Pediatr Emerg Care
· 2025 Dec · PMID 40988402
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Persistent jaundice in a newborn infant past 2 weeks of age requires timely evaluation for cholestasis or unconjugated hyperbilirubinemia. Untreated biliary atresia may result in death within a year of age and is the mos...Persistent jaundice in a newborn infant past 2 weeks of age requires timely evaluation for cholestasis or unconjugated hyperbilirubinemia. Untreated biliary atresia may result in death within a year of age and is the most common cause of death in children with liver disease. It is also the most common indication for liver transplantation in children when Kasai hepatic portoenterostomy fails. Ultrasound is the primary initial imaging modality for suspected biliary atresia, primarily looking for absence of the gallbladder and the triangular cord sign, with a thickened echogenic anterior wall of the right portal vein (EARPV measuring >4 mm). We report a case in which point-of-care ultrasound was used to evaluate suspected biliary atresia and expedite care, with the diagnosis subsequently confirmed by liver biopsy and surgery.
Mirfazaelian H, Darafshi AS, Sedaghat M
… +1 more, Akbari H
Pediatr Emerg Care
· 2025 Dec · PMID 40976933
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OBJECTIVE: Children in the emergency department (ED) experience distress due to many factors, such as pain. Although ketamine has analgesic and sedative effects, its parenteral administration causes pain and anxiety. It...OBJECTIVE: Children in the emergency department (ED) experience distress due to many factors, such as pain. Although ketamine has analgesic and sedative effects, its parenteral administration causes pain and anxiety. It is notable that ketamine can be administered intranasally for analgesia. We hypothesized that the administration of intranasal (IN) ketamine for analgesia before intramuscular ketamine injection would diminish the injection pain without any adverse effect. METHODS: This study was a randomized, double-blind, placebo-controlled clinical trial conducted in the ED. The IN ketamine group received a dose of 1.5 mg/kg intranasally diluted to 1 mL, while the placebo group received 1 mL of sterile water. Injection pain was assessed using the FLACC scale (0 to 10), encompassing the face, leg, activity, cry, and consolability. Sedation time and adverse effects were also assessed. RESULT: Eighty-four patients were enrolled. While the median (IQR) injection pain score in the placebo group was 10 (10 to 10), it was 1 (0 to 5) in the intervention group ( P <0.001). The sedation time in the control group was 80.9±33.6 minutes and 86.4±19.8 in the intervention arm ( P= 0.07). After excluding intraoral procedures, 7 (16.7%) and 2 (4.2%) patients had vomiting in the intervention and placebo groups, respectively. In addition, 3 (7%) patients of the IN-ketamine group had hypoventilation that was resolved with simple airway maneuvers. CONCLUSION: Although IN ketamine demonstrated efficacy in reducing injection-related pain, its adverse event profile may limit its practicality in routine settings.
Yoo S, Hwang E, Kang JE
… +2 more, Cheon CK, Kim Y
Pediatr Emerg Care
· 2026 Jan · PMID 40976924
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OBJECTIVE: This study aimed to determine whether measured serum osmolality could serve as a reliable marker for assessing the severity and predicting outcomes of pediatric diabetic ketoacidosis (DKA). METHODS: We retrosp...OBJECTIVE: This study aimed to determine whether measured serum osmolality could serve as a reliable marker for assessing the severity and predicting outcomes of pediatric diabetic ketoacidosis (DKA). METHODS: We retrospectively analyzed pediatric patients (<19 y) admitted with hyperglycemic crises from 2009 to 2022. Patients were classified into isolated DKA (serum osmolality ≤320 mOsm/kg) and hyperosmolar DKA (>320 mOsm/kg). Clinical characteristics, laboratory results, severity indicators, and outcomes were compared. We further evaluated diagnostic accuracy between measured serum osmolality and calculated effective osmolality, the current marker used by International Society of Pediatric and Adolescent Diabetes guidelines. RESULTS: Among 135 DKA episodes, hyperosmolar DKA (n = 69, 51.1%) presented more severe clinical features than isolated DKA (n = 66, 48.8%), including higher incidences of altered mental status (43.5% vs 12.1%), intensive care unit (ICU) admission (31.9% vs 12.1%), acute kidney injury (AKI; 58.0% vs 12.1%), and prolonged hospitalization (11 vs 8 days). In multivariate logistic regression, higher measured serum osmolality was significantly associated with altered mental status [odds ratio (OR), 1.048; 95% CI, 1.007-1.090], ICU admission (OR, 1.062; 95% CI, 1.016-1.111), AKI (OR, 1.070; 95% CI, 1.027-1.112), and prolonged hospital stay (OR, 1.032; 95% CI, 1.001-1.064; all P < 0.05). Measured serum osmolality demonstrated superior predictive performance for altered mental status [area under the receiver operating characteristic curve (AUROC), 0.751] and AKI (AUROC, 0.856) compared with calculated osmolality. CONCLUSION: Measured serum osmolality is strongly associated with clinical severity and outcomes in pediatric DKA. Incorporating it into clinical guidelines may improve risk stratification and management of pediatric hyperglycemic crises.
