Implementing the IOM Recommendations for Improving Pediatric Emergency Care in Your Emergency Department: Start From Where You Are!

Background. In low-income countries, pediatric emergency care is largely underdeveloped although child mortality in emergency care is more than twice that of adults, and mortality after discharge is high. Aim. We aimed at describing characteristics, triage categories, and post-discharge mortality in a pediatric emergency population in Nepal. Methods. We prospectively assessed characteristics and triage categories of pediatric patients who entered the emergency department (ED) in a local hospital. Patient households were followed-up by telephone interviews at 90 days. Results. The majority of pediatric emergency patients presented with injuries and infections (~40% each). Girls attended ED less frequent than boys. High triage priority categories (orange and red) were strong indicators for intensive care need and for mortality after discharge. Conclusion. The study supports the use and development of a pediatric triage systems in a low-resource general ED setting. We identify a need for interventions that can reduce mortality after pediatric emergency care. Interventions to reduce pediatric emergency disease burden in this setting should emphasize prevention and effective treatment of infections and injuries.

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Identification of practically important traumatic brain injury using Pediatric Emergency Care Applied Research Network rule in children younger than 2 years with minor head trauma

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907920975371 ◽

2020 ◽

pp. 102490792097537

Author(s):

Jon Soo Kim ◽

Jin Cheol Kim ◽

Won Young Sung

Keyword(s):

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Head Trauma ◽

Emergency Care ◽

Applied Research ◽

Pediatric Emergency ◽

Research Network ◽

Minor Head Trauma ◽

Pediatric Emergency Care

Background: Minor head trauma is frequently presented to the pediatric emergency department. Despite the burden this injury poses on public health, evidence-based clinical guidelines on the assessment and management of pediatric minor head trauma remain unestablished, particularly in children below 2 years. We aimed to assess the diagnostic accuracy of a clinical decision rule (Pediatric Emergency Care Applied Research Network rule) and physician discretion in the recognition of practically important traumatic brain injury in children below 2 years of age presenting with minor head trauma to the emergency department. Methods: The medical records of children younger than 2 years presenting with head trauma to the emergency department were reviewed with Glasgow Coma Scale scores of 14–15. Practically important traumatic brain injury is a clinically essential traumatic brain injury including all cranial abnormalities (e.g. skull fracture) detected by computed tomography. All predictor variables of the Pediatric Emergency Care Applied Research Network rule and practically important traumatic brain injury outcomes were validated. Results: We enrolled and analyzed 433 children below 2 years. The most frequently observed mechanisms of injury in decreasing order were as follows: falls > 90 cm, head struck by high-impact objects, slip down, and automobile traffic accident. Of 224 children, positive findings were observed in 35 and 144 had one or more predictors of Pediatric Emergency Care Applied Research Network rule. The sensitivity, specificity, and negative likelihood ratio of the Pediatric Emergency Care Applied Research Network rule for practically important traumatic brain injury were 94.3%, 41.3%, and 0.14, respectively. Conclusion: The Pediatric Emergency Care Applied Research Network rule would assist in clinical decision-making to appropriately detect potential head injuries in children below 2 years, thereby reducing unnecessary performance of computed tomography scan.

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Pediatric emergency care in a low-income country: Characteristics and outcomes of presentations to a tertiary-care emergency department in Mozambique

PLoS ONE ◽

10.1371/journal.pone.0241209 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241209

Author(s):

Valentina Brugnolaro ◽

Laura Nai Fovino ◽

Serena Calgaro ◽

Giovanni Putoto ◽

Arlindo Rosario Muhelo ◽

...

