Predictors for Acute Appendicitis in Children.

Background: Acute appendicitis in children is the most common condition requiring urgent evaluation and surgery in the emergency department. At times, despite the appendix being seen on ultrasound (US), there can be discrepancy as to whether a patient has clinical appendicitis. Secondary findings suggestive of appendicitis can be helpful in identifying and evaluating these children.

Predictors of abnormal electrocardiograms in the pediatric emergency department.

Background: Electrocardiograms (ECGs) are ordered in the pediatric emergency room for a wide variety of chief complaints.

Objectives: Criteria are lacking as to when physicians should obtain ECGs. This study uses a large retrospective cohort of 880 pediatric emergency department (ED) patients to highlight objective criteria including significant medical history and specific vital sign abnormalities to guide clinicians as to which patients might have an abnormal ECG.

Diagnostic accuracy of laboratory and ultrasound findings in patients with a non-visualized appendix.

Ultrasound (US) and laboratory testing are initial diagnostic tests for acute appendicitis. A diagnostic dilemma develops when the appendix is not visualized on US. Objective: To determine if specific US findings and/or laboratory results predict acute appendicitis when the appendix is not visualized.

Adverse events and satisfaction with use of intranasal midazolam for emergency department procedures in children.

Purpose: Procedural sedation is commonly performed in the emergency department (ED). Having safe and fast means of providing sedation and anxiolysis to children is important for the child's tolerance of the procedure, parent satisfaction and efficient patient flow in the ED.

Objective: To evaluate fasting times associated with the administration of intranasal midazolam (INM) and associated complications.

Trampoline Park and Home Trampoline Injuries.

Background And Objective: Trampoline parks, indoor recreational facilities with wall-to-wall trampolines, are increasing in number and popularity. The objective was to identify trends in emergency department visits for trampoline park injuries (TPIs) and compare TPI characteristics with home trampoline injuries (HTIs).

Methods: Data on trampoline injuries from the National Electronic Injury Surveillance System from 2010 to 2014 were analyzed.

Imaging for Suspected Appendicitis: Variation Between Academic and Private Practice Models.

Background: Little is known regarding the effect of different emergency department (ED) practice models on computed tomography (CT) and ultrasound (US) utilization for suspected appendicitis in the ED and through the potential inpatient hospital stay.

Objectives: Examination rates of CT and US for suspected appendicitis at 2 different pediatric EDs (PEDs) through hospital admission: an academic affiliated tertiary PED (site A) compared with a private practice tertiary care PED (site B).

Methods: All visits with the ICD-9 (International Classification of Diseases, Ninth Revision) chief complaint of abdominal pain were retrospectively examined from May 1, 2009, to February 21, 2012.

Reconnecting patients with their primary care provider: an intervention for reducing nonurgent pediatric emergency department visits.

Objective: Intervention to reduce nonurgent pediatric emergency department (PED) visits over a 12-month follow-up.

Methods: Prospective, randomized, controlled trial enrolled children seen in the PED for nonurgent concerns. Intervention subjects received a structured session/handout specific to their primary care provider (PCP), which outlined ways to obtain medical advice.

Rare-earth magnet ingestion: a childhood danger reaches adolescence.

Ingestion of multiple magnets may cause serious gastrointestinal morbidity, such as pressure necrosis, perforation, fistula formation, or intestinal obstruction due to forceful attraction across bowel wall. Although the consequences of multiple magnet ingestion are well documented in young children, the current popularity of small, powerful rare-earth magnets marketed as "desk toys" has heightened this safety concern in all pediatric age groups. A recent US Consumer Product Safety Commission product-wide warning additionally reports the adolescent practice of using toy high-powered, ball-bearing magnets to simulate tongue and lip piercings, a behavior that may increase risk of inadvertent ingestion.

Pulmonary embolism in the pediatric emergency department.

Objective: To describe patients who present to the pediatric emergency department (PED) and are subsequently diagnosed with pulmonary embolism (PE).

Methods: Electronic medical records from 2003 to 2011 of a tertiary care pediatric health care system was retrospectively reviewed to identify patients <21 years who had a final International Classification of Diseases, Ninth Revision diagnosis of PE. Patient demographics, and hospital course were recorded.

High-flow nasal cannula use in children with respiratory distress in the emergency department: predicting the need for subsequent intubation.

Background: High-flow nasal cannula (HFNC) is a safe, well-tolerated, and noninvasive method of respiratory support that has seen increasing use in the care of children with respiratory distress. High-flow nasal cannula may be able to prevent intubations in infants and children with respiratory distress.

Objective: The objective of this study was to determine the clinical and patient characteristics that predict success or failure of HFNC therapy in children presenting to the pediatric emergency department (PED) with respiratory distress.

Acute neck infections in children: who is likely to undergo surgical drainage?

Background: Superficial neck infections including lymphadenitis and abscesses are commonly encountered in pediatric emergency departments (PEDs). It is often unclear which patients are likely to develop an abscess that necessitates surgical drainage. In evaluating these patients, computed tomography (CT) and ultrasound are often used to identify/confirm abscess formation.

Supraventricular tachycardia in the pediatric trauma patient: a case report.

Any injured patient who is cool and tachycardic is considered to be in shock until proven otherwise.(1) We describe the diagnostic challenge when evaluating persistent tachycardia in the setting of multiple system trauma with hemorrhagic shock. This is a unique case of a 17-year-old patient with the secondary condition of cardiogenic shock due to supraventricular tachycardia (SVT) complicating ongoing hemorrhagic shock from a facial laceration.

