Pediatrics

Does pSOFA in the PED Predict Mortality?

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The pSOFA score was not a good screening tool for predicting in-hospital mortality when used in a pediatric emergency department (PED) setting.

Source
Validation of the Pediatric Sequential Organ Failure Assessment Score and Evaluation of Third International Consensus Definitions for Sepsis and Septic Shock Definitions in the Pediatric Emergency Department. JAMA Pediatr. 2022 May 16. doi: 10.1001/jamapediatrics.2022.1301. Online ahead of print.

Pediatric Asthma – One or Two-Dose Dexamethasone?

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A single dose of dexamethasone was as effective as two in treatment of mild to moderate pediatric asthma exacerbations in the emergency department.

Source
Single-Dose Dexamethasone Is Not Inferior to 2 Doses in Mild to Moderate Pediatric Asthma Exacerbations in the Emergency Department. Pediatr Emerg Care. 2022 May 3. doi: 10.1097/PEC.0000000000002727. Online ahead of print.

Can I Discharge a Pediatric Patient with Abnormal Vital Signs?

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18% of children in this cohort were discharged from a pediatric ED with at least one abnormal vital sign. In all-comers, there was no significant difference in return rate between those discharged with or without abnormal vital signs. Those who, at time of discharge, had two or more abnormal vital signs or were less than 3 years of age were more likely to return.

Source
Outcomes of patients discharged from the pediatric emergency department with abnormal vital signs. Am J Emerg Med. 2022 Apr 26;57:76-80. Doi: 10.1016/j.ajem.2022.04.021.

Recalculating…UTICalc Removes Race as Part of Score

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Race was strongly associated with UTI risk, with non-Black children having 2-4 times greater odds of infection. However, replacement of race with 2 other variable resulted in similar diagnostic accuracy for the UTICalc tool.

Source
Reassessment of the Role of Race in Calculating the Risk for Urinary Tract Infection: A Systematic Review and Meta-analysis. JAMA Pediatr. 2022 Apr 18. doi: 10.1001/jamapediatrics.2022.0700. Online ahead of print.

Pediatric Appendicitis – Is Non-Op Management Safe?

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Nonoperative management (NOM) for uncomplicated appendicitis has become more common over the past 10 years in the pediatric population. Although many children do well, those who have recurrences have higher rates of surgical complications and hospitalizations.

Source
Nonoperative Management of Uncomplicated Appendicitis. Pediatrics. 2022 Apr 18;e2021054693. doi: 10.1542/peds.2021-054693. Online ahead of print.

How Often Does EMS Perform Pediatric Airway Management?

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One in 180 out-of-hospital pediatric encounters require bag-mask ventilation (BMV) or advanced airway management (AAM). Of these, 49% involve tracheal intubation (TI) despite a lack of evidence showing superiority to BMV.

Source
Epidemiology of out-of-hospital pediatric airway management in the 2019 national emergency medical services information system data set. Resuscitation. 2022 Apr;173:124-133. doi: 10.1016/j.resuscitation.2022.01.008. Epub 2022 Jan 19.

New Outbreak of Acute Hepatitis in Children – Why?

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A new, rare form of acute hepatitis has been seen in children, mostly under age 5 years, that presents with vomiting, diarrhea, and abdominal pain, followed by acute hepatitis with jaundice. If you see a child with a “stomach virus” who has jaundice – check labs!

Source
Acute hepatitis is identified in more children, but cause remains elusive. BMJ. 2022 May 6;377:o1156. doi: 10.1136/bmj.o1156.

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