Adoption and utilization of device-assisted telemedicine.

We estimate the effect of adopting a digital device for performing medical exams at home during telehealth visits. We match visits of adopters and non-adopters who used the same virtual care clinic but without the device and compare healthcare utilization after the matched visits. We find that device adoption, partially offset by decreased use of other primary care modalities, results in a 12% higher utilization rate of primary care and increased use of antibiotics.

Bacterial vs viral etiology of fever: A prospective study of a host score for supporting etiologic accuracy of emergency department physicians.

Background: A host-protein score (BV score) that combines the circulating levels of TNF-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein 10 (IP-10) and C-reactive protein (CRP) was developed for distinguishing bacterial from viral infection. This study assessed the potential of the BV score to impact decision making and antibiotic stewardship at the emergency department (ED), by comparing BV score's performance to physician's etiological suspicion at patient presentation.

Methods: Rosetta study participants, aged 3 months to 18 years with febrile respiratory tract infection or fever without source, were prospectively recruited in a tertiary care pediatric ED.

The effect of environmental noise isolation on bronchiolitis severity in hospitalised children.

Aim: Bronchiolitis is an infectious disease, with no effective treatment. Music and Mozart's works specifically are known to have a positive effect on physiological parameters, while noise is considered harmful. We aim to evaluate the short-term effect of environmental noise detachment and/or music listening on the course of bronchiolitis in hospitalised children.

A management model for admission and treatment of pediatric trauma cases.

Background: Pediatric trauma, particularly major trauma cases, are often treated in less than optimal facilities by providers who lack training and experience in treating severely injured children. We aimed to develop a management model for admission and treatment of pediatric trauma using the Theory of Constraints (TOC).

Methods: We conducted interviews with 17 highly experienced policy makers, senior nursing managers and medical managers in pediatrics and trauma.

Diagnoses and Health Care Utilization for After-Hours Telemedicine Versus Primary Care Visits.

Objective: The use of a nation-wide, pediatricians online (PO) after-hours telemedicine service has been offered in Israel for more than a decade. We sought to compare PO visits with those to the primary care pediatrician (PCP).

Methods: This is a retrospective cross-sectional study using Israel's largest health care provider database.

Severe abrupt (thunderclap) non-traumatic headache at the pediatric emergency department - a retrospective study.

Background: Adult abrupt severe non-traumatic headache (thunderclap) is often related to serious underlying etiologies such as subarachnoid hemorrhage. However, data are sparse regarding thunderclap headache in the pediatric population.

Objective: The aim of the study was to evaluate the prevalence, characteristics and causes of thunderclap headache in the pediatric and adolescent population, aged 6-18 years, presenting to a pediatric emergency department.

Physician and nurses' perception of paediatric trauma care in Israeli emergency departments.

Background: Treatment of paediatric trauma requires specialized infrastructure, medical equipment, medical staff and ancillary support personnel that have been specifically trained for such tasks.

Aims And Objectives: To examine the perceptions and attitudes of physicians and nurses in general and paediatric emergency departments (PEDs) on training, confidence, and management of paediatric trauma in order to facilitate the establishment of an optimal model for admitting and treating paediatric trauma patients.

Design: Drawing on published literature and a previously conducted qualitative study that explored the provision of medical care to paediatric trauma patients, we conducted an attitude survey.

Pediatric Preparedness of European Emergency Departments: A Multicenter International Survey.

Introduction: Children and adolescents often lack optimal emergency care. The objective of the study was to assess the level of preparedness of European emergency departments (EDs) for pediatric patients.

Methods: This was an international multicenter Internet-based survey of EDs with attending children and adolescents younger than 18 years in 101 EDs from 21 countries.

Assessing patient safety in a pediatric telemedicine setting: a multi-methods study.

Background: Telemedicine and telephone-triage may compromise patient safety, particularly if urgency is underestimated. We aimed to explore the level of safety of a pediatric telemedicine service, with particular reference to the appropriateness of the medical diagnoses made by the online physicians and the reasonableness of their decisions.

Methods: This retrospective multi-method study investigated the decision-making process of physicians in a pediatric tele-triage service provided in Israel.

The role of non-medical factors in physicians' decision-making process in a pediatric telemedicine service.