Clinical factors associated with invasive testing and imaging in patients with complex febrile seizures.

Background: Complex febrile seizures (CFSs) are a common diagnosis in the pediatric emergency department (PED). Although multiple studies have shown a low likelihood of intracranial infections and abnormal neuroimaging findings among those who present with CFS, the absence of a consensus recommendation and the diversity of CFS presentations (ie, multiple seizures, prolonged seizure, focal seizure) often drive physicians to do a more extensive workup than needed. Few studies examine the factors that influence providers to pursue invasive testing and emergent neuroimaging.

The use of ondansetron for nausea and vomiting after head injury and its effect on return rates from the pediatric ED.

Background: The use of ondansetron in children with vomiting after a head injury has not been well studied. Concern about masking serious injury is a potential barrier to its use.

Objective: The aim of this study was to evaluate the use of ondansetron in children with head injury and symptoms of vomiting in the pediatric emergency department (PED) and its effect on return rates and masking of more serious injuries.

Effects of a system-wide fracture care program to enhance access and follow-up for orthopedics.

Objectives: Fractures of the extremities are commonly encountered in pediatric emergency departments (PEDs) nationwide. These fractures can lead to bone malformation and deformities if not managed properly. There are multiple barriers to obtaining necessary outpatient follow-up for fracture care, which leads to increased return to the PED for management.

Ondansetron use in the pediatric emergency room for diagnoses other than acute gastroenteritis.

Background: Ondansetron is widely used in the pediatric emergency department (PED) for vomiting and acute gastroenteritis (GE). Little is known about the spectrum of its use in diagnoses other than acute GE.

Objective: The objective of this study was to evaluate the spectrum of diagnoses for which ondansetron is used in the PED.

Trends in computed tomography utilization in the pediatric emergency department.

Objective: The purpose of this study was to determine the overall trend of computed tomography (CT) utilization in the pediatric emergency department (PED) from 2003 to 2010 and to determine trends categorized by common chief complaints.

Methods: Electronic chart records at 2 tertiary care PEDs within a large pediatric health care system were reviewed from January 2003 through December 2010. The annual CT utilization rate, by anatomic location, was determined.

Pediatric abscess characteristics associated with hospital admission from the ED.

Objective: To determine the characteristics of pediatric soft tissue abscesses that result in hospital admission.

Methods: All visits for soft tissue abscesses to the study emergency department (ED) were examined during 2008. Detailed records were reviewed to determine ED disposition, abscess size, location, presence of fever, duration of symptoms, previous antibiotic therapy, prior ED visit(s), and wound and blood culture results.

Cardiac disease in pediatric patients presenting to a pediatric ED with chest pain.

Background: Chest pain is a frequent chief complaint among the pediatric population. To date, limited data exist on the full spectrum of emergent cardiac disease among such patients; and existing data have been limited to relatively small cohorts.

Objectives: The aims of the study were to investigate the emergent cardiac etiologies of chest pain in a large cohort of patients presenting to a tertiary care pediatric emergency department (PED) and to examine the use of resources (electrocardiogram, chest radiograph, echocardiogram, and laboratories) in those with and without cardiac-related chest pain.

Practice characteristics that influence nonurgent pediatric emergency department utilization.

Objective: The goal of this study was to determine what characteristics of a primary care pediatric practice are associated with nonurgent use of the pediatric emergency department (PED).

Methods: Primary care practice characteristics were prospectively collected from 33 practices. Nonurgent and urgent visits to the PED for patients from these practices were analyzed retrospectively.

Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: are we masking alternative diagnoses?

Study Objective: We evaluate the effect of ondansetron use in cases of suspected gastroenteritis on the proportion of hospital admissions and return visits and assess whether children who receive ondansetron on their initial visit to the pediatric emergency department (ED) for suspected gastroenteritis return with an alternative diagnosis more frequently than those who did not receive ondansetron.

Methods: This is a retrospective review of visits to 2 tertiary care pediatric EDs with an International Classification of Diseases, Ninth Revision diagnosis of vomiting or gastroenteritis. A logistic regression model was developed to determine the effect of ondansetron use during the initial pediatric ED visit on hospital admission, return to the pediatric ED within 72 hours, and admission on this return visit.

Access to outpatient follow-up orthopedic care after pediatric emergency department visits: impact of implementation of a managed Medicaid program.

Objective: A Medicaid managed care (MMC) program was instituted regionally with the goal of improving quality and access to care for underserved populations. The purpose of this study was to determine whether the implementation of an MMC program has affected access to timely orthopedic follow-up care.

Methods: All visits to 2 tertiary care pediatric emergency departments (PED) with a diagnosis of extremity fracture or dislocation were examined for a 5-month period after implementation of MMC and compared with the same periods during 2004 and 2005.

Effects of tobacco smoke exposure on asthma prevalence and medical care use in North Carolina middle school children.

Objectives: We sought to determine the effects of exposure to environmental tobacco smoke (ETS) and childhood cigarette smoking on asthma symptoms among middle school children in North Carolina.

Methods: During 1999-2000, information was collected from a survey completed by the children. Outcomes of asthma symptom reporting were regressed on tobacco smoke exposures.