Intravenous dextrose for children with gastroenteritis and dehydration: a double-blind randomized controlled trial.

Study Objective: We seek to determine whether an initial intravenous bolus of 5% dextrose in normal saline solution compared with normal saline solution will lead to a lower proportion of hospitalized patients and a greater reduction in serum ketone levels in children with gastroenteritis and dehydration.

Methods: We enrolled children aged 6 months to 6 years in a double-blind, randomized controlled trial of patients presenting to a pediatric emergency department. Subjects were randomized to receive a 20 mL/kg infusion of either 5% dextrose in normal saline solution or normal saline solution.

Pediatric traumatic brain injury and radiation risks: a clinical decision analysis.

Objective: To determine the optimal imaging strategy for young children with minor head injury considering health-related quality of life and radiation risk. In children with minor head trauma, the risk of missing a clinically important traumatic brain injury (ciTBI) must be weighed against the risk of radiation-induced malignancy from computed tomography (CT) to assess impact on public health.

Study Design: We included children <2 years old with minor blunt head trauma defined by a Glasgow Coma Scale score of 14-15.

Debriefing assessment for simulation in healthcare: development and psychometric properties.

Introduction: This study examined the reliability of the scores of an assessment instrument, the Debriefing Assessment for Simulation in Healthcare (DASH), in evaluating the quality of health care simulation debriefings. The secondary objective was to evaluate whether the instrument's scores demonstrate evidence of validity.

Methods: Two aspects of reliability were examined, interrater reliability and internal consistency.

The effect of abdominal pain duration on the accuracy of diagnostic imaging for pediatric appendicitis.

Study Objective: Advanced imaging with computed tomography (CT) or ultrasonography is frequently used to evaluate for appendicitis. The duration of the abdominal pain may be related to the stage of disease and therefore the interpretability of radiologic studies. Here, we investigate the influence of the duration of pain on the diagnostic accuracy of advanced imaging in children being evaluated for acute appendicitis.

Adherence to PALS Sepsis Guidelines and Hospital Length of Stay.

Background And Objectives: Few studies have evaluated sepsis guideline adherence in a tertiary pediatric emergency department setting. We sought to evaluate (1) adherence to 2006 Pediatric Advanced Life Support guidelines for severe sepsis and septic shock (SS), (2) barriers to adherence, and (3) hospital length of stay (LOS) contingent on guideline adherence.

Methods: Prospective cohort study of children presenting to a large urban academic pediatric emergency department with SS.

Pediatric emergency department crowding is associated with a lower likelihood of hospital admission.

Objectives: Emergency department (ED) crowding may affect disposition decision-making. The objective was to measure the effect of ED crowding on probability of admission and return visit to the ED after discharge.

Methods: The authors studied a historical cohort at a large pediatric ED over 40 months.

Interfacility transfers of noncritically ill children to academic pediatric emergency departments.

Objectives: We aimed to characterize the demographics, diagnoses, and management of transferred patients who were directly discharged from the emergency department (ED) or admitted less than 24 hours.

Methods: We conducted a retrospective, cross-sectional study of patients classified as interfacility ED transfers over a 12-month period in the Pediatric Health Information System database, an administrative database of 42 tertiary care pediatric US hospitals. The primary study outcomes were ED resource utilization at the receiving facility with a focus on children who were discharged directly from the ED or admitted less than 24 hours.

Children injured by violence in the United States: emergency department utilization, 2000-2008.

Objectives: Children victimized by violence are often treated in the emergency department (ED). However, our understanding of the magnitude and financial costs of this patient population is inadequate. The authors examined the scope, risk factors for, and financial cost of ED visits for intentional injury in children in the United States over time.

Impact of in-hospital enteroviral polymerase chain reaction testing on the clinical management of children with meningitis.

Background: Enteroviral meningitis is a common cause of meningitis in children which requires only supportive care.

Objective: To evaluate the impact of implementing an in-hospital enteroviral polymerase chain reaction (EVPCR) testing protocol on the clinical management of children with meningitis.

Design: Retrospective cohort study.

Diagnostic imaging and negative appendectomy rates in children: effects of age and gender.

