Pediatric Mental Health Emergencies During 5 COVID-19 Waves in New York City.

Objectives: To describe the proportion of pediatric mental health emergency department (MH-ED) visits across 5 COVID-19 waves in New York City (NYC) and to examine the relationship between MH-ED visits, COVID-19 prevalence, and societal restrictions.

Methods: We conducted a time-series analysis of MH-ED visits among patients ages 5 to 17 years using the INSIGHT Clinical Research Network, a database from 5 medical centers in NYC from January 1, 2016, to June 12, 2022. We estimated seasonally adjusted changes in MH-ED visit rates during the COVID-19 pandemic, compared with predicted prepandemic levels, specific to each COVID-19 wave and stratified by mental health diagnoses and sociodemographic characteristics.

Predicting Delayed Shock in Multisystem Inflammatory Disease in Children: A Multicenter Analysis From the New York City Tri-State Region.

Objectives: Patients with multisystem inflammatory disease in children (MIS-C) are at risk of developing shock. Our objectives were to determine independent predictors associated with development of delayed shock (≥3 hours from emergency department [ED] arrival) in patients with MIS-C and to derive a model predicting those at low risk for delayed shock.

Methods: We conducted a retrospective cross-sectional study of 22 pediatric EDs in the New York City tri-state area.

Burnout in Pediatric Emergency Medicine Physicians: A Predictive Model.

Objectives: This study aims to determine the prevalence of and identify predictors associated with burnout in pediatric emergency medicine (PEM) physicians and to construct a predictive model for burnout in this population to stratify risk.

Methods: We conducted a cross-sectional electronic survey study among a random sample of board-certified or board-eligible PEM physicians throughout the United States and Canada. Our primary outcome was burnout assessed using the Maslach Burnout Inventory on 3 subscales: emotional exhaustion, depersonalization, and personal accomplishment.

Rapid Absolute Neutrophil Count Testing Guides Targeted Antimicrobial Therapy in Febrile Pediatric Oncology Patients.

Objectives: It is well established that early antibiotic administration leads to improved outcomes in febrile neutropenic patients. To achieve this, many institutions administer empiric antibiotics to all febrile oncology patients in the emergency setting, before knowing their neutropenic status. This study evaluates the role of rapid absolute neutrophil count (ANC) testing in the targeted antimicrobial management of nonneutropenic febrile oncology patients.

Telemedicine Medical Screening Evaluation Expedites the Initiation of Emergency Care for Children.

Objective: Prior studies show that staffing a physician at triage expedites care in the emergency department. Our objective was to describe the novel application and effect of a telemedicine medical screening evaluation (Tele-MSE) at triage on quality metrics in the pediatric emergency department (PED).

Methods: We conducted a retrospective quasi-experimental pre-post intervention study of patients presenting to an urban PED from December 2017 to November 2019 who received a Tele-MSE at triage.

A Blueprint for Pediatric Emergency Resource Reallocation During the COVID-19 Pandemic: An NYC Hospital Experience.

Objective: We present a blueprint for the reallocation of pediatric emergency resources in response to the COVID-19 pandemic.

Methods: New York-Presbyterian Hospital - Weill Cornell Medical Center is an urban, quaternary, academic medical center, a level 1 trauma center, and a regional burn center located in New York City. The novel coronavirus (COVID-19) pandemic created a unique challenge for pediatric emergency medicine.

The Use of Ultrasound-Measured Optic Nerve Sheath Diameter to Predict Ventriculoperitoneal Shunt Failure in Children.

Objective: The goal of this study was to assess the accuracy of ultrasound-measured optic nerve sheath diameter (ONSD) as a screen for ventriculoperitoneal shunt failure.

Methods: We prospectively enrolled a convenience sample of children presenting to the ED with suspected shunt failure. The ONSD was measured by ultrasound and compared with computed tomography/magnetic resonance imaging (CT/MRI) and neurosurgical impression.

Adolescents' and young adults' perspectives on their emergency care.

Objectives: The aim of this study was to assess the perspectives of adolescents and young adults seen in the emergency department (ED) on the optimal age for transition from a pediatric ED (PED) to an adult ED (AED) as well as the appropriateness of their assigned ED site. Secondary aims were to determine ED physicians' understanding and assessment of their psychosocial needs, to determine whether subjects had a primary care provider (PCP), as well as to identify resources they felt would improve their ED experience.

Methods: This study used in-person structured interviews on a convenience sample of ED patients aged 15 to 25 years.

Influenza virus infection and the risk of serious bacterial infections in young febrile infants.

Objective: We aimed to determine the risk of SBIs in febrile infants with influenza virus infections and compare this risk with that of febrile infants without influenza infections.

Patients And Methods: We conducted a multicenter, prospective, cross-sectional study during 3 consecutive influenza seasons. All febrile infants View Article and Find Full Text PDF

Does a pain scale improve pain assessment in the pediatric emergency department?

Objective: Pain management in children requires rapid and sensitive assessment. The Wong-Baker FACES pain scale (WBFPS) is a widely accepted, validated tool to assess pain in children. Our objective was to determine whether incorporation of the WBFPS into the emergency medical record (EMR) improves pain documentation in the pediatric emergency department.

Sterile cerebrospinal fluid pleocytosis in young infants with urinary tract infections.

In a multicenter prospective study, 91 of 1025 febrile infants View Article and Find Full Text PDF

ALARA: is there a cause for alarm? Reducing radiation risks from computed tomography scanning in children.

Purpose Of Review: Radiation exposure from computed tomography is associated with a small but significant increase in risk for fatal cancer over a child's lifetime. This review aims to heighten awareness and spearhead efforts to reduce unnecessary computed tomography scans in children.

Recent Findings: The use of pediatric computed tomography continues to grow despite evidence on known risks of computed tomography-related radiation and induction of fatal cancers in children.

Clinical and demographic factors associated with urinary tract infection in young febrile infants.

Objective: Previous research has identified clinical predictors for urinary tract infection (UTI) to guide urine screening in febrile children <24 months of age. These studies have been limited to single centers, and few have focused on young infants who may be most at risk for complications if a UTI is missed. The objective of this study was to identify clinical and demographic factors associated with UTI in febrile infants who are < or =60 days of age using a prospective multicenter cohort.

Novel monitoring techniques for use with procedural sedation.

Purpose Of Review: A variety of pharmacologic agents used for procedural sedation in children to reduce pain and anxiety may produce respiratory depression and hypotension. Although standard monitoring guidelines include oxygen saturation, this measurement is limited as a guide to respiratory function. This review discusses two new monitoring techniques recently introduced to the pediatric emergency department that facilitate procedural sedation and reduce potential adverse effects of the medications administered.

Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections.

Background: The evaluation of young febrile infants is controversial, in part because it is unclear whether clinical evidence of a viral infection significantly reduces the risk of serious bacterial infections (SBIs). Specifically, it remains unclear whether the risk of SBI is altered in a meaningful way in the presence of respiratory syncytial virus (RSV) infections.

Objective: The objective of this study was to determine the risk of SBI in young febrile infants who are infected with RSV compared with those without RSV infections.