Recent Research

The work of the EMSC Program is rooted in the latest scientific evidence. Below, explore the most recent EMSC-related research.

  • Katherine Remick
  • Marianne Gausche-Hill
The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.
  • Hannah Canter
  • Jennifer Reed
  • Chella Palmer
  • T Charles Casper
  • Kristin Stukus
  • Sarah Schmidt
  • Michelle Pickett
  • Cynthia Mollen
  • Cara Elsholz
  • Andrea T Cruz
  • Erin Augustine
  • Monika K Goyal
CONCLUSIONS AND RELEVANCE: In this cross-sectional study of sexually active adolescents presenting to the ED, the majority of participants reported using at least 1 form of contraception; however, LARCs were the least used option, and 28.9% of participants reported no contraceptive use. The unintended pregnancy risk was almost 8% in the study population. Few patients eligible for EC received it. These data suggest a high need and potential opportunity for provision of contraception services in...
  • Sriram Ramgopal
  • Christian Martin-Gill
  • Kenneth A Michelson
CONCLUSIONS: A low proportion of children have documentation of complete vital signs, highlighting areas in need of improvement to better align with pediatric readiness quality initiatives. A high proportion of children had abnormal vital signs using PALS criteria. Few abnormalities were associated with hospitalization or transfer.
  • Julie C Leonard
  • Monica Harding
  • Lawrence J Cook
  • Jeffrey R Leonard
  • Kathleen M Adelgais
  • Fahd A Ahmad
  • Lorin R Browne
  • Rebecca K Burger
  • Pradip P Chaudhari
  • Daniel J Corwin
  • Nicolaus W Glomb
  • Lois K Lee
  • Sylvia Owusu-Ansah
  • Lauren C Riney
  • Alexander J Rogers
  • Daniel M Rubalcava
  • Robert E Sapien
  • Matthew A Szadkowski
  • Leah Tzimenatos
  • Caleb E Ward
  • Kenneth Yen
  • Nathan Kuppermann
BACKGROUND: Cervical spine injuries in children are uncommon but potentially devastating; however, indiscriminate neck imaging after trauma unnecessarily exposes children to ionising radiation. The aim of this study was to derive and validate a paediatric clinical prediction rule that can be incorporated into an algorithm to guide radiographic screening for cervical spine injury among children in the emergency department.
  • Katherine E Remick
  • Marianne Gausche-Hill
  • Amber Lin
  • Jeremy D Goldhaber-Fiebert
  • Benjamin Lang
  • Ashley Foster
  • Beech Burns
  • Peter C Jenkins
  • Hilary A Hewes
  • Nathan Kuppermann
  • K John McConnell
  • Jennifer Marin
  • Christopher Weyant
  • Rachel Ford
  • Sean R Babcock
  • Craig D Newgard
  • Pediatric Readiness Study Group
CONCLUSIONS: Annual hospital costs for HPR are modest, particularly when considered per child.
  • Margaret Samuels-Kalow
  • Krislyn M Boggs
  • Stephanie S Loo
  • Maeve F Swanton
  • William A Manning
  • Rebecca E Cash
  • Courtney B Wolk
  • Elizabeth R Alpern
  • Kenneth A Michelson
  • Katherine E Remick
  • Carlos A Camargo
CONCLUSIONS: Implementation of the PECC role appears to be limited by heterogeneous interpretations of the PECC, de-prioritization of pediatrics, and limited system resources. However, many participants described motivation to improve pediatric care and implement the PECC role in context of increasing pediatric visits; they offered strategies for future implementation efforts.
  • Craig D Newgard
  • McKenna Smith
  • Amber Lin
  • K John McConnell
  • Katherine E Remick
  • Randall S Burd
  • Jennifer R Marin
  • N Clay Mann
  • Marianne Gausche-Hill
  • Hilary A Hewes
  • Angela Child
  • Benjamin Lang
  • Ashley A Foster
  • Brandon Maughan
  • Jeremy D Goldhaber-Fiebert
  • Pediatric Readiness Study Group
High emergency department (ED) pediatric readiness is associated with improved survival in children, but the cost is unknown. We evaluated the costs of emergency care for children across quartiles of ED pediatric readiness. This was a retrospective cohort study of children aged 0-17 years receiving emergency services in 747 EDs in 9 states from January 1, 2012, through December 31, 2017. We measured ED pediatric readiness using the weighted Pediatric Readiness Score (range: 0-100). The primary...
  • Joelle N Simpson
  • Joseph L Wright
This article summarizes how pediatricians may be uniquely positioned to mitigate the long-term trajectory of COVID-19 on the health and wellness of pediatric patients especially with regard to screening for social determinants of health that are recognized drivers of disparate health outcomes. Health inequities, that is, disproportionately deleterious health outcomes that affect marginalized populations, have been a major source of vulnerability in past public health emergencies and natural...
  • Anna Lin
  • Sarita Chung
The concepts of pediatric surge in the United States continue to evolve from a theoretic framework to practical implementation. As disasters become more frequent, ranging from natural to human-caused, children remain a vulnerable population. The coronavirus disease 2019 pandemic and the 2022 to 2023 tripledemic respiratory surge revealed advances and continued challenges in our ability to care for a large influx of pediatric patients. Understanding pediatric surge through the framework of the 4...
  • Sanyukta Desai
  • Katherine E Remick
Although children account for 20% of all emergency department (ED) visits, the majority of children seek emergency care in hospitals that see fewer than 10 children per day. The National Pediatric Readiness Project has defined key system-level standards for all EDs to safely care for ill and injured children. High pediatric readiness is associated with improvement in mortality for critically ill and injured children. However, to improve readiness and sustain system-level changes, hospitals must...
  • Caroline G Melhado
  • Katherine Remick
  • Amy Miskovic
  • Bhavin Patel
  • Hilary A Hewes
  • Craig D Newgard
  • Avery B Nathens
  • Charles Macias
  • Lisa Gray
  • Brian K Yorkgitis
  • Michael W Dingeldein
  • Aaron R Jensen
CONCLUSION: ED pediatric readiness in trauma centers remains variable and is predictably lower in centers that lack inpatient resources. There is, however, no aspect of ED pediatric readiness that is constrained to high-level pediatric facilities, and a highest quartile wPRS was achieved in all types of adult centers in our study. Ongoing efforts to improve pediatric readiness for initial stabilization at non-pediatric centers are needed, particularly in centers that routinely transfer children...
  • Andrew T Krack
  • Michelle Eckerle
  • Prashant Mahajan
  • Octavio Ramilo
  • John M VanBuren
  • Russell K Banks
  • T Charles Casper
  • David Schnadower
  • Nathan Kuppermann
  • Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)
CONCLUSIONS: Leukopenia ≤2500 cells/μL in febrile infants ≤60 days old is associated with IBIs. However, in the presence of normal PCT levels, no patients with leukopenia had IBIs. While this suggests leukopenia ≤2500 cells/μL is a risk factor for IBIs in non-critically ill young febrile infants only when PCT is unavailable or elevated, the overall low frequency of leukopenia in this cohort warrants caution in interpretation, with future validation required.
  • Mohannad Abu-Sultanah
  • Riad Lutfi
  • Samer Abu-Sultaneh
  • Kellie J Pearson
  • Erin E Montgomery
  • Travis Whitfill
  • Marc A Auerbach
  • Kamal Abulebda
CONCLUSIONS: In this cohort, improving pediatric readiness scores in GEDs was associated with significant improvements in PICU and hospital length of stay. Future initiatives should focus on disseminating pediatric readiness efforts to improve outcomes of critically ill children nationally.