Huang J, Chen F, Zhou J
… +6 more, Li C, Liu T, Weng S, Zhou H, Yang L, Lu X
Pediatr Emerg Care
· 2026 Jan · PMID 40976888
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STUDY OBJECTIVE: To compare the efficacy, safety, and patient experience between cyanoacrylate tissue adhesive and conventional sutures for periorbital wound closure in children. METHODS: A prospective comparative study...STUDY OBJECTIVE: To compare the efficacy, safety, and patient experience between cyanoacrylate tissue adhesive and conventional sutures for periorbital wound closure in children. METHODS: A prospective comparative study evaluated 145 pediatric patients with periorbital trauma treated with tissue adhesive (n=70) or conventional suturing (n=75) based on clinical assessment from September 2023 to October 2024. Primary outcomes were wound healing grades (grade I/II/III) and complication rates; secondary outcomes included procedure time (median, seconds), pain scores (mean, Wong-Baker FACES), Frankl behavioral compliance scores (mean), and parental satisfaction. Statistical analysis used t tests, Mann-Whitney U tests, and χ 2 tests. RESULTS: The adhesive group had significantly shorter procedure time (184 vs. 692 s, P <0.001), lower pain scores (2.8 vs. 5.6, P <0.001), and higher compliance (Frankl 3.1 vs. 2.3, P <0.01). No significant differences were observed in grade I healing rates (97.1% vs. 93.3%) or complication rates (2.9% vs. 4.0%, P =0.24). CONCLUSIONS: In pediatric periorbital trauma, use of tissue adhesive was associated with reduced treatment time and pain scores, with similar healing outcomes compared with sutures, suggesting it may serve as a viable alternative.
Pediatr Emerg Care
· 2025 Dec · PMID 40974485
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OBJECTIVES: Despite the ongoing mental health crisis among US youth and the critical role that pediatricians caring for children and adolescents in emergency departments (EDs) play, there are limited studies capturing th...OBJECTIVES: Despite the ongoing mental health crisis among US youth and the critical role that pediatricians caring for children and adolescents in emergency departments (EDs) play, there are limited studies capturing these pediatricians' concerns, experiences, and needs. METHODS: National weighted survey data on mental health care were collected in 2022 from the American Academy of Pediatrics Pediatrician Life and Career Experience Study (PLACES) participants (response=67%). We analyzed responses from 115 pediatricians caring for children and adolescents in the ED. Participants reported perspectives on: (a) overall pediatric mental health concerns; (b) frequency of mental health presentations; (c) experience prescribing psychotropic medication; and (d) referral difficulty. We systematically examined open-ended responses on the most pressing mental health needs. RESULTS: Eighty-four percent of pediatricians caring for children and adolescents in the ED reported that mental health is a significant problem for youth in their community. Nearly all (98%) reported caring for children and adolescents with mental health conditions in the past month. Many reported daily encounters with pediatric patients experiencing mental health conditions, including anxiety, depression, and suicidal ideation. One in five reported prescribing psychotropic medication in the past year, none of whom reported being "very" comfortable doing so. One in five said resources to care for children and adolescents with mental health conditions were very or moderately available in their community. Open-ended responses (n=79) highlighted the urgent need for resources and solutions at the national level. CONCLUSIONS: Pediatricians in the ED have significant concerns about child and adolescent mental health in their communities, and many see youth with anxiety, depression, and suicidal behavior daily. Findings underscore a need for more support for pediatricians in the ED and innovative solutions to improve child and adolescent mental health.
