July 2019

Gabapentinoids were associated with increased risk of suicidal behavior, overdose, injuries, and car crashes.

Overall yield of blood culture for pediatric community acquired pneumonia (CAP) was low; 91 blood cultures were needed to get one positive result. But in children admitted to the ICU, one child had bacteremia for every 24 cultures obtained; one for every 12 in children with parapneumonic effusion.

Helping impaired physicians is part of our profession’s self-regulatory duty. The goal is to ensure patient safety, help physicians get help, and restore them to practice whenever possible.

Burnout is complex - with individual and systemic causes and solutions. Here are five systems and organizational-level ways to reduce it.

Physician (all healthcare worker) burnout is very costly to organizations, which means small investments to reduce it produce big returns financially and for clinicians’ quality of life.

Ultralow-dose chest CT (ULCT) had perfect diagnostic accuracy for minor traumatic injury to the chest. It was superior to plain CXR and delivered the same, or in several cases, a lower radiation dose.

Ultrasound guided IVs were more successful on first-stick than traditional in children with predicted difficult IV access.

Freestanding EDs are popular with patients and physicians but do little to expand access to care, reduce traditional ED congestion, and lower overall healthcare costs.

There was no difference in levetiracetam vs phenytoin as second-line agents after benzodiazepines for pediatric status epilepticus in median time to seizure cessation. Levetiracetam may have other advantages, as it is able to be given over 5 minutes (vs 20 minutes for phenytoin) and causes fewer adverse effects.

This paves the way for deriving a pediatric c-spine injury (PCSI) rule. In the meantime, children without the following variables - diving, axial load, neck pain, inability to move neck, altered mental status, intubation, or respiratory distress - had low risk of PCSI.