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Diagnostics
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Diagnosis and Treatment of Pediatric Emergencies
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Diagnosis and Treatment of Pediatric Emergencies

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (31 May 2024) | Viewed by 19829

Special Issue Editor

Dr. Katerina Kambouri

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Guest Editor
Department of Pediatric Surgery, Democritus University of Thrace, 68100 Alexandroupolis, Greece
Interests: pediatric surgery; pediatric urology; emergency medicine; trauma
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues, 

Pediatric patients present to the emergency department with various pathologies. Children of all ages differ from adult patients due to their anatomy, physiology, development, and emotional needs. Reduced familiarity with pediatric emergencies, their diagnosis and their management can lead to unnecessary work up in the emergency department. Also, advances on the treatment of these emergencies could limit hospital stays or readmission and of course children’s mortality.

The aim of this special issue entitled ‘Diagnosis and Treatment of Pediatric Emergencies’ is to provide information about the diagnosis or the advances on the management of various pediatric emergency cases in order to help pediatricians, pediatric surgeons, general practitioners, and emergency physicians to improve their knowledge and manage successfully these particular pathologies.

We invite researchers and authors to submit original research or review articles on this topic aiming at the improvement of pediatric emergency care.

Dr. Katerina Kambouri
Guest Editor

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. Diagnostics is an international peer-reviewed open access semimonthly 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 2600 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.

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Published Papers (7 papers)

