significantly reduces time to urological consultation and has the potential to expedite surgical intervention if POCUS can reliably replace RADUS. These results highlight the value of integrating POCUS into ED workflows for testicular torsion.
Use of Ondansetron for Pediatric Gastroenteritis in the Pediatric Emergency Department: An Evaluation of the Pediatric Emergency Care Applied Research Network Registry.
Ramgopal S, Michelson KA
Pediatr Emerg Care · 2026 Feb · PMID 41614723 · Publisher ↗
OBJECTIVE: To evaluate the association of emergency department (ED) ondansetron with hospitalization with acute gastroenteritis (AGE) in children. METHODS: We conducted a retrospective study using the PECARN Registry of...
OBJECTIVE: To evaluate the association of emergency department (ED) ondansetron with hospitalization with acute gastroenteritis (AGE) in children. METHODS: We conducted a retrospective study using the PECARN Registry of children with AGE. Within a sample matched on vital signs, demographics, clinical severity, imaging performance, and intravenous fluids provision, we used conditional logistic regression to assess associations between administration of ondansetron and hospitalization. We compared rates of 7-day return visits with significant diagnoses between children who did and who did not receive ondansetron on their initial encounter. RESULTS: We included 543,541 encounters, of which ondansetron was administered in 39.7%. After matching, hospital admission occurred in 11.8% and 17.7% of children who did and did not receive ondansetron, respectively, with standardized mean differences <0.1. Ondansetron was negatively associated with hospitalization (OR: 0.61, 95% CI: 0.60-0.63). Children given ondansetron on their index visit had a higher percentage of 7-day return visits with appendicitis (absolute percentage difference, +0.05%, 95% CI: +0.03%, +0.07%), but a lower percentage of return visits with sepsis or bacteremia (-0.03%, 95% CI: -0.05%, -0.01%) compared with children not given ondansetron on their index visit. CONCLUSIONS: Children receiving ondansetron for AGE in the ED had an ∼40% lower odds of hospitalization. While appendicitis was diagnosed more frequently within 7 days among children given ondansetron compared with those not given ondansetron, sepsis or bacteremia were less frequently diagnosed. These findings align with prospective studies demonstrating the beneficial impact of ondansetron use in pediatric AGE.
Weather-Related Exposures and Emergency Department Visits for Pediatric Sickle Cell Complications.
Gonzalez F, Hall M, Habre R … +4 more , Berry JG, Xu Y, Liberman DB, Chaudhari PP
Pediatr Emerg Care · 2026 May · PMID 41605849 · Publisher ↗
OBJECTIVE: Sickle cell disease (SCD) is an inherited disorder that leads to significant morbidity from health complications beginning in childhood. Weather-related factors may influence the frequency of SCD complications...
OBJECTIVE: Sickle cell disease (SCD) is an inherited disorder that leads to significant morbidity from health complications beginning in childhood. Weather-related factors may influence the frequency of SCD complications, but evidence regarding the impact of weather changes in the pediatric population remains limited. Our objective was to determine the association between weather-related exposures and odds of emergency department (ED) visits for acute complications in youth with SCD. METHODS: We conducted a retrospective case-crossover study of ED encounters among patients aged 0 to 21 years at 40 US children's hospitals (2015-2020). ED visits for vaso-occlusive crisis (VOC) and/or acute chest syndrome (ACS) were included. Patients were categorized as low-risk or high risk based on the number of ED visits in the preceding year. We constructed single-variable conditional logistic regression models to identify the odds of ED visit in association with weather-related exposures of temperature, heat index (HI), and wet bulb globe temperature (WBGT). RESULTS: Among 48,885 ED encounters for VOC and ACS in high-risk patients, increases in temperature, HI, and WBGT on lag day 3 were associated with increased odds of ED visits for VOC. Increases in these variables were associated with decreased odds of ED visits for ACS. No significant associations were found for low-risk patients. CONCLUSIONS: Increased temperature, HI, and WBGT among high-risk pediatric patients with SCD were associated with increased odds of ED visit for VOC and decreased odds for ACS. As climate change progresses, further studies are needed to identify population, neighborhood, and patient-level environmental risk factors contributing to acute complications for patients with SCD.
Video Versus Direct Laryngoscope for Pediatric Intubation During Cardiopulmonary Resuscitation: A Systematic Review and Meta-analysis of Simulation-based Trials.
