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1-20 of 200 results by Jenny Guyther
The PRoMPT BOLUS trial (Pragmatic Pediatric Trial of Balanced versus Normal Saline Fluid in Sepsis) is the largest randomized controlled trial to date comparing balanced crystalloids to 0.9% normal saline in children with septic shock. The primary outcome showed no significant difference in major adverse kidney events at 30 days between the two groups. The secondary outcome showed no significant difference in 30 or 90 day mortality.
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This study by Peters et al. (2026), published in Prehospital Emergency Care, is the first nationwide analysis of cardiac arrest occurring during interfacility transport (IFT) by EMS, finding that critical care transport (CCT) was associated with more than double the odds of ROSC compared to ALS (aOR 2.21, 95% CI 1.42–3.48), while BLS care was associated with significantly worse outcomes.
Overall ROSC rate: 50.3% — broken down as 32.9% (BLS), 45.3% (ALS), and 59.5% (CCT)
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This was a metanalysis which included 5 studies of 3933 pediatric patients requiring seizure management without IV access, mostly in the prehospital setting.
Bottom line: IM midazolam appears superior to IN midazolam as a first-line non-IV benzodiazepine for pediatric seizures in the prehospital setting, though IN remains a clinically effective alternative — particularly when caregiver acceptability and ease of administration are prioritized.
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This was a retrospective study of the pediatric cardiac arrests over a 5 year period (including COVID years) in Vienna.
Infants (<1 year) had the highest incidence of OHCA among all pediatric age groups, consistent with German registry data showing an incidence of 23.4 per 100,000 in this age group.
Non-shockable rhythms (asystole/PEA) predominated, as expected given that most pediatric OHCA results from progressive respiratory failure or shock rather than primary cardiac causes.
Survival to hospital discharge remained low, consistent with international data showing pediatric OHCA survival ranging from 6.6% for infants to 17.3% for adolescents in the US CARES registry.
Bystander CPR rates and witnessed arrest status were important modifiable factors associated with improved outcomes, aligning with findings from the adult Vienna cohort where witnessed arrests with shockable rhythms had substantially higher survival (39% vs. 9.3% overall).
The study highlighted that even in a high-resource, physician-staffed EMS system, pediatric OHCA outcomes remain poor, underscoring the importance of primary prevention and early bystander intervention
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Previous pediatric studies have shown that 1) air transport has shown improved outcomes compared to matched ground transports but 2) air transport may be overutilized.
This was a multicenter retrospective study using the Pediatric Emergency Care Applied Research Network Registry from 2012-2021 looking at pediatric patients transported to the ED by helicopter. This registry does not differentiate between field transports and interfacility transfers. The study looked to identify patients who were discharged from the ED or had a hospital stay < 48 hours. 7722 patients were included with a median age of 5.9 years. 20% of these patients were discharged from the ED. Among those admitted, over half were discharged within 48 hours. Patients who were discharged from the ED were found to have triage < ESI 1, missing a systolic blood pressure or temperature. Tachycardia, tachypnea, hypertension and abnormal temperature were associated with a lower rate of ED discharge.
Bottom line: Additional research is needed to identify patients who may be more appropriate for ground transport or when transport is not needed (or could be replaced with telemedicine).
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US and International guidelines differ on the initial defibrillation dose in pediatric patients. International, European, Australian and New Zealand guidelines had recommend an initial dose of 4 J/kg for the initial and all subsequent doses while the American Heart Association recommends an initial dose of 2-4J/kg (with 2 J/kg in the teaching algorithms) with subsequent shocks being at least at 4J/kg and no greater than 10 J/kg. More recently, ILCOR suggested an initial dose of 2-4 J/kg.
This was a systemic review of 7 observational studies, mostly involving in hospital pediatric cardiac arrests. Outcomes of termination of VF/pVT, ROSC and survival to hospital discharged were examined in relation to the initial J/kg dose that was used compared to initial doses of 2 J/kg. Outcomes were neither better or worse with doses < 1.5 J/kg or > 2.5 J/kg. Additional research is needed as this certainty of this evidence was considered “very low.”