Pediatr Emerg Care
· 2026 Jan · PMID 40958472
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BACKGROUND: Pediatric ocular trauma is the leading cause of monocular blindness and comprises 7% of injuries. Prompt treatment is mandatory but may vary by facility type. This study investigates factors influencing treat...BACKGROUND: Pediatric ocular trauma is the leading cause of monocular blindness and comprises 7% of injuries. Prompt treatment is mandatory but may vary by facility type. This study investigates factors influencing treating facility, comparing level 1 and level 2 verified pediatric trauma centers (PTC) with other trauma centers (non-PTC). METHODS: The National Trauma Data Bank 2019 was examined for ages 1 to 18 years with ICD10 ocular trauma diagnoses. Descriptive statistics compared patients of PTCs versus non-PTCs. Logistic regression was used to examine the association between treatment at PTC and type of ocular injury, adjusting for age, race, ethnicity, sex, socioeconomic status, injury severity score (ISS), and suspicion of child abuse. A second logistic regression model evaluated the association between direct transfer from emergency department (ED) to operating room (OR) and injury type, and adjusted for confounders. End points included surgical intervention and discharge disposition. RESULTS: Of 645 patients with ocular trauma, 67.6% were male, 14% were Hispanic. Median age was 10 years at PTC versus 13 years non-PTC ( P =0.001). Two hundred eighty-two (44%) were treated in PTC. There was no difference in proportion with ISS >15 or mechanism of ocular injury. One hundred forty-six patients were taken directly to OR from ED, with no difference between PTC and non-PTC. The most common diagnoses for patients taken directly to OR were eye or adnexa contusion and laceration, globe or adnexal open wound, and orbital wall fractures. There was no association between type of injury and treatment at PTC versus non-PTC. 71 abuse reports were noted, of which 23 (32.4%) were treated in PTCs, compared with 48 (67.6%) treated at non-PTCs ( P =0.036). Logistic regression examination of direct to OR admission revealed only Hispanic ethnicity was significantly associated ( P =0.03). CONCLUSIONS: Pediatric ocular traumas are treated at both PTCs and non-PTCs at a similar rate and level of severity. Younger children and more Hispanic children tended to be treated at PTCs. More abuse reports were noted in non-PTCs. Hispanic ethnicity was noted to be inversely associated with direct transfer to OR from ED. This study should form the background from which evaluation of outcomes can begin, to clarify the optimal treatment pathways for pediatric ocular trauma, and if there are disparities in outcomes. TYPE OF STUDY: Retrospective cross-sectional study.
Frederick AB, Tresslar CE, Rinaldi MB
… +2 more, Moake MM, Hollinger LE
Pediatr Emerg Care
· 2026 Jan · PMID 40936182
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Point-of-care ultrasound (POCUS) plays a vital role in rapid diagnosis and management in emergency settings. We present a case of a 9-year-old male who presented after a high-speed motor vehicle collision with a negative...Point-of-care ultrasound (POCUS) plays a vital role in rapid diagnosis and management in emergency settings. We present a case of a 9-year-old male who presented after a high-speed motor vehicle collision with a negative focused assessment with sonography for trauma (FAST). However, the quality assurance (QA) review raised concerns for a splenic mass. Further imaging confirmed the finding, and the patient underwent elective splenectomy, revealing a rare benign littoral cell angioma. This case illustrates the importance of QA in identifying findings during POCUS exams, the limitations of POCUS compared with comprehensive imaging, and the value of a multidisciplinary approach to pediatric trauma care.
