Pediatric Emergency Care[JOURNAL]
Sun
200 papers
Implementing a Multidisciplinary Trauma Simulation Curriculum for Pediatric Emergency Medicine Fellows.
Bunke C, Hartman H, Ching A … +1 more , Visclosky T
Pediatr Emerg Care · 2026 Mar · PMID 41437184 · Publisher ↗
OBJECTIVES: Unintentional injury is a leading cause of morbidity and mortality in children. The Accreditation Council for Graduate Medical Education (ACGME) requires competency in medical and trauma resuscitation in pati...
OBJECTIVES: Unintentional injury is a leading cause of morbidity and mortality in children. The Accreditation Council for Graduate Medical Education (ACGME) requires competency in medical and trauma resuscitation in patients from newborn through adulthood. Yet there is a paucity of data regarding best practices for pediatric trauma training. The goal of this study was to evaluate knowledge gaps in pediatric trauma training, implement a trauma simulation curriculum, and evaluate changes in fellows comfort level with trauma skills preimplementation and postimplementation. METHODS: We utilized Kern's 6-step approach to design an innovative longitudinal trauma curriculum for Pediatric Emergency Medicine (PEM) fellows. A needs assessment was sent to PEM faculty, PEM fellows, pediatric surgery faculty, pediatric surgery fellows, and pediatric ED nursing. Learning objectives were derived and categorized as technical skills, nontechnical skills, and case-based medical knowledge. This guided a year-long curriculum including 11 simulation cases and 3 didactic sessions. The curriculum was assessed at Kirkpatrick levels 1 and 2 through preimplementation and postimplementation surveys. We assessed fellows' self-reported comfort and faculty perception of the supervision required. RESULTS: Fellows began with higher overall comfort with nontechnical skills compared with technical skills. Following implementation, there was a statistically significant improvement in fellow comfort in overall technical skills ( P < 0.05), traction splint application ( P < 0.05), and initiating massive transfusion protocol ( P < 0.05). There were positive trends in obtaining access, placing pelvic binders, managing increased intracranial pressure, and leadership skills. There were no statistically significant findings noted in the surveys completed by the faculty. CONCLUSIONS: This study presents a promising foundation for a comprehensive longitudinal pediatric trauma curriculum. Our study, while small, showed overall improvement in fellow comfort with trauma resuscitation at Kirkpatrick level 1, most notably with technical skills. Future areas of research include increased sample size, enhanced skills assessment methods, and expansion to other trauma team stakeholders.
Predictors of Osteochondral Fractures Following Patellar Dislocation in the Pediatric Emergency Department.
Shaath K, Paquin H, Nault ML … +3 more , Miron MC, Mupesse C, Gravel J
Pediatr Emerg Care · 2026 Apr · PMID 41436728 · Publisher ↗
BACKGROUND: Patellar dislocations are frequently seen in the emergency department (ED). Almost all children with a reduced patellar dislocation will have a knee radiography, while only 10% have a fracture identified on x...
BACKGROUND: Patellar dislocations are frequently seen in the emergency department (ED). Almost all children with a reduced patellar dislocation will have a knee radiography, while only 10% have a fracture identified on x-ray. OBJECTIVE: The primary purpose of the study was to identify factors predicting osteochondral fractures among children with patellar dislocation reduced in the ED. METHODS: This was a retrospective cohort study of all children aged between 1 and 18 years old with patellar dislocation who needed a reduction in a tertiary care pediatric ED between 2019 and 2024. The primary outcome was the presence of a fracture identified by radiology (x-ray or MRI) during ED visit or follow-up at the orthopedic clinic. Multiple independent variables were evaluated as potential predictors. These were related to the patient (age, sex, previous patellar dislocation), the accident, and the physical examination before and after reduction, as well as finding at the follow-up at the orthopedic clinic. All charts were evaluated using a standardized form, and 10% were evaluated in duplicate to ensure interrater reliability. The primary analysis was the association between the independent variable and fracture using logistic regression. RESULTS: There was a total of 316 diagnoses of patellar luxation in 276 children with a median age of 14 years. Ninety-six children had their patellar dislocation reduced at the ED and were included in the study, of whom 19 (20%) had a fracture. Of all variables tested, only the persistence of knee swelling at orthopedic follow-up was associated with a higher risk of fracture (OR: 13.39; 95% CI: 1.70-105.32). CONCLUSION: Approximately 20% of children who needed a reduction in the ED for patellar dislocation had a fracture. Persistent knee swelling at follow-up is a potential predictor of fracture.
Real-World Rapid Brain Magnetic Resonance Imaging Utilization in the Pediatric Emergency Setting: A 10-Year Cross-Sectional Study.