  • Fiona A Pirrocco
  • Hamy Temkit
  • Cherisse Mechem
  • Karen Yeager
CONCLUSIONS: This study addresses important knowledge gaps regarding transfers from IHS and tribal EDs, highlights potential high-impact areas for pediatric readiness, and emphasizes the need for more granular data to inform resource allocation and educational interventions. Further studies are needed to delineate potentially avoidable transfers seen within this population.
  • Stacy M Goins
  • Steven Thornton
  • Elizabeth Horne
  • Brooke Hoehn
  • Erin Brush
  • Julie Thamby
  • Angela Hemesath
  • Sarah Cantrell
  • Emily Greenwald
  • Elisabeth Tracy
CONCLUSIONS: This review suggests that diverse strategies exist to promote pediatric readiness. Most training programs are interdisciplinary and use a variety of educational techniques. However, studies infrequently report examining the impact of educational interventions on patient-centered outcomes and lack detail in describing their curriculum. Future educational efforts would benefit from heightened attention to such outcome measures and a rigorous description of their curricula to allow for...
  • James F Holmes
  • Kenneth Yen
  • Irma T Ugalde
  • Paul Ishimine
  • Pradip P Chaudhari
  • Nisa Atigapramoj
  • Mohamed Badawy
  • Kevan A McCarten-Gibbs
  • Donovan Nielsen
  • Allyson C Sage
  • Grant Tatro
  • Jeffrey S Upperman
  • P David Adelson
  • Daniel J Tancredi
  • Nathan Kuppermann
BACKGROUND: The intra-abdominal injury and traumatic brain injury prediction rules derived by the Pediatric Emergency Care Applied Research Network (PECARN) were designed to reduce inappropriate use of CT in children with abdominal and head trauma, respectively. We aimed to validate these prediction rules for children presenting to emergency departments with blunt abdominal or minor head trauma.
  • Jennifer A Hoffmann
  • Camille P Carter
  • Cody S Olsen
  • David Ashby
  • Kamali L Bouvay
  • Susan J Duffy
  • James M Chamberlain
  • Sofia S Chaudhary
  • Nicolaus W Glomb
  • Jacqueline Grupp-Phelan
  • Maya Haasz
  • Erin P O'Donnell
  • Mohsen Saidinejad
  • Bashar S Shihabuddin
  • Leah Tzimenatos
  • Neil G Uspal
  • Joseph J Zorc
  • Lawrence J Cook
  • Elizabeth R Alpern
  • PECARN Registry Study Group
CONCLUSIONS: During the late pandemic, pediatric MH ED visits decreased below expected rates; however, visits by females and for specific conditions remained elevated, indicating a need for increased attention to these groups. Prolonged ED visit lengths may reflect inadequate availability of MH services.
  • Roberto Velasco
  • Borja Gomez
  • Ismael Labiano
  • Ana Mier
  • Alberto Ugedo
  • Javier Benito
  • Santiago Mintegi
CONCLUSIONS: The performance of blood biomarkers, except for procalcitonin, in febrile young infants is lower in fever of very short duration, decreasing the accuracy of the clinical decision rules.
  • Cheryl A King
  • David Brent
  • Jacqueline Grupp-Phelan
  • Kent Page
  • Ewa Czyz
  • Taylor C McGuire
  • E Melinda Mahabee-Gittens
  • Lucy Block
  • T Charles Casper
CONCLUSIONS: Results from this large-scale prospective study suggest the importance of TB, PB, and PPE to our understanding of suicidal thoughts and suicide attempts among adolescents, pointing to promising prevention and intervention targets.
  • Emma Tavender
  • Nitaa Eapen
  • Junfeng Wang
  • Vanessa C Rausa
  • Franz E Babl
  • Natalie Phillips
BACKGROUND: Paediatric cervical spine injury (CSI) after blunt trauma is rare but can have severe consequences. Clinical decision rules (CDRs) have been developed to guide clinical decision-making, minimise unnecessary tests and associated risks, whilst detecting all significant CSIs. Several validated CDRs are used to guide imaging decision-making in adults following blunt trauma and clinical criteria have been proposed as possible paediatric-specific CDRs. Little information is known about...
  • Stefanie G Ames
  • Apoorva Salvi
  • Amber Lin
  • Susan Malveau
  • N Clay Mann
  • Peter C Jenkins
  • Matthew Hansen
  • Linda Papa
  • Sabrina Schmitz
  • Cesar Sabogal
  • Craig D Newgard
  • Pediatric Readiness Study Group
CONCLUSIONS: The 1-year mortality of children presenting to an ED is 2.2% for injured children and 1.4% for medically ill children with most deaths occurring in the ED. Future interventional trials, quality improvement efforts, and health policy focused in the ED could have the potential to improve outcomes of pediatric patients.
  • Jennifer K Saper
  • Michelle L Macy
  • Christian Martin-Gill
  • Sriram Ramgopal
CONCLUSIONS: EMS encounters from outpatient settings most commonly originate from outpatient offices, relative to urgent care settings, where pediatric emergency readiness may be limited. It is important that outpatient settings and providers are ready for varied emergencies, including those occurring for a behavioral health concern, and that readiness guidelines are updated to address these needs.
  • Jacqueline Grupp-Phelan
  • Adam Horwitz
  • David Brent
  • Lauren Chernick
  • Rohit Shenoi
  • Charlie Casper
  • Michael Webb
  • Cheryl King
  • Pediatric Emergency Care Applied Research Network (PECARN)
CONCLUSIONS: The CASSY can be a valuable tool in providing patient-specific risk probabilities for a suicide attempt at 3 months and tailor the threshold cutoffs based on the availability of local mental health resources. We give an example of a clinical risk pathway, which should include segmentation of the ED population by medical versus psychiatric chief complaint.
  • Monica Christine Ciorba
  • Marc Maegele
CONCLUSION: 4% of polytrauma patients are children. Because children differ from adults both anatomically and physiologically, the diagnostic evaluation and management of polytrauma in children presents a special challenge. The evidence base for pediatric polytrauma management is still inadequate; current recommendations are based on consensus, in consideration of the special features of children compared to adults.
  • Caleb E Ward
  • Kathleen M Adelgais
  • Maija Holsti
  • Kammy K Jacobsen
  • Harold K Simon
  • Claudia R Morris
  • Victor M Gonzalez
  • Gonzalo Lerner
  • Kimia Ghaffari
  • John M VanBuren
  • E Brooke Lerner
  • Manish I Shah
  • Pediatric Emergency Care Applied Research Network (PECARN) PediDOSE Study Group
CONCLUSIONS: In communities where this study will occur, most respondents supported PediDOSE being conducted with EFIC and most approved of children being enrolled without prior consent. Support was lowest among non-Hispanic Black respondents and highest among health care providers. Further research is needed to determine optimal ways to address the concerns of specific racial and ethnic groups when conducting EFIC trials.
  • Michelle Pintea
  • Deanna Dahl Grove
CONCLUSIONS: Health care coalitions and localities can use this tool to evaluate pediatric preparedness, identify needed improvements, and improve outcomes for children, families, and communities.
  • Kathryn Westphal
  • Hania Adib
  • Vignesh Doraiswamy
  • Kevin Basiago
  • Jennifer Lee
  • Sumeet L Banker
  • John Morrison
  • Saylor McCartor
  • Stephanie Berger
  • Erinn O Schmit
  • Annalise Van Meurs
  • Meredith Mitchell
  • Clifton Lee
  • Julie K Wood
  • Lauren G Tapp
  • Deborah Kunkel
  • Elizabeth E Halvorson
  • Nicholas M Potisek
  • Hypothermic Young Infant Research Collaborative
CONCLUSIONS: Several febrile infant decision tools were highly sensitive, minimizing missed SBIs and IBIs in hypothermic infants. However, the low specificity of these decision tools may lead to unnecessary testing, antimicrobial exposure, and hospitalization.
