Search Results (456)

Air quality in the San Joaquin Valley (SJV) ranks among the worst in the US. Exposures to traffic-related air pollutants have been associated with pediatric health complications, and few studies have investigated respiratory complications in relation to short-term exposures to PM less than 2.5 microns in diameter (PM_2.5) in the SJV. We used Bayesian Poisson spatiotemporal conditional autoregressive models to analyze the association between PM_2.5 and pediatric respiratory emergency department (ED) visits in Fresno County, California. Additional analyses stratified respiratory outcomes by sex and age group. Weekly ambient PM_2.5 levels were estimated for each zip code using community science and regulatory air monitors. Weekly residential zip code counts of respiratory ED visits were provided by Fresno County Department of Public Health and Valley Children’s Hospital from 2 April 2022 to 31 December 2024. A ten-fold increase in PM_2.5 was associated with increased asthma ED visits among females (Relative Risk (RR):1.15; 95% Credible Interval (CrI):1.01, 1.32) and children aged 0 to 4 (RR:1.18; 95% CrI:1.03, 1.34) and other chronic respiratory conditions among males (RR:1.93; 95% CrI:1.19, 3.16) and ages 10 to 14 (RR:2.90; 95% CrI:1.32, 6.30). Findings suggest that efforts to better assess and reduce pollution exposures will improve public health in the SJV. Full article

Acute lymphoblastic leukemia (ALL) is a malignant neoplasm of the blood and bone marrow characterized by the uncontrolled proliferation of precursor cells of B- or T-lymphocyte lineage. Usually, the disease arises because of spontaneous mutations in bone marrow cells. Risk factors include genetic predisposition, exposure to ionizing radiation, prior chemotherapy or radiotherapy, and certain environmental factors. Clinical manifestations may include recurrent infections, anemia, and an increased tendency toward bleeding and stroke. A 12-year-old boy presented to the emergency department with a sudden decrease in visual acuity in the right eye. Best-corrected visual acuity (BCVA) in the right eye was 0.02, and intraocular pressure (IOP) was 16 mmHg. Ophthalmologic examination revealed a macular hemorrhage in the right eye. Blood samples were obtained for laboratory analysis. Complete blood count demonstrated leukocytosis with a white blood cell (WBC) count of 362.58 × 10³/µL, thrombocytopenia with a platelet (PLT) count of 87 × 10³/µL, hemoglobin (Hgb) level of 8.7 g/dL, and a red blood cell (RBC) count of 3.46 × 10⁶/µL. The patient was subsequently referred to the Department of Pediatric Hematology, where the diagnosis of acute lymphoblastic leukemia of B-cell precursor origin was confirmed. Appropriate systemic therapy targeting the underlying disease was initiated. Full article

Background: This study was conducted to examine the relationships between distress and eustress levels and lifestyles and self-perception in adolescents presenting to a pediatric emergency department with psychosocial complaints. Methods: This descriptive cross-sectional study was conducted in a single training and research hospital with 142 adolescents aged 12–17 years who presented to a pediatric emergency department with psychosocial complaints. Data were collected using an introductory information form, the Adolescent Distress–Eustress Scale, the Adolescent Lifestyle Scale, and the Self-Perception Scale for Adolescents. Pearson correlation analyses were performed to examine bivariate relationships among variables. Multiple linear regression analyses were conducted to identify variables independently associated with lifestyle and self-perception scores after controlling for relevant sociodemographic variables. Variables were entered simultaneously into the regression model. Results: Distress level was significantly negatively correlated with self-perception and lifestyle scores, whereas eustress level was positively correlated with both variables (p < 0.001). In multiple linear regression analyses, eustress, distress, and economic status were significantly and independently associated with self-perception and lifestyle scores. The models explained 45.9% and 44.8% of the variance in self-perception and lifestyle, respectively. Adolescents reporting better sleep patterns, higher academic achievement, greater self-confidence, and perceived social acceptance had higher self-perception and lifestyle scores (p < 0.05). Conclusions: These findings highlight the importance of stress perception and socioeconomic factors in understanding psychosocial well-being among adolescents presenting to pediatric emergency departments. Full article