Toliao JM, Yeo C, Shiosaki J … +4 more , Tang-Tan A, Ha JH, Chiarelli PA, Chaudhari PP
Pediatr Emerg Care · 2026 Apr · PMID 41436437 · Publisher ↗
OBJECTIVES: Rapid brain MRI (rMRI) provides a radiation-free neuroimaging tool to screen children without sedation. Our objective was to retrospectively analyze clinical rMRI utilization by describing demographics, opera...
OBJECTIVES: Rapid brain MRI (rMRI) provides a radiation-free neuroimaging tool to screen children without sedation. Our objective was to retrospectively analyze clinical rMRI utilization by describing demographics, operational metrics, clinical indications, and temporal trends associated with rMRI utilization in the emergency department (ED). METHODS: We conducted a single-center, retrospective, cross-sectional study of children who underwent rMRI in the ED at an urban children's hospital between May 2014 and March 2024. We used descriptive statistics to examine operational metrics and trends in rMRI utilization over the study period. We performed a subgroup analysis of operational metrics by age and clinical indication. RESULTS: We included 2401 patients who underwent rMRI during their ED encounter. rMRI was frequently performed in infants and toddlers younger than 3 years old (n = 604, 25.1%), with a median patient age of 8.0 [interquartile range (IQR): 3.0 to 14.5] years. The median (IQR) time to scan was 3.5 (2.4 to 5.1) hours, and the median (IQR) ED length of stay was 7.5 (5.8 to 9.6) hours. Of the total, 1917 (79.8%) patients were initially triaged as "emergent," and 990 (41.2%) were discharged home from the ED. rMRI was predominantly used to evaluate ventricular shunt function (n = 2069, 86.1%) and traumatic brain injury (n = 214, 9.0%). Annual rMRI utilization increased by 80.8% between 2015 and 2023, with an average utilization rate increase of 46.1 scans annually between the years 2015 and 2019, and relatively static utilization rate from 2020 to 2023. CONCLUSIONS: This work supports the feasibility of widespread rMRI in the high-volume ED care setting, including for young children. rMRI utilization increased over time, with the technique most frequently used to evaluate ventricular shunt function and traumatic brain injury.
Don't Get MAD: Managing Agitation With De-Escalation Training in a Pediatric Emergency Department.
Georgadarellis AG, Shabanova V, Hoffman P … +3 more , Tiyyagura G, Auerbach M, Langhan ML
Pediatr Emerg Care · 2026 Mar · PMID 41422423 · Publisher ↗
OBJECTIVES: Acute agitation is a behavioral health emergency necessitating timely, effective intervention. Consensus guidelines recommend de-escalation techniques before restraint use. We examined the impact of de-escala...
OBJECTIVES: Acute agitation is a behavioral health emergency necessitating timely, effective intervention. Consensus guidelines recommend de-escalation techniques before restraint use. We examined the impact of de-escalation training on attitudes, knowledge, and behaviors of interdisciplinary staff caring for agitated patients in the pediatric emergency department (PED). METHODS: Asynchronous, multi-faceted de-escalation training interventions were delivered biweekly in an urban tertiary care PED as one facet of a quality improvement initiative to reduce disparities in physical restraint use. An electronic survey including the Management of Aggression and Violence Attitude Scale (MAVAS) plus questions on knowledge of and behaviors with pediatric agitation was distributed before and after the training interventions. Baseline and post-intervention survey results were compared, measuring changes in attitudes, knowledge, and self-reported behaviors. RESULTS: Sixty-one of 148 (41%) eligible participants completed the baseline survey and 44 (30%) completed the post-intervention survey. Post-intervention, participants were less likely to agree that it is difficult to prevent patients from becoming violent or aggressive (OR=0.31, 95% CI: 0.14-0.70) or that internal causative factors contribute to patient aggression (OR=0.50, 95% CI: 0.26-0.97). Post-intervention, respondents were more likely to recognize existing racial disparities in pediatric restraint use (OR=3.41, 95% CI: 1.64-7.09) and to believe that agitated patients were verbally de-escalated without restraint use often (OR= 2.11, 95% CI: 1.02-4.37). CONCLUSIONS: After implementing asynchronous, multi-faceted de-escalation training, PED staff positively shifted their attitudes of children with acute agitation, improved knowledge about disparities in their care, and were more likely to believe that verbal de-escalation of agitated patients without restraint use was used often. De-escalation training can be easily implemented and impactful, and these data warrant further investigation into best de-escalation practices.
Discrepancies Between Estimated and Expressed Abscess Volume in Pediatric Incision and Drainage.
Neal JT, Waltman EM, Miller AF … +7 more , Gravel CA, Chiang EL, Ansari E, Fleegler EW, Ozonoff A, Landschaft A, Kimia AA
Pediatr Emerg Care · 2026 Apr · PMID 41422417 · Publisher ↗
BACKGROUND: Incision and drainage (I&D) is the standard treatment for pediatric abscesses. However, discrepancies between estimated abscess volume, determined clinically or by point-of-care ultrasound (POCUS), and the ac...