Lee IK, Lee KH, Choi IY … +2 more , Kim NJ, Kim K
Pediatr Emerg Care · 2026 Apr · PMID 41559033 · Publisher ↗
PURPOSE: High-quality cardiopulmonary resuscitation (CPR) is crucial for improving survival in cardiac arrest. Effective airway management can enhance outcomes but remains challenging due to anatomical and physiological...
PURPOSE: High-quality cardiopulmonary resuscitation (CPR) is crucial for improving survival in cardiac arrest. Effective airway management can enhance outcomes but remains challenging due to anatomical and physiological factors in children. However, whether endotracheal intubation is superior to bag-valve-mask ventilation during CPR remains uncertain. Video laryngoscopes have emerged as an alternative to direct laryngoscopes, offering enhanced visualization; however, their efficacy for pediatric CPR remains unclear. This systematic review and meta-analysis aimed to compare the efficacy of video laryngoscopes and direct laryngoscopes during pediatric CPR in simulation-based studies. METHODS: A systematic search of PubMed, Embase, and The Cochrane Library was conducted up to February 2025. Only randomized controlled trials conducted in simulation settings comparing video and direct laryngoscopes in pediatric CPR were included. The primary outcomes were the first attempt success rate and the overall success rate. The secondary outcomes included intubation time, Cormack and Lehane grade as an indicator of glottic visualization, and dental compression. The risk of bias for the included studies was assessed using the Cochrane Risk of Bias tool. Two reviewers independently evaluated each domain, and disagreements were resolved by consensus. RESULTS: Thirteen simulation-based studies with 2080 intubation attempts in manikins were included. Direct laryngoscopes demonstrated a 35% lower relative first-attempt success rate (RR: 0.65, 95% CI: 0.59-0.71) and a 17% lower relative overall success rate (RR: 0.83, 95% CI: 0.80-0.88) compared with video laryngoscopes. Intubation time was 8.13 seconds longer with direct laryngoscopes (MD: 8.13 s, 95% CI: 4.82-11.44). Furthermore, direct laryngoscopes were associated with a 39% lower relative likelihood of Cormack and Lehane grade 1 view (RR: 0.61, 95% CI: 0.49-0.76), and 6.05 times higher relative risk of dental compression (RR: 6.05, 95% CI: 2.93-12.52) compared with video laryngoscopes. CONCLUSION: Video laryngoscopes significantly improve intubation success rates and reduce intubation time during simulation-based pediatric CPR. Future research should validate these findings in clinical settings and evaluate device-specific features to optimize outcomes.
Ultrasound-Based Prediction Model for Air Enema Failure in Pediatric Ileocolic Intussusception: Comparison of Point-of-Care Ultrasound and Radiologist-Performed Ultrasound.
Kim SH, Kwon JH, Paek SH … +5 more , Park SH, Kim MJ, Byun YH, Song HY, Kim JH
Pediatr Emerg Care · 2026 May · PMID 41559014 · Publisher ↗
OBJECTIVES: Pediatric ileocolic intussusception often presents without classic symptoms, making early diagnosis and management challenging. While the enema reduction is the standard treatment, failed reduction may lead t...
OBJECTIVES: Pediatric ileocolic intussusception often presents without classic symptoms, making early diagnosis and management challenging. While the enema reduction is the standard treatment, failed reduction may lead to surgical intervention. This study aimed to identify predictors of reduction failure focusing on ultrasonographic features, to develop a predictive model and to assess capabilities of point-of-care ultrasound (POCUS). METHODS: We conducted a retrospective study at a pediatric emergency center from January 2020 to December 2024. Children who underwent air enema reduction for ileocolic intussusception were included. Univariable and multivariable logistic regression analyses were performed to identify predictors of reduction failure. A prediction model was constructed using ultrasound features and validated using a distinct cohort. Paired comparative analysis between POCUS and radiologist-performed ultrasound was performed. RESULTS: Among 179 children, 35 experienced failure. Most of the demographic and symptom-based variables were not significantly associated with outcomes. Radiologist-performed US revealed that lymph nodes around the lesion, greater invagination length, hypoechoic ring thickness, and suspected low vascularity were associated with failure. A multivariable logistic regression model using 6 ultrasound features demonstrated good predictive performance. External validation with 58 patients yielded good predictive performance and 100% sensitivity. Comparative analysis showed that radiologists more frequently assessed long-axis views and vascularity, identifying risk features more comprehensively than pediatric emergency physicians. CONCLUSIONS: Ultrasound-based features are possibly more reliable predictors of enema reduction failure in pediatric emergency settings. Our validated model and comparative analysis highlight the importance of standardized ultrasound assessment and support the expanded role of POCUS.
