Pediatric Emergency Care[JOURNAL]
Sun
200 papers
Ultrasound-Guided Nerve Block for Pediatric Femur Fractures: A Secondary Analysis of Needle Tip Distance.
Riera A, Lawson SL, Klekowski N … +9 more , Moake MM, Snelling PJ, Toney AG, Ng C, Pade KH, The TS, Shaahinfar A, Chaudoin LT, Binder ZW
Pediatr Emerg Care · 2026 Feb · PMID 41220086 · Publisher ↗
BACKGROUND: Fascia iliaca compartment nerve blocks (FICNB) have been shown to be an effective management strategy for pediatric femur fractures in the emergency department, but they can be performed using different techn...
BACKGROUND: Fascia iliaca compartment nerve blocks (FICNB) have been shown to be an effective management strategy for pediatric femur fractures in the emergency department, but they can be performed using different techniques. Our main objective was to evaluate the association between needle tip distance to the femoral nerve and pain score reduction following ultrasound-guided FICNB in pediatric patients with acute femur fractures. METHODS: We conducted a secondary analysis of a prospective, multicenter observational study conducted in the United States and Australia. Participants were children aged 4 to 17 years with isolated femur fractures who received a FICNB, divided into 2 groups based on ultrasound visualization of needle tip distance from the femoral nerve: ≥5 mm or <5 mm. The main outcome was a comparison of the mean pain score reduction between groups using the Faces Pain Scale-Revised (FPS-R). The FPS-R is a validated 0 to 10 continuous scale in which participants self-report their pain intensity. Pain scores were taken immediately before the nerve block (t 0 ) and 60 minutes postprocedure (t 60 ). In addition, adverse events were recorded. Differences in mean pain scores were analyzed using t tests, and categorical variables were compared with Fisher exact test. RESULTS: Of the 54 participants who received a FICNB (31 with needle tip ≥5 mm from the femoral nerve, 23 with needle tip <5 mm), 49 had a t 60 pain score available for analysis (30 in the ≥5 mm group, 19 in the <5 mm group). Pain scores at t 0 were similar between both groups. Both groups experienced a reduction in mean pain score at t 60 [≥5 mm group 3.5 vs <5 mm group 4.6, difference between groups: 1.1 (95% CI, -0.6 to 2.7)]. No serious adverse events were reported. CONCLUSION: In pediatric patients with acute femur fractures, needle tip distance from the femoral nerve does not seem to be associated with a difference in pain score reduction or the occurrence of serious adverse events.
Comparison of Adenosine Administration Utilizing a Single-Syringe Versus a Double-Syringe Method in a Simulated Pediatric Patient.
Schafer B, Steidl KE, Burgess JL … +4 more , Calleo V, Rose P, Su M, Seabury R
Pediatr Emerg Care · 2026 Feb · PMID 41178114 · Publisher ↗
OBJECTIVES: The primary objective was to compare adenosine administration time with the single syringe (SS) versus double syringe (DS) method in a simulated pediatric emergency department (ED) patient. Secondary objectiv...
OBJECTIVES: The primary objective was to compare adenosine administration time with the single syringe (SS) versus double syringe (DS) method in a simulated pediatric emergency department (ED) patient. Secondary objectives were to compare preparation time, preparation errors, administration errors, and participant preference/perception. METHODS: This was a prospective, randomized, crossover simulation study. Adenosine doses were prepared by a pharmacist and administered by a physician. The primary outcome was administration time. Secondary outcomes were preparation times, participant preference, pharmacist-rated ease of preparation, and physician-rated ease of administration. RESULTS: Sixteen pharmacist-physician pairs were included. The SS method had a shorter administration time versus the DS method [SS, median (IQR): 13 (10 to 15.8) s versus DS, median (IQR): 26 (20.8 to 31.3) s, P <0.001; median difference (95% CI): -13 (-22.5 to -9) s]. There were no significant differences in preparation times or pharmacist-rated ease of administration between the SS and DS methods. The SS method had a higher physician-rated ease of administration and was preferred by 68.8% of study participants. CONCLUSIONS: The SS method had a faster adenosine administration time versus the DS method in a simulation setting, while also having similar preparation time, preparation errors, and administration errors. The SS method was rated easier to administer and preferred by most participants. Further study is required, as this study is limited by its simulation design and lack of clinical outcomes.
Nurse-Led Visits Reduce In-Person Referral From Urgent Care Telehealth.
Mason A, Whitt M, Skoglund D … +4 more , Sifers L, Johnson J, Black A, Nedved A
Pediatr Emerg Care · 2026 Feb · PMID 41177995 · Publisher ↗
OBJECTIVE: To evaluate the impact of nurse-led visits on in-person referrals for clinical evaluation from pediatric urgent care telehealth. METHODS: We conducted this quality improvement study within our 3 freestanding i...
