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Children
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Considerations in Pediatric Emergency Medicine
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Considerations in Pediatric Emergency Medicine

A special issue of Children (ISSN 2227-9067).

Deadline for manuscript submissions: closed (15 February 2022) | Viewed by 18539

Special Issue Editors

Prof. Dr. Richard Lichenstein

E-Mail Website
Guest Editor
University of Maryland School of Medicine, Baltimore, MD 21201, USA
Interests: pediatric emergency medicine; injury prevention; disaster preparedness
Special Issues, Collections and Topics in MDPI journals
Dr. Jennifer F. Anders

E-Mail Website
Guest Editor
Johns Hopkins School of Medicine, Baltimore, MD 21218, USA
Interests: pediatric emergency research; fellowship training
Dr. Getachew Teshome

E-Mail Website
Guest Editor
University of Maryland School of Medicine, Baltimore, MD 21201, USA
Interests: pediatric emergency medicine; quality improvement; acute bronchiolitis; procedural sedation; telemedicine

Special Issue Information

Dear Colleagues,

Although the care of children in emergency situations has always been acknowledged, the development of pediatric emergency medicine into a more clearly described area of a pediatric subspecialty has only been seen over the last 40 years. Pediatric emergency medicine now encompasses not only direct care in the emergency department but also prehospital care, innovations in diagnostic testing, and radiology advances, as well as advancements in medical and trauma care. In addition, pediatric emergency medicine also incorporates quality improvement initiatives to improve the safety and quality of emergency care in all settings, including community emergency departments, academic medical centers, and children’s hospitals and urgent care facilities. This Special Issue addresses a wide variety of topics that surround pediatric emergency medicine that have previously been rarely considered or have developed with new innovations or scientific advances. We recognize the tremendous growth and scope of pediatric emergency medicine which continuously encourages us to assess all evidence and experience so that we can continue to strive to provide the best care possible for the populations we treat.

Prof. Richard Lichenstein
Dr. Jennifer F. Anders
Dr. Getachew Teshome
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Pediatric prehospital care
  • Pediatric emergency radiology
  • Pediatric trauma
  • Pediatric interfacility transfer
  • Appendicitis

Published Papers (7 papers)

