Heather Kelker, MD et. al.

Variation in the Use of Mechanical Ventilation and Medications for Pediatric Status Asthmaticus

  • Retrospective study of >121,000 asthma admissions
  • Children that received IPPV had higher mortality, were younger, had more pneumothoracies, aspiration pneumonitis and had longer LOS
  • Wide practice variability exists across hospitals with regard to frequency of IPPV and NIPPV use
  • More kids got IV Mag that received NIPPV overall
  • The most common sedatives used included Ketamine, Dexmedetomidine and Versed/Midazolam
  • The Bottom Line is that IPPV/NIPPV rates are not changing and wide variability of practice exists. We would benefit from National Guidelines

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Why we do what we do: Intravenous magnesium for asthma exacerbations

Jennifer F. Anders, MD et. al.

Creating an Evidence-Based Pediatric Prehospital Destination Tool (PDTree): An Expert Panel Process Using a Modified-Delphi Method

  • This study details the creation an evidence-based tool to guide destination choice for pediatric EMS patients
  • The group used a Modified-Delphi process to sort and categorize 18 conditions
  • The benefit of the Delphi process is that you leverage the knowledge of many stakeholders
  • Members were concerned that secondary transport – local hospital first then to a pediatric center – was potentially costly and delayed care.
  • Hospital options essentially included Level 1 Trauma, hospitals with a PICU, hospitals with a Peds ED/Peds inpatient, other facility – the panel decided, based on clinical scenario where kids should go first.
    • Closest ED e.g.. cardiac arrest, airway problem
    • Specialty/Trauma e.g.. arrest w/ ROSC, stroke, eye, hand injury, suspected cervical spine injury
    • Critical Care e.g.. shock, DKA, <2 years old with AMS, long bone fracture with deformity
    • Regional Pediatric e.g.. BRUE, hypoxia, sepsis, child abuse

Elizabeth R. Alpern, MD, MSCE et. al.

Time to Positive Blood and Cerebrospinal Fluid Cultures in Febrile Infants ≤ 60 Days-old

  • Secondary analysis of an observational dataset from PECARN
  • Included a subset of a convenience sample of babies ≤60 days old with positive blood and/or CSF cultures
    • UTI 8%, Bacteremia 2% and Meningitis 0.5%
  • Median time to positive blood culture was 18.6 hours (IQR 12-21.9hrs)
    • E. coli was most common blood, and mean positivity was 13h
    • Staph spp. were the most common contaminants and mean time to positivity was 27h
  • Median time to positive CSF culture was 5.8 hours (IQR 1.1-18.7)
    • Group B Strep was the most common CSF pathogen, and mean time to positivity was 1.7h
    • Staph spp. contaminants grew in 43.8h mean
  • These findings may reduce hospital LOS – I was impressed by how quickly CSF pathogens grew
  • 18h observation would miss 51% of bacteremia
  • 24h observation would miss 18% of bacteremia

Michele Nypaver, MD et. al.

The Michigan Emergency Department Improvement Collaborative:  A Novel Model for Implementing Large Scale Practice Change in Pediatric Emergency Care

  • This study details implementation of large scale changes across an entire state with different settings
  • Getting knowledge to the bedside takes too long
  • Performance data can reduce variability in practice
  • Initiatives included CT scans for head injuries and limiting Chest X-Rays for common illnesses (bronchiolitis, asthma)
  • This program will provide detailed data to participating sites – you can compare your results and those of your facility with others in the collaborative

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Community acquired pneumonia: Imaging

Bronchiolitis Part VI: Testing 1-2-3 Testing?

2017 Starter Pack: Head Injuries

Amanda Stewart, MD, MPH et. al.

Pediatric Emergency Department Visits for Homelessness After Shelter Eligibility Policy Change: An Interrupted Time Series Analysis

  • This retrospective cohort study investigated the frequency and costs of ED visits for homelessness after a policy change in Massachusetts
  • After the more restrictive policy, that asked families to “demonstrate” that they were homeless by staying one night in a place “not fit for human habitation” (which includes EDs) they saw a 6 fold increase in visits
  • More children seen in the ED had no medical complaints than before
  • The average cost for an ED visit was $522 – five times more than that of a night in the shelter

Jennifer Thull-Freedman et. al.

Improving the Pain Experience for Children with Limb Injury in the City of Calgary, Alberta: A Multi-Site Quality Improvement Collaborative

  • This QI initiative investigated why far fewer children with long bone injuries got pain meds than needed them
  • They wanted to get pain meds to more kids faster (<15 minutes)
  • They were able to increase the proportion of patients receiving analgesia from 28% to 41%
  • Median time to analgesia decreased from 37 to 12 minutes. One-third of kids did get pain meds pre arrival.
    • >80% got ibuprofen first
  • They have expanded to 26 sites – which is awesome!

Shilpa J. Patel, MD, MPH

Geographic Regions with Stricter Gun Laws Have Fewer Emergency Department Visits for Pediatric Firearm-Related Injuries: A Five-Year National Study

  • They used NEDS to do cross-sectional analysis of firearm related injuries
  • Trends in visits were noted to decrease from 65/100,000 to 51/100,000 (p<0.048) after 2013
    • Almost 90% were male, only 1/5 had private insurance, most were urban
  • There were fewer visits in the Northeast, and more in the Midwest, West and South – so, stricter gun laws lead to fewer visits
  • Policy in action!

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U.S. Regions with Stricter Gun Laws Have Lower Rates of Pediatrics Injuries Due to Firearms  – AAP