OBJECTIVE: To evaluate the impact of nurse-led visits on in-person referrals for clinical evaluation from pediatric urgent care telehealth. METHODS: We conducted this quality improvement study within our 3 freestanding in-person pediatric urgent care clinics and telehealth service. In May 2022, we implemented nurse-led visits to offer diagnostic and therapeutic interventions including rapid group A streptococcal testing, urinalysis, respiratory viral testing, and intramuscular antibiotic injections without requiring an additional clinical evaluation following a telehealth encounter. We measured the percentage of telehealth encounters with in-person referrals as the primary outcome. We tracked the percentage of encounters with nurse-led visits and return visits within 72 hours as process and balancing measures, respectively. We used control charts to identify special cause variation over time. RESULTS: In-person referrals following telehealth visits decreased from 23.0% to 12.3% after implementing nurse-led visits. The use of nurse-led visits increased over time from 4.0% to 6.8%. Rapid group A streptococcal testing accounted for most nurse-led visits (64.0%). Only 2.8% of nurse-led visits resulted in return visits within 72 hours. Nurse-led visits were associated with shorter length of stays (32 min) compared with in-person clinical evaluations (69 min) and had an average cost-savings of $135 compared with visits of similar medical complexity. CONCLUSION: Integrating nurse-led visits into urgent care telehealth encounters provides a safe and effective option for diagnostic and therapeutic interventions in the virtual setting. The results support the use of nurse-led visits to expand access to high-quality acute care, reduce unnecessary referrals, and promote evidence-based practice.
Selective Use of Magnetic Resonance Imaging for Facial Palsy in the Pediatric Emergency Department.
Kim DH, Chun MK, Lim SY … +5 more , Choi SJ, Lee JY, Han J, Lee JS, Park JS
Pediatr Emerg Care · 2026 Jan · PMID 41177779 · Full text
OBJECTIVES: This retrospective observational study evaluated the diagnostic efficiency of routine magnetic resonance imaging (MRI) in pediatric patients with facial palsy (FP) in the emergency department (ED). METHODS: P...
OBJECTIVES: This retrospective observational study evaluated the diagnostic efficiency of routine magnetic resonance imaging (MRI) in pediatric patients with facial palsy (FP) in the emergency department (ED). METHODS: Pediatric patients under 18 years of age who presented with FP at the ED of a single tertiary referral hospital between January 2010 and December 2022 were included. Clinical features were assessed and used for risk stratification, which informed the diagnostic utility of the MRI. RESULTS: A total of 134 pediatric patients were included [mean age, 99 mo; 53.7% male (n = 72)]. Seventeen patients (12.7%) were diagnosed with central FP (CFP). Among the clinical features, additional neurological examination abnormalities emerged as the most significant risk factor for CFP (odds ratio, 86.3; P < 0.001). Risk stratification based on neurological abnormalities, underlying conditions, and associated symptoms revealed that the diagnostic utility of MRI was significantly higher in the risk group than in the no-risk group ( P < 0.001; sensitivity, 100%; specificity, 84.6%). In contrast, patients in the no-risk group who underwent MRI experienced a mean increase of 294 minutes in the ED length of stay compared with those who did not undergo imaging. CONCLUSIONS: Routine MRI is valuable for detecting CFP in pediatric patients with neurological signs. However, its use in low-risk cases may provide limited clinical benefit, prolonging ED stay and increasing unnecessary use of medical resources. Therefore, selective imaging based on clinical indicators is recommended.
Assessing Pediatric CPR Practices in the Prehospital Setting: EMS Clinician Experience, Perceptions, and Resource Utilization.
Kleinman K, Jeffers JM, Tackett S … +3 more , Leppert M, Billings E, Anders JF
Pediatr Emerg Care · 2026 Feb · PMID 41171615 · Full text
OBJECTIVES: Pediatric out-of-hospital cardiac arrest (OHCA) is rare but critical, requiring rapid and effective cardiopulmonary resuscitation (CPR). Delivering high-performance CPR (HPCPR) in the prehospital setting is c...