BACKGROUND: Incision and drainage (I&D) is the standard treatment for pediatric abscesses. However, discrepancies between estimated abscess volume, determined clinically or by point-of-care ultrasound (POCUS), and the actual volume expressed may result from poor ultrasound or I&D technique. These discrepancies may lead to inappropriate management decisions and unnecessary procedures. OBJECTIVE: To determine the prevalence of discrepancies between estimated and expressed abscess volumes during pediatric I&D. METHODS: We conducted a cross-sectional chart review at a tertiary care pediatric emergency department (ED) between 2017 and 2023. Patients younger than or qual to 21 years with an attempted I&D were identified using a natural language processing tool. We focused on 2 groups based off of documented abscess diameter: predicted volumes of ≤1 mL and ≥10 mL. Per author discretion, these values correspond with decision-making of 'not worth pursuing I&D' and 'definitely worth pursuing I&D', respectively. We considered a positive discrepancy if for an expected abscess volume of ≤1 mL, the documented volume expressed was ≥10 mL (underestimated), and if for an expected volume of ≥10 mL, the documented volume was ≤3 mL (overestimated). Prevalence and confidence intervals were calculated using descriptive statistics. RESULTS: Among 653 patients, 13.2% of sonographic and 7.6% of clinical estimates underestimated abscess volume, whereas 2.3% of sonographic and 19.6% of clinical estimates overestimated abscess volume. Combined assessment reduced discrepancies to 5.2% underestimated and 1.2% overestimated. CONCLUSIONS: Combining clinical with POCUS assessment of pediatric abscesses provides better prediction of volume than reliance on a single method potentially reducing unnecessary procedures and missed I&D opportunities.
The Effect of a Rapid Assessment Team on Pediatric Emergency Medicine Department Operations and Throughput.
Ramirez R, Blumstein M, Lowe D … +2 more , Lozano JM, Peña BG
Pediatr Emerg Care · 2026 Apr · PMID 41422415 · Publisher ↗
OBJECTIVES: Length of stay (LOS) and left without being seen (LWBS) rates are key measures of emergency department (ED) throughput. Few studies in the pediatric ED setting exist looking at the effect of rapid assessment...
OBJECTIVES: Length of stay (LOS) and left without being seen (LWBS) rates are key measures of emergency department (ED) throughput. Few studies in the pediatric ED setting exist looking at the effect of rapid assessment team models on department operations/throughput. At our institution, a rapid assessment team was implemented to respond to patients who indicated a desire to leave before being evaluated, expedite assessment/treatment of lower-acuity cases that could be discharged directly, and initiate workups for patients experiencing excessive door-to-doctor times. We hypothesized that implementation of this team would be associated with decreased LOS, LWBS rates, and door-to-provider times in a pediatric ED. METHODS: We conducted a single-institution retrospective chart study to determine whether implementation of a rapid assessment team improved standard efficiency metrics (LWBS, LOS, door-to-provider time) within our pediatric ED. Data from a 4-year period (prerapid and postrapid assessment team implementation) were analyzed. Bivariate analyses (independent t test, Mann-Whitney U test, and χ 2 test) were used to assess the association between baseline characteristics and primary outcomes. Multivariable logistic regression for the LWBS rate and linear regression for LOS examined the association between different time periods and outcomes while controlling for confounders. RESULTS: In total, 348,483 valid cases were analyzed. After implementation, the LWBS rate decreased from 0.7% to 0.5% (OR: 0.79, 95% CI: 0.72-0.87; P <0.001). Mean LOS decreased by 15.7 minutes (95% CI: 14.8-16.7; P <0.001), and door-to-provider time decreased by 19.2 minutes (95% CI: 18.8-19.6; P <0.001). CONCLUSIONS: In our pediatric ED, implementation of a rapid assessment team was associated with reduced LOS, LWBS rates, and door-to-provider times.
A National Assessment of LGBTQ+ Curricular Needs in Pediatric Emergency Medicine Fellowship Programs.
Panzer ZR, Jones CD, Helwig S … +1 more , Bonachea EM
Pediatr Emerg Care · 2026 Apr · PMID 41414910 · Publisher ↗
OBJECTIVES: Although there has been an expansion of LGBTQ+curricula in graduate medical education, no studies evaluate LGBTQ+curricula in pediatric emergency medicine (PEM) fellowships. We evaluated: (1) the current stat...