Keyword(s):

Emergency Department ◽

Emergency Care ◽

Low Income ◽

Tertiary Care ◽

Pediatric Emergency ◽

Income Country ◽

Low Income Country ◽

Country Characteristics ◽

Pediatric Emergency Care

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Calcium blocking agents in pediatric emergency care

Pediatric Emergency Care ◽

10.1097/00006565-199003000-00016 ◽

1990 ◽

Vol 6 (1) ◽

pp. 52-57 ◽

Cited By ~ 3

Author(s):

ELI SHAHAR ◽

MAYER SAGY ◽

GIDEON KOREN ◽

ZOHAR BARZILAY

Keyword(s):

Emergency Care ◽

Pediatric Emergency ◽

Blocking Agents ◽

Pediatric Emergency Care

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SCHOOL NURSES AND PEDIATRIC EMERGENCY CARE IN NEW JERSEY

Pediatric Emergency Care ◽

10.1097/00006565-199708000-00031 ◽

1997 ◽

Vol 13 (4) ◽

pp. 299

Author(s):

Robert van Amerongen ◽

Sally Klig ◽

Abu Khan

Keyword(s):

New Jersey ◽

Emergency Care ◽

Pediatric Emergency ◽

School Nurses ◽

Pediatric Emergency Care

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Pediatric Emergency Medicine: A Developing Subspecialty

PEDIATRICS ◽

10.1542/peds.84.2.336 ◽

1989 ◽

Vol 84 (2) ◽

pp. 336-342

Author(s):

Marilyn Li ◽

M. Douglas Baker ◽

Leland J. Ropp

Keyword(s):

Emergency Medicine ◽

Emergency Care ◽

Emergency Departments ◽

Life Support ◽

Pediatric Emergency ◽

Advanced Trauma Life Support ◽

Full Time ◽

Pediatric Emergency Medicine ◽

Pediatric Hospitals ◽

Pediatric Emergency Care

Questionnaires were sent to 245 North American institutions with pediatric residency programs. There was a 69% response rate. Pediatric emergency care is provided in three types of facilities: emergency departments in pediatric hospitals, separate pediatric emergency departments or combined pediatric and adult emergency departments, in multidisciplinary hospitals. There are at least 262 pediatricians practicing full-time pediatric emergency medicine. The majority work in pediatric emergency departments, an average of 30.7 clinical hours per week. There are 27 pediatric emergency medicine programs with 46 fellows in training and 117 full-time positions available for emergency pediatricians throughout North America. Varying qualifications for these positions include board eligibility in pediatrics, certification in Basic Life Support or Advanced Trauma Life Support, and a fellowship in pediatric emergency medicine. The demonstrated need for pediatricians, preferably trained in emergency care, clearly indicates that pediatric emergency medicine is a rapidly developing subspecialty of Pediatrics that will be an attractive career choice for future pediatricians.

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Guidelines for Pediatric Emergency Care Facilities

PEDIATRICS ◽

10.1542/peds.96.3.526 ◽

1995 ◽

Vol 96 (3) ◽

pp. 526-537

Author(s):

Keyword(s):

Health Care ◽

Emergency Medical Services ◽

Emergency Care ◽

Pediatric Emergency ◽

Medical Services ◽

Emergency Medical ◽

Care Facilities ◽

Trained Personnel ◽

Pediatric Emergency Care

Emergency care for life-threatening pediatric illness and injury requires specialized resources including equipment, drugs, trained personnel, and facilities. The American Medical Association Commission on Emergency Medical Services has provided guidelines for the categorization of hospital pediatric emergency facilities that have been endorsed by the American Academy of Pediatrics (AAP).1 This document was used as the basis for these revised guidelines, which define: 1. The desirable characteristics of a system of Emergency Medical Services for Children (EMSC) that may help achieve a reduction in mortality and morbidity, including long-term disability. 2. The role of health care facilities in identifying and organizing the resources necessary to provide the best possible pediatric emergency care within a region. 3. An integrated system of facilities that provides timely access and appropriate levels of care for all critically ill or injured children. 4. The responsibility of the health cane facility for support of medical control of pre-hospital activities and the pediatric emergency care and education of pre-hospital providers, nurses, and physicians. 5. The role of pediatric centers in providing outreach education and consultation to community facilities. 6. The role of health cane facilities for maintaining communication with the medical home of the patient. Children have their emergency care needs met in a variety of settings, from small community hospitals to large medical centers. Resources available to these health care sites vary, and they may not always have the necessary equipment, supplies, and trained personnel required to meet the special needs of pediatric patients during emergency situations.

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