  • Krislyn M Boggs
  • Emma Voligny
  • Marc Auerbach
  • Janice A Espinola
  • Margaret E Samuels-Kalow
  • Ashley F Sullivan
  • Carlos A Camargo
CONCLUSIONS: There is variation in state PFRPs, although all prioritize the presence of a PECC. We encourage further research on the effect of different aspects of PFRPs on patient outcomes.
  • Carl O Eriksson
  • Nathan Bahr
  • Garth Meckler
  • Matthew Hansen
  • Grace Walker-Stevenson
  • Ahamed Idris
  • Tom P Aufderheide
  • Mohamud R Daya
  • Ericka L Fink
  • Jonathan Jui
  • Maureen Luetje
  • Christian Martin-Gill
  • Steven Mcgaughey
  • Jon Pelletier
  • Danny Thomas
  • Jeanne-Marie Guise
  • Child Safety Initiative–Emergency Medical Services for Children
CONCLUSIONS AND RELEVANCE: In this large geographically diverse cohort of children with EMS-treated OHCA, 60% of all patients experienced at least 1 severe ASE. The odds of a severe ASE were higher for neonates than adolescents and even higher when the cardiac arrest was birth related. Given the national increase in out-of-hospital births and ongoing poor outcomes of OHCA in young children, these findings represent an urgent call to action to improve care delivery and training for this...
  • Maryam Saran
  • Morteza Arab-Zozani
  • Meysam Behzadifar
  • Mehrdad Gholami
  • Samad Azari
  • Nicola Luigi Bragazzi
  • Masoud Behzadifar
CONCLUSION: Limitations of evidence: The restricted number of included studies may impact generalizability. High heterogeneity was observed, leading to subgroup analyses based on age, assessment criteria, and study region. Absent data on overuse causes hinders drawing conclusions on contributing factors. Furthermore, this study solely addressed overuse rates, not associated harm or benefits. Interpretation: The overuse of CT scans in mild head injury patients is concerning, as it can result in...
  • Amy Tucker
  • Teresa Bailey
  • Courtney Edwards
  • Amy Stewart
CONCLUSION: We found that participation in the quality improvement initiative was associated with emergency department pediatric readiness improvements.
  • Wen-Kai Cai
  • Yin-Chun Tien
  • Chia-Hao Hsu
No abstract
  • Alexander T Janke
  • Courtney W Mangus
  • Christopher M Fung
  • Neil Kamdar
  • Michelle L Macy
  • Michele M Nypaver
  • Keith E Kocher
CONCLUSIONS AND RELEVANCE: In this cohort study of more than 2.7 million ED visits, a pediatric viral illness surge was associated with different pediatric acute care across EDs in the state. Clinical management pathways and quality improvement efforts may more effectively mitigate dangerous clinical conditions with strong collaborative relationships across EDs and setting of care.
  • Mariann Nocera Kelley
  • Willliam Lynders
  • Emily Pelletier
  • Megan Petrucelli
  • Beth Emerson
  • Gunjan K Tiyyagura
  • Michael Paul Goldman
Prior reports describe the care children receive in community EDs (CEDs) compared with paediatric EDs (PEDs) as uneven. The Emergency Medical Services for Children (EMSC) initiative works to close these gaps using quality improvement (QI) methodology. Project champion from a community hospital network identified the use of safe pharmacological and non-pharmacological anxiolysis and analgesia (A&A) as one such gap and partnered with EMSC to address it. Our primary Specific, Measurable,...
  • Monika Goyal
  • Elizabeth R Alpern
  • Michael Webb
  • David C Brousseau
  • James M Chamberlain
  • Joseph J Zorc
  • Theresa Frey
  • Alexandria Wiersma
  • Bradley J Barney
  • Amy L Drendel
  • PECARN IMPROVE and PECARN Registry Study Groups
  • PECARN IMPROVE and PECARN Registry Study Groups
No abstract
  • Snimarjot Kaur
  • William Lynders
  • Michael Goldman
  • Christie Bruno
  • Juliana Morin
  • Scott Maruschock
  • Marc Auerbach
CONCLUSIONS: A locally facilitated CED in situ simulation curriculum was successfully developed and implemented under local leadership, with remote collaboration by AMC. The curriculum was well received and effective.
  • Daniel S Tsze
  • Nathan Kuppermann
  • T Charles Casper
  • Bradley J Barney
  • Lawrence P Richer
  • Danica B Liberman
  • Pamela J Okada
  • Claudia R Morris
  • Sage R Myers
  • Jane K Soung
  • Rakesh D Mistry
  • Lynn Babcock
  • Sandra P Spencer
  • Michael D Johnson
  • Eileen J Klein
  • Kimberly S Quayle
  • Dale W Steele
  • Andrea T Cruz
  • Alexander J Rogers
  • Danny G Thomas
  • Jacqueline M Grupp-Phelan
  • Tiffani J Johnson
  • Peter S Dayan
  • Pediatric Emergency Care Applied Research Network (PECARN)
INTRODUCTION: Headache is a common chief complaint of children presenting to emergency departments (EDs). Approximately 0.5%-1% will have emergent intracranial abnormalities (EIAs) such as brain tumours or strokes. However, more than one-third undergo emergent neuroimaging in the ED, resulting in a large number of children unnecessarily exposed to radiation. The overuse of neuroimaging in children with headaches in the ED is driven by clinician concern for life-threatening EIAs and lack of...
  • Chrystal Rutledge
  • Kristen Waddell
  • Stacy Gaither
  • Travis Whitfill
  • Marc Auerbach
  • Nancy Tofil
CONCLUSIONS: This study shows a significant disparity in the performance and readiness of GEDs versus a PED in a medically underserved area. More education and better access to resources is needed in these areas to adequately care for critically ill pediatric patients.
  • Caroline Q Stephens
  • Mary E Fallat
Pediatric trauma system development is essential to public health infrastructure and pediatric health systems. Currently, trauma systems are managed at the state level, with significant variation in consideration of pediatric needs. A recently developed Pediatric Trauma System Assessment Score (PTSAS) demonstrated that states with lower PTSAS have increased pediatric mortality from trauma. Critical gaps are identified within six PTSAS domains: Legislation and Funding, Access to Care, Injury...
  • Jennifer A Hoffmann
  • Camille P Carter
  • Cody S Olsen
  • Pradip P Chaudhari
  • Sofia Chaudhary
  • Susan Duffy
  • Nicolaus Glomb
  • Monika K Goyal
  • Jacqueline Grupp-Phelan
  • Maya Haasz
  • Bijan Ketabchi
  • Nicole Kravitz-Wirtz
  • E Brooke Lerner
  • Bashar Shihabuddin
  • Wendi Wendt
  • Lawrence J Cook
  • Elizabeth R Alpern
  • PECARN Registry Study Group
CONCLUSIONS: Firearm injury ED visits for children increased beyond expected prepandemic trends, with greater increases among certain population subgroups. These findings may inform firearm injury prevention efforts.
