Oral enteral nutrition in the emergency department for children with bronchiolitis hospitalized on high flow nasal cannula.

Objectives: We assessed whether initiation of oral enteral nutrition in the emergency department (ED) for patients with bronchiolitis hospitalized on humidified high flow nasal cannula (HHFNC) was associated with a shorter hospital length of stay (LOS) without an increase in return ED visits or hospital readmissions.

Patients And Methods: This retrospective cohort study included children ≤24 months of age with bronchiolitis hospitalized to the general pediatric floor on HHFNC in two time periods: October 1, 2018 - April 30, 2019, and following implementation of a revised institutional bronchiolitis pathway that encouraged enteral nutrition initiation in the ED, October 1, 2021 - April 30, 2022. The primary outcome of interest was hospital LOS where the exposure was enteral feeding in the ED.

Impact of initial high flow nasal cannula flow rates on clinical outcomes in children with bronchiolitis.

Purpose: Our aim was to evaluate the impact of the initial high flow nasal cannula (HFNC) flow rate on clinical outcomes in children with bronchiolitis.

Methods: This secondary analysis of retrospective data included children <2 years who required HFNC for bronchiolitis between 10/01/2018-04/20/2019, and following implementation of a revised institutional bronchiolitis pathway between 10/01/2021-04/30/2022. The new pathway recommended weight-based initiation of HFNC at 1.

Outcome of interhospital pediatric foreign body transfers.

Background: Children with foreign bodies are often transferred from general emergency departments (EDs) to children's hospitals for optimal management. Our objective was to describe the outcomes of interhospital pediatric foreign body transfers and examine factors associated with potentially avoidable transfers (PATs) in this cohort.

Methods: We conducted a retrospective cohort study of children aged <18 years transferred to our hospital for the primary complaint of foreign body from January 1, 2020, to September 30, 2022.

Clinical Reasoning: A 67-Year-Old Man With Multiple Intracranial Lesions.

A wide variety of diseases present with intracranial lesions. In this case report, a 67-year-old man initially presented to an outside hospital with nausea, headache, and ataxia and was found to have multiple intracranial lesions. Diagnostic workup was ultimately unrevealing, and his condition improved after a course of steroids and antibiotics.

Efficacy of Biomarkers in Identifying Abnormal Echocardiogram in Multisystem Inflammatory Syndrome in Children.

Cardiac involvement in multisystem inflammatory syndrome in children (MIS-C) is common and contributes to significant morbidity and mortality. We evaluated the efficacy of cardiac biomarkers in detection of an abnormal echocardiogram in MIS-C patients. A retrospective chart review of children ≤18 years diagnosed with MIS-C at our hospital was performed.

Influenza vaccination coverage among an urban pediatric asthma population: Implications for population health.

Introduction: Asthma is the most common chronic disease in children. Children with asthma are at high risk for complications from influenza; however annual influenza vaccination rates for this population are suboptimal. The overall aim of this study was to describe the characteristics of a high-risk population of children with asthma presenting to an urban pediatric emergency department according to influenza vaccination status.

Evaluation of advanced practice provider related return visits to a pediatric emergency department and their outcomes.

Background: While multiple studies have evaluated physician-related return visits (RVs) to a pediatric emergency department (PED) limited data exists for Advanced Practice Provider (APP)-related RVs, hence our study aimed to evaluate APP-related RVs and their outcomes in a PED.

Methods: We conducted a retrospective review of 72-h RVs where clinical care was independently provided by an APP during the index visit from January 2018 to December 2019. We extracted patient demographics, index and return visits' characteristics and outcomes.

Toys and Toy Accessories Strike Back: Pediatric Injuries From Plush Toys, Toy Figurines, and Doll and Toy Accessories.

Objective: The aim of the study was to examine age-associated injury trends and severe injury proportions for plush toys, toy figurines, and doll and toy accessories. We hypothesized that the proportion of severe injuries would be highest in the younger than 3-year and 3- to 5-year age groups.