Pediatric psychiatric emergency department (ED) visits have increased globally, yet many children do not receive timely outpatient follow-up. Although South Korea provides universal health coverage through its National Health Insurance (NHI), additional financial barriers may impede the continuity of mental health care. This study examined whether supplemental private insurance is associated with improved outpatient mental health follow-up after pediatric psychiatric ED visits within a universal coverage system. A retrospective cohort study was conducted at a tertiary children’s hospital in South Korea including 520 psychiatric ED visits (480 unique patients aged <18 years) from 2016 to 2024. The primary outcome was attendance at an outpatient mental health visit within 30 days of ED discharge. Multivariable logistic regression was used to assess the association between insurance type (NHI-only versus NHI plus supplemental private insurance) and follow-up, adjusting for age, sex, clinical presentation, and prior mental health care. Overall, 53.7% of patients attended a 30-day follow-up visit. Patients with supplemental private insurance had significantly higher follow-up rates than those with NHI alone (58.8% vs. 45.5%, p = 0.019). In adjusted analysis, supplemental private insurance was independently associated with increased follow-up (adjusted odds ratio 1.50, 95% confidence interval 1.10–2.05, p = 0.02). A significant interaction was observed between insurance type and prior mental health care (p_interaction = 0.03): the insurance effect was pronounced among patients without prior outpatient mental health treatment (45.6% vs. 38.8%) but negligible among those with prior treatment (71.9% vs. 72.5%). Prior outpatient mental health treatment (adjusted odds ratio 2.00, 95% confidence interval 1.30–3.10) and suicidal presentation were also significant predictors. Even within a universal health coverage system, supplemental private insurance is associated with better outpatient follow-up after pediatric psychiatric emergencies, particularly among patients new to the mental health system. Reducing financial barriers, expanding community-based mental health services, and strengthening care coordination are essential to ensure equitable continuity of care for all children. Full article

Background: Pediatric septic shock remains a major cause of morbidity and mortality and requires timely recognition and management across multiple hospital settings. Although intensive care support is critical, outcomes are also influenced by earlier phases of care, including emergency department recognition, first-hour treatment, inpatient monitoring, and timely escalation to the pediatric intensive care unit (PICU). Objective: We aimed to review pediatric septic shock across the full hospital trajectory, from emergency department recognition to PICU management and outcomes, with emphasis on diagnostic challenges, early treatment, escalation of care, and prognostic assessment. Methods: This narrative review was based on a structured literature search of PubMed/MEDLINE, Scopus, and the Cochrane Library, with emphasis on international guidelines, consensus statements, systematic reviews, and clinically relevant pediatric studies addressing recognition, resuscitation, escalation, intensive care management, and outcomes in pediatric septic shock. Results: Pediatric septic shock is best approached as a dynamic continuum rather than a single event. Early recognition is complicated by age-dependent physiology, nonspecific presentation, and delayed hypotension. Timely antimicrobial therapy, individualized fluid resuscitation, early vasoactive support, and repeated reassessment during the first hours are central to management. Ward surveillance and prompt escalation to PICU are critical, as delayed recognition of deterioration may worsen organ dysfunction and resource use. In the PICU, phenotype-informed hemodynamic support, fluid stewardship, respiratory support, and organ support are essential. Outcomes should be evaluated beyond mortality to include organ dysfunction burden, duration of support, length of stay, and longer-term functional recovery. Conclusions: Pediatric septic shock outcomes are shaped by the entire hospital care pathway rather than PICU treatment alone. A trajectory-based, continuum-of-care approach may improve timely diagnosis, escalation, and short- and longer-term outcomes. Full article