  • Alejandra Arango
  • David Brent
  • Jacqueline Grupp-Phelan
  • Bradley J Barney
  • Anthony Spirito
  • Megan M Mroczkowski
  • Rohit Shenoi
  • Melinda Mahabee-Gittens
  • T Charles Casper
  • Cheryl King
  • Pediatric Emergency Care Applied Research Network (PECARN)
CONCLUSIONS: In this large and geographically diverse sample, overall and school connectedness were related prospectively to lower likelihood of suicide attempts, and connectedness was more protective for youth not in certain high-risk subgroups. Results inform preventive efforts aimed at improving youth connectedness and reducing suicide risk.
  • Kathleen M Brown
  • Nicole S Glaser
  • Julie K McManemy
  • Andrew DePiero
  • Lise E Nigrovic
  • Kimberly S Quayle
  • Michael J Stoner
  • Jeff E Schunk
  • Jennifer L Trainor
  • Leah Tzimenatos
  • Arleta Rewers
  • Sage R Myers
  • Maria Y Kwok
  • Simona Ghetti
  • T Charles Casper
  • Cody S Olsen
  • Nathan Kuppermann
  • Pediatric Emergency Care Applied Research Network Diabetic Ketoacidosis FLUID Study Group
CONCLUSIONS: Protocol adherence data in the FLUID Trial suggest that physicians are uncomfortable using weight-based fluid calculations for overweight or obese children. However, higher rates of fluid infusion were not associated with increased risk of mental status changes or cerebral injury, suggesting that physicians should not limit fluid resuscitation in obese children and youth with DKA.
  • Jessica A Harper
  • Amanda C Coyle
  • Clara Tam
  • Megan Skakum
  • Mirna Ragheb
  • Lucy Wilson
  • Mê-Linh Lê
  • Terry P Klassen
  • Alex Aregbesola
BACKGROUND: Most children who need emergency care visit general emergency departments and urgent care centres; the weighted pediatric readiness score (WPRS) is currently used to evaluate emergency departments' readiness for pediatric patients. The aim of this study was to determine whether a higher WPRS was associated with decreased mortality and improved health care outcomes and utilization.
  • Caroline Melhado
  • Katherine Remick
  • Amy Miskovic
  • Bhavin Patel
  • Hilary A Hewes
  • Craig D Newgard
  • Avery B Nathens
  • Charles Macias
  • Lisa Gray
  • Brian K Yorkgitis
  • Michael W Dingeldein
  • Aaron R Jensen
CONCLUSION: Trauma centers should address gaps in pediatric readiness to include a pediatric-specific quality improvement plan and aim to achieve wPRS ≥93.
  • Derya Bako
  • Utku Özer
  • Engin Beydoğan
BACKGROUND: Minor head trauma is a common reason for emergency department visits in children, but many of these cases are not clinically significant. Despite established criteria for selecting patients who require computed tomography (CT), concerns about overuse of CT persist. This study aimed to determine the frequency of clinically important traumatic brain injury by retrospectively evaluating cranial CT scans in children categorized as very low risk for such injuries based on PECARN...
  • Todd A Florin
  • Octavio Ramilo
  • Russell K Banks
  • David Schnadower
  • Kimberly S Quayle
  • Elizabeth C Powell
  • Michelle L Pickett
  • Lise E Nigrovic
  • Rakesh Mistry
  • Aaron N Leetch
  • Robert W Hickey
  • Eric W Glissmeyer
  • Peter S Dayan
  • Andrea T Cruz
  • Daniel M Cohen
  • Amanda Bogie
  • Fran Balamuth
  • Shireen M Atabaki
  • John M VanBuren
  • Prashant Mahajan
  • Nathan Kuppermann
  • Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)
CONCLUSIONS: Radiographic pneumonias were uncommon in febrile infants. Viral detection was common. Pneumonia was associated with respiratory distress, but few other factors. Although ANC and PCT levels were elevated in infants with definite pneumonias, further work is necessary to evaluate the role of blood biomarkers in infant pneumonias.
  • Colleen K Gutman
  • Jeanine E Hall
  • K Casey Lion
No abstract
  • Peter C Jenkins
  • Amber Lin
  • Stefanie G Ames
  • Craig D Newgard
  • Benjamin Lang
  • James E Winslow
  • Jennifer R Marin
  • Jennifer N B Cook
  • Jeremy D Goldhaber-Fiebert
  • Linda Papa
  • Mark R Zonfrillo
  • Matthew Hansen
  • Stephen P Wall
  • Susan Malveau
  • Nathan Kuppermann
  • Pediatric Readiness Study Group
CONCLUSIONS AND RELEVANCE: In this study, racial and ethnic disparities in mortality existed among children treated for acute medical emergencies but not traumatic injuries. Increased ED pediatric readiness was associated with reduced disparities; it was estimated that increasing the ED pediatric readiness levels of hospitals in the 3 lowest quartiles would result in an estimated 3-fold reduction in disparity for pediatric mortality. However, increased pediatric readiness did not eliminate...
  • JoAnna K Leyenaar
  • Seneca D Freyleue
  • Mary Arakelyan
  • David C Goodman
  • A James O'Malley
CONCLUSIONS AND RELEVANCE: Between 2009 and 2019, the largest decreases in pediatric hospitalizations occurred at rural and urban nonteaching hospitals. Clinical and policy initiatives to support hospitals with low pediatric volumes may be needed to maintain hospital access and pediatric readiness, particularly in rural communities.
  • Kendall J Burdick
  • Aixa Perez Coulter
  • Michael Tirabassi
CONCLUSIONS: We did not find evidence that prehospital transport within the "Golden Hour" had a substantial association with survival, though it may be associated with length of stay. There are many factors contributing to trauma outcomes, so efforts should continue to expand access and pediatric readiness.
  • Mohsen Saidinejad
  • Susan Duffy
  • Dina Wallin
  • Jennifer A Hoffmann
  • Madeline Joseph
  • Jennifer Schieferle Uhlenbrock
  • Kathleen Brown
  • Muhammad Waseem
  • Sally K Snow
  • Madeline Andrew
  • Alice A Kuo
  • Carmen Sulton
  • Thomas Chun
  • Lois K Lee
  • AMERICAN ACADEMY OF PEDIATRICS
  • Committee on Pediatric Emergency Medicine
  • Gregory P Conners
  • James Callahan
  • Toni Gross
  • Madeline Joseph
  • Lois Lee
  • Elizabeth Mack
  • Jennifer Marin
  • Suzan Mazor
  • Ronald Paul
  • Nathan Timm
  • AMERICAN COLLEGE OF EMERGENCY PHYSICIANS
  • Pediatric Emergency Medicine Committee
  • Ann M Dietrich
  • Kiyetta H Alade
  • Christopher S Amato
  • Zaza Atanelov
  • Marc Auerbach
  • Isabel A Barata
  • Lee S Benjamin
  • Kathleen T Berg
  • Kathleen Brown
  • Cindy Chang
  • Jessica Chow
  • Corrie E Chumpitazi
  • Ilene A Claudius
  • Joshua Easter
  • Ashley Foster
  • Sean M Fox
  • Marianne Gausche-Hill
  • Michael J Gerardi
  • Jeffrey M Goodloe
  • Melanie Heniff
  • James Jim L Homme
  • Paul T Ishimine
  • Susan D John
  • Madeline M Joseph
  • Samuel Hiu-Fung Lam
  • Simone L Lawson
  • Moon O Lee
  • Joyce Li
  • Sophia D Lin
  • Dyllon Ivy Martini
  • Larry Bruce Mellick
  • Donna Mendez
  • Emory M Petrack
  • Lauren Rice
  • Emily A Rose
  • Timothy Ruttan
  • Mohsen Saidinejad
  • Genevieve Santillanes
  • Joelle N Simpson
  • Shyam M Sivasankar
  • Daniel Slubowski
  • Annalise Sorrentino
  • Michael J Stoner
  • Carmen D Sulton
  • Jonathan H Valente
  • Samreen Vora
  • Jessica J Wall
  • Dina Wallin
  • Theresa A Walls
  • Muhammad Waseem
  • Dale P Woolridge
  • EMERGENCY NURSES ASSOCIATION
  • Pediatric Committee
  • Cam Brandt
  • Krisi M Kult
  • Justin J Milici
  • Nicholas A Nelson
  • Michele A Redlo
  • Maureen R Curtis Cooper
  • Michele Redlo
  • Krisi Kult
  • Katherine Logee
  • Dixie Elizabeth Bryant
  • Maureen Curtis Cooper
  • Kristen Cline
  • POLICY STATEMENT
  • Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of All Children
  • This article is being jointly published in Pediatrics, Annals of Emergency Medicine, and Journal of Emergency Nursing.