Methods: We analyzed injury patterns from plush toys, toy figurines, and doll and toy accessories for ages of 0 to 18 years from 2010 to 2018 using the Consumer Product Safety Commission National Electronic Injury Surveillance System.

Mechanical Anastomotic Coupling Device versus Hand-sewn Venous Anastomosis in Head and Neck Reconstruction-An Analysis of 1694 Venous Anastomoses.

 There is a steep learning curve to attain a consistently good result in microvascular surgery. The venous anastomosis is a critical step in free-tissue transfer. The margin of error is less and the outcome depends on the surgeon's skill and technique.

Minor head injury transfers: Trends and outcomes.

Background: Children with traumatic head injury are often transferred from community Emergency Departments (ED) to a Pediatric Emergency Department (PED). The primary objective of this study was to describe the outcomes of minor head injury (MHI) transfers to a PED. The secondary objective was to report Computed Tomography (CT) utilization rates for MHI.

Pediatric minor head injury related return visits to the emergency department and their outcome.

Background: Minor head injury (MHI) in children is a common emergency department (ED) presentation. It is well established that majority of these patients don't require imaging and can be safely discharged. What is less known is how often these children come back to the ED and the outcome of their revisits? The objective of this study was to describe the frequency and outcome of unscheduled return visits (RVs) for MHI in a pediatric ED.

Reducing Computed Tomography Scan Utilization for Pediatric Minor Head Injury in the Emergency Department: A Quality Improvement Initiative.

Background: The validated Pediatric Emergency Care Applied Research Network (PECARN) prediction rules are meant to aid clinicians in safely reducing unwarranted imaging in children with minor head injuries (MHI). Even so, computed tomography (CT) scan utilization remains high, especially in intermediate-risk (per PECARN) MHI patients. The primary objective of this quality improvement initiative was to reduce CT utilization rates in the intermediate-risk MHI patients.

Coherent anti-Stokes Raman scattering imaging of microcalcifications associated with breast cancer.

Chemical imaging of calcifications was demonstrated in the depth of a tissue. Using long wavelength excitation, broadband coherent anti-Stokes Raman scattering and hierarchical cluster analysis, imaging and chemical analysis were performed 2 mm below the skin level in a model system. Applications to breast cancer diagnostics and imaging are discussed together with the methods to further extend the depth and improve the spatial resolution of chemical imaging.

Factors associated with avoidable interhospital transfers for children with a minor head injury.

Introduction: Children with minor head injuries (MHI) are routinely transferred to a pediatric trauma center for definitive care. Unwarranted transfers result in minimal benefit to the patient and add substantially to healthcare costs. The purpose of this study is to explore the factors associated with avoidable interhospital transfers of children with MHI.

Baseline Performance of Real-World Clinical Practice Within a Statewide Emergency Medicine Quality Network: The Michigan Emergency Department Improvement Collaborative (MEDIC).

Study Objective: Large-scale quality and performance measurement across unaffiliated hospitals is an important strategy to drive practice change. The Michigan Emergency Department Improvement Collaborative (MEDIC), established in 2015, has baseline performance data to identify practice variation across 15 diverse emergency departments (EDs) on key emergency care quality indicators.

Methods: MEDIC is a unique physician-led partnership supported by a major third-party payer.

Inflammatory flaccid myelitis in a patient with both anti-CRMP-5 IgG and CNS HIV escape.

Anticollapsin-responsive mediator protein 5 (CRMP-5) IgG is an antibody generally associated with small-cell lung cancer, which is known to cause paraneoplastic neurological syndromes, including encephalitis, myelitis and neuropathy. HIV escape is a phenomenon in which a patient with low or undetectable levels of HIV RNA in plasma is found to have elevated levels in cerebrospinal fluid (CSF). We present a case of a 58-year-old HIV-positive woman with undetectable plasma viral load who developed a subacute flaccid paraparesis.