Using Human Factors and Systems Simulation to Optimize the Usability of a Code Documentation Tool.
Biesbroek S, Dubé M, Arnold J … +5 more , Chan-MacRae M, Kats DJ, Coogle L, Swenson M, Hron JD
Pediatr Emerg Care · 2026 Apr · PMID 41559006 · Publisher ↗
OBJECTIVES: Implementing a new electronic health record (EHR) system in high-pressure, high-stakes environments, such as documenting during pediatric and neonatal cardiac and respiratory arrest scenarios, can be challeng...
OBJECTIVES: Implementing a new electronic health record (EHR) system in high-pressure, high-stakes environments, such as documenting during pediatric and neonatal cardiac and respiratory arrest scenarios, can be challenging for health care staff. Poorly designed tools or technology that don't align with existing workflows may lead to incomplete or inaccurate documentation. Lower adoption rates and continued reliance on paper forms for code documentation can result in gaps in patient data within the EHR, requiring the transcription of critical information after the event. METHODS: This project utilized human factors usability testing and systems-focused simulation evaluation methods to assess code documentation tools with end-users from critical care areas (ED, ICU, NICU) during the EHR design phase. RESULTS: A total of 202 recommendations to enhance the EHR's usability and functionality were made across the 3 testing cycles (2 rounds of usability testing and 1 cycle of systems simulation sessions). The majority of recommendations were focused on improvements to the software and technology of the code narrator tool directly. Post-launch assessment showed that nearly 2/3 of the usability recommendations were implemented within the first year of use. CONCLUSIONS: Improving the design of these tools and ensuring seamless workflow integration is essential for increasing adoption and enhancing the accuracy of patient records.
PEMTalk: Improving Delivery of Serious News in Pediatric Emergency Medicine.
Lee JY, Emlet LL, Choi S … +6 more , Hamilton M, Maurer SH, Brown AW, Tavarez MM, Spears NB, Lunoe MM
Pediatr Emerg Care · 2026 May · PMID 41540589 · Publisher ↗
OBJECTIVES: Pediatric emergency medicine (PEM) physicians deliver serious news (DSN) in stressful situations that impact both families and physicians. Our objective was to assess the impact of a PEM-focused workshop on D...
OBJECTIVES: Pediatric emergency medicine (PEM) physicians deliver serious news (DSN) in stressful situations that impact both families and physicians. Our objective was to assess the impact of a PEM-focused workshop on DSN in improving the self-perceived preparedness, skill level, and stress management of PEM physicians. METHODS: We designed a simulation-based communication workshop, "PEMTalk," utilizing simulated parents to teach PEM attendings and fellows to effectively DSN. The workshop was conducted in a virtual and in-person format from 2018 to 2023. We developed 3 scenarios unique to PEM. Pre- and postintervention surveys were administered to assess the workshop's impact. RESULTS: A total of 74 participants completed surveys. Among the 34 first-time participants, there were improvements in provider's self-perceived ability to DSN (41% vs. 97%; P <0.001), respond to emotions (50% vs. 97%; P <0.001), and decrease in stress (47% vs. 21%; P =0.003) due to DSN. Among the 23 participants who participated in the study more than once, there were sustained improvements in their self-perceived ability to DSN (39% vs. 69%; P =0.02). Fellows (53% of participants) were more likely than attendings to report improvement in DSN [OR 6; 95% CI (1.05-41.67); P =0.04]. There was no difference in outcomes between in-person and virtual formats. CONCLUSION: PEMTalk enhanced participants' self-reported comfort while reducing stress associated with DSN in a simulated setting. Next steps include incorporating objective assessments, evaluating the impact on patient care, and disseminating the workshop to the broader PEM community.
ED Lung Ultrasound of Suspected Atelectasis and Assessment of Reaeration in Children: A Case Series.
Pek JH, Tsung JW
Pediatr Emerg Care · 2026 Mar · PMID 41540557 · Publisher ↗
OBJECTIVES: Point-of-care ultrasound of the lung is a useful tool in the assessment of pediatric patients with acute respiratory distress or hypoxemia. However, the sonographic features of atelectasis and pneumonia appea...