Mental and behavioral health (MBH) emergencies in children and youth continue to increasingly affect not only the emergency department (ED), but the entire spectrum of emergency medical services for children, from prehospital services to the community. Inadequate community and institutional infrastructure to care for children and youth with MBH conditions makes the ED an essential part of the health care safety net for these patients. As a result, an increasing number of children and youth are...
  • Chris A Rees
  • David C Brousseau
  • Daniel M Cohen
  • Anthony Villella
  • Carlton Dampier
  • Kathleen Brown
  • Andrew Campbell
  • Corrie E Chumpitazi
  • Gladstone Airewele
  • Todd Chang
  • Christopher Denton
  • Angela Ellison
  • Alexis Thompson
  • Fahd Ahmad
  • Nitya Bakshi
  • Keli D Coleman
  • Sara Leibovich
  • Deborah Leake
  • Dunia Hatabah
  • Hagar Wilkinson
  • Michelle Robinson
  • T Charles Casper
  • Elliott Vichinsky
  • Claudia R Morris
  • SCD Arginine Study Group and PECARN
BACKGROUND: Despite substantial illness burden and healthcare utilization conferred by pain from vaso-occlusive episodes (VOE) in children with sickle cell disease (SCD), disease-modifying therapies to effectively treat SCD-VOE are lacking. The aim of the Sickle Cell Disease Treatment with Arginine Therapy (STArT) Trial is to provide definitive evidence regarding the efficacy of intravenous arginine as a treatment for acute SCD-VOE among children, adolescents, and young adults.
  • Mohsen Saidinejad
  • Susan Duffy
  • Dina Wallin
  • Jennifer A Hoffmann
  • Madeline M Joseph
  • Jennifer Schieferle Uhlenbrock
  • Kathleen Brown
  • Muhammad Waseem
  • Sally Snow
  • Madeline Andrew
  • Alice A Kuo
  • Carmen Sulton
  • Thomas Chun
  • Lois K Lee
  • AMERICAN ACADEMY OF PEDIATRICS Committee on Pediatric Emergency Medicine
  • AMERICAN COLLEGE OF EMERGENCY PHYSICIANS Pediatric Emergency Medicine Committee
  • EMERGENCY NURSES ASSOCIATION Pediatric Committee
Mental and behavioral health (MBH) emergencies in children and youth continue to increasingly affect not only the emergency department (ED), but the entire spectrum of emergency medical services for children, from prehospital services to the community. Inadequate community and institutional infrastructure to care for children and youth with MBH conditions makes the ED an essential part of the health care safety net for these patients. As a result, an increasing number of children and youth are...
  • Mohsen Saidinejad
  • Susan Duffy
  • Dina Wallin
  • Jennifer A Hoffmann
  • Madeline Joseph
  • Jennifer Schieferle Uhlenbrock
  • Kathleen Brown
  • Muhammad Waseem
  • Sally K Snow
  • Madeline Andrew
  • Alice A Kuo
  • Carmen Sulton
  • Thomas Chun
  • Lois K Lee
Mental and behavioral health (MBH) emergencies in children and youth continue to increasingly affect not only the emergency department (ED), but the entire spectrum of emergency medical services for children, from prehospital services to the community. Inadequate community and institutional infrastructure to care for children and youth with MBH conditions makes the ED an essential part of the health care safety net for these patients. As a result, an increasing number of children and youth are...
  • Molly M Diaz Kane
Head injuries, and specifically blunt head trauma, are common among pediatric patients of all ages. Patients may present to their primary care provider, to urgent care, or to the emergency department after head trauma. Such injuries may occur as a result of a variety of mechanisms, including falls, motor vehicle collisions, or sports injuries. Clinical decision rules exist to help guide the clinician in the initial evaluation of head injury and in determining when head imaging may be indicated....
  • Nina E Glass
  • Apoorva Salvi
  • Ran Wei
  • Amber Lin
  • Susan Malveau
  • Jennifer N B Cook
  • N Clay Mann
  • Randall S Burd
  • Peter C Jenkins
  • Matthew Hansen
  • Nicholas M Mohr
  • Caroline Stephens
  • Mary E Fallat
  • E Brooke Lerner
  • Brendan G Carr
  • Stephen P Wall
  • Craig D Newgard
CONCLUSIONS AND RELEVANCE: These findings suggest that trauma centers with high ED pediatric readiness had lower mortality after considering transport time and proximity. Improving ED pediatric readiness among all trauma centers, rather than selective transport to trauma centers with high ED readiness, had the largest association with pediatric survival. Thus, increased pediatric readiness at all US trauma centers may substantially improve patient outcomes after trauma.
  • Alfred Sacchetti
  • Eric Hicken
  • W Richard Bukata
  • Dana Durso
CONCLUSIONS: Pediatric patients seeking ED care overwhelmingly arrive through a private mode regardless of the severity of their problem or type of ED in which treated. Emergency Medical Services programs and state hospital regulatory agencies need to recognize this practice and assure the pediatric competence of every ED within their system.
  • Steven W Thornton
  • Harold J Leraas
  • Elizabeth Horne
  • Marcelo Cerullo
  • Doreen Chang
  • Emily Greenwald
  • Suresh Agarwal
  • Krista L Haines
  • Elisabeth T Tracy
CONCLUSIONS: There is relatively limited exposure to high-acuity pediatric trauma at US centers. Investigation into pediatric trauma resuscitation education and simulation may promote pediatric readiness and lead to improved outcomes.
  • Ernest Leva
  • Minh-Tu Do
  • Rachael Grieco
  • Anna Petrova
This study demonstrates the trend of computed tomography (CT) usage for children with mild traumatic brain injury (mTBI) in the context of the initiation of the Safe CT Imaging Collaborative Initiative to promote the Pediatric Emergency Care Applied Research Network (PECARN) rules at the acute care hospitals in New Jersey. We used administrative databases of 10 children's and 59 general hospitals to compare CT rates before 2014-2015, during 2016, and after the initiation of the program...
  • Ashley A Foster
  • Joyce Li
  • Matthew H Wilkinson
  • Michael Ely
  • Marianne Gausche-Hill
  • Craig Newgard
  • Katherine Remick
CONCLUSION: Characteristics of PECC workforce vary but PECC activities of education and QI work are common among all. There is a reported need for additional training and support. Further studies will determine the impact of PECC characteristics on pediatric readiness.