Cafferty R, Leonard J, Gillette R
… +4 more, Bagg M, Haasz M, O'Leary ST, Ambroggio L
Pediatr Emerg Care
· 2025 Dec · PMID 40936175
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OBJECTIVES: Pediatric emergency department (ED) visits for mental and behavioral health concerns are rising. Understanding psychosocial predictors of ED mental health visits among youth with elevated suicide risk may inf...OBJECTIVES: Pediatric emergency department (ED) visits for mental and behavioral health concerns are rising. Understanding psychosocial predictors of ED mental health visits among youth with elevated suicide risk may inform tailored interventions and/or targeted resource allocation, decreasing ED utilization. We examined the association between self-reported psychosocial risk factors among youth screened "at-risk" for suicide during a nonmental health index ED visit and subsequent ED mental health visits. METHODS: This single-center retrospective cohort study had an exploratory, hypothesis-generating design. We included youth aged 10 to 18 years who presented to the ED between July 2020 and June 2023 for a nonmental health concern, were identified as "at-risk" for suicide during universal screening, and completed a psychosocial risk questionnaire. Subsequent ED mental health visits were tracked for 6 months after the index encounter, through December 2023. Psychosocial factors were compared between youth with and without a subsequent mental health visit using χ 2 and Fisher exact tests. Multivariable logistic regression models assessed associations between risk factors and subsequent ED mental health visits. RESULTS: Of 740 youth, 88 (11.9%) had a subsequent ED mental health visit, most (69.3%) for suicidal ideation. Youth were female (70.9%), non-White (63.6%), Hispanic (50.7%), publicly insured (71.8%), and the median age was 15.2 years; many (48.9%) had no known mental health conditions. For the subgroup with prior ED mental health visit(s), the odds of a subsequent ED mental health visit were higher in youth who identified as sexual and gender minority (aOR: 3.05; 95% CI: 1.15, 8.09) and individuals who reported prior nonsuicidal self-injury (aOR 3.01; 95% CI: 1.05, 8.66). CONCLUSIONS: Our results suggest a potential subpopulation, youth screened at-risk for suicide who identify as sexual and gender minority or report prior nonsuicidal self-injury, who may benefit from tailored interventions and/or resources to decrease subsequent ED utilization.
Pediatr Emerg Care
· 2025 Dec · PMID 40931405
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OBJECTIVES: The primary aim of this study was to compare resource utilization between lower and higher-risk brief resolved unexplained events (BRUE) in the general (GED) and pediatric (PED) emergency departments. METHODS...OBJECTIVES: The primary aim of this study was to compare resource utilization between lower and higher-risk brief resolved unexplained events (BRUE) in the general (GED) and pediatric (PED) emergency departments. METHODS: We conducted a retrospective chart review of BRUE cases from a large health system over 6-and-a-half years. Our primary outcome was the count of diagnostic tests per encounter. Laboratory tests, imaging, and cardiovascular studies were compared between lower and higher-risk BRUE overall and between each category in the GED and PED. Negative binomial regression was used to identify factors associated with increased testing for BRUE, with the count of diagnostic tests as the dependent variable. A priori covariates considered for regression modeling included type of ED, age in days, sex, race, ethnicity, type of insurance, preferred language, and need for interpreter. RESULTS: Two hundred twenty of the 373 (59%) cases identified by administrative review were clinical BRUE cases based on chart review. Twenty (9%) were lower-risk and 200 (91%) higher-risk. Overall, more tests were performed in higher-risk BRUE than lower-risk BRUE [median: 2 (interquartile range-IQR: 1 to 5.75) vs. median: 1 (IQR: 0 to 2), P =0.01]. There was no difference in the number of tests performed in lower-risk BRUE in the GED and PED. Fewer tests were performed in higher-risk BRUE in the GED [median: 1 (IQR: 0 to 2) vs. median: 3 (IQR: 1 to 6), P <0.001]. Ninety-one percent of BRUE from GED and 85% from PED were admitted or transferred ( P =0.37). In the regression model, only the type of ED [PED as reference; β: -0.925 (95% CI: -1.263 to -0.586), P <0.001] remained significant. CONCLUSION: Fewer tests were performed for higher-risk BRUE in the GED compared with the PED; however, a majority of all BRUE are admitted or transferred. This finding suggests there are potential opportunities for decreasing variation in BRUE testing and management.