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Research

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8 pages, 607 KiB  
Article
Association between Stress Hyperglycemia and Adverse Outcomes in Children Visiting the Pediatric Emergency Department
by Woori Bae and Moon Bae Ahn
Children 2022, 9(4), 505; https://doi.org/10.3390/children9040505 - 02 Apr 2022
Cited by 2 | Viewed by 1803
Abstract
Stress hyperglycemia (SH) is often identified in patients visiting the pediatric emergency department (PED), and SH in adults has been associated with adverse outcomes, including mortality. In this retrospective study, we determined the adverse outcomes according to blood glucose (BG) levels of children [...] Read more.
Stress hyperglycemia (SH) is often identified in patients visiting the pediatric emergency department (PED), and SH in adults has been associated with adverse outcomes, including mortality. In this retrospective study, we determined the adverse outcomes according to blood glucose (BG) levels of children visiting the PED of tertiary hospitals. Data were collected from the electronic medical records of children aged <18 years between 1 January 2011 and 31 December 2020. A total of 44,905 visits were included in the analysis. SH was identified in 1506 patients, with an incidence rate of 3.4%. Compared to those without SH, patients with SH had significantly higher ward admission rates (52.6% vs. 35.9%, p < 0.001), intensive care unit admission rates (2.6% vs. 0.7%, p < 0.001), and mortality rates (2.7% vs. 0.3%, p < 0.001). Compared to the normoglycemic group of 45 ≤ BG < 150 mg/dL, the odds ratios (95% CI) for mortality were 5.61 (3.35–9.37), 27.96 (14.95–52.26), 44.22 (17.03–114.82), and 39.94 (16.31–97.81) for levels 150 ≤ BG < 200, 200 ≤ BG < 250, 250 ≤ BG < 300 and ≥300 mg/dL, respectively. This suggests that SH is common in children visiting the PED and is associated with higher adverse outcomes. Thus, there is a need to quickly identify its cause and take prompt intervention to resolve it. Full article
(This article belongs to the Special Issue Considerations in Pediatric Emergency Medicine)
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12 pages, 834 KiB  
Article
Both Medical and Context Elements Influence the Decision-Making Processes of Pediatricians
by Lisa Schurmans, David De Coninck, Birgitte Schoenmakers, Peter de Winter and Jaan Toelen
Children 2022, 9(3), 403; https://doi.org/10.3390/children9030403 - 11 Mar 2022
Viewed by 1916
Abstract
We wanted to investigate the relationship of medical and non-medical factors with the clinical decision-making of pediatricians. We hypothesize that the addition of relevant medical information (either alarming or reassuring) will influence the physician’s decision-making, but that the addition of non-medical information will [...] Read more.
We wanted to investigate the relationship of medical and non-medical factors with the clinical decision-making of pediatricians. We hypothesize that the addition of relevant medical information (either alarming or reassuring) will influence the physician’s decision-making, but that the addition of non-medical information will also play a role. To investigate this, we designed an online questionnaire containing ten clinical case-based scenarios, of which five focused on medical factors and five on non-medical/context factors, each scored on a five-point Likert scale. In total, 113 pediatricians completed the online questionnaire. Both medical and non-medical/context factors were considered relevant to change the initial decision in most cases. Additional information of an alarming nature induces the physician to become more worried, whereas reassuring information decreases this worry. In some cases, with the medical factors, the gender and the age of the pediatrician does have some effect on the clinical decision-making. We conclude that medical decision-making is affected by multiple intrinsic and extrinsic factors that differ between physicians. Our data indicate that these non-medical factors must be considered when making a medical decision, as it is crucial to be aware that they have a substantial influence on that decision-making. Full article
(This article belongs to the Special Issue Considerations in Pediatric Emergency Medicine)
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11 pages, 851 KiB  
Article
Tracheal Tube Misplacement after Emergency Intubation in Pediatric Trauma Patients: A Retrospective, Exploratory Study
by Franziska Rost, Bernd Donaubauer, Holger Kirsten, Thomas Schwarz, Peter Zimmermann, Manuela Siekmeyer, Daniel Gräfe, Sebastian Ebel, Christian Kleber, Martin Lacher and Manuel Florian Struck
Children 2022, 9(2), 289; https://doi.org/10.3390/children9020289 - 18 Feb 2022
Cited by 6 | Viewed by 2278
Abstract
Inadvertent tracheal tube misplacement and particularly endobronchial intubation are well-known complications of emergency endotracheal intubation (ETI) in pediatric trauma patients, which require repositioning of the tube to avoid impairment of gas exchange. The main aim of study was to identify the frequency of [...] Read more.
Inadvertent tracheal tube misplacement and particularly endobronchial intubation are well-known complications of emergency endotracheal intubation (ETI) in pediatric trauma patients, which require repositioning of the tube to avoid impairment of gas exchange. The main aim of study was to identify the frequency of tube misplacement and associated factors of pediatric trauma patients who received ETI either by prehospital physician-staffed emergency medical service (EMS), or at emergency department (ED) admission to a single level-1 trauma center. Sixty-five patients (median age 14 years and median injury severity score 29) were included. Of these, 30 underwent helicopter EMS ETI, 29 ground EMS ETI, and 6 ED ETI. Seventeen cases (26%) of tracheal tube misplacement were recognized. After multivariable analysis, tracheal tube misplacement was independently negatively associated with body weight (OR 0.86; 95% CI, 0.76–0.99; p = 0.032) and helicopter EMS ETI (OR 0.20; 95% CI, 0.04–0.97; p = 0.036). Two of nineteen patients received tube thoracostomy due to endobronchial intubation. Mortality and length of stay were comparable in patients with misplaced tubes and correctly placed tubes. The results suggest that particularly small children require attention to avoid tracheal tube misplacement, which emphasizes the need for special training. Helicopter EMS physicians’ expertise might be beneficial in prehospital pediatric trauma patients requiring advanced airway management. Full article