The WW domain-containing oxidoreductase (WWOX) gene, well-known as a tumor suppressor, also has a crucial role as a transcription factor in the developing brain. The bi-allelic loss of the WWOX gene causes a condition characterized by drug-resistant epilepsy, developmental delay, and neurological impairments, often resulting in mortality within the first year of life, known as WWOX-related epileptic encephalopathy (WOREE) syndrome (MIM: 616211). Whole Exome Sequencing (WES) analysis was performed on a female patient who died within three months of birth and was diagnosed with microcephaly, severe early-onset refractory seizures, and drug-resistant epileptic encephalopathy. WES revealed a 38 kb CNV deletion spanning WWOX exons 6–7, and a known frameshift variant in exon 8, impairing a highly clinically significant region of the encoded protein. Clinical and genetic features of reported WOREE patients with WWOX gene deletions similar to our patient were analyzed. Our case highlights the clinical heterogeneity of WWOX variants in WOREE syndrome and expands the spectrum of reported compound heterozygous deletions. Further research needs to elucidate WWOX pathophysiology and improve diagnostic and therapeutic strategies. Full article

Objectives: To evaluate how often pain is assessed and treated in pediatric trauma patients transported by Emergency Medical Services (EMS) to a pediatric emergency department (ED), and to compare current practice with national recommendations of the Polish Ministry of Health for prehospital pediatric pain management. Methods: We conducted a retrospective analysis of EMS and ED documentation for all trauma patients under 18 years of age transported to the Pediatric Teaching Hospital of the University Clinical Center of the Medical University of Warsaw between 1 January and 31 December 2021. A total of 981 patients with injury or suspected injury or burns were included without exclusion criteria. For patients with documented pain scores, we analyzed pain intensity (0–10), the scales used [Visual Analog Scale (VAS), Numerical Rating Scale (NRS), Wong–Baker Faces Pain Rating Scale (FACES)], body region injured, Glasgow Coma Scale (GCS) score, suspected alcohol or psychoactive substance use, and type and route of analgesic administration. We further evaluated non-pharmacological interventions, pain reassessment, and achievement of at least 50% pain reduction, as defined in national guidelines. Statistical analysis included Student’s t-test or ANOVA for quantitative variables and maximum likelihood chi-square tests for qualitative variables (α = 0.05). Results: Pain was assessed in 839/981 (85.5%) patients; 651/839 (77.6%) reported pain, most frequently of moderate intensity. Despite this, only 208/981 (21.2%) patients received analgesics prehospitally. Morphine and paracetamol were the most frequently used drugs, predominantly administered intravenously, while non-opioid monotherapy was commonly used in patients with lower baseline pain scores. Less than half of all patients received any non-pharmacological intervention whatsoever. Pain was reassessed in 734/839 (87.5%) patients, with a mean reassessment time of approximately 10 min; however, in many cases reassessment occurred earlier than the expected onset of analgesic action. Overall, only 29.4% of patients with pain and documented reassessment achieved the recommended ≥50% reduction in pain intensity, and at least 70.2% of the cohort had no documented evidence of treatment fully complying with national recommendations. Conclusions: In this real-world prehospital and ED cohort, pediatric trauma pain remains under-treated, and adherence to national guidelines on opioid-based analgesia and pain reassessment is suboptimal. Further efforts are needed to improve documentation, expand the recommended pharmacological options for mild pain, and strengthen education on guideline-concordant pediatric pain management in EMS. Full article