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Research

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12 pages, 5525 KiB  
Article
Ask Doctor Smartphone! An App to Help Physicians Manage Foreign Body Ingestions in Children
by Marco Di Mitri, Giovanni Parente, Cristian Bisanti, Eduje Thomas, Sara Maria Cravano, Chiara Cordola, Marzia Vastano, Edoardo Collautti, Annalisa Di Carmine, Michela Maffi, Simone D’Antonio, Michele Libri, Tommaso Gargano and Mario Lima
Diagnostics 2023, 13(20), 3285; https://doi.org/10.3390/diagnostics13203285 - 23 Oct 2023
Viewed by 998
Abstract
Background: Foreign body ingestion (FBI) represents the most common cause of emergent gastrointestinal endoscopy in children. FBI’s management can be quite challenging for physicians because of the variability of the clinical presentation, and the decision tree becomes even more intricate because of patient-specific [...] Read more.
Background: Foreign body ingestion (FBI) represents the most common cause of emergent gastrointestinal endoscopy in children. FBI’s management can be quite challenging for physicians because of the variability of the clinical presentation, and the decision tree becomes even more intricate because of patient-specific variables that must be considered in the pediatric age range (e.g., age of patients and neuropsychiatric disorders) in addition to the mere characteristics of the foreign body. We present an application for smartphones designed for pediatricians and pediatric surgeons based on the latest guidelines from the official pediatric societies. The app aims to help physicians manage FBI quickly and properly in children. Materials and methods: The latest pediatric FBI management guidelines were reviewed and summarized. The flow chart we obtained guided the development of a smartphone application. A questionnaire was administered to all pediatric surgeon trainees at our institute to test the feasibility and helpfulness of the application. Results: An app for smartphones was obtained and shared for free on the Google Play Store and Apple Store. The app guides the physician step by step in the diagnostic process, analyzing all patient- and foreign body-specific characteristics. The app consultation ends with a suggestion of the most proper decision to make in terms of further radiological investigations and the indication and timing of endoscopy. A questionnaire administered to trainees proved the app to be useful and easy to use. Conclusion: We developed an app able to help pediatricians and pediatric surgeons manage FBI in children, providing standardized and updated recommendations in a smart and easily available way. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Pediatric Emergencies)
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13 pages, 1326 KiB  
Article
Predicting Complicated Appendicitis in Children: Pros and Cons of a New Score Combining Clinical Signs, Laboratory Values, and Ultrasound Images (CLU Score)
by Konstantina Bekiaridou, Katerina Kambouri, Alexandra Giatromanolaki, Soultana Foutzitzi, Maria Kouroupi, Maria Aggelidou and Savas Deftereos
Diagnostics 2023, 13(13), 2275; https://doi.org/10.3390/diagnostics13132275 - 5 Jul 2023
Cited by 5 | Viewed by 1884
Abstract
Background: This retrospective study aimed to combine the clinical signs, laboratory values, and ultrasound images of 199 children with acute appendicitis in order to create a new predictive score for complicated appendicitis in children. Methods: The study included children who had clinical examination [...] Read more.
Background: This retrospective study aimed to combine the clinical signs, laboratory values, and ultrasound images of 199 children with acute appendicitis in order to create a new predictive score for complicated appendicitis in children. Methods: The study included children who had clinical examination of abdominal pain (description of pain, anorexia, body temperature, nausea or vomiting, duration of symptoms), laboratory findings on admission (white blood cell, platelets, neutrophils, C-reactive protein), preoperative abdominal ultrasound, and histopathological report after an operation for appendicitis in their records during the period from January 2016 to February 2022. Results: According to the statistical analysis of the values using multivariate logistic regression models, the patients with appendiceal diameter ≥ 8.45 mm, no target sign appearance, appendicolith, abscess, peritonitis, neutrophils ≥ 78.95%, C-reactive protein ≥ 1.99 mg/dL, body temperature ≥ 38 °C, pain migration to right lower quadrant, and duration of symptoms < 24 h were more likely to suffer from complicated appendicitis. The new score was comprised of the 10 variables that were found statistically significant in the multivariate logistic model. Each of these variables was assigned a score of 1 due to the values that were associated with complicated appendicitis. Conclusions: A cutoff value of ≥4 has been a good indicator of the final score. The sensitivity with the usage of this score is 81.1%, the specificity 82.4%, the PPV 73.2%, the NPV approaches 88% and finally the accuracy is 81.9%. Also, the pros and cons of this score are discussed in this study. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Pediatric Emergencies)
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17 pages, 724 KiB  
Article
Mirroring Perinatal Outcomes in a Romanian Adolescent Cohort of Pregnant Women from 2015 to 2021
by Daniela Roxana Matasariu, Irina Dumitrascu, Iuliana Elena Bujor, Alexandra Elena Cristofor, Lucian Vasile Boiculese, Cristina Elena Mandici, Mihaela Grigore, Demetra Socolov, Florin Nechifor and Alexandra Ursache
Diagnostics 2023, 13(13), 2186; https://doi.org/10.3390/diagnostics13132186 - 27 Jun 2023
Viewed by 1397
Abstract
Although the rates of adolescent pregnancies appear to have dropped according to the World Health Organization (WHO), the decrease in the age of the first menarche and better nutrition seems to contribute to the otherwise high rate of adolescent pregnancy worldwide, despite the [...] Read more.