The complex process of medical decision-making is prone also to medically extraneous influences or "non-medical" factors. We aimed to investigate the possible role of non-medical factors in doctors' decision-making process in a telemedicine setting. Interviews with 15 physicians who work in a pediatric telemedicine service were conducted.

Performance of Two Head Injury Decision Rules Evaluated on an External Cohort of 18,913 Children.

Background: The Pediatric Emergency Care Applied Research Network (PECARN) decision rule demonstrates high sensitivity for identifying children at low risk for clinically important traumatic brain injury (ciTBI). As with the PECARN rule, the Israeli Decision Algorithm for Identifying TBI in Children (IDITBIC) recommends proceeding directly to computed tomography (CT) in children with Glasgow Coma Score (GCS) <15. The aim was to assess the diagnostic accuracy of two clinical rules that assign children with GCS <15 at presentation directly to CT.

Research priorities for European paediatric emergency medicine.

Objective: Research in European Paediatric Emergency Medicine (REPEM) network is a collaborative group of 69 paediatric emergency medicine (PEM) physicians from 20 countries in Europe, initiated in 2006. To further improve paediatric emergency care in Europe, the aim of this study was to define research priorities for PEM in Europe to guide the development of future research projects.

Design And Setting: We carried out an online survey in a modified three-stage Delphi study.

Physicians' experiences, attitudes and challenges in a Pediatric Telemedicine Service.

Background: Telemedicine in general, and telephone triage, in particular, is considered a high-stress clinical activity and involves decision making under conditions of uncertainty and urgency.

Aim: We wanted to explore the experiences, attitudes, and challenges of the physicians in a Pediatric Telemedicine Service operated in Israel, and to explore whether the doctors are using non-medical factors (not related to the medical problem), when making the clinical decisions in this setting.

Methods: We used a qualitative methodology in order to obtain rich data that would reflect the participants' subjective experiences.

Pediatric Diabetic Ketoacidosis With Hypotensive Shock and Rash-An Unusual Presentation.

We describe a previously healthy adolescent boy who presented with respiratory distress, hypotensive shock, and a diffuse erythematous rash. The final diagnosis was diabetic ketoacidosis. Caregivers should be alert to this unusual combination of symptoms in the emergency department setting in order to improve the recognition and management of children with new-onset diabetes.

Perspectives of health professionals on the best care settings for pediatric trauma casualties: a qualitative study.

Background: Critically-injured children are frequently treated by providers who lack specialty pediatric training in facilities that have not been modified for the care of children. We set out to understand the attitudes and perspectives of policy makers, and senior nursing and medical managers in the Israeli healthcare system, concerning the provision of medical care to pediatric trauma casualties in emergency departments.

Methods: We conducted semi-structured interviews with 17 health professionals from medical centers across Israel and the Ministry of Health.

[Telemedicine: a novel service in pediatric emergency care].

Introduction: Telemedicine is a field that deals with monitoring and caring for patients who are physically apart from the caregivers, so they cannot communicate without technological means. The use of telemedicine has been recognized by a number of official organizations worldwide. This article reviews a unique service, "pediatrician online", provided by Clalit HMO, through Medtrix Ltd, with Schneider Children's Hospital specialists' supervision.

Evidence of a link between fever and microscopic hematuria in children.

Unlabelled: Despite the common conception that febrile illnesses are associated with microscopic hematuria in children, a review of the literature failed to disclose supportive evidence. The aim of this study was to evaluate this relationship. Background data were collected for a convenience sample of children aged 4-18 years who presented to the emergency department (ED) of a tertiary pediatric medical center.

Extracorporeal Membrane Oxygenation as a Resuscitation Measure in the Pediatric Emergency Department.

Background: Extracorporeal membrane oxygenation (ECMO) may serve as a bridge to regain cardiac function in refractory resuscitation. However, its use has so far been limited owing to low availability, especially in emergency departments.

Objectives: To describe two children with acute myocarditis successfully treated with ECMO in the emergency department of a tertiary pediatric medical center.

From cradle to adolescence: the development of Research in European Pediatric Emergency Medicine.