OBJECTIVES: Although there has been an expansion of LGBTQ+curricula in graduate medical education, no studies evaluate LGBTQ+curricula in pediatric emergency medicine (PEM) fellowships. We evaluated: (1) the current state of curricula dedicated to LGBTQ+ topics and patient population in pediatric emergency medicine fellowships and (2) the current knowledge and attitudes of PEM fellows and program directors (PDs) relevant to the care of LGBTQ+youth. METHODS: An anonymous electronic survey was disseminated via REDCap from January to March 2024 to all current PEM PDs and fellows through the American Academy of Pediatrics' Section on Pediatric Emergency Medicine PEM PD Survey Committee. RESULTS: We received a response rate of 26% of PEM fellows (71/268) and 31% of PEM PDs (27/87) with representation from all regions of the United States. Seventy-eight percent of PEM fellows and 63% of PDs were unsatisfied with their current education on LGBTQ+topics. Overall, 24% of PEM fellows and 11% of PDs reported receiving no LGBTQ+education. Over 90% of PEM fellows and 70% of PDs believed it was important to understand LGBTQ+-related topics. Topics reported as commonly missing from their current curricula included LGBTQ+-related terminology and national and local resources available to this patient population. CONCLUSIONS: PEM fellows and PDs responding to our survey were not satisfied with their current curricula on LGBTQ+-related topics. An opportunity for improvement is the inclusion of commonly missed LGBTQ+ topics in PEM fellowship curricula. National opportunities include the creation of a standardized curriculum for PEM LGBTQ+-focused care.
Resuscitative Efforts by Emergency Medical Services for Neonates Within the First Six Hours of Life: A Nationwide Cross-Sectional Analysis.
Peters GA, Swanton MF, Walsh LV … +5 more , Ciccolo GE, Kaimal AJ, Samuels-Kalow ME, Camargo CA, Cash RE
Pediatr Emerg Care · 2026 Mar · PMID 41396274 · Full text
OBJECTIVE: The purpose of this study was to describe the prehospital care for neonatal resuscitations (age <6 h) encountered by emergency medical services (EMS) in the United States. METHODS: We conducted a cross-section...
OBJECTIVE: The purpose of this study was to describe the prehospital care for neonatal resuscitations (age <6 h) encountered by emergency medical services (EMS) in the United States. METHODS: We conducted a cross-sectional analysis of EMS patient care records in the 2018 and 2019 National EMS Information System Public Release Version 3.4 data sets. We included EMS activations related to a 9-1-1 scene response for patients <6 hours old with evidence of resuscitative efforts or an out-of-hospital cardiac arrest. We examined patient, community, emergency response, and clinical characteristics using descriptive statistics. RESULTS: A total of 580 EMS encounters were included, of which 184 (31.7%) involved out-of-hospital cardiac arrest. Median patient age was 30 minutes (IQR: 5 to 60). Most responses were by advanced life support (93.1%), and median total prehospital time was 32.8 minutes (IQR: 24.0 to 45.9). The majority of encounters took place in a private residence (73.3%) in an urban setting (83.2%). The patient was left on scene in 3.1% of encounters, and all others were transported to the hospital. Basic airway management was most often required (74.3%), oxygen was delivered in 43.5% of cases, and advanced airway management was performed in 5.7% of encounters. Field delivery was performed in 20.5% of encounters, and compressions/defibrillation were performed in 21.2% of cases. CONCLUSION: Prehospital neonatal resuscitation by EMS is uncommon but often requires advanced interventions rarely performed by EMS on newborn patients. These findings have important implications for EMS training and education, including the development of protocols, training programs, and other preparedness innovations for neonatal resuscitation specific to the prehospital setting.
Mindful Scanning: Lung Point of Care Ultrasound for Diagnosing Retroscapular Pneumonia in Children.
Cordone A, Constantine E, Riera A
Pediatr Emerg Care · 2026 Feb · PMID 41396189 · Publisher ↗
Diagnosing pneumonia in children presenting with nonspecific symptoms such as chest or back pain can be challenging. We present two cases in which specific positioning and ultrasonography technique were necessary to dete...
Diagnosing pneumonia in children presenting with nonspecific symptoms such as chest or back pain can be challenging. We present two cases in which specific positioning and ultrasonography technique were necessary to detect retroscapular consolidations, which traditionally have been thought to be difficult or impossible to visualize with point-of-care lung ultrasound (POCUS).
Pain Management in Children With Suspected Appendicitis in the Pediatric Emergency Department.
Moriel G, Pham PK, Chaudhari PP … +1 more , Liu DR
Pediatr Emerg Care · 2026 Apr · PMID 41396169 · Publisher ↗
OBJECTIVES: Abdominal pain is a common presenting symptom in the pediatric emergency department (ED), with appendicitis being the most common surgical emergency. Administration of analgesia, including opioids, has not be...