Background/Objectives: Febrile illness in returning travelers presents a diagnostic and operational challenge for emergency medicine clinicians as early symptoms of high-consequence tropical infections often overlap with common viral syndromes. This review synthesizes current evidence to guide frontline clinicians in the systematic evaluation, diagnosis, and management of internally acquired febrile illnesses with a focus on pathogen of greatest relevance to United States (US) emergency departments (ED). Methods: We conducted a narrative review of the literature addressing epidemiology, clinical presentation, diagnostic testing, and management strategies for key travel-associated infections. Special consideration was given to rapid diagnostic modalities, pediatric risk factors, and infections most frequently implicated in returning travelers, including chikungunya (CHIK), dengue virus (DENV) disease, Ebola virus (EBV) disease, malaria, Mpox, typhoid fever (TF), yellow fever (YF), and Zika virus (ZIKV) disease. Results: Effective evaluation begins with a detailed travel and exposure history, recognition of epidemiologic and clinical red flags, and targeted use of rapid diagnostic tests. Malaria remains the most common life-threatening cause of post-travel fever and the only pathogen with reliable Food and Drug Administration (FDA)-cleared rapid testing available in the ED. Arboviral infections such as DENV, CHIK, ZIKV, and YFrequire region-specific consideration and phase-appropriate molecular or serologic evaluation. Emerging and high-consequence pathogens, including Mpox and EBV, necessitate strict infection control measures and coordination with public health authorities. Pediatric travelers, particularly those visiting friends and relatives, face disproportionate risk for severe systemic infections and often require broader diagnostic testing. Conclusions: A structured approach integrating travel history, focused examination, rapid diagnostics, and early recognition of high-risk features is essential to improving outcomes for febrile returning travelers. Strengthened vector control, enhanced vaccination uptake, and global surveillance are critical to reducing future disease burden. Full article

Background: Pediatric surgical care in Germany is delivered within a highly decentralized system, and training structures vary considerably between institutions. Adequate operative exposure is essential for competency-based training. The specialty requires a high number of operative procedures during training, yet concerns have been raised that residents may not achieve the required case numbers within the standard training period. The German Model Training Regulations (Musterweiterbildungsordnung, MWBO) define 22 procedural categories with specific case number targets for pediatric surgery. However, the extent to which current training structures allow for the fulfillment of these requirements remains unclear. This study examines the distribution of procedures and residents across different hospital types and estimates whether the available procedural volume may be sufficient under simplified allocation assumptions. Methods: We conducted a nationwide analysis of pediatric surgical training capacity in Germany using procedural data from hospital quality reports published by the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) between 2012 and 2023. A total of 3440 OPS codes were assigned to 22 training categories, and case volumes were analyzed across different hospital types. The estimated training capacity was calculated assuming even distribution of cases among residents, and that all eligible procedures are performed with full resident access. Results: Data from an average of 82.3 pediatric surgical departments per year were analyzed, including 29.7% university hospitals, 58.7% non-university departments, and 11.7% other institutions. Most departments reported fewer than five residents. Between 2012 and 2023, the mean number of residents increased slightly across all hospital types, while inpatient numbers declined. Consequently, inpatient exposure decreased from 469.8 to 354.0 cases per resident per year. Patient exposure differed significantly by institutional category (p < 0.001), with higher exposure in non-university departments compared with university hospitals. Across all hospital types, the mean number of fulfilled procedural training categories declined over time. No institution met the target numbers for all categories without cooperation with other units. Thoracic surgery procedures were least frequently covered, whereas appendectomies and inguinal hernia repairs were most consistently fulfilled. Distinct patterns of subspecialization emerged, with trauma procedures less frequently reported at university hospitals and thoracic procedures less frequently reported at non-university departments. Although the overall national procedural volume appears sufficient for most training requirements, low-volume and highly specialized procedures were concentrated at selected centers, limiting their accessibility for trainees. Conclusions: Even though there are sufficient pediatric surgical procedures in Germany, they are unevenly distributed between hospitals. Under a simplified allocation model, many pediatric surgical departments in Germany currently lack sufficient procedural volume to meet training requirements in the defined training timeframe for all trainees. Structural reforms—including mandatory national documentation, minor MWBO adjustments and the creation of training networks—are necessary to ensure comprehensive and equitable pediatric surgical education. Without these changes, extended training durations and reduced trainee satisfaction may contribute to workforce shortages and limit the future quality of pediatric surgical care in Germany. Full article