Pediatric emergency medicine (PEM) has been developing rapidly but heterogeneously in many European countries in recent years, and many national PEM societies have been founded to improve the quality of care of ill and injured children and adolescents. Key facets of any such improvement are the development, delivery and translation of high-quality research. Research in European Pediatric Emergency Medicine (REPEM) has developed a robust international structure involving clinicians, academics and national PEM research networks.

Predictors of severe H1N1 infection in children presenting within Pediatric Emergency Research Networks (PERN): retrospective case-control study.

Objective: To identify historical and clinical findings at emergency department presentation associated with severe H1N1 outcome in children presenting with influenza-like illness.

Design: Multicentre retrospective case-control study.

Setting: 79 emergency departments of hospitals associated with the Pediatric Emergency Research Networks in 12 countries.

[Pediatric injuries from mass casualty events in Israel: a ten-year summary].

Background: Children are the most vulnerable sub-population in mass casualty events (MCEs), however, characteristics of MCE related injuries among children have not been well described.

Aim: The aim of our study was to characterize childhood injuries resulting from MCEs in Israel including parameters such as magnitude, injury mechanism and severity and use of hospital resources.

Methods: We conducted a descriptive study of MCE related injuries among hospitalized children (0-17 years) between the years 1998-2007 and recorded in the Israel Trauma Registry (ITR).

Pediatric emergency research networks: a global initiative in pediatric emergency medicine.

Objectives: Objectives of the Pediatric Emergency Research Network's (PERN's) meeting included (1) learn about each of the participating network's missions, goals, and infrastructure; (2) share important contributions each network has made to the creation of new knowledge; (3) discuss "best practices" to improve each network's effectiveness; and (4) explore the potential for a collaborative research project as proof of concept that would help us promote quality of care of the acutely ill and injured child/youth globally.

Methods: In October 2009, a multiday meeting was attended by 18 delegates representing the following pediatric emergency medicine research networks: Pediatric Emergency Medicine Collaborative Research Committee (United States), Pediatric Emergency Care Applied Research Network (United States), Pediatric Emergency Research of Canada (Canada), Paediatric Research in Emergency Departments International Collaborative (Australia and New Zealand), and Research in European Pediatric Emergency Medicine (15 countries in Europe and the Middle East).

Results: The inaugural meeting of PERN demonstrated that there is a common desire for high-quality research and the dissemination of this research to improve health and outcomes of acutely ill and injured children and youths throughout the world.

Pediatric Emergency Research Networks: a global initiative in pediatric emergency medicine.

Objectives: The objectives of the Pediatric Emergency Research Network's (PERN) meeting were to (i) learn about each of the participating network's missions, goals, and infrastructure; (ii) share important contributions that each network has made to the creation of new knowledge; (iii) discuss 'best practices' to improve each network's effectiveness and (iv) explore the potential for a collaborative research project as proof-of-concept that would help promote quality of care of the acutely ill and injured child/youth globally.

Methods: In October 2009 a multiday meeting was attended by 18 delegates representing the following pediatric emergency medicine research networks: Pediatric Emergency Medicine Collaborative Research Committee (USA); Pediatric Emergency Care Applied Research Network (USA); Pediatric Emergency Research of Canada (Canada); Pediatric Research in Emergency Departments International Collaborative (Australia and New Zealand); and Research in European Pediatric Emergency Medicine (15 countries in Europe and the Middle East).

Results: The inaugural meeting of PERN showed that there is a common desire for high-quality research and the dissemination of this research to improve health and outcomes of acutely ill and injured children and youths throughout the world.

Management of children with nonfebrile seizures in the emergency department.

Background: Children with seizures are often referred to the emergency department where they are typically evaluated by a physician with limited knowledge of pediatric epileptology and undergo a costly and extensive work-up that contributes little to the final decision.

Aim: The aim of this study was to examine the medical management of children with nonfebrile seizures in the emergency department and to define the potential role of the neurology clinic in this context.

Materials And Methods: The files of 85 children who made 104 visits to the emergency department of a pediatric tertiary hospital for nonfebrile seizures were retrospectively reviewed.

[Emergency Department (ED) administrative data--what can we learn from this data about pediatric injury? Is there a need for a designated injury surveillance system?].

Background: Data on injury characteristics can help direct prevention activities.

Aims: To explore the potential use of Emergency Department (ED) data as a source of information regarding child injury in Israel. To examine the need for a designated injury surveillance system in Israel.