OBJECTIVES: Abdominal pain is a common presenting symptom in the pediatric emergency department (ED), with appendicitis being the most common surgical emergency. Administration of analgesia, including opioids, has not been shown to delay the diagnosis of appendicitis, yet oligoanalgesia remains a common occurrence. We aimed to determine the proportion of any analgesia and opioid analgesia administration, the median time to first analgesia administration, and to identify factors associated with the administration of any analgesia and opioid analgesia in patients with suspected appendicitis. METHODS: We conducted a single-center cross-sectional study of children less than 18 years of age evaluated in the pediatric ED from June 2014 to June 2021 for suspected appendicitis. Deidentified data were extracted from the electronic record through a data repository. Our primary outcomes were the administration of analgesia and the median time to first analgesia administration. We used descriptive statistics and multivariate regression analysis to compare independent influences on analgesia administration. RESULTS: During the 8-year study period, 7065 children were evaluated for appendicitis. Overall, 4821 (68.2%) received some form of analgesia, 3157 (44.7%) received nonopioid analgesia only, and 1664 (23.6%) received opioid analgesia during their ED visit. Overall median time to first analgesia was 104 minutes. Median time to first nonopioid analgesia and first opioid analgesia was 94.5 minutes and 136 minutes, respectively. Moderate and severe pain scores, fever, tachycardia, and higher ESI level of acuity were significantly associated with analgesia administration. CONCLUSIONS: Analgesia administration in children with suspected appendicitis varies considerably. Efforts to target more consistent and timely pediatric pain management practices are needed.
An Assessment of Child Life Service and Pain Management in Pediatric Trauma Patients.
Merritt M, Kasselman L, VanBuskirk B
Pediatr Emerg Care · 2026 Mar · PMID 41384322 · Publisher ↗
OBJECTIVE: The objective of this study is to investigate differences in pain outcomes for pediatric trauma patients who receive Child Life Services versus pediatric trauma patients who do not. METHODS: Retrospective char...
OBJECTIVE: The objective of this study is to investigate differences in pain outcomes for pediatric trauma patients who receive Child Life Services versus pediatric trauma patients who do not. METHODS: Retrospective chart reviews were completed on patients birth to 21 years of age who were seen by trauma services in the Emergency Department and various inpatient units. These individuals were characterized into 2 groups: those seen by child life specialists and those who were not. Pain scores were recorded by using the following scales: face, legs, activity, cry, consolability (FLACC), The Wong-Baker FACES, the Verbal Numeric Rating Score, and Critical Care Pain Observation Tool (CPOT). Baseline data included age, sex, race, injury type, Injury Severity Score (ISS), pain score, and length of stay. Patients were matched using the initial pain score and ISS score. An ordinal logistic model was built regressing pain at discharge on group (CLS visit or no CLS visit). Significance was set at P ≤0.05. RESULTS: One hundred ninety-six patients' data were used; 107 (54%) of them had been seen by child life specialists. The study groups had similar baseline demographics and injury severity scores. The pain score at discharge was significantly lower in children with child life services' visits (median=0, min=0, max=10) compared with those without [median=2, min=0, max=10; OR=0.48, 95% CI (0.28, 0.83), P =0.009]. CONCLUSIONS: Certified child life specialist involvement in pediatric trauma patients' care correlates to a lower pain score upon discharge.
Are Health Equity Rounds an Acceptable Format to Address Education on Implicit Bias and Structural Racism in Pediatric Emergency Settings?: A Mixed-Methods Study.
Sheridan N, Robinson A, Masud F … +2 more , de Schaetzen C, Tse S
Pediatr Emerg Care · 2026 Mar · PMID 41359488 · Publisher ↗
OBJECTIVES: Implicit bias and structural racism in pediatric health care cause significant inequities and poorer outcomes. To help educate pediatric health-care providers, health equity rounds (HER) engage teams in discu...
OBJECTIVES: Implicit bias and structural racism in pediatric health care cause significant inequities and poorer outcomes. To help educate pediatric health-care providers, health equity rounds (HER) engage teams in discussions on the impact of bias and racism on patient care using a case-based curriculum. This mixed-methods study assessed the feasibility and acceptability of incorporating HER in a pediatric emergency medicine (PEM) setting. METHODS: Two HERs, focusing on implicit bias in medicine (June 2021) and linguistic barriers to health care (December 2021), were completed during the institution's multidisciplinary, PEM update rounds. Cases presented were selected if patient care and/or outcomes were negatively affected, were appropriate for educational discussion and relevant to the presentation topic. HER participants were invited to complete an online survey and semi-structured interview post-HER to explore their experiences, including professional and personal impacts. RESULTS: Both HERs were well-attended and had a moderate survey uptake (20/25 vs. 14/22). Three-quarters of survey participants found HER engaging (80%), and believed the learned objectives would impact their clinical practice (73.7% vs. 78.6%). Responses varied between presentations for educational value (80% vs. 61.6%) and interest in future HERs (94.7% vs. 78.6%). Four themes emerged from 3 qualitative interviews: HER satisfaction and experience, influence on service provision, supports and resources, and ideas for future HERs. CONCLUSIONS: Our findings suggest HER is an acceptable and feasible forum for discussing and reflective practice on relevant topics in PEM educational sessions. Implementing HER in other specialized areas or settings and the impact of different topics should be explored further.