OBJECTIVES: Pediatric out-of-hospital cardiac arrest (OHCA) is rare but critical, requiring rapid and effective cardiopulmonary resuscitation (CPR). Delivering high-performance CPR (HPCPR) in the prehospital setting is challenging, especially for EMS clinicians with limited pediatric exposure. This study aimed to assess EMS clinicians' pediatric CPR experience, confidence in HPCPR, and access to CPR feedback systems. A secondary objective was to evaluate perceptions of augmented reality (AR) feedback systems. METHODS: A cross-sectional survey was distributed electronically to EMS clinicians in 5 Maryland counties from January to May 2024. The survey included items on demographics, CPR experience, confidence in pediatric resuscitation, feedback device usage, and opinions on AR-based guidance. Descriptive and comparative analyses were conducted based on clinician type, experience, and administrative role. RESULTS: Fifty-eight EMS clinicians participated. While 78% had performed pediatric CPR, experience differed significantly by clinician type and years of service. Paramedics (87%) and clinicians with >6 years' experience (87%) had greater exposure than EMTs (46%) and less experienced clinicians (42%) ( P <0.05). Confidence in HPCPR was higher for adults (98%) than for infants (84%) and toddlers (83%). Only 52% had access to pediatric CPR feedback devices, although 97% of users reported improved CPR quality. Among those without access, 93% believed feedback would improve performance. Interest in AR feedback was moderate; barriers included cost, reliability, and training. CONCLUSIONS: EMS clinicians vary in pediatric CPR experience and access to performance tools. Expanded pediatric training and real-time feedback technologies may improve prehospital resuscitation outcomes.
Response to Concerns on "Ketorolac as an Analgesic in Pediatric Acute Pain Management: A Systematic Review and Meta-analysis".
Alsabri M, Adel Diab R, Alqeeq BF
Pediatr Emerg Care · 2025 Nov · PMID 41162825 · Publisher ↗
Abstract loading — click title to view on PubMed.
Presentation and Diagnosis of Spondylolysis.
Arant KR, Canastra NG, Zonfrillo MR … +2 more , Eberson CP, Cruz AI
Pediatr Emerg Care · 2025 Nov · PMID 41162824 · Publisher ↗
Spondylolysis is a defect of the pars interarticularis resulting from developmental or acquired stress. It is a common injury in children, and while most patients are asymptomatic, spondylolysis may also lead to signific...
Spondylolysis is a defect of the pars interarticularis resulting from developmental or acquired stress. It is a common injury in children, and while most patients are asymptomatic, spondylolysis may also lead to significant back pain. There should be an index of clinical suspicion for patients presenting to the emergency department with back pain, and various radiographic modalities can be used for diagnosis, with referral to ongoing and definitive treatment.
Corrected QT Intervals in the Pediatric Emergency Department: Don't Be Misled.
Wilson JA, Dasgupta S, Johnsrude C
Pediatr Emerg Care · 2026 Jan · PMID 41140108 · Publisher ↗
OBJECTIVES: Pediatric health care providers request electrocardiograms (ECGs) for diverse clinical presentations, and are understandably concerned when the corrected QT (QTc) interval is prolonged. Subsequent confirmatio...
OBJECTIVES: Pediatric health care providers request electrocardiograms (ECGs) for diverse clinical presentations, and are understandably concerned when the corrected QT (QTc) interval is prolonged. Subsequent confirmation by pediatric cardiologists often finds that the unconfirmed QTc intervals previously displayed on ECGs were inaccurate. We evaluated the principal factors responsible for disparate QT/QTc intervals, and highlight the impact on decision-making. We include a straightforward approach to determine accurate QTc intervals for providers awaiting finalized interpretations. METHODS: Two hundred pediatric cardiologist-confirmed pediatric ECGs were analyzed to evaluate differences between automated unconfirmed and cardiologist-confirmed QT interval measurements. QTc intervals were calculated using Bazett formula (QTcB), and frequency of normal, borderline, and abnormally prolonged QTcB were compared between unconfirmed and confirmed interpretations. The mean QT interval and heart rate for the cohort were used to calculate QTc values using contemporary non-Bazett formulae. RESULTS: Automated QT and QTcB intervals were longer than confirmed values by ~25 ms and ~30 ms, respectively ( P < 0.0001). The QTcB of 19/200 (~10%) unconfirmed ECGs were borderline or abnormally prolonged, compared with a single confirmed ECG with a borderline QTcB. QTc values using common non-Bazett formulae were markedly shorter than QTcB. CONCLUSIONS: The QTc values displayed on unconfirmed pediatric ECGs are often different from those subsequently adjudicated by cardiologists, and may substantially influence clinical impressions and decision-making by primary providers. Providers in the pediatric ED should be aware that variable methods and algorithms "behind the scenes" cause these variations, and have tools to confirm QTc values in advance of delayed confirmation by a cardiologist.
Care or Crisis? Exploring Variations in Emergency Department Management of Pediatric Suicide Risk.