Although the rates of adolescent pregnancies appear to have dropped according to the World Health Organization (WHO), the decrease in the age of the first menarche and better nutrition seems to contribute to the otherwise high rate of adolescent pregnancy worldwide, despite the efforts of different organizations to improve upon this trend. We conducted a population-based retrospective cohort study from January 2015 to December 2021 using our hospitals’ database. We totaled 2.954 adolescent and 6.802 adult pregnancies. First, we compared younger adolescents’ outcomes with those of older adolescents, as well as with adolescents aged between 18 and 19 years old; secondly, we compared adolescent pregnancies with adult ones. We detected higher percentages of cephalo-pelvic disproportion (43.2%), cervical dystocia (20.7%), and twin pregnancy (2.7%) in underage adolescents compared with 32%, 14.1%, and 1% in older underage adolescents, respectively, and 15.3%, 3.1%, and 0.6% in older ones. As teens became older, the likelihood of malpresentations and previous C-sections rose, whereas the likelihood of vaginal lacerations declined. When comparing adolescents with adult women, we found more cases that required episiotomy (48.1% compared with 34.6%), instrumental delivery (2.1% compared with 1%), and cervical laceration (10.7% compared with 8.4%) in the adolescent group, but the rates of malpresentation (11.4% compared with 13.5%), previous C-section (13.9% compared with 17.7%), and placenta and vasa praevia (4.5.6% compared with 14%) were higher in the adult women group. Adolescent pregnancy is prone to being associated with higher risks and complications and continues to represent a challenge for our medical system. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Pediatric Emergencies)
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10 pages, 731 KiB  
Article
Acute Appendicitis Following COVID-19 Infection in Pediatric Patients: A Single Center’s Study in Greece
by Christos Kaselas, Maria Florou, Maria Tsopozidi and Ioannis Spyridakis
Diagnostics 2023, 13(12), 2070; https://doi.org/10.3390/diagnostics13122070 - 15 Jun 2023
Cited by 2 | Viewed by 2132
Abstract
Purpose: This study investigated the potential association between the previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive infection, as well as vaccination, and the presentation of acute appendicitis in pediatric patients. It has been three years since the World Health Organization (WHO) [...] Read more.
Purpose: This study investigated the potential association between the previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive infection, as well as vaccination, and the presentation of acute appendicitis in pediatric patients. It has been three years since the World Health Organization (WHO) declared the SARS-CoV-2 pandemic, and city lockdowns and self-protective measures have been applied worldwide. In an effort to contribute to the research on the probable long-term complications of the COVID-19 infection as well as the vaccination against SARS-CoV-2, the current study was designed and investigated patients’ health records in the post-quarantine era. Methods: A retrospective analysis of patients admitted and treated surgically for acute appendicitis from January 2022 to June 2022 was conducted. Demographic and personal data, as well as the COVID-19 infection history of each child, were recorded. The patients who were negative for a previous COVID-19 infection were excluded. For the rest of the sample, the time-to-onset of acute appendicitis, the severity of appendicitis (complicated or uncomplicated), and the vaccination status of the patients were examined. Regarding the time-to-onset of appendicitis, we divided the patients into three groups: group A with a time-to-onset < 3 months, group B with a time-to-onset of 3–6 months, and group C with a time-to-onset of >6 months. Statistical analysis followed and was considered significant if p < 0.05. Results: Sixty-six children with a mean age of 10.5 years (range 1–15 years) were admitted for acute appendicitis during the determined period. After excluding 30 children that were negative for previous COVID-19 infection, we divided the patients into three groups: group A-23 children, group B-7 children, and group C-6 children. A statistically significant incidence of acute appendicitis diagnosis in <3 months after laboratory-confirmed COVID-19 infection (p < 0.01) was found. The incidence of complicated appendicitis was greater in patients with a positive SARS-CoV-2 history, with an estimated odds ratio of 1.8 (p > 0.05). The majority of the children (92%) had not received a COVID-19 vaccination. For the vaccinated children, the relative risk for complicated appendicitis was equal to 1.5 (p > 0.05). Conclusions: The results of our study demonstrate a potential positive relationship between COVID-19 infection and subsequent acute appendicitis in pediatric patients. There are also some speculations on the presentation of complicated cases of appendicitis following COVID-19 infection or vaccination, but these need to be further proven. Further data are required to better understand this potential complication of COVID-19 infection as well as the role of vaccines in the current post-vaccine era. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Pediatric Emergencies)
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13 pages, 539 KiB  
Article
Association of the Bacteria of the Vermiform Appendix and the Peritoneal Cavity with Complicated Acute Appendicitis in Children
by Konstantinos Zachos, Fevronia Kolonitsiou, Antonios Panagidis, Despoina Gkentzi, Sotirios Fouzas, Vasileios Alexopoulos, Eirini Kostopoulou, Stylianos Roupakias, Aggeliki Vervenioti, Theodore Dassios, George Georgiou and Xenophon Sinopidis
Diagnostics 2023, 13(11), 1839; https://doi.org/10.3390/diagnostics13111839 - 24 May 2023
Cited by 4 | Viewed by 3820
Abstract
Background: Primary infection has been questioned as the pathogenetic cause of acute appendicitis. We attempted to identify the bacteria involved and to investigate if their species, types, or combinations affected the severity of acute appendicitis in children. Methods: Samples from both the appendiceal [...] Read more.
Background: Primary infection has been questioned as the pathogenetic cause of acute appendicitis. We attempted to identify the bacteria involved and to investigate if their species, types, or combinations affected the severity of acute appendicitis in children. Methods: Samples from both the appendiceal lumen and the peritoneal cavity of 72 children who underwent appendectomy were collected to perform bacterial culture analysis. The outcomes were studied to identify if and how they were associated with the severity of the disease. Regression analysis was performed to identify any risk factors associated with complicated appendicitis. Results: Escherichia coli, Pseudomonas aeruginosa, and Streptococcus species were the most common pathogens found in the study population. The same microorganisms, either combined or separate, were the most common in the appendiceal lumen and the peritoneal cavity of patients with complicated appendicitis. Gram-negative bacteria and polymicrobial cultures in the peritoneal fluid and in the appendiceal lumen were associated with complicated appendicitis. Polymicrobial cultures in the peritoneal cavity presented a four times higher risk of complicated appendicitis. Conclusions: Polymicrobial presentation and Gram-negative bacteria are associated with complicated appendicitis. Antibiotic regimens should target the combinations of the most frequently identified pathogens, speculating the value of early antipseudomonal intervention. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Pediatric Emergencies)
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Review

