Articles: pediatrics.
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Pediatric emergency care · Feb 2025
Highlights From the 2023 Revision of Pediatric Tactical Emergency Casualty Care Guidelines.
In 2023 the Committee for Tactical Emergency Casualty Care (C-TECC) issued updated Pediatric Tactical Emergency Casualty Care (TECC) Guidelines ( Guidelines ) that focus on the delivery of stabilizing care of children who are the victims of high-threat incidents such as an active shooter event. The Guidelines provide evidence-based and best practice recommendations to those individuals and departments that specifically provide operational medical support to law enforcement agencies caring for children in this uniquely dangerous environment where traditional resources may not be available. This article highlights key takeaway points from the Guidelines , including several updates since the first version was released in 2013. ⋯ The high-threat environment is dynamic and there is competing safety, tactical/operational, and patient care priorities for responders when infants and children are injured. The Guidelines provide recommendations on the type of medical and psychological care that should be considered under each phase of threat and establishes the context for how and why to deliver (or potentially defer) certain interventions under some circumstances in order the maximize the opportunity for a good outcome for an injured pediatric patient. The Guidelines also emphasize the importance of synergizing hospital-based pediatric trauma care with those law enforcement and fire/emergency medical services that may provide field care to children under high-threat circumstances.
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Case Reports
Delayed diagnosis of pediatric bladder rupture with atypical presentation after a minor fall.
Pediatric bladder injuries, though uncommon, typically result from blunt trauma, often associated with motor vehicle collisions. While most bladder injuries are linked to pelvic fractures, this association may be less common in children due to anatomical differences. Bladder injuries are classified as extraperitoneal, intraperitoneal, or combined, with intraperitoneal injuries being rarer but more prevalent in children due to their higher abdominal bladder position. This case report discusses a rare instance of delayed intraperitoneal bladder rupture in a young child following a relatively minor fall, emphasizing diagnostic challenges. ⋯ A 4-year-old female presented with new onset abdominal pain, vomiting, and subjective fever three days after a minor fall. Initial evaluation revealed diffuse abdominal tenderness, elevated creatinine, and moderate ascites on ultrasound with no gross hematuria. Despite treatment for presumed acute kidney injury, the patient's condition worsened, leading to the identification of a large posterior dome bladder rupture via cystography. Surgical repair was performed, and the patient was discharged with a full recovery after sequential removal of urinary catheters. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Intraperitoneal bladder rupture can occur in healthy children after minor trauma and may not present acutely with the classic signs of gross hematuria and peritonitis. Emergency physicians should consider this diagnosis in young children with unexplained ascites, abdominal pain, hematuria, and renal failure, even with only a remote history of minor abdominal trauma.
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To evaluate for increases in the use and costs of respiratory viral testing in pediatric emergency departments (EDs) because of the COVID-19 pandemic. ⋯ Respiratory testing and associated costs increased during the COVID-19 pandemic and were sustained despite decreasing incidence of disease. These findings highlight a need for further efforts to clarify indications for viral testing in the ED and efforts to reduce low-value testing.
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Previous studies in adults admitted to pediatric hospitals primarily investigated associations between complex chronic condition characteristics and patient outcomes. Our study explored the association of age with length of stay (LOS) and total cost in these adults, accounting for other patient factors. ⋯ There was a significant positive association between age and total cost, with adults 18-20 years having 13% higher total cost (95% confidence interval [CI]: 12%-15%), 21-25 years with 25% higher total cost (95% CI: 22%-29%), and 25-99 years having 72% higher total cost (95% CI: 66%-79%) than 1-17 years. Our findings suggest expanding upon the existing status quo to identify the most appropriate environment to care for this unique and growing population, especially given the anticipated reduction in pediatric beds and subspecialty expertise.
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Chronic pain is common among children and adolescents; however, the diagnoses in the newly developed 11th revision of the International Classification of Diseases (ICD-11) chronic pain chapter are based on adult criteria, overlooking pediatric neurodevelopmental differences. The chronic pain diagnoses have demonstrated good clinical applicability in adults, but to date, no field study has examined these diagnoses to the most specific diagnostic level in a pediatric sample. The current study aimed to explore pediatric representation within the ICD-11, with focus on chronic primary pain. ⋯ The latter also exhibited the lowest agreement between HCPs and algorithm. The current study underscores the need for evidence-based improvements to the ICD-11 diagnostic criteria in pediatrics. Developing pediatric coding notes could improve the visibility of patients internationally and improve the likelihood of receiving reimbursement for necessary treatments through accurate coding.