Practice-Change Pathway to Reduce Procedural Distress During Intussusception Reduction-A Quality Improvement Initiative.
Swed Tobia R, Daya T, Desai N … +4 more , Gilley M, Baird R, Poonai N, Sabhaney V
Pediatr Emerg Care · 2026 Feb · PMID 41354971 · Publisher ↗
OBJECTIVES: Intussusception is a medical emergency requiring reduction with a pneumatic or hydrostatic enema. Although evidence supports the safety of medications to reduce distress during the procedure, their use remain...
OBJECTIVES: Intussusception is a medical emergency requiring reduction with a pneumatic or hydrostatic enema. Although evidence supports the safety of medications to reduce distress during the procedure, their use remains limited. This quality improvement (QI) project aimed to provide analgesic and anxiolytic medications to all eligible patients undergoing pneumatic reduction within 1 year. METHODS: A multidisciplinary team developed a standardized clinical pathway to provide both intranasal fentanyl and midazolam for all patients undergoing intussusception reduction. The interventions included staff education, team engagement, and process interventions through sequential Plan-Do-Study-Act cycles. The primary outcome measure was pathway provision. Process measures included documentation of pain and sedation scores, while balancing measures assessed adverse events, failed reductions, and perforation rates. RESULTS: Over the project period, 25 patients were diagnosed with intussusception. Two patients with lead points proceeded directly to surgery. Among the 23 patients with planned pneumatic reduction, 19 (82%) had successful reductions, 2 had spontaneous reductions, and 2 required surgical intervention due to failed reductions. Pathway provision improved from 0% at baseline to 100% by the project's end. Pain score documentation reached 100%. No cases of serious adverse events or intestinal perforation were reported. Pathway compliance remained at 100% during the sustainment period. The interval number of days between patients who did not receive analgesia and anxiolysis was short initially but progressively lengthened. CONCLUSIONS: This QI initiative improved rates of analgesic and anxiolytic provision to reduce distress in patients undergoing intussusception reduction, without adverse outcomes. This project highlights the effectiveness of structured interventions in optimizing pediatric procedural pain management and potentially serves as a model for spread to other pediatric emergency departments.
Pediatric Epididymitis With Atypical Evolution: A Case of Testicular Necrosis and Review of Management Strategies.
Jaime Dávila R, Cornelio Ramos JI, Galván Hernández F … +2 more , Mata RR, González AG
Pediatr Emerg Care · 2026 Mar · PMID 41354938 · Publisher ↗
INTRODUCTION: Acute epididymitis (AE) in children usually responds to conservative therapy. However, in rare cases (1% to 2%), it may progress to severe complications such as testicular infarction or necrosis due to vasc...
INTRODUCTION: Acute epididymitis (AE) in children usually responds to conservative therapy. However, in rare cases (1% to 2%), it may progress to severe complications such as testicular infarction or necrosis due to vascular compromise. We report a case of progressive segmental testicular necrosis following presumed post-infectious AE after a recent viral respiratory illness. METHODS: An 8-year-old boy presented with a 2-day history of left testicular pain, swelling, and erythema. Initial Doppler ultrasound revealed epididymal enlargement, hyperemia, and reactive hydrocele without signs of torsion. Urine culture was collected, and empirical ibuprofen and trimethoprim-sulfamethoxazole were prescribed. RESULTS: Six days later, symptoms worsened with increased swelling and pain. Repeat Doppler ultrasound demonstrated hypoechoic avascular areas and reduced flow, consistent with necrosis. Urine, blood, and smegma cultures were negative. Surgical exploration revealed extensive testicular necrosis without torsion, leading to simple orchiectomy. Histopathology confirmed ischemic necrosis secondary to an inflammatory process. The observed evolution supports the concept of TCS, in which rising intratesticular pressure due to venous congestion and extraluminal compression within the noncompliant tunica albuginea leads to impaired microcirculatory perfusion and ischemic necrosis. CONCLUSIONS: Testicular necrosis is an exceedingly uncommon but serious complication of AOE in children. Persistent pain, increasing testicular size, or poor clinical response should prompt early Doppler reassessment and consideration of surgical exploration. Recognition of TCS as a possible pathophysiological mechanism may help guide timely diagnosis and intervention to prevent irreversible ischemic injury.
Comparative Evaluation of Different Pediatric Early Warning Scores in Predicting Clinical Outcomes in Pediatric Emergency Observation Units.
Tazegül M, Türkmen Karaağaç A, Güven Ş
Pediatr Emerg Care · 2026 Mar · PMID 41354861 · Publisher ↗
BACKGROUND: Pediatric early warning scores (PEWS) are designed to predict clinical deterioration and enhance patient management in emergency observation units. Several PEWS models exist, but few studies have compared the...
