Development of a reference standard to assign bacterial versus viral infection etiology using an all-inclusive methodology for comparison of novel diagnostic tool performance.

Background: Diagnostic test evaluation requires a reference standard. We describe an approach for creating a reference standard for acute infection using unrestricted adjudication and apply it to compare biomarker tools.

Methods: Adults and children with suspected acute infection enrolled in three prospective studies at emergency departments and urgent cares were included.

Ruptured Appendicitis Within an Intussusception on Point-of-Care Ultrasound.

This case describes a 21-month-old girl who was transferred to our pediatric emergency department with daily fevers for 9 days and concern for intussusception on an ultrasound obtained at the outside hospital. Her examination was notable for diffuse tenderness to palpation with no rebound or guarding. Point-of-care-ultrasound (POCUS) revealed a noncompressible, target-shaped structure in the right midabdomen, which appeared to contain a dilated loop of bowel surrounded by a hypoechoic fluid collection.

Establishing the international research priorities for pediatric emergency medicine point-of-care ultrasound: A modified Delphi study.

Background: The Pediatric Emergency Medicine (PEM) Point-of-care Ultrasound (POCUS) Network (P2Network) was established in 2014 to provide a platform for international collaboration among experts, including multicenter research. The objective of this study was to use expert consensus to identify and prioritize PEM POCUS topics, to inform future collaborative multicenter research.

Methods: Online surveys were administered in a two-stage, modified Delphi study.

Accuracy and Interrater Reliability of Point-of-Care Ultrasonography Image Interpretation for Intussusception.

Objectives: The aim of this study was to determine the accuracy and interrater reliability of (1) point-of-care ultrasound (POCUS) image interpretation for identification of intussusception and (2) reliability of secondary signs associated with intussusception among experts compared with novice POCUS reviewers.

Methods: We conducted a planned secondary analysis of a prospective, convenience sample of children aged 3 months to 6 years who were evaluated with POCUS for intussusception across 17 international pediatric emergency departments between October 2018 and December 2020. A random sample of 100 POCUS examinations was reviewed by novice and expert POCUS reviewers.

Development of a Consensus-Based Definition of Focused Assessment With Sonography for Trauma in Children.

Importance: The wide variation in the accuracy and reliability of the Focused Assessment With Sonography for Trauma (FAST) and the extended FAST (E-FAST) for children after blunt abdominal trauma reflects user expertise. FAST and E-FAST that are performed by experts tend to be more complete, better quality, and more often clinically valuable.

Objective: To develop definitions of a complete, high-quality, and accurate interpretation for the FAST and E-FAST in children with injury using an expert, consensus-based modified Delphi technique.

Morel-Lavallee Lesion: POCUS Review.

This case describes an 18-year-old woman who presented to the pediatric emergency department with 2 days of worsening right knee pain and swelling. The patient's history was remarkable for a motor vehicle accident 12 days before presentation, as well as recent treatment for a gonococcal sexually transmitted infection 9 days before presentation. Her examination was notable for a large area of fluctuance of her right knee without overlying erythema or appreciable intraarticular effusion.

Diagnostic Accuracy of Point-of-Care Ultrasound for Intussusception: A Multicenter, Noninferiority Study of Paired Diagnostic Tests.

Study Objective: To determine the diagnostic accuracy of point-of-care ultrasound (POCUS) performed by experienced clinician sonologists compared to radiology-performed ultrasound (RADUS) for detection of clinically important intussusception, defined as intussusception requiring radiographic or surgical reduction.

Methods: We conducted a multicenter, noninferiority, observational study among a convenience sample of children aged 3 months to 6 years treated in tertiary care emergency departments across North and Central America, Europe, and Australia. The primary outcome was diagnostic accuracy of POCUS and RADUS with respect to clinically important intussusception.

Mechanical ventilation of pediatric patients in the emergency department.

When pediatric patients require mechanical ventilation in the emergency department, the emergency clinician should be prepared to select initial ventilator settings and respond to an intubated patient's dynamic physiologic needs to ensure ongoing oxygenation, ventilation, and hemodynamic stability. Pressure-targeted ventilation is generally recommended in pediatric patients, with initial ventilator settings varying depending on age and the etiology of respiratory failure. This issue reviews indications for mechanical ventilation and offers recommendations for ventilator settings and dosing of analgesics, sedatives, and neuromuscular blockers, with a focus on patient populations in whom the approach to mechanical ventilation may be different.

