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.

Current PALS (and ACLS) algorithms recommend repeat epinephrine doses q3-5 minutes.  This study suggested that this is too frequent.  If doses were spaced 8-10 minutes, pediatric patients had significantly better survival.

PALS recommends giving a fluid bolus to children in shock over 5-10minutes.  This study showed that giving it more slowly, over 15-20 minutes likely decreased the need for mechanical ventilation.

Medication overuse headache (MOH), also known as rebound headache or drug-induced headache, may be the stuff of legend.  The evidence for it is sketchy. The authors say, "Until the evidence is better, we should avoid dogmatism about the use of symptomatic medication."

If a pediatric surgeon needs to delay appendectomy, you can reassure families this is a safe practice and will not increase the risk for adverse outcomes, like perforation.

This large multi-center prospective study of pediatric sedation found adverse events occurred in 12%, most mild desaturation or vomiting.  Severe adverse events occurred in 1%.  Ketamine given alone was the safest drug.  Propofol alone, ketamine + fentanyl, or ketamine + propofol were associated with greater risk for severe adverse events.

No clinical criteria were powerful diagnostic discriminators of the presence or absence of pneumonia in children, though some were fair.  When in doubt, a CXR is probably warranted, with the exceptions of obvious bronchiolitis or asthma.  Low SpO2 (</= 95 to 96%) or increased work of breathing were the best predictors of radiographic pneumonia in children; auscultatory findings and tachypnea were poor.  You don't need a CXR if no cough, no fever, no tachypnea, and normal SpO2.