BACKGROUND: Pediatric early warning scores (PEWS) are designed to predict clinical deterioration and enhance patient management in emergency observation units. Several PEWS models exist, but few studies have compared their accuracy in predicting clinical outcomes. This study evaluated and compared the diagnostic performance of 4 PEWS models (Monaghan, Parshuram, Tibbals, Brilli) in our tertiary hospital's pediatric emergency department (PED). METHODS: A prospective observational cohort study was conducted from January to April 2023, involving 193 patients. The measured outcomes were discharge, ward admission, intensive care unit admission, and mortality. For each PEWS model, sensitivity, specificity, likelihood ratios, and the area under the receiver operating characteristic curve (AUC) were statistically analyzed. RESULTS: The median age of the patients was 4 years, with 57% males and 43% females. Primary diagnoses included respiratory, neurological, and gastrointestinal diseases. Ward admissions were 40.41%, and ICU admissions were 8.30%. Among the evaluated PEWS models, the one developed by Parshuram and colleagues exhibited the highest diagnostic accuracy in our PED. For ward admissions at a threshold score ≥4, the AUC was 0.678, with sensitivity 72.34% and specificity 63.27%. For ICU admissions at a threshold score ≥8, the AUC was 0.816, with sensitivity of 68.75% and specificity of 85.71%. CONCLUSION: PEWS are valuable tools for outcome assessment in PEDs. The Parshuram model demonstrated superior diagnostic performance in the studied population. However, the selection of an appropriate PEWS model and determination of suitable threshold scores should be tailored to the specific sociodemographic and clinical characteristics of each health care center.
Delayed Effect After Procedural Sedation With Oral Ketamine and Midazolam: A Case Series.
Del Pizzo J, McAndrew L
Pediatr Emerg Care · 2026 Feb · PMID 41330920 · Publisher ↗
In 2025, we reported our experience with the following regimen for pediatric ED procedural sedation: 6 mg/kg oral (PO) ketamine (max 200 mg) and 0.5 mg/kg PO midazolam (max 15 mg). We present 2 children who received this...
In 2025, we reported our experience with the following regimen for pediatric ED procedural sedation: 6 mg/kg oral (PO) ketamine (max 200 mg) and 0.5 mg/kg PO midazolam (max 15 mg). We present 2 children who received this regimen with respiratory depression after apparent recovery. PO ketamine and midazolam may cause a delayed sedative effect, which may limit its usefulness.
Calcitonin Gene-Related Peptide for Identifying Pediatric Bacterial Musculoskeletal Infections: A Prospective, Multicenter Study.
Kahane CG, Nigrovic LE, Yang D … +6 more , Majzoub JA, Kellogg MD, Kaplan RL, Cruz AT, Chiu IM, Lyons TW
Pediatr Emerg Care · 2026 Mar · PMID 41298312 · Publisher ↗
OBJECTIVES: Bacterial musculoskeletal infections (MSKIs) can be challenging to diagnose. We compared the accuracy of calcitonin gene-related peptide (CGRP), a neuropeptide which is transcribed from the same gene as proca...
OBJECTIVES: Bacterial musculoskeletal infections (MSKIs) can be challenging to diagnose. We compared the accuracy of calcitonin gene-related peptide (CGRP), a neuropeptide which is transcribed from the same gene as procalcitonin, to procalcitonin for the diagnosis of a MSKI in children. METHODS: We conducted a prospective cohort study of patients 21 years old or younger who underwent evaluation for MSKIs at one of 3 emergency departments. Our primary outcome was a MSKI, defined as septic arthritis, osteomyelitis, or pyomyositis. We used a Spearman correlation coefficient to measure the association between serum CGRP and procalcitonin and compared the diagnostic accuracy using area under the receiver operating characteristic curve (AUC) analysis. RESULTS: Of the 200 enrolled patients, 33 (17%) had a MSKI. Overall, median serum CGRP level did not differ between patients with and without a MSKI (13.5 pg/mL MSKI vs 10.9 pg/mL no MSKI; difference: 2.6, 95% CI: -0.6, 5.8), while PCT was higher in patients with a MSKI (0.12 ng/mL MSKIs vs 0.04 ng/mL no MSKI; difference: 0.08, 95% CI: 0.03 to 0.13). CGRP and PCT levels were not correlated (Spearman rank coefficient: -0.01, 95% CI: -0.15 to 0.13). CGRP had a lower AUC than procalcitonin [0.57, 95% CI: 0.47 to 0.66 CGRP vs 0.78, 95% CI: 0.69 to 0.87 PCT, P < 0.01]. CONCLUSIONS: Although biochemically related, CGRP was not correlated with procalcitonin in children undergoing evaluation for a MSKI. Our exploratory pilot highlights the ongoing need for novel biomarkers for the accurate and timely identification of children with a MSKI.
Pediatric Clonidine Toxicity: A Review.