Prichett LM, Fujii-Rios H, Finney A … +1 more , Haroz EE
Pediatr Emerg Care · 2026 Feb · PMID 41134645 · Publisher ↗
OBJECTIVES: Acute care settings often serve as the first point of contact for pediatric patients at risk of suicide, requiring clinicians to make complex decisions about care. There is significant variability in suicide...
OBJECTIVES: Acute care settings often serve as the first point of contact for pediatric patients at risk of suicide, requiring clinicians to make complex decisions about care. There is significant variability in suicide risk management across pediatric emergency departments (EDs) in the United States. In this work, we examined the care provided to pediatric patients with suicide risk in the ED setting and whether this care varies by key demographic factors, such as age, race, sex, or income status. METHODS: In this retrospective analysis of electronic health record (EHR) data from 2 pediatric ED settings, we used a series of mixed multilevel regression models to evaluate differences in ED length of stay, admission, and the odds of ordered home psychotherapeutic medications or intramuscular restraint medications in patients with identified suicide risk. RESULTS: Among visits with identified suicide risk, patients with private insurance were more likely to have home psychotherapeutic medication ordered (aOR: 1.74, 95% CI: 1.25-2.43). Compared with White patients, Black patients had a 23% shorter LOS (aIRR: 0.77, 95% CI: 0.65-0.91), were 65% less likely to receive ED-ordered home psychotherapeutic medication (aOR: 0.35, 95% CI: 0.25-0.49), and were 48% less likely to be admitted (aOR: 0.52, 95% CI: 0.35-0.76). Hispanic/Latino patients had 72% lower odds of receiving ED-ordered home psychotherapeutic medication (aOR: 0.28, 95% CI: 0.16-0.49). CONCLUSIONS: There is substantial variation in the emergency care of youth presenting with suicide risk. Our findings demonstrate significant differences in LOS, discharge disposition, and ED-medication management across insurance types and racial and ethnic groups.
Association Between Hyperuricemia and Dehydration in Children With Acute Gastroenteritis.
Kim HJ
Pediatr Emerg Care · 2026 Feb · PMID 41128445 · Publisher ↗
OBJECTIVES: Acute gastroenteritis (AGE) is one of the most common diseases in children, and detecting dehydration status is important for managing it. Volume depletion and altered urate excretion through the gastrointest...
OBJECTIVES: Acute gastroenteritis (AGE) is one of the most common diseases in children, and detecting dehydration status is important for managing it. Volume depletion and altered urate excretion through the gastrointestinal tract can cause hyperuricemia. This study aimed to evaluate the role of hyperuricemia in assessing the severity of dehydration in children. METHODS: This retrospective study included patients aged 7 to 18 years who were diagnosed with AGE. We used both the clinical dehydration scale and measured amount of weight loss at the time of emergency room visiting to evaluate the dehydration status. Age-based and sex-based reference values of uric acid were used to define hyperuricemia. RESULTS: Of the 95 patients with AGE, 40 (42.1%) showed moderate-to-severe dehydration. Hyperuricemia was observed in 44 (46.3%) patients and was more common (95.0 vs. 10.9%, P <0.001) in patients with moderate-to-severe dehydration than in those with mild dehydration. In multivariate analysis, hyperuricemia (OR: 5.13; 95% CI: 2.453-10.526) and bicarbonate levels <15 mmol/L (OR: 3.25; 95% CI: 0.225-7.259) were significant factors associated with moderate-to-severe dehydration. CONCLUSIONS: Uric acid levels were correlated with dehydration in children with AGE.
Sketching Silence: Exploring the Use of Children's Drawings as an Early Bullying Detection Tool.
Mongillo DL, Waseem M, Fields PJ
Pediatr Emerg Care · 2026 Feb · PMID 41104702 · Publisher ↗
OBJECTIVES: Can an innovative projective drawing test assist children in disclosing their bullying exposure? Bullying leads to recurrent emergency department visits for physical or emotional trauma, hindered by children'...