OBJECTIVES: Point-of-care ultrasound of the lung is a useful tool in the assessment of pediatric patients with acute respiratory distress or hypoxemia. However, the sonographic features of atelectasis and pneumonia appear similar. Unlike pneumonia, the use of lung ultrasound to diagnose atelectasis and assess its reaeration in children is not well described. We describe the lung ultrasound features of atelectasis correlated with radiographic imaging and clinical context. METHODS: This series describes 5 pediatric ED patients with atelectasis, confirmed by lung ultrasound with radiographic correlation, to illustrate the use of PoCUS in guiding interventions such as chest physiotherapy and assessing reaeration. RESULTS: In all 5 cases, lung ultrasound identified lung consolidations consistent with atelectasis, which appeared sonographically similar to pneumonia. Static air bronchograms were seen in all cases. In 1 case of asthma exacerbation, repeat ultrasound demonstrated complete resolution of atelectasis following chest physiotherapy, correlating with clinical improvement. In the other 4 cases, including patients with cystic fibrosis and bronchiolitis, the consolidations persisted on repeat ultrasound despite various treatments for atelectasis. CONCLUSIONS: The overlap between the sonographic features of lung consolidation in atelectasis and pneumonia in children makes it difficult to distinguish between the 2 conditions reliably based on lung ultrasound alone. Clinicians will need to interpret PoCUS images within the patient's clinical context, using radiographic correlation when available. Assessment of atelectasis reaeration on lung ultrasound is feasible and easily repeatable at the point of care, allowing for real-time monitoring of lung consolidations in response to therapy.
Fatal Firearm Violence and Previous Interactions With the Pediatric Health Care System.
Morris C, Bronstein D, Donnelly KA
Pediatr Emerg Care · 2026 Apr · PMID 41536005 · Publisher ↗
OBJECTIVES: Describe the interactions of young people killed by firearms with the pediatric health care system, with a focus on emergency department care. Characterize victims' risk factors for firearm violence as docume...
OBJECTIVES: Describe the interactions of young people killed by firearms with the pediatric health care system, with a focus on emergency department care. Characterize victims' risk factors for firearm violence as documented in the medical record. METHODS: Subjects were identified by querying the Gun Violence Archive (GVA) for individuals aged 13 to 30 who were fatally shot in Washington, D.C. between January 1, 2018 and December 31, 2022. GVA victims were matched to medical records within our pediatric hospital system. Records were analyzed for demographics, violence risk factors, and health care utilization. RESULTS: A total of 352 patients met inclusion criteria. The most common risk factors ascertained from medical record review were accidental injury (70.5%), violent injury (45.4%), and involvement with the juvenile justice system (32.9%). Individuals with greater than 5 risk factors comprised only 9.4% of our population but accounted for more than a quarter of the total risk factors documented, including 46.8% of child abuse cases, 31.2% of firearm injuries, 25% of juvenile justice cases, and the majority of mental and behavioral health risk factors (89.4% of behavioral issues, 55.2% of mood problems, and 54.1% of ADHD cases). Conversely, thirty-eight subjects (10.8%) had no documented risk factors. Subjects visited our ED multiple times (mean 5.74 visits) and the majority (70.1%) visited an outpatient clinic. CONCLUSIONS: Young victims of firearms had a range of risk factors for firearm violence and multiple interactions with our pediatric hospital system before death. Each interaction represents an opportunity to screen and intervene. This work also points to the opportunity to change the inequitable systems responsible for these risk factors. Further work must be done to evaluate which risk factors are most predictive and how they develop over time.
Development of an Implementation Strategy Plan to Improve Care for Pediatric Emergency Department Patients With a Possible Sexually Transmitted Infection.
Merchant RC, Ramirez-Castillo D, Strother C … +5 more , Solnick R, Martinez PM, Connell B, Steever J, Clark MA
Pediatr Emerg Care · 2026 Mar · PMID 41535984 · Full text
OBJECTIVES: Despite the existence of evidence-based guidelines from the Centers for Disease Control and Prevention, studies have demonstrated the need for improvement in the evaluation and treatment of adolescents and yo...