Background And Objectives: Diagnostic imaging is often used in the evaluation of children with possible appendicitis. The utility of imaging may vary according to a patient's age and gender. The objectives of this study were (1) to examine the use of computed tomography (CT) and ultrasound for age and gender subgroups of children undergoing an appendectomy; and (2) to study the association between imaging and negative appendectomy rates (NARs) among these subgroups.

Extremity fracture pain after emergency department reduction and casting: predictors of pain after discharge.

Study Objective: The aims of this study are to determine the prevalence of pediatric extremity fracture pain after emergency department (ED) discharge, compare pain severity between fractures requiring simple casting versus sedated reduction and casting, and explore predictors of postdischarge pain.

Methods: This is a prospective observational study of children aged 4 to younger than 18 years and presenting to the ED with extremity fracture from May 2010 to February 2011. The Parents' Postoperative Pain Measure, which scores pain according to 15 behavior-related questions, was completed 48 to 72 hours after discharge.

Application of the world health organization criteria to predict radiographic pneumonia in a US-based pediatric emergency department.

Background: The World Health Organization (WHO) established guidelines that rely on simple clinical signs for the diagnosis of childhood pneumonia in resource-limited settings. Our objective was to evaluate the test characteristics of the WHO criteria for the diagnosis of radiographic pneumonia in the emergency department setting.

Methods: We prospectively collected clinical information from children ≤5 years of age presenting to a US-based pediatric emergency department who had a chest radiograph performed for suspicion of pneumonia.

Ability of pediatric physicians to judge the likelihood of intussusception.

Background: Intussusception is the most common cause of intestinal obstruction in infants and children. To date, no study has evaluated the ability of physicians to predict the likelihood of intussusception.

Objective: This study aimed to determine the ability of pediatric physicians to predict intussusception in patients being evaluated for intussusception and to investigate whether certain clinical findings correlate with physicians' risk assessment.

Advanced radiologic imaging for pediatric appendicitis, 2005-2009: trends and outcomes.

Objectives: To examine the variability in the use of computed tomography (CT) and ultrasound (US) for children with appendicitis and identify associations with clinical outcomes, and to demonstrate any trends in diagnostic imaging between 2005 and 2009.

Study Design: This was a retrospective review of children evaluated for appendicitis in an emergency department between 2005 and 2009 using an administrative database of 40 pediatric institutions in the United States. Imaging utilization by institutions was studied for association with 3 clinical outcomes.

Systematic review and meta-analysis of preterm birth and later systolic blood pressure.

Lower birth weight because of fetal growth restriction is associated with higher blood pressure later in life, but the extent to which preterm birth (<37 completed weeks' gestation) or very low birth weight (<1500 g) predicts higher blood pressure is less clear. We performed a systematic review of 27 observational studies that compared the resting or ambulatory systolic blood pressure or diagnosis of hypertension among children, adolescents, and adults born preterm or very low birth weight with those born at term. We performed a meta-analysis with the subset of 10 studies that reported the resting systolic blood pressure difference in millimeters of mercury with 95% CIs or SEs.

Reference values of nocturnal oxygenation for use in outpatient oxygen weaning protocols in premature infants.

Objective: To define reference ranges for oxygen saturation (SpO(2) ) values in healthy full-term infants in the first days of life and in preterm infants off supplemental oxygen as they approach neonatal intensive care unit (NICU) discharge.

Methods: From April 2009 to March 2010, we enrolled convenience samples of full-term infants from the newborn nursery and former preterm infants who did not require supplemental oxygen at the time of discharge from the NICU. Overnight SpO(2) and signal quality recordings were obtained and analyzed for duration of artifact-free recording time (AFRT), time (s) with SpO(2) less than several different target saturations (90-95%), and number of falls in SpO(2) by ≥4% and ≥10%.

Variability in the interpretation of chest radiographs for the diagnosis of pneumonia in children.

Background: Although chest radiography is commonly used to establish the diagnosis of pneumonia in children, the reliability of radiographic findings among radiologists is not well described.

Objective: We sought to evaluate the inter-rater and intra-rater reliability of radiographic features commonly described by radiologists in childhood pneumonia.