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14 pages, 798 KiB  
Review
Diabetic Ketoacidosis in Children and Adolescents; Diagnostic and Therapeutic Pitfalls
by Eirini Kostopoulou, Xenophon Sinopidis, Sotirios Fouzas, Despoina Gkentzi, Theodore Dassios, Stylianos Roupakias and Gabriel Dimitriou
Diagnostics 2023, 13(15), 2602; https://doi.org/10.3390/diagnostics13152602 - 4 Aug 2023
Cited by 5 | Viewed by 6762
Abstract
Diabetic ketoacidosis (DKA) represents an acute, severe complication of relative insulin deficiency and a common presentation of Type 1 Diabetes Mellitus (T1DM) primarily and, occasionally, Type 2 Diabetes Mellitus (T2DM) in children and adolescents. It is characterized by the biochemical triad of hyperglycaemia, [...] Read more.
Diabetic ketoacidosis (DKA) represents an acute, severe complication of relative insulin deficiency and a common presentation of Type 1 Diabetes Mellitus (T1DM) primarily and, occasionally, Type 2 Diabetes Mellitus (T2DM) in children and adolescents. It is characterized by the biochemical triad of hyperglycaemia, ketonaemia and/or ketonuria, and acidaemia. Clinical symptoms include dehydration, tachypnoea, gastrointestinal symptoms, and reduced level of consciousness, precipitated by a variably long period of polyuria, polydipsia, and weight loss. The present review aims to summarize potential pitfalls in the diagnosis and management of DKA. A literature review was conducted using the Pubmed/Medline and Scopus databases including articles published from 2000 onwards. Diagnostic challenges include differentiating between T1DM and T2DM, between DKA and hyperosmolar hyperglycaemic state (HHS), and between DKA and alternative diagnoses presenting with overlapping symptoms, such as pneumonia, asthma exacerbation, urinary tract infection, gastroenteritis, acute abdomen, and central nervous system infection. The mainstays of DKA management include careful fluid resuscitation, timely intravenous insulin administration, restoration of shifting electrolyte disorders and addressing underlying precipitating factors. However, evidence suggests that optimal treatment remains a therapeutic challenge. Accurate and rapid diagnosis, prompt intervention, and meticulous monitoring are of major importance to break the vicious cycle of life-threatening events and prevent severe complications during this potentially fatal medical emergency. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Pediatric Emergencies)
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17 pages, 1063 KiB  
Review
Reasons for Delayed Diagnosis of Pediatric Acute Appendicitis during the COVID-19 Era: A Narrative Review
by George Pantalos, Smaragda Papachristidou, Eleftheria Mavrigiannaki, Nikolaos Zavras and George Vaos
Diagnostics 2023, 13(15), 2571; https://doi.org/10.3390/diagnostics13152571 - 2 Aug 2023
Cited by 2 | Viewed by 1451
Abstract
Global pandemics cause health system disruptions. The inadvertent disruption in surgical emergency care during the Coronavirus Disease 2019 (COVID-19) pandemic has been the topic of several published studies. Our aim was to summarize the reasons that led to the delayed diagnosis of pediatric [...] Read more.
Global pandemics cause health system disruptions. The inadvertent disruption in surgical emergency care during the Coronavirus Disease 2019 (COVID-19) pandemic has been the topic of several published studies. Our aim was to summarize the reasons that led to the delayed diagnosis of pediatric appendicitis during the COVID-19 era. This systematic literature search evaluated studies containing pediatric appendicitis patient data regarding outcomes, times to hospital admission or times from symptom onset to emergency department visit. Studies elucidating reasons for delays in the management of pediatric appendicitis were also reviewed. Ultimately, 42 studies were included. Several reasons for delayed diagnosis are analyzed such as changes to public health measures, fear of exposure to COVID-19, increased use of telemedicine, COVID-19 infection with concurrent acute appendicitis, recurrence of appendicitis after non-operative management and increased time to intraoperative diagnosis. Time to hospital admission in conjunction with patient outcomes was extracted and analyzed as an indicative measure of delayed management. Delayed diagnosis of acute appendicitis has been documented in many studies with various effects on outcomes. Suspicion of pediatric acute appendicitis must always lead to prompt medical examination, regardless of pandemic status. Telemedicine can be valuable if properly applied. Data from this era can guide future health system policies. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Pediatric Emergencies)
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