Lung Ultrasound Findings in Children With Asthma Exacerbations.

Objective: We sought to assess whether the presence and extent of lung ultrasound (LUS) findings were associated with asthma exacerbation severity in children.

Methods: We enrolled a convenience sample of patients aged 5-18 years presenting with acute asthma exacerbation to a tertiary care pediatric emergency department. Severity of an asthma exacerbation (mild, moderate, severe) was assessed within 1 hour of the LUS using the Hospital Asthma Severity Score, a validated asthma assessment tool.

Splinting of Low-Risk Pediatric Fractures.

This review covers common orthopedic injuries seen after acute traumatic injury. A thorough physical examination and radiographic review of these injuries are key to ensuring appropriate management. Although many injuries may require urgent or emergent orthopedic consultation and management, this review focuses on injuries that are low-risk and amenable to splinting with outpatient orthopedic follow-up.

Surgical Specialty Consultation for Pediatric Facial Laceration Repair: An American and Canadian Survey.

Objective: We sought to describe patterns of and indications for surgical specialty consultation for facial laceration repair in pediatric emergency departments (PEDs).

Methods: We performed a multicenter survey of PED leadership throughout the United States and Canada evaluating the practice patterns of surgical specialty consultation for patients presenting for facial lacerations requiring repair. We measured demographics of PEDs, factors influencing the decision to obtain a surgical specialty consultation, and the presence and components of consultation guidelines.

Test Characteristics of Cardiac Point-of-Care Ultrasound in Children With Preexisting Cardiac Conditions.

Objective: The aim of the study is to assess diagnostic performance of cardiac point-of-care ultrasound (POCUS) performed by pediatric emergency medicine (PEM) physicians in children with preexisting cardiac disease.

Methods: We evaluated the use of cardiac POCUS performed by PEM physicians among a convenience sample of children with preexisting cardiac disease presenting to a tertiary care pediatric ED. We assessed patient characteristics and the indication for POCUS.

Alternative care sites and resident exposure in pediatric emergency medicine: Who, what, and where.

Objectives: Emergency medicine (EM) physicians and pediatricians who provide acute pediatric care depend on clinical exposure during residency to learn pediatric EM. Increasing volumes of pediatric patients, especially with behavioral health complaints, have stressed pediatric emergency departments (ED) and prompted clinical operations innovations including alternative care sites outside the main ED. We investigated the impact of these recent trends and resulting alternative care sites on the exposure of residents to core pediatric conditions.

A review of the 2020 update of the Pediatric Advanced Life Support guidelines.

Pediatric cardiac arrest presents an infrequent but high-stakes event for emergency clinicians, who need to maintain expertise in this area. Evidence regarding pediatric resuscitations has been accumulating substantially over the past decade and highlights the unique considerations and challenges when resuscitating children. This issue reviews resuscitation principles of children in cardiac arrest while addressing the newest evidence-based and best-practice recommendations by the American Heart Association.

See one, see one, teach one - Decisions on allocating intubation opportunities in pediatric emergency medicine.

Background: Decisions about who should perform tracheal intubation in academic settings must balance the needs of trainees to develop competency in pediatric intubation with patient safety. Airway protocols during the COVID-19 pandemic may have reduced opportunities for trainees, representing an opportunity to examine the impact of shifting laryngoscopy responsibilities away from trainees.

Methods: This observational study combined data from 11 pediatric emergency departments in North America participating in either the National Emergency Airway Registry for Children (NEAR4KIDS) or a national pediatric emergency medicine airway education collaborative.

The limits of the "system of schools" approach: Superintendent perspectives on change efforts in U.S. Catholic school systems.

Catholic schooling in the United States is suffering from a persistent enrollment crisis that has triggered the need for system-wide organizational reforms. However, most of the changes that the sector has experienced has taken place in individual schools making decisions about how to operationally sustain their individual school community. In this article, we present findings from a qualitative analysis of 26 superintendents of (arch)diocesan Catholic school systems in order to better understand why there has been an absence of system-level change in the Catholic sector in the U.

Yield of Plain Radiography in Addition to Ultrasound Among Children with Hip Pain.

Background: Children with limp or hip pain often undergo radiographs and ultrasound as part of their initial evaluation. Previous research suggests that hip radiography may have limited utility, and early use of ultrasound may safely reduce the use of radiographs.

Objectives: We sought to assess the utility of radiography in addition to ultrasound by evaluating the rate of bony abnormalities present on hip radiographs among children with and without effusion on ultrasound.

Use of Cardiac Point-of-Care Ultrasound in the Pediatric Emergency Department.

Objectives: We sought to describe the test characteristics of cardiac point-of-care ultrasound (POCUS) performed by pediatric emergency medicine (PEM) physicians after structured cardiac POCUS training.

