Pediatric emergency care
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Pediatric emergency care · Feb 2022
Observational StudyEmergency Department Adolescent Suicidality: A Pilot Study to Determine How Common Actual Attempts Are.
Adolescent mental health is a rapidly escalating presentation to emergency departments in the United States with depression and suicidal thoughts being the most prevalent condition. Much of the research and focus has been on preventing future attempts. However, one outcome that may be very important in addition to focus on is the impact of presentations for thoughts without self-injury. The aim was to evaluate outcomes of interest for a larger prospective observational adolescent suicidal trial including frequency of suicide attempts versus thoughts and factors associated with each outcome. ⋯ Adolescent mental health is a growing issue for pediatric emergency departments nationally. Prospective research to identify factors associated with worsening outcomes is important to identify and potentially modify if possible. This study did not find any specific factors associated with a suicide attempt, but found that less than half of patients presenting with suicidality actual made an attempt. Future research should focus on not only limiting suicide attempts but also using decreased emergency department visits for worsening thoughts as an outcome of interest.
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To assess the impact of the COVID-19 pandemic on physical abuse in young children, we compared the following before and during the pandemic: (1) skeletal survey volume, (2) percent of skeletal surveys revealing clinically unsuspected (occult) fractures, and (3) clinical severity of presentation. We hypothesized that during the pandemic, children with minor abusive injuries would be less likely to present for care, but severely injured children would present at a comparable rate to prepandemic times. We expected that during the pandemic, the volume of skeletal surveys would decrease but the percentage revealing occult fractures would increase and that injury severity would increase. ⋯ Despite a >20% decrease in skeletal survey performance early in the pandemic, the percent of skeletal surveys revealing occult fractures did not increase. Our results suggest that decreases in medical evaluations for abuse did not stem from decreased presentation of less severely injured children.
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Pediatric emergency care · Feb 2022
Pediatric Patients Brought by Emergency Medical Services to the Emergency Department: An Analysis From the National Hospital Ambulatory Medical Care Survey.
To describe the epidemiology of emergency department (ED) visits by pediatric patients transported from the out-of-hospital setting (ie, scene) by emergency medical services (EMS), and identify factors associated with EMS transport. ⋯ Four percent of pediatric ED patients are transported to the ED by EMS from the scene. These patients receive a rapid and resource intense diagnostic evaluation, suggesting that higher acuity. Black patients, adolescents, and those with trauma were more likely to be transported by EMS.
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Pediatric emergency care · Feb 2022
Characteristics of Injuries Sustained Under the Influence of Alcohol in a Group of Adolescents: Is it Possible to Establish a Typical Clinical Picture of an Underage Patient Who Suffered From an Injury Under the Influence of Alcohol?
Fractures of the limbs and craniocerebral trauma are the most common injuries in children and adolescents. Their frequency ranges widely from 32% to 85% and is the main reason for hospitalization in pediatric population. The number of injuries sustained under the influence of alcohol is increasing although the data concerning that subject is limited and usually includes both adult and teenage patients. ⋯ Traumatic brain injury under the influence of alcohol in adolescents differs from trauma in patients who had not drunk alcohol. Similar areas of injury result in a more severe course of illness in the examined group.
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Pediatric emergency care · Feb 2022
Multisystem Inflammatory Syndrome in Children: Examining Emerging Data and Identifying Key Knowledge Gaps.
Multisystem inflammatory syndrome in children (MIS-C) is a syndrome of abnormal immune response after severe acute respiratory syndrome coronavirus 2 infection that can result in organ dysfunction including severe cardiovascular compromise in children. Increased evidence supports a clinical and laboratory profile in MIS-C distinct from Kawasaki disease, with MIS-C typically occurring in older children and with more prominent gastrointestinal and neurologic symptoms, as well as increased inflammation, lymphopenia, and cardiac injury on laboratory testing. However, high-level evidence regarding best practices for treatment and long-term outcomes in MIS-C is limited.