In children without other comorbidities, with moderate to severe community acquired pneumonia requiring hospitalization, the yield of blood culture was very low.  Most isolated organisms were Streptococcus pneumoniae, 82% of which were penicillin sensitive.

Spinal cord injury without radiographic abnormality (SCIWORA) was very rare, 27/34069 (0.08%).  Although NEXUS enrolled 3000 patients <18 years, down to age 1, all patients with SCIWORA were adults in this cohort.

In patients age 5 years through adulthood with sore throat of any cause, use of a single, low-dose steroid (most often dexamethasone 10mg or 0.6mg/kg for children, max 10mg; most given orally) were twice as likely to have pain relief at 24 hours.

Substantial agreement on clinical exam findings in children with suspicion of pneumonia was only present for wheezing and retractions.  All other clinical exam findings had poor to moderate agreement between clinician examiners.

The NEXUS criteria can be used to determine which patients do not need c-spine x-rays.  Since this was published, we have shifted to predominantly CT imaging, which is more sensitive.  Also, we have learned that NEXUS is not as sensitive in elderly patients.

The CBC is not a very good test for identifying invasive bacterial infections in febrile infants ≤60 days. If you used common normal ranges of WBC count (5000-14900) and absolute neutrophil count <10k, you would have missed 63% and 82% of invasive bacterial infections, respectively.

Diagnostic accuracy of the digitally interpreted rapid influenza A and B antigen tests (DIA) was better than the traditional rapid flu tests, 77-80% sensitive vs. 53-54% sensitive.  In children compared to adults, the sensitivity was 18.5 points higher for flu A and 32 points higher for flu B with the traditional rapid test; 12 and 25 points higher for the DIA respectively; 2.7% points higher for nucleic acid amplification tests (NAATs).  NAATs were about 95% sensitive overall.  All tests had specificity of about 98%.

There was no difference in cosmetic outcome with use of absorbable vs. nonabsorbable suture for pediatric lacerations, though there was a nonsignificant trend to absorbable being superior.  There was also no difference in dehiscence or infection rate between the two.

Why do people seek emergency or urgent care?  This quick systematic review of the literature identified 5 reasons.

The diagnostic accuracy of rapid streptococcal antigen testing is such that a negative test rules out disease and should not be treated; a positive test rules it in and should be treated.