Methods: We evaluated the use of clinically indicated cardiac POCUS by PEM physicians in a single tertiary care pediatric emergency department after implementation of a focused cardiac POCUS training curriculum. The test characteristics of the sonologist interpretation were compared with expert POCUS review, by PEM physicians who have completed PEM POCUS fellowship training, for the assessment of both pericardial effusion and left ventricular systolic dysfunction.

Does Point-of-Care Gastric Ultrasound Correlate With Reported Fasting Time?

Objective: Traditionally, patient-reported fasting time has been the primary objective presedation measure of aspiration risk. Recently, gastric ultrasound has been used to assess gastric volume for the determination of aspiration risk in patients undergoing anesthesia in the operative setting. We sought to determine the correlation of gastric volume estimated by point-of-care ultrasound (POCUS) to reported fasting time.

Racial and Ethnic Differences in Emergency Department Utilization and Diagnosis for Sports-Related Head Injuries.

Prior studies have shown racial differences in concussion awareness and outcome. To assess if racial or ethnic differences exist in Emergency Department (ED) utilization and diagnosis for children with sports-related head injuries. We performed a retrospective, cross-sectional analysis of ED visits from 2008 to 2017 using National Electronic Injury Surveillance System (NEISS) data.

Sacral Myeloradiculitis: An Uncommon Complication of Genital Herpes Infection.

Herpes simplex virus 1 and 2 infections affect up to 50 million people in the United States, with a natural history of recurrent viral shedding with or without recurrence of symptoms. Although many patients remain asymptomatic or with mild symptoms, a spectrum of rare but significant nervous system complications have been reported. Although urinary retention and constipation associated with genital herpesvirus infections is often attributed to painful genital ulcerations, herpesvirus-associated lumbosacral myeloradiculitis has been reported in adults.

Improving Efficiency and Communication around Sedated Fracture Reductions in a Pediatric Emergency Department.

Introduction: Procedural sedation for fracture reduction in the pediatric emergency department (ED) is a time-consuming process requiring multidisciplinary coordination. We implemented a quality improvement initiative aimed at (1) decreasing mean ED length of stay (LOS) for children with sedated long bone fracture reductions by 15% over 12 months and (2) improving interdisciplinary communication around procedural sedation.

Methods: Pediatric emergency medicine fellows at a children's hospital designed and implemented an initiative targeting the efficiency of the sedation process.

Interrater reliability of pediatric point-of-care lung ultrasound findings.

Objective: We sought to assess interrater reliability (IRR) of lung point-of-care ultrasound (POCUS) findings among pediatric patients with suspected pneumonia.

Methods: A convenience sample of patients between the ages of 6 months and 18 years with a clinical suspicion of pneumonia had a lung ultrasound performed by a POCUS-credentialed emergency medicine physician with subsequent expert review. Each lung zone was assessed as either normal or abnormal, and specific ultrasound findings were recorded.

Variation in Pediatric Procedural Sedations Across Children's Hospital Emergency Departments.

Objectives: Describe the trends in pediatric sedation use over time and determine variation in use of procedural sedation across children's hospital emergency departments (EDs).

Methods: We analyzed ED data from 35 hospitals within the Pediatric Health Information System for patients <19 years old who received sedation medications and were discharged from 2009 to 2014. Patients with chronic comorbidities or undergoing intubation were excluded.

Point-of-Care Ultrasound to Diagnose Postpericardiotomy Syndrome in a Child.

We report a case of a patient presenting with abdominal pain after cardiac surgery who was noted on point-of-care ultrasound (POCUS) to have pericardial and pleural effusion, in addition to ascites. The most notable findings were pleural and pericardial effusions, which combined with symptomatology met criteria for postpericardiotomy syndrome. Point-of-care ultrasound expedited the diagnosis of a pericardial effusion with impending tamponade and transfer for pericardiocentesis and placement of pericardial drain.

Lack of host SPARC enhances vascular function and tumor spread in an orthotopic murine model of pancreatic carcinoma.

Utilizing subcutaneous tumor models, we previously validated SPARC (secreted protein acidic and rich in cysteine) as a key component of the stromal response, where it regulated tumor size, angiogenesis and extracellular matrix deposition. In the present study, we demonstrate that pancreatic tumors grown orthotopically in Sparc-null (Sparc(-/-)) mice are more metastatic than tumors grown in wild-type (Sparc(+/+)) littermates. Tumors grown in Sparc(-/-) mice display reduced deposition of fibrillar collagens I and III, basement membrane collagen IV and the collagen-associated proteoglycan decorin.

The Adnectin CT-322 is a novel VEGF receptor 2 inhibitor that decreases tumor burden in an orthotopic mouse model of pancreatic cancer.

Background: Pancreatic cancer continues to have a 5-year survival of less than 5%. Therefore, more effective therapies are necessary to improve prognosis in this disease. Angiogenesis is required for tumor growth, and subsequently, mediators of angiogenesis are attractive targets for therapy.