  • Keli D Coleman
  • Kenneth McKinley
  • Angela M Ellison
  • Elizabeth R Alpern
  • Selena Hariharan
  • Irina Topoz
  • Morgan Wurtz
  • Blake Nielsen
  • Lawrence J Cook
  • Claudia R Morris
  • Amanda M Brandow
  • Andrew D Campbell
  • Robert I Liem
  • Rachelle Nuss
  • Charles T Quinn
  • Alexis A Thompson
  • Anthony Villella
  • Allison A King
  • Ana Baumann
  • Warren Frankenberger
  • David C Brousseau
CONCLUSION: Nearly 30% of ED discharged visits after SCD pain treatment had a return visit within 14 days. Increased efforts are needed to identify causes for high ED return visit rates and ensure optimal ED and post-ED care.
  • Katherine E Remick
  • Hilary A Hewes
  • Michael Ely
  • Patricia Schmuhl
  • Rachel Crady
  • Lawrence J Cook
  • Lorah Ludwig
  • Marianne Gausche-Hill
CONCLUSIONS AND RELEVANCE: These data demonstrate improvements in key domains of pediatric readiness despite losses in the health care workforce, including PECCs, during the COVID-19 pandemic, and suggest organizational changes in EDs to maintain pediatric readiness.
  • Marc A Auerbach
  • Travis Whitfill
  • Erin Montgomery
  • James Leung
  • David Kessler
  • Isabel T Gross
  • Barbara M Walsh
  • Melinda Fiedor Hamilton
  • Marcie Gawel
  • Shruti Kant
  • Stephen Janofsky
  • Linda L Brown
  • Theresa A Walls
  • Michelle Alletag
  • Anna Sessa
  • Grace M Arteaga
  • Ashley Keilman
  • Wendy Van Ittersum
  • Maia S Rutman
  • Pavan Zaveri
  • Grace Good
  • Jessica C Schoen
  • Meghan Lavoie
  • Mark Mannenbach
  • Ladonna Bigham
  • Robert A Dudas
  • Chrystal Rutledge
  • Pamela J Okada
  • Michelle Moegling
  • Ingrid Anderson
  • Khoon-Yen Tay
  • Daniel J Scherzer
  • Samreen Vora
  • Stacy Gaither
  • Daniel Fenster
  • Derick Jones
  • Michelle Aebersold
  • Jenny Chatfield
  • Lynda Knight
  • Marc Berg
  • Ana Makharashvili
  • Jessica Katznelson
  • Emily Mathias
  • Riad Lutfi
  • Samer Abu-Sultaneh
  • Brian Burns
  • Patricia Padlipsky
  • Jumie Lee
  • Lucas Butler
  • Sarah Alander
  • Anita Thomas
  • Ambika Bhatnagar
  • Farrukh N Jafri
  • Jason Crellin
  • Kamal Abulebda
CONCLUSIONS: A low quality of pediatric resuscitative care, measured using simulation, was noted across a cohort of GEDs. Hospital factors associated with higher quality included: an affiliation with a PAMC, designation of a pediatric emergency care coordinator, higher pediatric volume, and geographic location. A weak correlation was noted between quality and pediatric readiness scores.
  • Kristen Waddell
  • Stacy L Gaither
  • Nicholas Rockwell
  • Nancy M Tofil
  • Chrystal Rutledge
CONCLUSIONS: A multifaceted program of in situ simulation education and formal feedback on patient management can improve community GED management of pediatric patients with DKA.
  • Heather X Rhodes
  • Gina Berg
  • Anthony L Shadiack
  • Kevin D Thomas
  • Jennifer L Horawski
  • Geoff Boyer
  • Sara M Kleist
  • Aaron I Worthley
  • David I Rosenberg
  • Scott B Gutovitz
  • George A Helmrich
  • Saptarshi Biswas
  • Antonio P Pepe
CONCLUSIONS: We identified additional factors associated with complex mild traumatic brain injury, including motorcycle collision and all-terrain vehicle trauma, unspecified mechanism, and consult activation that are not in the PECARN imaging decision rule. Adding these variables may aid in determining the need for appropriate CT scanning.
  • Stanislas Roche
  • Amandine Crombé
  • Axel Benhamed
  • Jean-François Hak
  • Alexia Dabadie
  • Clémence Fauconnier-Fatus
  • Adelaïde Rega
  • Grégoire Pech-Gourg
  • Karim Tazarourte
  • Mylène Seux
  • Adrien Acquier
  • Guillaume Gorincour
CONCLUSION AND RELEVANCE: In this cohort study of 5146 children who underwent HCT for PHT, knowing the odds of clinical and radiological features for ICHs and fractures could help emergency physicians and radiologists improve their image analysis and avoid missing significant injuries. The PECARN rules were not implemented in nearly two-thirds of patients.
  • Samuel Wade Ross
  • Eric Campion
  • Aaron R Jensen
  • Lisa Gray
  • Toni Gross
  • Nicholas Namias
  • Jeffrey M Goodloe
  • Eileen M Bulger
  • Peter E Fischer
  • Mary E Fallat
Injury is the leading cause of death in children older than 1 year, and children make up 22% of the population. Pediatric readiness (PR) of the nation's emergency departments and state trauma and emergency medical services (EMS) systems is conceptually important and vital to mitigate mortality and morbidity in this population. The extension of PR to the trauma community has become a focused area for training, staffing, education, and equipment at all levels of trauma center designation, and...
  • Mohsen Saidinejad
  • Isabel Barata
  • Ashley Foster
  • Timothy K Ruttan
  • Muhammad Waseem
  • Douglas K Holtzman
  • Lee S Benjamin
  • Sam Shahid
  • Kathleen Berg
  • Dina Wallin
  • Shireen M Atabaki
  • Madeline M Joseph
  • ACEP Pediatric Emergency Medicine Committee
In 2006, the Institute of Medicine published a report titled "Emergency Care for Children: Growing Pains," in which it described pediatric emergency care as uneven at best. Since then, telehealth has emerged as one of the great equalizers in care of children, particularly for those in rural and underresourced communities. Clinicians in these settings may lack pediatric-specific specialization or experience in caring for critically ill or injured children. Telehealth consultation can provide...
  • Ann L Young
  • Michael C Monuteaux
  • Tabitha M Cooney
  • Kenneth A Michelson
CONCLUSIONS: Delayed ED diagnosis of pediatric CNS tumors is common and frequently requires multiple ED encounters. Prevention of delays should focus on careful evaluation of young or chronically ill children, mitigating disparities for Black and publicly insured children, and improving pediatric readiness in rural and nonteaching EDs.
  • Baiming Zou
  • Xinlei Mi
  • Elizabeth Stone
  • Fei Zou
CONCLUSION: These results indicate that the PermFIT-DNN framework robustly identifies significant clinical features associated with TBI status and improves prediction performance. The findings could be used to inform the development of clinical decision tools designed to inform triage decisions.
  • Jennifer L Trainor
  • Nicole S Glaser
  • Leah Tzimenatos
  • Michael J Stoner
  • Kathleen M Brown
  • Julie K McManemy
  • Jeffrey E Schunk
  • Kimberly S Quayle
  • Lise E Nigrovic
  • Arleta Rewers
  • Sage R Myers
  • Jonathan E Bennett
  • Maria Y Kwok
  • Cody S Olsen
  • T Charles Casper
  • Simona Ghetti
  • Nathan Kuppermann
  • Pediatric Emergency Care Applied Research Network (PECARN) FLUID Study Group
CONCLUSION: Most children with DKA have mild-to-moderate dehydration. Although biochemical measures were more closely associated with the severity of dehydration than clinical assessments, neither were sufficiently predictive to inform rehydration practice.