OBJECTIVES: Despite the existence of evidence-based guidelines from the Centers for Disease Control and Prevention, studies have demonstrated the need for improvement in the evaluation and treatment of adolescents and young adults with a possible sexually transmitted infection (STI) presenting for care in pediatric emergency departments (PEDs) and general emergency departments (EDs) in the United States. We created an implementation strategy plan for our PED designed to improve STI care for patients. METHODS: Using the Tailored Implementation in Chronic Diseases (TICD) determinants framework, we identified, prioritized, and investigated determinants of implementation success of our initiative. We then conducted stakeholder interviews to refine and design an implementation strategy plan that addressed identified barriers and facilitators. RESULTS: The resulting implementation strategy included: (1) a standardized STI care protocol; (2) electronic health record (EHR) enhancements, including smart phrases and tailored order sets; (3) staff training materials and academic detailing sessions for physicians and nurses; (4) an adolescent-friendly discharge instruction handout; (5) an EHR-based referral system to an adolescent health clinic; (6) visual aids to support accurate STI sample collection' and (7) an evaluation plan to assess protocol uptake, documentation quality, treatment accuracy, and follow-up linkage. CONCLUSIONS: This TICD-informed, stakeholder-driven approach may serve as a model for EDs aiming to enhance STI care delivery for adolescent and young adult patients.
Comparison of Diagnostic Imaging Patterns Between Pediatric and Adult Trained Physicians in Adolescent Trauma Activations.
Jonsson B, Ellis TW, Klinkner DB … +1 more , Homme JL
Pediatr Emerg Care · 2026 Apr · PMID 41535726 · Publisher ↗
OBJECTIVES: The aim of this study was to investigate differences in utilization of diagnostic imaging between the adult and pediatric trauma teams when caring for adolescent trauma patients. METHODS: This was a retrospec...
OBJECTIVES: The aim of this study was to investigate differences in utilization of diagnostic imaging between the adult and pediatric trauma teams when caring for adolescent trauma patients. METHODS: This was a retrospective observational study from 2015 to 2019 comparing pediatric trauma team activations for patients ages 12 to 14 and adult trauma team activations for patients ages 15 to 17 at a single institution verified as both a level I adult and a level I pediatric trauma center. Data were collected from a prospective trauma registry and manual chart review of the electronic medical records. The primary outcome was the frequency of whole body computed tomography (WBCT) and computed tomography (CT) imaging of individual body regions. RESULTS: We identified 191 adult and 100 pediatric trauma team cases, with similar proportions transferred from outside hospitals (40% vs. 43%). Among patients presenting directly from the scene, WBCT use was significantly higher in the adult trauma team group (64% vs. 12%; RR: 5.21; 95% CI: 2.57-10.58), as was CT of all individual body regions. For transferred patients, the adult trauma team more often performed WBCT and individual CT scans, excluding head CT. CT imaging rates before transfer did not differ between groups. No significant differences were observed in injury severity scores, altered mental status, length of stay, or missed injuries. CONCLUSIONS: Among adolescents with similar injury severity, the adult trauma team more frequently utilizes WBCT and regional CT than the pediatric team. However, CT use before transfer from outside hospitals without dedicated pediatric trauma teams was similar across age groups.
A Novel Approach Using Relative Value Units to Quantify Workload and Its Association With Patient and Family Experience in the Pediatric Emergency Department.
Ha T, McKinley KW, Chamberlain JM … +3 more , Zorc JJ, Walker M, Morrison SN
Pediatr Emerg Care · 2026 Apr · PMID 41535724 · Publisher ↗
OBJECTIVES: To measure the association between overall workload and patient and family experience (PFE) in a pediatric emergency department (ED). Our secondary objective was to assess the construct validity of total ED R...
