External Validation of Brief Resolved Unexplained Events Prediction Rules for Serious Underlying Diagnosis.

Importance: The American Academy of Pediatrics (AAP) higher-risk criteria for brief resolved unexplained events (BRUE) have a low positive predictive value (4.8%) and misclassify most infants as higher risk (>90%). New BRUE prediction rules from a US cohort of 3283 infants showed improved discrimination; however, these rules have not been validated in an external cohort.

Characteristics of a revised quick sequential organ failure assessment score (RqSOFA) to predict in-hospital mortality of patients visiting the emergency department via ambulance: an observational cohort study.

The National Early Warning Score (NEWS), Quick Sequential Organ Failure Assessment (qSOFA), and modified qSOFA (MqSOFA) are scoring systems that rely on vital signs. However, NEWS is time-consuming, qSOFA has low sensitivity, and MqSOFA includes a difficult calculation. To address these issues, we developed the Revised qSOFA score (RqSOFA) that consists of percutaneous oxygen saturation, oxygen usage, Simple Shock Index, and the parameters of qSOFA.

Symptomatology and Management of Adult Anaphylaxis according to Trigger: A Cross-Sectional Study.

Introduction: Anaphylaxis is an acute life-threatening allergy, most commonly provoked by food, venom, or drugs. There is limited data regarding differences in symptomatology between anaphylaxis provoked by different triggers. This study aimed to assess sociodemographic characteristics, clinical symptoms, and management of anaphylaxis, according to triggers in adults.

Identifying serious underlying diagnoses among patients with brief resolved unexplained events (BRUEs): a Canadian cohort study.

Objective: To describe the demographics and clinical outcomes of infants with brief resolved unexplained events (BRUE).

Design: A retrospective cohort study.

Setting: 11 centres within the Canadian Paediatric Inpatient Research Network.

Management of anaphylaxis after pre-hospital epinephrine use in children with food-induced anaphylaxis.

Background: Previous guidelines recommend prompt epinephrine administration, followed by observation in the emergency department (ED). The need for transfer in all cases of anaphylaxis has recently been challenged.

Objective: To evaluate the need for additional ED treatment among children with anaphylaxis who received prehospital epinephrine.

A national survey of children's experiences and needs when attending Canadian pediatric emergency departments.

Background: Optimizing a child's emergency department (ED) experience positively impacts their memories and future healthcare interactions. Our objectives were to describe children's perspectives of their needs and experiences during their ED visit and relate this to their understanding of their condition.

Methods: 514 children, aged 7-17 years, and their caregivers presenting to 10 Canadian pediatric EDs completed a descriptive cross-sectional survey from 2018-2020.

Screen time and sleep in children.

Question: I continue to hear concerns from parents in my practice about the frequent use of light-emitting devices by their children. I have also found that many children suffer from sleep disturbances. What are the effects of screen time on sleep, and what are some best practices for sleep hygiene and screen use among children?

Answer: Screen time is higher now than before the onset of the COVID-19 pandemic, and knowledge about the effects of screen time is evolving.

The acute care burden of asthma in children was profoundly reduced during the COVID-19 pandemic: A multi-centre Canadian retrospective study.

Objectives: Asthma is a chronic lung condition that can be exacerbated when triggered by viruses. Pandemic public health restrictions aimed to reduce COVID-19 transmission indirectly effected other circulating viruses. This study assessed the impact of the pandemic and associated public health measures on acute paediatric asthma across four tertiary sites in three Canadian provinces.

Should you test for urinary tract infection in children with respiratory symptoms?

Question: An 8-month-old boy presented to our clinic with a 3-day history of fever. He has had a cough and rhinorrhea since the onset of the fever, and his 4-year-old sibling has recently had cough and cold symptoms. I have heard that the presence of respiratory symptoms means that urinary tract infection (UTI) is less likely.

Clinical characteristics and management of pediatric egg-induced anaphylaxis: A cross-sectional study.

Background: Egg is the third most common food allergy in children; however, data on pediatric egg-induced anaphylaxis are sparse.

Objective: To describe the clinical characteristics, management, and outcomes of pediatric egg-induced anaphylaxis.

Methods: Children presenting with anaphylaxis were recruited from 13 emergency departments as part of the Cross-Canada Anaphylaxis Registry, from which data on anaphylaxis triggered by egg were extracted.

Treatment Delay of Febrile Urinary Tract Infections Among Infants With Respiratory Symptoms.

Objective: To evaluate whether antibiotic treatment of febrile urinary tract infection (UTI) is delayed in febrile infants with respiratory symptoms compared with those without.

Study Design: Data of infants 2-24 months of age diagnosed with UTI from March 1, 2012 to May 31, 2023 were collected from our hospital's medical charts and triage records. Patients with known congenital anomalies of the kidney and urinary tract or a history of febrile UTI were excluded.

Management of acute supraventricular tachycardia in children.

Question: Recently, a 3-year-old patient in my practice urgently needed to go to the emergency department. The patient was found to have supraventricular tachycardia (SVT) and needed immediate treatment with adenosine. What evidence is currently available for management of SVT in children?

Answer: Supraventricular tachycardia is a common cardiac condition in the pediatric population that manifests as a narrow QRS complex tachycardia on electrocardiography.

Antibiotic treatment duration for community-acquired pneumonia in children.

Question: A 4-year-old child was seen in our clinic with a clinical presentation consistent with community-acquired pneumonia (CAP). He was prescribed oral amoxicillin and a colleague asked about the duration of treatment. What is the current available evidence for treatment duration for uncomplicated CAP in an outpatient setting?

Answer: Previously the recommended duration of antibiotic treatment of uncomplicated CAP was 10 days.

Anterior cutaneous nerve entrapment syndrome in children.

Question: I frequently see adolescents with recurrent abdominal pain in my family medicine clinic. While the diagnosis frequently is a benign condition such as constipation, I recently heard that after 2 years of recurrent pain, an adolescent was diagnosed with anterior cutaneous nerve entrapment syndrome (ACNES). How is this condition diagnosed? What is the recommended treatment?

Answer: Anterior cutaneous nerve entrapment syndrome, first described almost 100 years ago, is caused by entrapment of the anterior branch of the abdominal cutaneous nerve as it pierces the anterior rectus abdominis muscle fascia.

Neuroimaging to diagnose central nervous system tumours in children.

Question: Headache, vomiting, lethargy, and seizures are common symptoms in healthy children with benign viral illnesses, but they are also signs that could represent a central nervous system (CNS) tumour. Primary care providers and guardians are hesitant to expose children to radiation associated with computed tomography scans or take on risks associated with the sedation frequently needed for magnetic resonance imaging. When should primary care providers order radiologic head imaging for children with common symptoms to identify those with a CNS tumour?

Answer: Central nervous system tumours have no pathognomonic features, which often results in delays in diagnosis.

Factors associated with US caregivers' uptake of pediatric COVID-19 vaccine by race and ethnicity.

Objectives: To assess differences in willingness to vaccinate children against COVID-19, and factors that may be associated with increased acceptance, among US caregivers of various racial and ethnic identities who presented with their child to the Emergency Department (ED) after emergency use authorization of vaccines for children ages 5-11.

Study Design: A multicenter, cross-sectional survey of caregivers presenting to 11 pediatric EDs in the United States in November-December 2021. Caregivers were asked about their identified race and ethnicity and if they planned to vaccinate their child.