OBJECTIVES: Can an innovative projective drawing test assist children in disclosing their bullying exposure? Bullying leads to recurrent emergency department visits for physical or emotional trauma, hindered by children's reluctance to verbalize. Identifying patterns, referred to as graphic indicators, can characterize forms of trauma linked to bullying. METHODS: Sixty-four children aged 7 to 18 years with psychosomatic complaints at a pediatric hospital emergency department were asked to draw themselves on paper. Drawings were scored blindly by counting the frequency of 22 graphic indicators on self-figure drawings used to assess various forms of child abuse. Children were categorized using the Illinois Bully Scale score. Discriminant analysis evaluated the relative weighting of the 22 graphic indicators, aiming for optimal discrimination between the bullied and non-bullied groups. ROC analysis was utilized to maximize the diagnostic accuracy of the drawing test. RESULTS: Four graphic indicators emerged as potential markers of bullying: (1) missing legs or feet, (2) dots, hollowed or crossed eyes, (3) double line, hollowed, or shaded facial contours, and (4) asymmetric or horizontal arm positions. Discriminant scores ranged from 0.00 (indicating no bullying) to 4.76 (indicating bullying). The criterion separating the two groups was a discriminant score >1.90. The resulting area under the curve was 0.88 ( P < 0.001), indicating good predictive ability. The test demonstrated a sensitivity of 69% and a specificity of 91%. CONCLUSIONS: Identifiable drawing cues in children may signal bullying, highlighting the need for further research to develop a standardized tool for early identification of bullying exposure before it can be applied in practice.
Decreased Lumbar Puncture Utilization Following Implementation of Febrile Infant Guidelines in a Pediatric ED.
Guernsey D, Horner C, Patel P
Pediatr Emerg Care · 2026 Feb · PMID 41094731 · Publisher ↗
BACKGROUND: Fever in infants under 60 days old raises concern for invasive bacterial infections. In 2021, the American Academy of Pediatrics (AAP) released updated guidelines, including revised recommendations for infant...
BACKGROUND: Fever in infants under 60 days old raises concern for invasive bacterial infections. In 2021, the American Academy of Pediatrics (AAP) released updated guidelines, including revised recommendations for infants aged 22 to 28 days, to reduce unnecessary lumbar punctures (LP), hospitalizations, and antibiotic use. This study hypothesized that the guidelines would reduce LPs, specifically in the newly stratified age group. METHODS: We conducted a retrospective cohort study at a single pediatric emergency department of febrile infants aged 22 to 60 days presenting between October 1, 2019, and September 30, 2023, with October 1, 2021, being the division between groups. Infants were excluded if ill-appearing, <37 weeks of gestation, or had complex medical histories. The primary outcome was the proportion undergoing LP. Subgroup analysis was performed by age group, and those identified as low-risk by initial laboratory evaluation. Secondary outcomes included hospital admission, length of stay, and antibiotic use. RESULTS: A total of 132 infants met the inclusion criteria (52 pre-guidelines, 80 post-guidelines), and no exclusion criteria were applied. Following guidelines, the proportion of LPs had a statistically significant decrease ( P =0.02), with the reduction maintained in the 22- to 28-day subgroup ( P =0.002). The rate of hospital admission and antibiotics followed a similar statistically significant decrease post-guideline introduction, which also maintained for the 22- to 28-day subgroup. There was no statistically significant difference for length of stay or in the 29- to 60-day subgroup analyses. For infants identified as low-risk by laboratory risk-stratification, we discovered a statistically significant reduction in LP following the guidelines ( P <0.001). CONCLUSIONS: Implementation of the 2021 AAP guidelines was associated with reduced LPs, hospitalizations, and antibiotic use in infants aged 22 to 60 days, with the greatest impact in the 22- to 28-day subgroup. These guidelines improve risk stratification and reduce invasive interventions while maintaining safe care. While the small sample size limits generalizability, these findings suggest a positive shift in clinical practice.
Cannabis Use Patterns and Blood Profiles in Adolescent Cannabinoid Hyperemesis Syndrome.
Bloom J, Beaudoin FL, Lin TR … +3 more , Gaipo A, Ortega C, Wightman RS
Pediatr Emerg Care · 2026 Jan · PMID 41088881 · Publisher ↗
OBJECTIVE: Adolescent use of cannabis in the United States is on the rise. Multiple toxicities and negative outcomes are possible with chronic or heavy cannabis use, including cannabinoid hyperemesis syndrome (CHS). This...