OBJECTIVES: To measure the association between overall workload and patient and family experience (PFE) in a pediatric emergency department (ED). Our secondary objective was to assess the construct validity of total ED Relative Value Units (RVUs) as an overall ED workload measure. METHODS: We performed a retrospective study from January 2022 to August 2023 using data from a large, urban, academic pediatric ED with approximately 85,000 patient visits annually. PFE was measured by surveys distributed to all patients discharged from ED. The association of overall ED workload with PFE was assessed using multivariate ordinal logistic regression. We examined the construct validity of total ED RVUs by replacing this measure with National Emergency Department Overcrowding Scale (NEDOCS) in the logistic regression model. RESULTS: Of 126,336 discharged visits, 7128 (5.6%) completed surveys. We found a statistically significant association between ED workload and PFE. For each 10 RVUs added to ED workload, the odds of more positive PFE decreased by 9% (95% CI: 8%-9%). The adjusted odds ratio of NEDOCS demonstrated a less pronounced association in the same direction; an increase of 10 points in NEDOCS was associated with 6% (95% CI: 5%-6%) decrease in the likelihood of higher PFE ratings. CONCLUSIONS: High ED workload, as measured by overall RVUs, was significantly associated with negative PFE. Similar results were found when we substituted NEDOCS for overall RVUs. Our findings suggest that overall RVUs may be a useful measure of ED workload and might provide a quantitative target for quality improvement.
Screening Pediatric Trauma Patients for Blunt Cerebrovascular Injury Using the McGovern Score: A Retrospective Cohort Study.
Osorio RG, Johnson AB, Neff LP … +7 more , Riera KM, Petty JK, Couture DE, Kramer CL, Venkataraman SS, Saha AK, McCrory MC
Pediatr Emerg Care · 2026 May · PMID 41535261 · Publisher ↗
BACKGROUND: Blunt cerebrovascular injury (BCVI), defined as an injury occurring to the carotid and/or vertebral arteries, occurs in ~1% of pediatric blunt trauma patients and is associated with morbidity and mortality. O...
BACKGROUND: Blunt cerebrovascular injury (BCVI), defined as an injury occurring to the carotid and/or vertebral arteries, occurs in ~1% of pediatric blunt trauma patients and is associated with morbidity and mortality. Our objective was to evaluate the sensitivity and specificity of the McGovern score, a pediatric-specific screening tool for BCVI, and describe the effect of its implementation on the use of additional imaging for BCVI and the detection of BCVI. METHODS: This was a retrospective cohort study of patients below 16 years old presenting with blunt trauma to the Pediatric Emergency Department of a tertiary care level 1 pediatric trauma center pre- (July 1, 2020, to November 30, 2021) and post- (December 1, 2021, to December 31, 2022) implementation of McGovern scoring into the clinical decision algorithm for blunt trauma. Patient characteristics, diagnostic studies used [including computed tomography angiography (CTA) or magnetic resonance angiography (MRA) of the neck vessels], and outcomes (BCVI, stroke, mortality), were obtained from the medical record and compared pre-McGovern versus post-McGovern score implementation. RESULTS: A total of 1189 patients were included in the study; 664 p reimplementation of the McGovern scoring and 525 postimplementation. Median age was 6 years (IQR 2 to 11), and 668 (56%) were trauma activations (leveled traumas), with no significant differences in patient characteristics between the 2 cohorts. Imaging for BCVI was performed in 13 (2.0%) patients in the preimplementation group and 27 (5.0%) patients in the postimplementation group ( P =0.003). BCVI was detected in 12/1189 patients overall (1.0%); 2 in the preimplementation group (0.3%), and 10 (1.9%) in the postimplementation group ( P =0.007). In the postimplementation group, the sensitivity of the McGovern score was 90% while the specificity was 96.7%. CONCLUSIONS: The implementation of the McGovern score into the pediatric trauma decision algorithm was associated with the detection of an increased number of BCVIs compared to the preimplementation group, with good sensitivity and specificity, but a significant increase in the use of imaging.
High Flow Nasal Cannula Use in Bronchiolitis: Predicting Need for Early Escalation of Care.
Hintz LK, Lorenz D, Lipshaw MJ … +7 more , Miller C, Zorc JJ, Kolaitis IN, Jones JM, Rothstein R, Shehab O, Florin TA
Pediatr Emerg Care · 2026 Mar · PMID 41527360 · Publisher ↗
OBJECTIVES: High-flow nasal cannula (HFNC) use in bronchiolitis has increased substantially with wide variability, likely due to the lack of objective means of predicting clinical outcomes. Our objective was to identify...