(This article belongs to the Special Issue Considerations in Pediatric Emergency Medicine)
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9 pages, 491 KiB  
Article
Limited Utility of SIRS Criteria for Identifying Serious Infections in Febrile Young Infants
by Osamu Nomura, Yoshihiko Morikawa, Takaaki Mori, Yusuke Hagiwara, Hiroshi Sakakibara, Yuho Horikoshi and Nobuaki Inoue
Children 2021, 8(11), 1003; https://doi.org/10.3390/children8111003 - 03 Nov 2021
Cited by 2 | Viewed by 2006
Abstract
(1) Background: Young infants have a high risk of serious infection. The Systematic Inflammatory Response Syndrome (SIRS) criteria can be useful to identify both serious bacterial and viral infections. The aims of this study were to evaluate the diagnostic performance of the SIRS [...] Read more.
(1) Background: Young infants have a high risk of serious infection. The Systematic Inflammatory Response Syndrome (SIRS) criteria can be useful to identify both serious bacterial and viral infections. The aims of this study were to evaluate the diagnostic performance of the SIRS criteria for identifying serious infections in febrile young infants and to identify potential clinical predictors of such infections. (2) Methods: We conducted this prospective cohort study including febrile young infants (aged < 90 days) seen at the emergency department with a body temperature of 38.0 °C or higher. We calculated the diagnostic performance parameters and conducted the logistic regression analysis to identify the predictors of serious infection. (3) Results: Of 311 enrolled patients, 36.7% (n = 114) met the SIRS criteria and 28.6% (n = 89) had a serious infection. The sensitivity, specificity, positive predictive value, and positive likelihood ratio of the SIRS criteria for serious infection was 45.9%, 69.4%, 43.5%, 71.4%, 1.5, and 0.8, respectively. Logistic regression showed that male gender, body temperature ≥ 38.5 °C, heart rate ≥ 178 bpm, and age ≤ 50 days were significant predictors. (4) Conclusions: The performance of the SIRS criteria for predicting serious infections among febrile young infants was poor. Full article
(This article belongs to the Special Issue Considerations in Pediatric Emergency Medicine)
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11 pages, 1762 KiB  
Article
Creating a Pediatric Prehospital Destination Decision Tool Using a Modified Delphi Method
by Jennifer F. Anders, Jennifer N. Fishe, Kyle A. Fratta, Jessica H. Katznelson, Matthew J. Levy, Richard Lichenstein, Michael G. Milin, Joelle N. Simpson, Theresa A. Walls and Heather L. Winger
Children 2021, 8(8), 658; https://doi.org/10.3390/children8080658 - 29 Jul 2021
Cited by 4 | Viewed by 1967
Abstract
Decisions for patient transport by emergency medical services (EMS) are individualized; while established guidelines help direct adult patients to specialty hospitals, no such pediatric equivalents are in wide use. When children are transported to a hospital that cannot provide definitive care, care is [...] Read more.
Decisions for patient transport by emergency medical services (EMS) are individualized; while established guidelines help direct adult patients to specialty hospitals, no such pediatric equivalents are in wide use. When children are transported to a hospital that cannot provide definitive care, care is delayed and may cause adverse events. Therefore, we created a novel evidence-based decision tool to support EMS destination choice. A multidisciplinary expert panel (EP) of stakeholders reviewed published literature. Four facility capability levels for pediatric care were defined. Using a modified Delphi method, the EP matched specific conditions to a facility pediatric-capability level in a draft tool. The literature review and EP recommendations identified seventeen pediatric medical conditions at risk for secondary transport. In the first voting round, two were rejected, nine met consensus for a specific facility capability level, and six did not reach consensus on the destination facility level. A second round reached consensus on a facility level for the six conditions as well as revision of one previously rejected condition. In the third round, the panel selected a visual display format. Finally, the panel unanimously approved the PDTree. Using a modified Delphi technique, we developed the PDTree EMS destination decision tool by incorporating existing evidence and the expertise of a multidisciplinary panel. Full article
(This article belongs to the Special Issue Considerations in Pediatric Emergency Medicine)
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9 pages, 228 KiB  
Article
Polish Medical Air Rescue Crew Interventions Concerning Neonatal Patients
by Ewa Rzońca, Grażyna Bączek, Marcin Podgórski and Robert Gałązkowski
Children 2021, 8(7), 557; https://doi.org/10.3390/children8070557 - 29 Jun 2021
Cited by 1 | Viewed by 1671
Abstract
The purpose of the study was to present the characteristics of Helicopter Emergency Medical Service (HEMS) and Emergency Medical Service (EMS) interventions concerning newborns in Poland. The study involved a retrospective analysis of missions by Polish Medical Air Rescue crews concerning newborns, carried [...] Read more.
The purpose of the study was to present the characteristics of Helicopter Emergency Medical Service (HEMS) and Emergency Medical Service (EMS) interventions concerning newborns in Poland. The study involved a retrospective analysis of missions by Polish Medical Air Rescue crews concerning newborns, carried out in Poland between January 2011 and December 2020. Polish Medical Air Rescue crews were most commonly dispatched to urban areas (86.83%), for patient transfer (59.67%), using an airplane (65.43%), between 7 AM and 6:59 PM (93.14%), and in the summer (28.67%). Further management involved handing over the neonatal patient to a ground neonatal ambulance team. Most of the patients studied were male (58.02%), and the most common diagnosis requiring the HEMS or EMS intervention was a congenital heart defect (31.41%). The most common medical emergency procedure performed by Polish Medical Air Rescue crew members for the neonatal patients was intravenous cannulation (43.07%). The odds ratio for congenital malformations was higher in male newborns. The type of Polish Medical Air Rescue mission was associated with the location of the call, time of the call, ICD-10 diagnosis associated with the dispatch, selected clinical findings, most commonly performed medical emergency procedures, and mission duration and distance covered. Full article
(This article belongs to the Special Issue Considerations in Pediatric Emergency Medicine)