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Pancreatic injury in pediatric blunt abdominal trauma is rare.
This study was a secondary analysis of the data collected by the Pediatric Emergency Care Applied Research Network (PECARN) in the Intra-abdominal Injury Study Group. Of the children who had blunt abdominal trauma, 6% had intraabdominal injuries and 1% had pancreatitis. A patient was considered as having traumatic pancreatitis if they had 2 of the following: 1) upper abdominal tenderness, 2) serum lipase of amylase > 3 x the upper limit of normal or 3) imaging study positive for pancreatitis.
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Cervical spine injuries (CSI) are uncommon in children, but when present, they are often devastating. However, the application of a cervical collar in children is not benign and adverse effects include neck pain and discomfort and the downward tunnel vision it may create at the hospital leading to unnecessary testing. Recently, the PECARN group published a set of criteria to determine who requires imaging of the cervical spine in the emergency department. A planned subset of this initial study was to collect the impressions of EMS as they pertained to the 9 criteria to determine if these criteria could safely be used by EMS. The patients who were brought in by EMS with the potential for cervical spine injury, who were evaluated by the trauma team and/or had cervical imaging AND had electronic case reports filled out by EMS were included in the final analysis. Only 57% of the patients possible could be included based on the number of electronic case reports that were filled out.
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This was review of 24 studies across 21 years that aimed to look at the complications associated with pediatric intubation in the hospital. The article also includes a list of all the articles with brief conclusions from each study for those interested.
Among a combined 7135 patients, there was an 84.7% overall success rate with a 30.1% rate of complication. There was a 69.8% first pass success rate. Desaturations < 90% was the most common complication followed by mainstem intubation. Studies also noted cardiac arrhythmia (55/3858 patients), hypotension (121/4536 patients) and cardiac arrest in 105/4836 patients). Other adverse events included esophageal intubation, surgical airway management and airway trauma.
Indications for intubation from most to least common are: neurologic, respiratory, trauma, cardiac arrest, sepsis, shock, cardiac failure and intoxication.
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The debate of the best way to administer epinephrine in cardiac arrest continues. Pediatric arrests are different from adults in many ways, but some differences in arrest include 1) data supporting improved survival with early epinephrine administration and 2) less IVs are placed in children overall compared to adults making IO placement possibly quicker.
In this study, 739 patients were included with a median age of 1 year. The IO was used in 72% of patients and an IV was used in 27.6% of patients. There was no difference between survival to hospital discharge or prehospital ROSC between the two groups.
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Bottom line: Socioeconomic differences in outcomes of cardiac arrest are present in the pediatric population as well and CPR education and resources should be present in ALL communities.
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Bottom line: Education to the public is needed to help to improve the information relayed to telecommunicators in an emergency. Further telecommunicator education can help to overcome the barriers within their control, such as the recognition of agonal breathing.
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The European resuscitation council recommends AL (anterior-lateral) pad positioning while the American Heart Association recommends AL or AP (anterior-posterior) pad placement for defibrillation.
This was a prospective cohort study over a 4 year period in a single EMS jurisdiction. Adult patients with a medical cardiac arrest with an initial rhythm of VT/VF were included. The primary outcome was ROSC at any period of time.
Patients with AP pad placement (compared to AL) had a higher adjusted odds ratio of ROSC at any time (1.34), but not statistically different odds of pulse in the ED, survival to hospital admission or discharge, or functional status at hospital discharge.
The AP pad placement group also required less shocks on average and had earlier and initial sustained rates of ROSC. Further research is needed with respect to initial pad placement in the cardiac arrest population.
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This was a retrospective study at a tertiary pediatric emergency department over a 10 year period. Authors sought to determine the number of patients who developed radiographic pneumonia after an initial normal CXR.