Monti J, Jennings B, Schissel M
… +3 more, McKinsey J, El Feghaly RE, Nedved A
Pediatr Emerg Care
· 2025 Dec · PMID 40926417
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OBJECTIVE: To increase the percentage of first-line antibiotics prescribed for acute otitis media (AOM) and pharyngitis, the percentage of treated pharyngitis with a positive group A streptococcus (GAS) test, and the per...OBJECTIVE: To increase the percentage of first-line antibiotics prescribed for acute otitis media (AOM) and pharyngitis, the percentage of treated pharyngitis with a positive group A streptococcus (GAS) test, and the percentage of nonsevere AOM patients prescribed delayed antibiotics in pediatric urgent care clinics (UCCs). METHODS: The American Academy of Pediatrics Section on Urgent Care Medicine and Pediatric Acute and Critical Care Quality Network developed a multicenter quality improvement collaborative. We used national guidelines to determine criteria for nonsevere AOM and first-line antibiotics for AOM and pharyngitis. Participating UCCs committed at least 3 clinicians to submit 10 encounters for each diagnosis per month during the intervention period (October 2022 to June 2023). Clinicians signed commitment letters, participated in monthly learning sessions, and tested UCC-selected interventions. RESULTS: We recruited 84 participants from 13 UCCs. Participants submitted 5017 AOM encounters and 3762 pharyngitis encounters. The use of first-line antibiotics for AOM and GAS pharyngitis remained stable at 75.7% and 79.9%, respectively, throughout the project. The documentation of delayed antibiotic criteria increased from a range of 26%-27% at baseline to 83% [5.42% per month (95% CI: 4.03-6.81)]. This corresponded to an increase in use of delayed antibiotics for AOM from a range of 32%-42% at baseline to 70% by the end of the intervention period [2.53% per month (95% CI: 0.57-4.48)]. Rates of GAS testing before treating pharyngitis increased during baseline and remained high (>96%) throughout the intervention period. CONCLUSIONS: This multicenter collaborative provided education and networking to increase the use of delayed antibiotics for AOM in pediatric UCCs.
Pediatr Emerg Care
· 2026 Jan · PMID 40922132
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OBJECTIVES: Casino shifts, which end at 4 AM and allow sleep during the circadian "anchor period," may improve sleep and reduce fatigue for pediatric emergency medicine (PEM) fellows working night shifts. We hypothesized...OBJECTIVES: Casino shifts, which end at 4 AM and allow sleep during the circadian "anchor period," may improve sleep and reduce fatigue for pediatric emergency medicine (PEM) fellows working night shifts. We hypothesized that using a casino shift model would improve perceived fatigue levels and measured sleep metrics. METHODS: In this pilot prospective observational cohort study, fellows worked traditional night shifts for one month (control) followed by casino shifts for one month (intervention). Sleep data were collected using a validated wrist actigraph (ReadiBand), and subjective perceptions of fatigue were collected using surveys. RESULTS: Eight fellows participated in the study. Compared with the control month, the intervention month was associated with increased sleep quantity and sleep efficiency as measured by the actigraph. Fellows also reported reduced perceived fatigue and improved energy levels during the intervention month. CONCLUSIONS: Switching to a casino shift schedule was associated with improvements in measured sleep and perceived fatigue among a cohort of PEM fellows in this pilot study. These preliminary findings warrant further investigation with larger samples and randomized scheduling to further explore the potential benefits and limitations of casino shift models in emergency medicine.
Freyleue SD, Arakelyan M, Schaefer AP
… +4 more, Moen EL, O'Malley AJ, Goodman DC, Leyenaar JK
Pediatr Emerg Care
· 2025 Dec · PMID 40908749
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OBJECTIVE: Children with medical complexity (CMC) may bypass emergency departments (EDs) close to home to seek care at hospitals with more specialized pediatric services. However, few studies have examined ED choice for...OBJECTIVE: Children with medical complexity (CMC) may bypass emergency departments (EDs) close to home to seek care at hospitals with more specialized pediatric services. However, few studies have examined ED choice for CMC or how this differs by rurality. This work describes rural-urban differences in ED care and bypass patterns, examines associations between ED bypass and visit outcomes, and identifies factors associated with ED bypass. METHODS: We analyzed 2012 to 2017 all-payer claims data from Colorado, Massachusetts, and New Hampshire. Bypass was defined as a driving time of ≥5 minutes than time to the closest ED. We used logistic regression to identify factors associated with ED bypass and examine associations between bypass and rates of inter-facility transfer, index hospital admission, and in-hospital mortality. RESULTS: In total, 82,747 CMC experienced 284,374 ED visits. Rural-residing CMC were more often insured by Medicaid, more likely to travel >30 minutes, and less likely to bypass their closest EDs (26.9% vs. 43.7% for urban-residing CMC). In adjusted regression models, ED bypass was associated with significantly increased odds of admission (OR=2.19, 95% CI: 1.51-3.16) but not with interfacility transfer or mortality. Chronic condition primary diagnosis was associated with increased odds of bypass, and Medicaid coverage was associated with decreased odds of bypass for both rural-residing and urban-residing CMC. CONCLUSIONS: Rural-residing and urban-residing CMC differed in where they sought ED care and in their ED bypass patterns. These findings illustrate several factors that may be associated with ED choice for CMC and can inform clinical improvement efforts for this population.