OBJECTIVES: High-flow nasal cannula (HFNC) use in bronchiolitis has increased substantially with wide variability, likely due to the lack of objective means of predicting clinical outcomes. Our objective was to identify features associated with care escalation for infants started on HFNC in the Emergency Department (ED), thereby assisting in disposition of patients and optimizing the utilization of limited resources. METHODS: This is a retrospective cohort study from 3 free-standing children's hospitals of infants younger than or equal to 12 months with bronchiolitis who were initiated on HFNC in the ED between 2/1/2018 and 3/1/2020. The primary outcome was escalation of care within the first 24 hours after HFNC initiation [transfer to pediatric intensive care unit (PICU) and/or initiation of noninvasive positive pressure ventilation (NIPPV) or mechanical ventilation (MV)]. A clinical prediction model was developed using multivariable logistic regression. RESULTS: We included 738 infants with a mean age of 5.4 months (SD 3.4), of which 73 (10%) experienced care escalation within the first 24 hours. Fever, tachypnea, tachycardia, and hypoxemia were associated with escalation, whereas historical features, physical examination findings, and response to ED therapies were not. A prediction model consisting of the highest ED respiratory rate and the lowest oxygen saturation yielded an AUC of 0.75, with a sensitivity of 57.9% and specificity of 82.2% (based on an optimal predicted probability threshold of 7.9%). CONCLUSIONS: Hypoxemia and tachypnea predicted early escalation of care in infants with bronchiolitis with moderate performance. This model may have promise to assist with management decisions; however, it requires prospective validation.
Suspected Pediatric Appendicitis Management in the Emergency Department: A Prospective Observational Study in an Australian Pediatric Emergency Department.
Lee WH, O'Brien S, Mckinnon EJ … +3 more , Craig S, Dalziel S, Borland ML
Pediatr Emerg Care · 2026 Mar · PMID 41524284 · Full text
OBJECTIVE: Abdominal pain is a common pediatric presentation in the emergency department (ED), and acute appendicitis (AA) is the most common surgical diagnosis. This study describes the management of suspected AA in a t...
OBJECTIVE: Abdominal pain is a common pediatric presentation in the emergency department (ED), and acute appendicitis (AA) is the most common surgical diagnosis. This study describes the management of suspected AA in a tertiary Australian pediatric ED. METHODS: A single-center prospective observational study was performed between November 2022 and May 2023. Children aged 5 to 15 years presenting to the ED with acute abdominal pain and clinician suspicion of AA were included. Clinical gestalt was measured using a 5-point Likert Scale before and after blood tests. Diagnosis of AA was confirmed on histopathology, and non-AA was confirmed with follow-up at 30 to 60 days. RESULTS: The study enrolled 481 children; AA was diagnosed in 146 (30.6%). Patients with AA were older (11.1 vs. 10.0 y) and more likely to be male (69.2% vs. 48.1%) compared with those without AA. Blood tests were performed in 449 (93.3%) children, with higher rates in AA cases (100% vs. 90.4%). Gestalt improved with blood test results, with overall diagnostic accuracy increasing from 65.9% pre-blood tests to 88.5% post-blood tests. Ultrasound (US) was performed in 361 (75.1%) children with a diagnostic accuracy of 90.6% and was frequently used even in patients deemed low-risk post-blood tests (65.7%). One hundred and fifty (31.2%) of suspected AA cases underwent surgery, with 3 negative appendectomies and 1 ovarian cystectomy without appendectomy. Median (IQR) hospital length of stay was significantly longer for AA cases than non-AA cases [50.8 (35.3 to 95.0) h vs. 7.1 (4.6 to 16.8) h]. CONCLUSIONS: This study reviews the management and outcomes of suspected AA in a high-volume Australian ED. It shows the importance of blood tests in improving diagnostic accuracy of clinician gestalt and highlights the potential overuse of US in low-risk patients. Future research should explore a more structured diagnostic approach to increase diagnostic accuracy, optimize resource utilization, and improve patient outcomes.
A Descriptive Study Evaluating Trends in Firearm Injuries at an Urban, Level 1 Pediatric Trauma Center.
Nsofor M, Rominger A, Puchalski A … +3 more , Allen T, Waddell M, Teich S
Pediatr Emerg Care · 2026 Mar · PMID 41500991 · Publisher ↗
OBJECTIVE: In the United States, firearm-related injuries are the leading cause of death in individuals aged 0 to 24 years and lead to substantial cost burden, mortality, and morbidity. This study identifies trends of pe...