Review

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8 pages, 1772 KiB  
Review
Magnetic Resonance Imaging as the Primary Imaging Modality in Children Presenting with Inflammatory Nontraumatic Atlantoaxial Rotatory Subluxation
by Katharina J. Wenger, Elke Hattingen and Luciana Porto
Children 2021, 8(5), 329; https://doi.org/10.3390/children8050329 - 23 Apr 2021
Cited by 2 | Viewed by 5853
Abstract
Inflammatory nontraumatic atlantoaxial rotatory subluxation (AAS) in children is an often-missed diagnosis, especially in the early stages of disease. Abscess formation and spinal cord compression are serious risks that call for immediate surgical attention. Neither radiographs nor non-enhanced computed tomography (CT) images sufficiently [...] Read more.
Inflammatory nontraumatic atlantoaxial rotatory subluxation (AAS) in children is an often-missed diagnosis, especially in the early stages of disease. Abscess formation and spinal cord compression are serious risks that call for immediate surgical attention. Neither radiographs nor non-enhanced computed tomography (CT) images sufficiently indicate inflammatory processes. Magnetic resonance imaging (MRI) allows a thorough evaluation of paraspinal soft tissues, joints, and ligaments. In addition, it can show evidence of vertebral distraction and spinal cord compression. After conducting a scoping review of the literature, along with scientific and practical considerations, we outlined a standardized pediatric MRI protocol for suspected inflammatory nontraumatic AAS. We recommend contrast-enhanced MRI as the primary diagnostic imaging modality in children with signs of torticollis in combination with nasopharyngeal inflammatory or ear nose and throat (ENT) surgical history. Full article
(This article belongs to the Special Issue Considerations in Pediatric Emergency Medicine)
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