Pediatr Emerg Care
· 2025 Nov · PMID 40903849
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This Special Feature article accompanies the manuscript "Site-Level Variation in Tracheal Intubation in the Pediatric Emergency Department: A Report from the National Emergency Airway Registry for Pediatric Emergency Med...This Special Feature article accompanies the manuscript "Site-Level Variation in Tracheal Intubation in the Pediatric Emergency Department: A Report from the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM)" and provides background on the formation, structure, and future directions of the NEAR4PEM collaborative. Established in 2021 as a subgroup of the National Emergency Airway Registry for Children (NEAR4KIDS), NEAR4PEM is a rapidly growing multicenter registry and collaborative focused on advancing the science and practice of airway management in pediatric emergency settings. Participating sites prospectively collect data on pediatric tracheal intubations to characterize practice variability, support quality improvement initiatives, and inform educational efforts in airway management. Since its inception, NEAR4PEM has expanded to include 20 sites across 3 countries, with many additional sites currently onboarding. This Special Feature outlines NEAR4PEM's mission, describes its integrated research, quality, and education initiatives, and highlights the collaborative's vision to expand its reach to a broader spectrum of emergency care settings, ensuring safe, evidence-based airway management for all children, regardless of where they receive care.
Malaria is a worldwide problem with significant disease burden in endemic areas, including part of sub-Saharan Africa and several countries in South and Central America. With increasing patterns of global migration, more...Malaria is a worldwide problem with significant disease burden in endemic areas, including part of sub-Saharan Africa and several countries in South and Central America. With increasing patterns of global migration, more children with malaria are presenting to nonendemic countries, a phenomenon known as imported malaria. This review summarizes the diagnosis and management of children with imported malaria, with emphasis on key features of the travel history, diagnostic challenges, and management strategies in the acute setting.
Greenwald E, Miller K, Wing R
… +22 more, Prieto M, Nagler J, Napolitano N, Polikoff L, Goldman M, Sterrett E, Jackson J, Melchionne Miseo C, Dean P, Nti B, Losito E, Caperell K, Kennedy C, Patel D, Deanehan JK, Bharath A, Killion J, Judge P, Joseph D, Ikeyama T, Nishisaki A, Kerrey BT
Pediatr Emerg Care
· 2025 Nov · PMID 40859870
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OBJECTIVES: To describe site-level variation in the performance and outcomes of tracheal intubation (TI) in pediatric emergency departments (PEDs) using the National Emergency Airway Registry for Pediatric Emergency Medi...OBJECTIVES: To describe site-level variation in the performance and outcomes of tracheal intubation (TI) in pediatric emergency departments (PEDs) using the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM). METHODS: A multicenter observational study of TI was performed between April 2018 and September 2023. TI data were obtained from the 16 PEDs contributing to the NEAR4PEM registry. Standard NEAR4PEM operational definitions were used. Site-level variation in TI performance and outcomes were reported using summary statistics and interquartile range (IQR), including first-attempt success (FAS) and adverse airway outcomes (AAOs). AAOs were defined as adverse tracheal intubation-associated events or oxygen desaturation (SpO2 <80%). RESULTS: A total of 1,729 TIs were performed. Median annual site visits were 52,500 (IQR: 39,750, 64,750). Median site admission rate was 14% (IQR: 11.7, 17). The proportion of infants was median 28.5% (IQR: 23, 32) and patients with a difficult airway feature was median 25% (IQR: 14, 37). A trainee performed a median 75% (IQR 71, 93) of first attempts. There was substantial variation among sites in TI practice (median, IQR): use of apneic oxygenation 38% (26, 53), use of a video laryngoscope 87% (67, 93), preinduction vagolytic use in infants 33% (5, 46), and TIs without paralysis 13% (10, 23). FAS per site was a median of 72% (IQR: 68, 76). The proportion of TIs with an AAO by site was median 24% (IQR: 16, 30). CONCLUSION: Considerable variation exists in performance and outcomes of TI across the PEDs participating in NEAR4PEM. These findings will be used to inform future research and quality improvement efforts.