OBJECTIVE: In the United States, firearm-related injuries are the leading cause of death in individuals aged 0 to 24 years and lead to substantial cost burden, mortality, and morbidity. This study identifies trends of pediatric firearm injury at this level I pediatric trauma center, which may inform violence prevention and firearm safety intervention at the local level. METHODS: This study is a retrospective review of the pediatric trauma registry at a level 1 pediatric trauma center of children (0 to 17.9 y) who presented between January 1, 2013 and December 31, 2022. Age, sex, race, ethnicity, number of GSWs, location of injury, disposition, intention, mortality, insurance status, length of stay, zip code of residence, location of shooting, hospital charges, and recidivism for firearm injury, police officer-related interactions, or violence-related events were reviewed and analyzed. RESULTS: There were 585 patient charts reviewed over the 10-year period. The rate of pediatric firearm injuries increased by almost 5 folds and fatality rates tripled from 2013 to 2022. The victims were predominantly male (82.9%), black (75.3), non-Hispanic (88.5%), and Medicaid holder/uninsured (86.3%). Assault accounted for 67% of all GSWs and 13.5% returned with an assault or violence-related concern; 6.4% returned for a GSW-related injury over the study period. The rate of firearm injuries increased from 9.09 (per 100,000) pre-COVID to 17.93 (per 100,000) post-COVID with a rate of 16.74 (per 100,000) while in the peak of the pandemic. CONCLUSIONS: This level 1 trauma center has seen an overall increase in pediatric GSW injuries and fatalities in 10 years.
Succinylcholine Versus Rocuronium for Pediatric Rapid Sequence Intubation in the Emergency Department.
Mendez D, Zatarain J, Paul K … +8 more , Abrams R, Sunesra R, Garza H, O'Connell D, Herman A, Barua-Nath U, Tuli S, Jehle D
Pediatr Emerg Care · 2026 Mar · PMID 41489184 · Publisher ↗
OBJECTIVES: Succinylcholine and rocuronium are neuromuscular blocking agents used in the emergency department (ED) during rapid sequence intubation (RSI). Very few studies have been conducted to determine which agent is...
OBJECTIVES: Succinylcholine and rocuronium are neuromuscular blocking agents used in the emergency department (ED) during rapid sequence intubation (RSI). Very few studies have been conducted to determine which agent is preferred for children. This study analyzed outcomes of death, post-traumatic stress disorder (PTSD) and malignant hyperthermia for children administered succinylcholine versus rocuronium for RSI in the ED. METHODS: This retrospective, propensity-matched study utilized the TriNetX database. Cohorts included children less than or equal to 17 years of age, given a paralytic agent plus etomidate or ketamine during intubation in the ED from 2004 to 2024. Cohorts were further stratified by the administration of succinylcholine or rocuronium. The outcomes measured were death, PTSD, and malignant hyperthermia. Propensity matching was done for demographics and pre-existing conditions. RESULTS: Before propensity matching, 2095 pediatric patients were identified. After propensity matching, 706 patients were identified in each cohort. After propensity matching, children administered succinylcholine had a lower rate of death (5.7% vs. 8.9%, RR: 0.65, 95% CI [0.43-0.93], P =0.019) but no significant difference in PTSD (2.6% vs. 3.7%, RR: 0.71, 95% CI [0.32-1.68], P =0.399). There was no significant difference in malignant hyperthermia. Subgroup analysis suggests that succinylcholine and etomidate were the best combination of drugs for RSI. CONCLUSIONS: Mortality rates were lower for children administered succinylcholine for RSI when compared with rocuronium. This study demonstrates a potential association between succinylcholine use and favorable RSI outcomes in the ED, though further prospective studies are needed.
Recognition, Diagnosis, and Management of Measles in the Emergency Department.
Daniels DK, Muppidi P, Rasakumar Y … +1 more , Conners GP
Pediatr Emerg Care · 2026 Jan · PMID 41461605 · Publisher ↗
Measles is a highly contagious viral infection that resulted in significant morbidity and mortality before widespread vaccination efforts began in the 1960s. In 2000, measles was declared eliminated in the United States;...
Measles is a highly contagious viral infection that resulted in significant morbidity and mortality before widespread vaccination efforts began in the 1960s. In 2000, measles was declared eliminated in the United States; however, continued global circulation combined with rising vaccine hesitancy has resulted in recent outbreaks of increasing severity. This review article highlights relevant epidemiology and prepares clinicians to differentiate measles infection from similar febrile exanthems of childhood. We review available diagnostics and the management of patients with or exposed to measles infection in an era of unfamiliarity with the condition.
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