Methods: Prospective case-based study.

Factors associated with the use of cervical spine computed tomography imaging in pediatric trauma patients.

Objectives: The objectives were to identify patient and hospital characteristics associated with the use of computed tomography (CT) imaging of the cervical spine (c-spine) in the evaluation of injured children and, in particular, to examine the influence of hospital setting.

Methods: This was a retrospective cohort of children younger than 19 years of age from the Massachusetts Hospital Emergency Department (ED) database who were discharged from the ED with an injury diagnosis from 2005 through 2009. Multivariable logistic regression was used to analyze characteristics associated with CT imaging of the c-spine.

Computed tomography for minor head injury: variation and trends in major United States pediatric emergency departments.

Objectives: To investigate the variation and trends in neuroimaging in children examined for minor head injury at major US pediatric emergency departments.

Study Design: We conducted a retrospective study of children <19 years of age with mild head injury who were examined and discharged home from the emergency department at 40 pediatric hospitals from 2005 to 2009 by using the Pediatric Health Information Systems database. Variation in computed tomography (CT) rates between hospitals was assessed for correlation with hospital-specific rates of intracranial hemorrhage, admission, and return visits.

Prediction of pneumonia in a pediatric emergency department.

Objective: To study the association between historical and physical examination findings and radiographic pneumonia in children who present with suspicion for pneumonia in the emergency department, and to develop a clinical decision rule for the use of chest radiography.

Methods: We conducted a prospective cohort study in an urban pediatric emergency department of patients younger than 21 who had a chest radiograph performed for suspicion of pneumonia (n = 2574). Pneumonia was categorized into 2 groups on the basis of an attending radiologist interpretation of the chest radiograph: radiographic pneumonia (includes definite and equivocal cases of pneumonia) and definite pneumonia.

Gray matter alterations in adults with attention-deficit/hyperactivity disorder identified by voxel based morphometry.

Background: Gray and white matter volume deficits have been reported in many structural magnetic resonance imaging (MRI) studies of children with attention-deficit/hyperactivity disorder (ADHD); however, there is a paucity of structural MRI studies of adults with ADHD. This study used voxel based morphometry and applied an a priori region of interest approach based on our previous work, as well as from well-developed neuroanatomical theories of ADHD.

Methods: Seventy-four adults with DSM-IV ADHD and 54 healthy control subjects comparable on age, sex, race, handedness, IQ, reading achievement, frequency of learning disabilities, and whole brain volume had an MRI on a 1.

Representativeness of participants in a clinical trial for attention-deficit/hyperactivity disorder? Comparison with adults from a large observational study.

Background: Clinical trials have demonstrated that pharmacotherapies can safely treat attention-deficit/hyperactivity disorder (ADHD) in adulthood. Eligibility criteria in these trials may significantly limit their external validity by excluding a significant portion of adults with ADHD in the general population. In particular, exclusion criteria may frequently exclude individuals with comorbid mental health conditions, which are common in the adult ADHD population.

A naturalistic 10-year prospective study of height and weight in children with attention-deficit hyperactivity disorder grown up: sex and treatment effects.

Objective: To assess the effect of attention-deficit/hyperactivity disorder (ADHD) and its treatment on growth outcomes in children followed into adulthood.

Study Design: Two identically designed, longitudinal, case-control studies of males and females with and without ADHD were combined; 124 and 137 control and subjects with ADHD, respectively, provided growth information at the 10- to 11-year follow-up. We used linear growth curve models to estimate the effect of time on change in height and whether this effect differed by sex and ADHD status.

Predictors of ADHD persistence in girls at 5-year follow-up.

Objective: The main aim of this study was to examine the age-dependent remission from ADHD in girls transitioning through childhood into adolescence and early adulthood.

Method: We conducted a 5-year prospective follow-up study of 123 girls with ADHD and 106 non-ADHD control girls aged between 6 and 17 years at ascertainment. ADHD was considered persistent at follow-up if participants met full diagnostic criteria for DSM-IV ADHD or met residual criteria for DSM-IV ADHD with associated impairment (Global Age Forum [GAF] score < 60).