OBJECTIVE: Adolescent use of cannabis in the United States is on the rise. Multiple toxicities and negative outcomes are possible with chronic or heavy cannabis use, including cannabinoid hyperemesis syndrome (CHS). This study analyzes a population of adolescent emergency department patients with cyclic vomiting onset after cannabis use, with a hypothesis that use patterns or biomarkers may offer insights into diagnostics, pathophysiology, or management of this disease. METHODS: This pilot prospective observational cohort study recruited pediatric emergency department patients aged 14 to 21 years with symptomatic cyclic vomiting onset after chronic cannabis use, and reassessed them at an asymptomatic follow-up visit. Cannabis use patterns were assessed with validated questionnaires, and blood profiles of cannabinoid metabolites and essential minerals and B vitamins were quantified and compared. RESULTS: We screened 869 adolescent ED patients and enrolled ten participants. All participants (n=10) had cannabis use disorder (n=9) or hazardous cannabis use (n=1) by the Cannabis Use Disorders Identification Test-Revised, and participants reported withdrawal symptoms when attempting to discontinue cannabis. There were significant differences in 11-hydroxy-delta-9-tetrahydrocannabinol between index [median 0.6 ng/mL (IQR: 0, 2.6)] and asymptomatic follow-up visits [median 4.2 ng/mL (IQR: 1.2, 10.1)]. Median vitamin and mineral concentrations were within reference ranges. CONCLUSIONS: Symptomatic adolescent patients with suspected CHS had evidence of cannabis use disorder and had significantly lower blood concentrations of 11-hydroxy-delta-9-tetrahydrocannabinol when symptomatic. Further research is needed to better explore the pathophysiology and diagnostics in adolescent CHS, and exploration and treatment of cannabis use disorder should be considered in these patients.
Standardization of Discharge Instructions by Age for Children Presenting to the ED With Mild Traumatic Brain Injury: A Quality Improvement Project.
Rana NK, Gerber NL, Osorio SN … +4 more , Alfonzo MJ, Rose SC, Beauchamp MH, Levine DA
Pediatr Emerg Care · 2026 Jan · PMID 41088525 · Publisher ↗
INTRODUCTION: Mild traumatic brain injuries (mTBI) are common in pediatric emergency departments (EDs), but inconsistent use of diagnostic labels leads to variable discharge instructions, especially with regard to concus...
INTRODUCTION: Mild traumatic brain injuries (mTBI) are common in pediatric emergency departments (EDs), but inconsistent use of diagnostic labels leads to variable discharge instructions, especially with regard to concussion. Lack of age-appropriate guidance can increase parental anxiety and ED revisits and hinder recovery. OBJECTIVE: This quality improvement (QI) initiative aimed to increase the proportion of mTBI patients receiving age-appropriate discharge instructions to 50% over 13 months in an urban pediatric ED. METHODS: An interdisciplinary QI team conducted an observational time series study with sequential experimentation at a quaternary academic medical center over 13 months. Using a key driver diagram, they created SMART aim, measures, and designed interventions which were tested through 5 Plan-Do-Study-Act (PDSA) cycles. Interventions included an educational curriculum, e-reminders, workspace materials, and pre-written electronic medical record (EMR) templates (smart phrases) for age-specific discharge instructions (0 to 5 y, ≥6 y), and parent surveys were used on a subset of sample families to assess knowledge, behavior, and anxiety post-discharge. Outcome measures included the percentage of age-appropriate discharge instructions provided and use of the new EMR smart phrase. Balancing measures tracked head computed tomography (CT) utilization, ED revisits within 14 days of discharge, and neurology referrals. Process control charts and rules to detect special cause variation were used to analyze data. We use descriptive statistics to analyze survey data. RESULTS: Among 1263 patients, age-appropriate discharge instruction rates improved from 36% to 56%. Smart phrases were used in 58% of relevant cases (n=628). No changes were observed in CT orders, ED revisits, or neurology referrals. Among 37 surveyed parents (28% response rate), 95% (n=35) found instructions helpful, and 68% (n=25) reported reduced anxiety. CONCLUSIONS: Implementing EMR smart phrases in a pediatric ED increased standardized, age-appropriate discharge instructions for children with mTBI. These low-cost interventions are scalable for broader ED use and other settings.
Distribution of Nonstandard Inflammatory and Cardiac Biomarker Levels in Children With Fever and Viral or Nonspecific Illness.
Steinberg DN, McLaren SH, Aschheim K … +2 more , Dayan PS, Lubell TR
Pediatr Emerg Care · 2026 Jan · PMID 41056077 · Publisher ↗
OBJECTIVES: To describe the distribution of laboratory values for nonstandard inflammatory and cardiac biomarkers in otherwise healthy children presenting to the pediatric emergency department (PED) with fever and viral...