  • Laura Mercurio
  • Daniel Corwin
  • Ron Kaplan
  • Angela M Ellison
  • Theron Charles Casper
  • Nathan Kuppermann
  • Jeffrey A Kline
CONCLUSIONS: This prospective multicenter observational study will not only test whether a set of simple criteria can safely exclude PE without need for imaging but also provide a resource to fill a critical knowledge gap about clinical characteristics of children with suspected and diagnosed PE.
  • Bashar S Shihabuddin
  • Jessica Fritter
  • Angela M Ellison
  • Andrea T Cruz
We conducted a survey study of clinical research coordinators (CRCs) at the member institutions of the Pediatric Emergency Care Applied Research Network, to determine the demographic and linguistic characteristics of CRCs around the network, and any perceived impact of those characteristics on their duties. A total of 53/74 CRCs completed the survey. Most respondents identified as "female," "white," and "not Hispanic/Latino." Most respondents felt that their race/ethnicity and their ability to...
  • Aaron E Kornblith
  • Chandan Singh
  • Gabriel Devlin
  • Newton Addo
  • Christian J Streck
  • James F Holmes
  • Nathan Kuppermann
  • Jacqueline Grupp-Phelan
  • Jeffrey Fineman
  • Atul J Butte
  • Bin Yu
CONCLUSION: The PCS data science framework vetted the PECARN CDI and its constituent predictor variables prior to external validation. We found that the 3 stable predictor variables represented all of the PECARN CDI's predictive performance on independent external validation. The PCS framework offers a less resource-intensive method than prospective validation to vet CDIs before external validation. We also found that the PECARN CDI will generalize well to new populations and should be...
  • Ewa Bućko
  • Patrycja Sosnowska-Sienkiewicz
  • Przemysław Lebioda
  • Przemysław Mańkowski
INTRODUCTION: The aim of the work is to present the possible struggles that a doctor of the Hospital Emergency Department for adults may encounter when admitting a pediatric patient with a head injury. Head trauma is the most common cause of death or permanent injury in the pediatric population. The lack of experience in dealing with a minor patient, as well as the lack of knowledge of anatomical and physiological differences make it necessary to introduce simple algorithms. It helps to...
  • Laurel A Parker
  • Laurie L Villamor
  • Lilly Groszman
  • Laurel Xiang
  • Deepika Koganti
  • Randi Smith
  • Richard Sola
CONCLUSION: Our study suggests that reinforcement of the PECARN guidelines should occur for ordering head CTs in adolescent blunt trauma patients. Future prospective studies are needed to validate the use of PECARN head CT guidelines in this patient population.
  • David A Brent
  • Lisa M Horowitz
  • Jacqueline Grupp-Phelan
  • Jeffrey A Bridge
  • Robert Gibbons
  • Lauren S Chernick
  • Margaret Rea
  • Mary F Cwik
  • Rohit P Shenoi
  • Joel A Fein
  • E Melinda Mahabee-Gittens
  • Shilpa J Patel
  • Rakesh D Mistry
  • Susan Duffy
  • Marlene D Melzer-Lange
  • Alexander Rogers
  • Daniel M Cohen
  • Allison Keller
  • Robert W Hickey
  • Kent Page
  • T Charles Casper
  • Cheryl A King
  • Pediatric Emergency Care Applied Research Network (PECARN)
CONCLUSIONS AND RELEVANCE: This study suggests that both the ASQ and the CASSY are appropriate for universal screening of patients in pediatric EDs. For the small subset of patients with psychiatric symptoms, the CASSY shows greater predictive validity.
  • Simona Ghetti
  • Nathan Kuppermann
  • Arleta Rewers
  • Sage R Myers
  • Jeff E Schunk
  • Michael J Stoner
  • Aris Garro
  • Kimberly S Quayle
  • Kathleen M Brown
  • Jennifer L Trainor
  • Leah Tzimenatos
  • Andrew D DePiero
  • Julie K McManemy
  • Lise E Nigrovic
  • Maria Y Kwok
  • Cody S Olsen
  • T Charles Casper
  • Nicole S Glaser
  • Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group
CONCLUSIONS: A single DKA episode is associated with lower IQ scores soon after exposure to DKA in young children.
  • Angelica Cercone
  • Sriram Ramgopal
  • Christian Martin-Gill
CONCLUSION: Documentation of complete vital signs and condition-specific assessments occurs less frequently in children, especially in younger age groups, as compared to adults, which is a finding that exists across urbanicity, region, and level of response. These findings provide a benchmark for clinical care, quality improvement, and research in the prehospital setting.
  • José Antonio Alonso-Cadenas
  • Rosa María Calderón Checa
  • Clara Ferrero García-Loygorri
  • Isabel Durán Hidalgo
  • María José Pérez García
  • Pablo Delgado Gómez
  • Raquel Jiménez García
  • en nombre del Grupo de Trabajo del Traumatismo Craneoencefálico leve en los lactantes menores de 3 meses
CONCLUSION: We found substantial variability and low adherence to the PECARN recommendations in the performance of imaging tests in infants aged less than 3 months with MHI in Spanish PEDs, mainly due to an excessive use of skull X-rays.
  • Gargi Mukherjee
  • Evan Orenstein
  • Shabnam Jain
  • Nicole Hames
CONCLUSIONS: After implementation of a guideline based on the PECARN prediction rule, we observed a reduction of LPs and antibiotics in low-risk infants. Overall, a decrease in LPs was observed, whereas antibiotic use and admissions remained unchanged.
  • Kavita Krishnan
  • Alice Su
  • Garry Sigman
  • Cara Joyce
  • Megan A Rech
  • Christina M Long
CONCLUSIONS: There is a lack of consistency in the evaluation and education of mTBI in pediatric patients. There is a need for personalized discharge instructions to ensure adequate patient and parent understanding and compliance. Further studies looking at long-term outcomes in these patients would also be beneficial.
  • Ashley A Foster
  • Jennifer A Hoffmann
No abstract
  • Craig D Newgard
  • Amber Lin
  • Susan Malveau
  • Jennifer N B Cook
  • McKenna Smith
  • Nathan Kuppermann
  • Katherine E Remick
  • Marianne Gausche-Hill
  • Jeremy Goldhaber-Fiebert
  • Randall S Burd
  • Hilary A Hewes
  • Apoorva Salvi
  • Haichang Xin
  • Stefanie G Ames
  • Peter C Jenkins
  • Jennifer Marin
  • Matthew Hansen
  • Nina E Glass
  • Avery B Nathens
  • K John McConnell
  • Mengtao Dai
  • Brendan Carr
  • Rachel Ford
  • Davis Yanez
  • Sean R Babcock
  • Benjamin Lang
  • N Clay Mann
  • Pediatric Readiness Study Group
CONCLUSIONS AND RELEVANCE: These findings suggest that children with injuries and medical conditions treated in EDs with high pediatric readiness had lower mortality during hospitalization and to 1 year.
  • Chris A Rees
  • David C Brousseau
  • Fahd A Ahmad
  • Jonathan Bennett
  • Seema Bhatt
  • Amanda Bogie
  • Kathleen M Brown
  • T Charles Casper
  • Laura L Chapman
  • Corrie E Chumpitazi
  • Daniel M Cohen
  • Carlton Dampier
  • Angela M Ellison
  • Hartmut Grasemann
  • Dunia Hatabah
  • Robert W Hickey
  • Lewis L Hsu
  • Nitya Bakshi
  • Sara Leibovich
  • Prabhumallikarjun Patil
  • Elizabeth C Powell
  • Rachel Richards
  • Syana Sarnaik
  • Debra L Weiner
  • Claudia R Morris
  • SCD Arginine Study Group and PECARN
Children with sickle cell disease (SCD) commonly experience vaso-occlusive pain episodes (VOE) due to sickling of erythrocytes, which often requires care in the emergency department. Our objective was to assess the use and impact of intranasal fentanyl for the treatment of children with SCD-VOE on discharge from the emergency department in a multicenter study. We conducted a cross-sectional study at 20 academic pediatric emergency departments in the United States and Canada. We used logistic...