Background: North Carolina faces persistent shortages of psychiatric professionals, particularly in rural and underserved regions, resulting in prolonged emergency department (ED) boarding, avoidable psychiatric hospitalizations, and inequitable access to behavioral health services. The North Carolina Statewide Telepsychiatry Program (NC-STeP), launched in 2013, is one of the nation’s longest-running statewide telepsychiatry programs. Objective: To summarize the development, implementation, outcomes, and lessons learned from NC-STeP across ED, community, maternal, pediatric, and university settings. Methods: Data were synthesized from NC-STeP operations, service data, and peer-reviewed publications (2013–2025). Results: NC-STeP completed 67,543 ED psychiatric assessments, prevented 11,802 hospitalizations, and generated $63.7 million in cost savings. Telepsychiatry increased safe discharges, reduced ED boarding, improved access, and revealed persistent equity gaps. Conclusions: NC-STeP demonstrates a scalable statewide telepsychiatry model improving throughput, reducing avoidable admissions, and expanding equitable behavioral health access. Full article

Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis in children < 24 months and a major public health concern, causing high rates of Emergency Department (ED) visits, hospitalizations, and Pediatric Intensive Care Unit (PICU) admissions. Nirsevimab is a recombinant monoclonal antibody recommended for all infants and high-risk children < 24 months. A retrospective single-center cohort study was conducted to evaluate the impact of nirsevimab introduction on bronchiolitis epidemiology in an Italian tertiary pediatric ED, accounting for 40,000 admissions/year. All children < 24 months who presented to our ED with bronchiolitis during two consecutive RSV seasons (first season: 1 October 2023 to 30 April 2024; second season: 1 October 2024 to 30 April 2025) were included. Descriptive and multivariate analyses are reported. Overall, 484 patients were analyzed (336 in 2023–2024; 148 in 2024–2025), with immunization coverage reaching 87.5% by April 2025. Compared with the previous season, RSV positivity decreased significantly (32.4% vs. 47.9%; p = 0.003) and was lower in immunized children (16.2% vs. 51.5%; p < 0.001). Immunization was associated with a reduced risk of RSV-positive swab in the second season (OR = 0.159, 95% CI: 0.059–0.397). Among RSV-negative patients, other respiratory viruses increased (p < 0.001), while co-infections increased in RSV-positive cases (p = 0.021). Hospitalization rates remained stable, though absolute admissions were halved. In conclusion, nirsevimab immunization reduced RSV burden, supporting its inclusion in universal prevention programs and the need for multicenter prospective studies to assess long-term outcomes. Full article

Background: Firearm injuries are the leading cause of mortality among youth in the United States and legislation is a key strategy in reducing youth firearm injuries and deaths. Maryland recently enacted a stronger child access prevention (CAP) law known as Jaelynn’s Law, which mandates secure firearm storage and imposes stricter penalties for violations. Objectives: The aim of this study was to examine firearm storage practices and beliefs in a pediatric and adult emergency department in Baltimore before and after the implementation of Jaelynn’s Law. Method: This descriptive study recruited 396 adult participants from pediatric and adult EDs at Johns Hopkins Hospital before and after the implementation of Jaelynn’s Law. Participants completed a survey on demographics, firearm ownership, and storage practices. Those with unsafe storage practices were provided educational pamphlets and safe storage devices. Data were analyzed using SPSS Statistics 28, with descriptive statistics, t-tests, and Chi-square analyses used to assess differences pre- and post-law implementation. Results: Of the participants, 29% owned firearms, with 86% of firearm owners having children in the home. Firearms were primarily stored locked and unloaded. No significant differences in storage practices were observed after implementation of Jaelynn’s Law. Participants cited quick access for personal protection as a key barrier to safe storage. Conclusions: We found no significant change in safe storage practices post-implementation of Jaelynn’s Law. Concerns about personal safety continue to be of primary concern and public health campaigns, legislative measures, and community investment are necessary to enhance safety and safe storage compliance. Full article