OBJECTIVES: To describe the distribution of laboratory values for nonstandard inflammatory and cardiac biomarkers in otherwise healthy children presenting to the pediatric emergency department (PED) with fever and viral or nonspecific illness. METHODS: Single-center retrospective study of otherwise healthy children 3 months to 20 years presenting to the PED with fever and had a laboratory evaluation for multisystem inflammatory syndrome in children (MIS-C) between April 15, 2020 and January 24, 2022. All patients had NT-pro-b-natriuretic peptide (NT-proBNP) or troponin obtained (as part of an institutional pathway for MIS-C evaluation) during this period. Children with comorbidities, MIS-C, Kawasaki disease, myocarditis, or definitive non-viral illness were excluded. We summarized d-dimer, ferritin, troponin, and NT-proBNP distributions using descriptive statistics. One-way analysis of variance tested for differences among 3 disease categories: non-SARS-CoV-2 viral illness, fever not otherwise specified (NOS), and SARS-CoV-2 infection. Outlier values were identified as three times the interquartile range above the third quartile on box-and-whisker plots. RESULTS: Of 134 eligible patients, 50, 65, and 19 were categorized as non-SARS-CoV-2 viral illness, fever NOS, and SARS-CoV-2 positive illness, respectively. Median age was 2 years. Median fever duration was 4 days, with 124/134 (93%) described as well-appearing and 112/134 (84%) discharged home. The median values for all biomarkers were within institutional laboratory reference ranges, with all distributions skewed to lower values, and without statistically significant differences between disease categories ( P > 0.05). D-dimer values were above the institutional reference range in 43/97 (44%), ferritin was above the reference range in 24/114 (21%), NT-proBNP was above the reference range in 26/123 (21%), and troponin levels were outside the range in 4/123 (3%). Thirteen patients had extreme outlier values. CONCLUSIONS: Otherwise healthy children presenting to the PED with a fever and viral or nonspecific illnesses may frequently have elevated serum d-dimer, ferritin, and NT-proBNP above institutional reference ranges. Troponin elevation was infrequent.
Optimizing Pediatric Trauma Team Performance Through Interdisciplinary Trauma Simulation and Feedback From Trauma Code Video Analysis.
Dikranian LC, Oag K, Vitale L … +3 more , Malaniak M, Thomas R, Levasseur K
Pediatr Emerg Care · 2026 Jan · PMID 41041905 · Publisher ↗
INTRODUCTION: Trauma is a leading cause of pediatric emergency visits, yet training often underemphasizes nontechnical skills (NOTECHS). Simulation-based training can improve these skills, and targeted video review (TVR)...
INTRODUCTION: Trauma is a leading cause of pediatric emergency visits, yet training often underemphasizes nontechnical skills (NOTECHS). Simulation-based training can improve these skills, and targeted video review (TVR) may further enhance debriefings by enabling precise, case-based feedback. This study evaluated the combined impact of multidisciplinary, simulation-based training and TVR on technical performance and NOTECHS during pediatric trauma resuscitations. METHODS: This prospective educational quality improvement study was conducted at a level 1 pediatric trauma center from February 2023 to July 2023. Multidisciplinary teams participated in in situ pediatric trauma simulations followed by structured debriefings incorporating TVR. Video reviews of preintervention and postintervention trauma activations (n = 76) assessed changes in team behavior and clinical metrics, including time-to-vitals, imaging, emergency department (ED) length of stay (LOS), and time-to-operating room (OR). Trauma performance was evaluated using the Trauma Team Evaluation Tool and T-NOTECHS. RESULTS: Seventy-six trauma activations (21 preintervention, 55 postintervention) were reviewed. Postintervention, the proportion of cases without an identified team leader decreased (33% to 9.1%), and those with a defined disposition plan increased (66.7% to 100%). Overall team performance improved (6.52 to 7.60/10; P < 0.001), with significant gains in communication and situational awareness ( P = 0.012 and P = 0.033, respectively). Time-to-vitals decreased significantly ( P = 0.027); while imaging, ED LOS, and time-to-OR showed nonsignificant changes. CONCLUSIONS: Simulation-based interdisciplinary training, paired with TVR improved teamwork, communication, and decision-making in pediatric trauma resuscitations. This approach reinforced protocol adherence and supported quality improvement. While effects on patient outcomes remain uncertain, these findings support simulation and TVR as strategies to enhance performance in high-acuity settings.
Utility of Shock Index and Pediatric Age-Adjusted Shock Index in Predicting Severe Sepsis and Septic Shock.
Yaradilmiş RM, Göktuğ A, Bodur İ … +9 more , Öztürk B, Aydin O, Güneylioğlu MM, Akkaya B, Erdem FŞ, Özcan AS, Güngör A, Karacan CD, Tuygun N
Pediatr Emerg Care · 2026 Jan · PMID 41039708 · Publisher ↗
INTRODUCTION: Early recognition of severe sepsis and septic shock in the pediatric emergency department (PED) is crucial for the success of early targeted therapy. The shock index (SI) and pediatric age-adjusted shock in...