  • Tadashi Miyagawa
  • Marina Saga
  • Minami Sasaki
  • Miyuki Shimizu
  • Akira Yamaura
CONCLUSIONS: These results confirm the role and importance of each of the predictors mentioned in the PECARN study and show that ML could discriminate between children with csTBI and the control group.
  • Craig D Newgard
  • Sean R Babcock
  • Xubo Song
  • Katherine E Remick
  • Marianne Gausche-Hill
  • Amber Lin
  • Susan Malveau
  • N Clay Mann
  • Avery B Nathens
  • Jennifer N B Cook
  • Peter C Jenkins
  • Randall S Burd
  • Hilary A Hewes
  • Nina E Glass
  • Aaron R Jensen
  • Mary E Fallat
  • Stefanie G Ames
  • Apoorva Salvi
  • K John McConnell
  • Rachel Ford
  • Marc Auerbach
  • Jessica Bailey
  • Tyne A Riddick
  • Haichang Xin
  • Nathan Kuppermann
  • Pediatric Readiness Study Group
CONCLUSIONS: ED pediatric readiness components related to specific policies, personnel, and equipment were the strongest predictors of pediatric survival and worked synergistically when combined.
  • Amélie Tremblay
  • Kathryn J Schneider
  • Keith Owen Yeates
  • Geoff Schneider
  • Pierre Frémont
BACKGROUND: Decision rules (eg, Canadian computed tomography head rule [CCHR] for adults and Pediatric Emergency Care Applied Research Network [PECARN] rule for children/adolescents) are used in emergency settings (emergency room [ER] rules) to assess traumatic brain injuries (TBIs). The rules have a high-sensitivity and near-perfect negative predictive value that help to rule out more severe TBI. CLINICAL QUESTION: Which criteria should be added to the Sport Concussion Assessment Tool 5 (SCAT5)...
  • José Antonio Alonso-Cadenas
  • Rosa María Calderón Checa
  • Arístides Rivas García
  • Isabel Durán Hidalgo
  • Marta Cabrero Hernández
  • Sara Ruiz González
  • María José Pérez García
  • Maria De Ceano-Vivas
  • Pablo Delgado Gómez
  • Miguel Antoñón Rodríguez
  • Rubén Moreno Sánchez
  • José Martínez Hernando
  • Cristina Muñoz López
  • Irene Ortiz Valentín
  • Raquel Jiménez García
No abstract
  • Irma T Ugalde
  • Pradip P Chaudhari
  • Mohamed Badawy
  • Paul Ishimine
  • Kevan A McCarten-Gibbs
  • Kenneth Yen
  • Nisa S Atigapramoj
  • Allyson Sage
  • Donovan Nielsen
  • P David Adelson
  • Jeffrey Upperman
  • Daniel Tancredi
  • Nathan Kuppermann
  • James F Holmes
CONCLUSIONS: This study will attempt to validate previously derived clinical prediction rules to accurately identify children at high and very low risk for clinically important IAIs and TBIs. Assuming successful validation, widespread implementation is then indicated, which will optimize the care of children who are injured by better aligning CT use with need.
  • Priya K Pai
  • Denise B Klinkner
Death and disability associated with traumatic injury can be significantly decreased with timely and appropriate care. Patients in rural areas tend to have disproportionately decreased access to this care, with the pediatric age group acting as a particularly difficult challenge for pre-hospital and rural hospital settings due to the unfamiliarity of those trauma response teams with pediatric age specific management guidelines as well as a disparity in resource availability. In this review, we...
  • Kristina Brumme
  • Hilary A Hewes
  • Rachel Richards
  • Marianne Gausche-Hill
  • Katherine Remick
  • Joelle Donofrio-Odmann
CONCLUSIONS: We found neighboring general EDs have a higher level of pediatric readiness as measured by the median weighted pediatric readiness score. High-acuity, pediatric-capable EDs may influence the pediatric readiness of neighboring general Eds, but further investigation is needed to clarify target areas for outreach by state and national partners to improve overall pediatric readiness.
  • Natalia Sutiman
  • Zi Xean Khoo
  • Gene Yong Kwang Ong
  • Rupini Piragasam
  • Shu Ling Chong
CONCLUSION: CRP strongly predicted SBIs, and PCT strongly predicted IBI. The Step-by-Step approach had the highest sensitivity and NPV, while Lab-score had the highest specificity and AUC in predicting SBIs and IBIs.
  • José Antonio Alonso-Cadenas
  • Rosa María Calderón Checa
  • Arístides Rivas García
  • Isabel Durán Hidalgo
  • Marta Cabrero Hernández
  • Sara Ruiz González
  • María José Pérez García
  • Maria De Ceano-Vivas
  • Pablo Delgado Gómez
  • Miguel Antoñón Rodríguez
  • Rubén Moreno Sánchez
  • José Martínez Hernando
  • Cristina Muñoz López
  • Irene Ortiz Valentín
  • Raquel Jiménez García
CONCLUSION: The PECARN rule for infants < 2 years old accurately identified infants < 3 months old at low risk for ciTBI in our population, although the adapted Spanish rule presented here could be even more accurate.
  • Alex Aregbesola
  • Oana Florescu
  • Clara Tam
  • Amanda Coyle
  • Lisa Knisley
  • Kaitlin Hogue
  • Darcy Beer
  • Scott Sawyer
  • Terry P Klassen
CONCLUSIONS: The pediatric readiness of the general EDs across Manitoba is comparable to other Canadian region, yet some domains need to be improved.
  • Mary E Fallat
  • Colin Treager
  • Sophie Humphrey
  • Lindsey Gumer
  • Kahir Jawad
  • Elissa Butler
  • Frederick B Rogers
  • Frederick P Rivara
  • Amelia T Collings
CONCLUSIONS AND RELEVANCE: Results of this cross-sectional study suggest that a more robust pediatric trauma system has a significant association with pediatric injury mortality. This study assessed the national landscape of capability and preparedness to provide pediatric trauma care at the state level. These parameters can tailor the maturation of children's interests within a state trauma system and assist with future state, regional, and national planning.
  • Hoi See Tsao
  • Rachael Alter
  • Erica Kane
  • Toni Gross
  • Lorin R Browne
  • Marc Auerbach
  • Julie C Leonard
  • Lorah Ludwig
  • Kathleen M Adelgais
CONCLUSION: Over the 6-month Learning Collaborative, nine states were successful in recruiting a substantial number of PECCs. Financial and time constraints were significant barriers to statewide PECC recruitment, yet these can be potentially addressed by EMS agency recognition programs.
  • Andrea T Cruz
  • Melisa S Tanverdi
  • Sarah J Swartz
  • Peter S Dayan
  • Veronica A Combs
  • Tamar R Lubell
CONCLUSIONS: Bacteremia or UTIs were diagnosed in one-quarter of all pediatric renal transplant recipients presenting with suspected infection within 2 years of transplant. Evaluations were highly variable, with one-third of visits not having urine cultures obtained. No single demographic, clinical or laboratory variable accurately identified patients with bacteremia, although combinations of findings may identify a high-risk population.