Background: Pediatric respiratory infections represent a leading cause of emergency department (ED) visits and hospitalizations. Chest X-rays are frequently used in their diagnostic evaluation, despite guideline recommendations advocating restrictive imaging strategies, particularly in young children with uncomplicated disease. Excessive imaging raises concerns regarding cumulative radiation exposure and inefficient resource utilization. Objectives: To quantify potentially unnecessary chest radiography use in hospitalized pediatric patients with respiratory infections and to identify age-related and diagnostic patterns suitable for targeted imaging optimization interventions. Methods: We conducted a retrospective observational study analyzing pediatric patients presented to the ED of a tertiary county hospital in Romania over a period of 12 months. Data regarding respiratory diagnoses, hospitalization status, patient age, and chest radiography utilization were extracted from electronic medical records. Results: Among more than 26,000 pediatric emergency presentations, 4139 children required hospitalization, of whom 1212 were diagnosed with respiratory infections. A total of 3414 chest radiographs were performed, with the highest imaging burden observed in children aged 0–4 years. Repeated imaging was common in interstitial pneumonia, bronchiolitis, and bronchial hyperreactivity. A strong negative correlation was identified between patient age and imaging frequency (r = −0.70, p < 0.001). Conclusions: Thoracic radiographs are disproportionately used in young children with respiratory infections, particularly in conditions with limited imaging indications. These findings provide an essential baseline for the development of targeted quality improvement interventions aimed at reducing unnecessary pediatric imaging. Full article

Background/Objectives: Pediatric emergency nursing requires timely, accurate interventions, yet educational content is not always aligned with clinical priorities. Identifying and prioritizing educational gaps based on clinical relevance and nurses’ current performance is essential to improve pediatric emergency care. Methods: This descriptive cross-sectional study assessed clinical performance and educational needs among nurses working in emergency departments, general wards, and intensive care units. Data were collected using a structured questionnaire on 20 pediatric emergency conditions and related procedures. Priorities were identified using the Borich Needs Assessment and the Locus for Focus model, based on differences between required and present competence and the level of perceived importance. Results: Educational needs were consistently high across participant characteristics. In both the Borich needs assessment and the Locus for Focus model, the highest priorities were identified in pediatric emergency nursing competencies related to time-critical emergencies and core procedures, particularly resuscitation and high-risk medication administration. Conclusions: Educational priorities in pediatric emergency nursing span urgent conditions and skill-intensive procedures. Although performance varied by age and experience, educational needs were consistently high, supporting continuous, standardized training. Simulation-based and mobile-enabled, scenario-focused education should be considered to enhance preparedness and response capacity among nursing students and early-career nurses. Full article

Background. Overcrowding in emergency departments (EDs), particularly pediatric emergency departments (PEDs), remains a significant challenge that affects patient outcomes and the efficiency of healthcare. Rapid diagnostic tests (RDTs) for respiratory viruses could be a promising tool for improving patient management by enabling prompt etiological diagnoses. This study investigated whether positive RDT results for influenza or adenovirus were associated with differences in length of stay (LOS) in a tertiary PED during epidemic seasons. Methods. A retrospective cohort study was conducted at IRCCS Istituto Giannina Gaslini, Genoa, Italy, over two epidemic seasons (December–February, 2023–2025). All consecutive pediatric patients presenting with fever and respiratory symptoms who underwent rapid diagnostic testing for influenza and/or adenovirus during two epidemic seasons were included. LOS was assessed as the time from triage to discharge (TTD) and from physician assignment to discharge (ATD). Patients were stratified by positive versus negative RDT results. Analyses between groups used the Mann–Whitney U-test for continuous variables and chi-square or Fisher’s exact test for categorical variables. A two-tailed p-value < 0.05 was considered significant. Results. Of the 1238 patients analyzed, the median age was 3.3 years (IQR 1.4–7.2), with male predominance (58.1%). A total of 330 patients (26.6%) tested positive. Compared with negative results, positive RDTs were associated with shorter median TTD (217.0 vs. 239.0 min, p < 0.001) and ATD (66.0 vs. 148.5 min, p < 0.001), which was consistent in both the influenza and adenovirus subgroups. No significant difference in 72 h readmission rates was observed between groups. Conclusions. Among children tested with RDTs for influenza and adenovirus, positive results were associated with reduced PED LOS without increasing early return visits. While these findings suggest a potential role in supporting patient flow, conclusions regarding the broader impact on PED overcrowding should be drawn with caution. Further prospective studies, including non-tested controls and additional viral targets, are required. Full article