INTRODUCTION: Early recognition of severe sepsis and septic shock in the pediatric emergency department (PED) is crucial for the success of early targeted therapy. The shock index (SI) and pediatric age-adjusted shock index (SIPA) are promising noninvasive tools for early risk stratification. This study aimed to evaluate the predictive performance of SI, SIPA, and modified indexes in severe outcomes. METHODS: This single-center retrospective cohort study included 238 pediatric patients aged 1 month to 18 years who met systemic inflammatory response syndrome criteria. Clinical findings and vital signs were collected at presentation. SI, SIPA, and modified indices were calculated using heart rate and systolic blood pressure. Biomarkers, including lactate and immature granulocyte percentage (IG%), were also recorded. RESULTS: Of 238 patients, 49 (20.6%) had severe sepsis or septic shock. SI ≥1.81 showed an AUC of 0.815, sensitivity of 81.6%, and specificity of 67.7%. SIPA had a sensitivity of 91.8% but a lower specificity (45.0%). Pediatric Shock Index and Temperature-adjusted and Age-adjusted Mean Shock Index had AUCs of 0.443 and 0.734, respectively. Age-specific SI cutoffs improved predictive performance, particularly in younger children. Combining SI with IG% or lactate enhances diagnostic accuracy. CONCLUSIONS: SI and SIPA are practical tools for early recognition of severe sepsis in children. Age-adjusted SI cutoffs improve accuracy. Diagnostic performance was further enhanced when combined with IG% and lactate, supporting their integration in PED clinical decision-making.
Resources Utilization May Not Accurately Reflect the Validity of Triage Scales.
Mirhaghi A
Pediatr Emerg Care · 2025 Oct · PMID 41028950 · Publisher ↗
Abstract loading — click title to view on PubMed.
Ultrasound-Guided Regional Analgesia in the Pediatric Emergency Department.
Shaahinfar A, Klekowski N, Kangwa M … +2 more , Parker MG, Binder ZW
Pediatr Emerg Care · 2025 Oct · PMID 41028949 · Publisher ↗
Ultrasound-guided regional analgesia (UGRA) is a valuable component of a multimodal approach to pain management for children in the emergency department (ED). While widely used in pediatric anesthesiology, its adoption i...
Ultrasound-guided regional analgesia (UGRA) is a valuable component of a multimodal approach to pain management for children in the emergency department (ED). While widely used in pediatric anesthesiology, its adoption in the pediatric ED setting remains limited despite growing evidence supporting its safety and efficacy. UGRA can provide effective analgesia for pediatric patients with painful conditions while reducing reliance on opioids. However, successful implementation of a pediatric UGRA program requires structured training, multidisciplinary collaboration, and workflow optimization. This review summarizes the evidence base for pediatric UGRA, highlights key pediatric considerations for emergency providers, and outlines strategies for program implementation, including educational resources and system-based approaches to ensure safe and effective use in the pediatric ED setting.
Variation in Availability and Ability to Share Data in a Global Pediatric Emergency Medicine Research Network.
Chamberlain J, Kuppermann N, Nigrovic LE … +14 more , Craig S, Yock-Corrales A, Babl FE, Klassen TP, Oostenbrink R, Schuh S, Florin TA, Dalziel SR, Pavlicich V, Lyttle MD, Plint A, Mintegi S, Bressan S, Roland D
Pediatr Emerg Care · 2025 Oct · PMID 41028948 · Publisher ↗
OBJECTIVES: Electronic health record data holds promise for collaborative research involving very large sample sizes with diverse populations. We performed this study to determine, in an international network, the types...
OBJECTIVES: Electronic health record data holds promise for collaborative research involving very large sample sizes with diverse populations. We performed this study to determine, in an international network, the types of data available and the ease of obtaining such data, and to develop a qualitative understanding of privacy and data security regulatory frameworks. METHODS: We performed an electronic survey of members of the Pediatric Emergency Research Networks, a voluntary association of 8 research networks. The survey included (1) Likert scale responses for ease of obtaining specific data types; and (2) Likert scale and open-ended questions about barriers and enablers to sharing data internationally, including establishing ongoing clinical data registries. RESULTS: Of 263 surveyed, 127 (48%) responded. While ~25% of all sites can access data easily, more than 25% of sites reported moderate difficulty. Visit identifiers, patient identifiers (allowing tracking of patients longitudinally), and some emergency department (ED) visit data (eg, patient age, reason for visit, ED disposition, and ED length-of-stay) are generally easily obtained. Less easily available data include vital signs, clinical scores, medications, and laboratory and radiology results, which would require manual chart review at many sites. Some data are not collected at all in a substantial proportion of hospitals, including patient race, ethnicity, and preferred language. The regulatory framework around patient privacy and data security represented significant barriers to sharing data for some sites, including requiring informed consent to share data. CONCLUSIONS: Many research hospitals face significant barriers to sharing electronic health record data for research purposes.
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