Pediatric Difficult Airway Response Team Utilization in the Emergency Department: A Case Series.

Objectives: A multidisciplinary pediatric difficult airway team was created at our institution to respond to hospital-wide airway emergencies. We report the characteristics, indications, and outcomes of these activations that occur in the pediatric emergency department (PED).

Methods: Retrospective, single-center cohort study comprised all difficult airway team activations occurring in the PED from the program's inception in 2008 to 2018.

Facial Artery Pseudoaneurysm in a Child Diagnosed With Point of Care Ultrasound.

This case describes a 3-year-old boy who was brought to the pediatric emergency department for evaluation of facial swelling. The patient's history was remarkable for a deep facial laceration 5 days prior that required surgical repair in the operating room. On the day of presentation, he was noted to have mild swelling and tenderness to palpation of the left jaw below the mandible, in the same location as his recent laceration repair.

Accuracy of point-of-care ultrasound and radiology-performed ultrasound for intussusception: A systematic review and meta-analysis.

Objective: It is unclear whether point-of-care ultrasound (POCUS) by emergency medicine physicians is as accurate as radiology-performed ultrasound (RADUS). We aim to summarize the diagnostic accuracy of ultrasonography for intussusception and to compare the performance between POCUS and RADUS.

Methods: Databases were searched from inception through February 2018 using pre-defined index terms.

Point-of-Care Ultrasound Identification of a Psoas Abscess in a Child Presenting With Hip Pain.

This case-report describes a 4-year-old girl brought to the emergency department for the evaluation of limp and elevated inflammatory markers. The patient's history and physical examination did not reveal a clear source of pathology. Point-of-care ultrasound identified a right-sided psoas abscess that was confirmed with computed tomography scan.

Bedside hip ultrasonography in the pediatric emergency department: a tool to guide management in patients presenting with limp.

We present a case of a 3-year-old girl brought to the emergency department for evaluation of limp after falling off the monkey bars 1 day prior. X-rays of the entire left lower extremity were normal with no evidence of fracture, dislocation, or effusion. Point-of-care ultrasound of the left hip demonstrated a hip effusion, which prompted further imaging, ultimately revealing an occult fracture of the left proximal femoral metaphysis.

Synovial fluid findings in children with knee monoarthritis in lyme disease endemic areas.

Background: Although Lyme and septic arthritis of the knee may have similar clinical presentations, septic arthritis requires prompt identification and treatment to avoid joint destruction. We sought to determine whether synovial fluid cell counts alone can discriminate between Lyme, septic, and other inflammatory arthritis.

Methods: We conducted a retrospective cohort study of children aged 1 to 18 years with knee monoarthritis who presented to 1 of 2 pediatric emergency departments located in Lyme endemic areas.

Distinguishing Lyme from septic knee monoarthritis in Lyme disease-endemic areas.

Objective: Because Lyme and septic arthritis may present similarly, we sought to identify children with knee monoarthritis at low risk for septic arthritis who may not require arthrocentesis.

Methods: We performed a retrospective study of children with knee monoarthritis presenting to 1 of 2 pediatric centers, both located in Lyme disease-endemic areas. Septic arthritis was defined by a positive result on synovial fluid culture or synovial fluid pleocytosis with a positive blood culture result.

Identification of phosphorylated residues that affect the activity of the mitotic kinase Aurora-A.

The activity of the kinase Aurora-A (Aur-A) peaks during mitosis and depends on phosphorylation by one or more unknown kinases. Mitotic phosphorylation sites were mapped by mass spec sequencing of recombinant Aur-A protein that had been activated by incubation in extracts of metaphase-arrested Xenopus eggs. Three sites were identified: serine 53 (Ser-53), threonine 295 (Thr-295), and serine 349 (Ser-349), which are equivalent to Ser-51, Thr-288, and Ser-342, respectively, in human Aur-A.

The genetic program of hematopoietic stem cells.

Blood cell production originates from a rare population of multipotent, self-renewing stem cells. A genome-wide gene expression analysis was performed in order to define regulatory pathways in stem cells as well as their global genetic program. Subtracted complementary DNA libraries from highly purified murine fetal liver stem cells were analyzed with bioinformatic and array hybridization strategies.