Articles: pediatrics.
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Eur J Trauma Emerg Surg · Jan 2025
Clinical consequence of the 4-week X-ray control after ESIN osteosynthesis of forearm fractures in children.
The absence of evidence based general guidelines for radiographic follow-ups of pediatric diaphyseal forearm fractures treated with ESIN results in an arbitrary array of X-ray examinations. In most pediatric traumatology departments, an X-ray check is carried out 4 weeks after ESIN osteosynthesis of forearm shaft fractures to detect incipient consolidation of the fracture. However, the elevated sensitivity to ionizing radiation requires special precautions in the pediatric populations. To prevent the indiscriminate use of this diagnostic tool it is necessary to assess the consequence of routinely taken X-rays at the 4-week follow-up. ⋯ This study provides evidence that standardized radiographic follow-up 4 weeks after surgical treatment has no clinical consequences if the course of the fracture is otherwise uneventful. It should be strictly reserved for pediatric patients with a complicated course.
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Pediatr Crit Care Me · Jan 2025
Severity of Impaired Oxygenation and Conservative Oxygenation Targets in Mechanically Ventilated Children: A Post Hoc Subgroup Analysis of the Oxy-PICU Trial of Conservative Oxygenation.
A conservative oxygenation strategy is recommended in adult and pediatric guidelines for the management of acute respiratory distress syndrome to reduce iatrogenic lung damage. In the recently reported Oxy-PICU trial, targeting peripheral oxygen saturations (Spo2) between 88% and 92% was associated with a shorter duration of organ support and greater survival, compared with Spo2 greater than 94%, in mechanically ventilated children following unplanned admission to PICU. We investigated whether this benefit was greater in those who had severely impaired oxygenation at randomization. ⋯ These data do not provide evidence that a conservative oxygenation strategy should be limited to mechanically ventilated children with severely impaired oxygenation.
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Objectives: Fatal and nonfatal pediatric opioid poisonings have increased in recent years. Emergency medical services (EMS) clinicians are often the first to respond to an opioid poisoning and administer opioid reversal therapy. Currently, the epidemiology of prehospital naloxone use among children and adolescents is incompletely characterized. ⋯ Naloxone was rarely documented to worsen clinical status. Our findings highlight the safety of prehospital naloxone use, as well as the importance of a high index of suspicion for opioid poisoning in the pediatric population. Opportunities exist to leverage linked data sources to develop interventions to improve prehospital opioid poisoning recognition and management.
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The Pediatric Emergency Care Applied Research Network (PECARN) derived and externally validated a clinical prediction rule to identify children with blunt torso trauma at low risk for intraabdominal injuries undergoing acute intervention (IAIAI). Little is known about the risk for IAIAI when only one or two prediction rule variables are positive. We sought to determine the risk for IAIAI when either one or two PECARN intraabdominal injury rule variables are positive. ⋯ Few children with blunt torso trauma and one or two PECARN predictor variables present have IAIAI. Those with GCS score <14, however, are at highest risk for IAIAI.