Neuman EN, Lipsett SC, Hirsch AW
… +3 more, Geanacopoulos AT, Monuteaux MC, Neuman MI
Pediatr Emerg Care
· 2026 Jan · PMID 40851116
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BACKGROUND AND OBJECTIVES: Chest radiographs (CXRs) are often performed among children presenting to the emergency department (ED) with chest pain. Given the limited data on this practice, we sought to evaluate the risk...BACKGROUND AND OBJECTIVES: Chest radiographs (CXRs) are often performed among children presenting to the emergency department (ED) with chest pain. Given the limited data on this practice, we sought to evaluate the risk of pneumonia among children presenting to an ED with chest pain and to further identify children at low risk of pneumonia. METHODS: We performed a secondary analysis of a prospective study enrolling children 5 to 18 years of age with chest pain who had a CXR performed for clinical suspicion of pneumonia. We compared the characteristics of children with and without pneumonia and used multivariable analyses to identify characteristics associated with radiographic pneumonia. RESULTS: A total of 240 children with chest pain undergoing CXR for clinical suspicion of pneumonia were enrolled [median age 11.5 years (IQR: 7.6, 15.4)]. Radiographic pneumonia was observed in 46 children (19%). The odds of pneumonia were higher among children with fever (aOR: 3.5, 95% CI: 1.6, 7.8), tachypnea (aOR: 2.7, 95% CI: 1.2, 6.2), crackles (aOR: 2.3, 95% CI: 1.1, 5.0), and diminished breath sounds (aOR: 2.5, 95% CI: 1.2, 5.1) on auscultation. A total of 45 of 46 children with pneumonia had one or more of the following: fever, tachypnea, crackles, or decreased breath sounds on auscultation (sensitivity 97.8%, 95% CI: 88.5%, 99.9%). CONCLUSIONS: Approximately 1 in 5 children presenting with chest pain and undergoing CXR had radiographic pneumonia. Pneumonia may be safely excluded among children with chest pain if there is no fever, tachypnea, crackles, or diminished breath sounds on examination.
Freire GC, Diong C, Gandhi S
… +5 more, Saunders NR, Neuman MI, Freedman SB, Friedman JN, Cohen E
Pediatr Emerg Care
· 2026 Jan · PMID 40847260
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OBJECTIVES: To compare low-value computed tomography (CT) use during pediatric emergency department (ED) visits by hospital type and physician specialty. METHODS: Repeated cross-sectional study using linked databases fro...OBJECTIVES: To compare low-value computed tomography (CT) use during pediatric emergency department (ED) visits by hospital type and physician specialty. METHODS: Repeated cross-sectional study using linked databases from Ontario, Canada. We reviewed pediatric ED discharges from 2010 to 2019 for 5 diagnoses with recommendations against routine CT use: abdominal pain, constipation, concussion, seizure, and headache. We evaluated CT use by hospital type (pediatric academic, adult academic, community with and without pediatric consultation) and provider specialty [pediatric emergency medicine (PEM), emergency medicine (EM), family medicine + EM, family medicine, pediatrician], using multivariable logistic regression, adjusting for patient, ED, and physician characteristics. RESULTS: We included 599,948 pediatric ED discharges [mean (SD) age 10.8 y (5.3); 55.4% females]: 5000 (1.2%) discharges for abdominal diagnoses included a CT, and 21,398 (11.4%) discharges for neurological diagnoses included a CT. Children had an increased adjusted odds ratio [aOR (95% CI)] of receiving a CT at all hospital types compared with pediatric academic hospitals: adult academic hospitals ranging from 1.10 (1.01 to 1.21) for headache to 3.46 (1.89 to 6.36) for constipation, community hospitals with pediatric consultation ranging from 1.54 (1.45 to 1.63) for concussion to 3.74 (2.38-5.90) for constipation, and community hospitals without pediatric consultation ranging from 1.24 (1.15 to 1.33) for concussion to 2.29 (1.36 to 3.87) for constipation. Those patients seen by nonpediatric providers (EM, family medicine + EM, family medicine) were more likely to receive CT scans than PEM physicians for all diagnoses. CONCLUSIONS: Low-value CT use was higher among children treated in nonpediatric EDs and by nonpediatric providers. Improvement initiatives should target specific hospital types and specialties.