Vaid RA, Shakeri S, Conners GP
Pediatr Emerg Care · 2025 Dec · PMID 41292070 · Publisher ↗
Clonidine is being increasingly prescribed in pediatric populations for behavioral conditions such as attention-deficit/hyperactivity disorder (ADHD), contributing to a rise in pediatric exposures and toxic ingestions. T...
Clonidine is being increasingly prescribed in pediatric populations for behavioral conditions such as attention-deficit/hyperactivity disorder (ADHD), contributing to a rise in pediatric exposures and toxic ingestions. This article reviews the toxicokinetics, clinical presentation, and management of pediatric clonidine toxicity. Children under 5 years old account for the highest proportion of clonidine exposures, most of which are unintentional. Clonidine toxicity mimics an opioid toxidrome, often presenting with CNS depression, miosis, bradycardia, and hypotension. Diagnosis is primarily clinical. While supportive care remains the core component of treatment, naloxone may be beneficial in reversing CNS depression, though higher-than-standard doses are often required. Given the potential for delayed and prolonged toxicity, particularly with ingestion of transdermal patches, early recognition and intervention are critical. This review equips clinicians to understand, diagnose, and manage pediatric clonidine toxicity, emphasizing the importance of supportive care and consideration of naloxone for severe cases.
Early Drainage Versus Antibiotic Treatment of Dental Abscesses in the Pediatric Emergency Department.
Gross I, Benenson-Weinberg T, Kadosh N … +6 more , Rushinek H, Nassar M, Rekhtman D, Pines N, Guzner N, Hashavya S
Pediatr Emerg Care · 2026 Feb · PMID 41276969 · Publisher ↗
OBJECTIVES: Dental abscesses are common pediatric emergencies requiring prompt intervention. It is unclear which treatment approach is superior in pediatric populations. This retrospective study compared outcomes between...
OBJECTIVES: Dental abscesses are common pediatric emergencies requiring prompt intervention. It is unclear which treatment approach is superior in pediatric populations. This retrospective study compared outcomes between pediatric patients treated with drainage and those managed with antibiotic treatment alone. METHODS: Data from 211 patients at 2 campuses of the same medical center were analyzed, assessing demographics, clinical presentation, laboratory findings, treatment modalities, and outcomes. RESULTS: Demographics, symptom duration, fever characteristics, or laboratory parameters were comparable between the two groups. There were no significant differences in hospitalization length or treatment failure rates. However, admission rates were significantly lower in the drainage group compared with the conservative treatment group (49% vs 63%, P = 0.04). CONCLUSION: Antibiotic treatment was found to be noninferior to drainage in terms of treatment failure and hospitalization duration, although admission rates were higher in the antibiotic treatment group. These findings suggest that antibiotic management may be an appropriate alternative in selected cases. Further prospective studies are needed to define the optimal treatment strategy based on clinical presentation and patient-specific factors.
Prevalence of Gender Identity and Incongruence in Adolescent Patients Presenting With Positive Behavioral Health Screens to a Pediatric Emergency Department.
Waddell R, Spray B, Crawley L … +4 more , Williams J, De Campos SB, Howard LE, Spiro DM
Pediatr Emerg Care · 2026 Feb · PMID 41267443 · Publisher ↗
OBJECTIVES: The objective of this study was to determine the prevalence of gender identity and gender incongruence among adolescents who screened positive for behavioral health concerns in a pediatric emergency departmen...
OBJECTIVES: The objective of this study was to determine the prevalence of gender identity and gender incongruence among adolescents who screened positive for behavioral health concerns in a pediatric emergency department. The study aimed to assess the relationship between gender incongruence, emotional distress, and suicidality. METHODS: This cross-sectional study was conducted in a single academic pediatric emergency department. Adolescents aged 13 to 18 years with positive behavioral health screens were approached for anonymous participation via electronic tablet without caregivers present. A validated self-report tool, the Gender Preoccupation and Stability Questionnaire-2 (GPSQ-2), was used to determine gender identity and sexual orientation. The primary outcomes were the prevalence of gender incongruence and gender identity. Secondary outcomes included levels of distress and suicidal ideation. Descriptive statistics and χ 2 or Fisher exact test were used for analysis. RESULTS: Among 131 eligible adolescents, 102 (78%) completed the study between August 2023 and August 2024 (mean age 15.1 y; 59% female at birth). Gender incongruence was reported by 16.6% (n=17), and 37% identified as nonheterosexual. Distress levels were significantly greater among gender-incongruent individuals compared with gender-congruent peers ( P <0.001). No statistically significant difference in suicidal ideation was observed between groups ( P =0.204). CONCLUSIONS: A higher than expected proportion of adolescents presenting with behavioral health concerns in a pediatric emergency setting reported gender identity and incongruence with associated psychological distress. If further studies confirm our results, these findings support incorporating inclusive screening practices and tailored mental health interventions in emergency care settings for adolescents at risk of self-harm.
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