9957 patients with suspected pneumonia were included. 240 had an additional CXR within 14 days and 27 (11% of those with a 2nd CXR) had developed PNA on the CXR. Overall, the rate was 1/370 children went on to have radiographic PNA in the next 14 days after an initial CXR. Tachypnea, hypoxia and dehydration at the initial visit were shown to be associated with later development of PNA on CXR.
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Pediatric CPR without an advanced airway in place requires 15 compressions to 2 ventilations per AHA and ILCOR guidelines. This can lead to a 2-4 second pause in compressions due to the time the ventilations take. The Maryland hiccup method is a novel description of two brief pauses for ventilations during the upstroke of compressions 14 and 15. This method was shown to improve the compression fraction and compressions per minute with no significant differences between standard CPR and the Maryland hiccup method in ventilation volume or compression depth determined on simulation mannequins. 38 Maryland EMS clinicians participated in this study.
A video demonstration of the Maryland Hiccup method is linked in the article and also available at: https://www.youtube.com/watch?v=RvFxhj7hzsQ .
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EMS is taught to assess levels of consciousness through the Glasgow Coma Scale (GCS) and AVPU (alert/responsive to verbal stimuli/responsive to painful stimuli/unresponsive).
This study aimed to find a cut off point for where GCS and AVPU scales correlate. The National EMS Information System data set was used to look at over 4 million patient encounters that had both GCS and AVPU documented.
Lower AVPU scores correlated with life-sustaining procedures, including those for airway management, seizure, and cardiac arrest. Optimal GCS cut points obtained via a grid-based search were 14 to 15 for alert (A), 11 to 13 for verbal (V), 7 to 10 for pain (P), and 3 to 6 for unresponsive (U).
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Children account for up to 20% of emergency department visits. In the US, up to 90% of children’s visits to emergency departments are to general EDs. The weighted pediatric readiness score (WPRS) was developed to assess the level of readiness of emergency departments to care for pediatric patients. The last assessment was in 2013 showed a mean score of 68.9. High readiness scores have been associated with decreased mortality. The same holds true for children with injuries presenting to trauma centers. The higher the WPRS score, the lower the risk of in hospital death. There was no difference if the patient presented in cardiac arrest. A 10 point increase in WPRS is associated with a lower odds of potentially avoidable transfers in both trauma and medical patients. More recent data has been collected, but has not yet been published. More information on pediatric readiness (for hospitals and EMS) can be found at: https://emscimprovement.center/domains/pediatric-readiness/.
Bottom line: Being Pediatric Ready improves the care of children.
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Early defibrillation is a key step in the cardiac arrest chain of survival. Public Access AEDs may be available more readily than waiting for first responders. Outside of simple awareness of where AEDs are located, there are newer ways to become aware of public AEDs near a cardiac arrest including cell phone apps or information given by 911. A British study showed that only 5.9% of AEDs were within 100 meters of the patient and 35% were within 500 meters. The distance between the AED and arrest may be a barrier for bystander AED use. This study looked to determine the time required to retrieve an AED and they hypothesized that a distance > 400 meters would be longer than the EMS response times.
This study used 15 women and 15 men to perform different runs in various environments in different seasons, retrieving AEDs at 200m through 600m and bringing it back to the patient. In these scenarios, only the 200m distance (400 m round trip) times were deemed to allow enough time to apply and use the AED prior to EMS arrival. Barriers to AED retrieval included traffic lights, cars, weather and pedestrians.
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Premature infants in the NICU are often given caffeine to help to prevent apneic episodes and this has been proven safe. This study aims to determine if caffeine will help infants < 8 weeks with bronchiolitis, even if there is no concern for apnea. The current recommended treatment for bronchiolitis is supportive care.
2 French Hospitals with the same protocols and resources for bronchiolitis participated. All infants admitted to each hospital with a diagnosis of bronchiolitis were included. Infants who presented to Hospital A received caffeine and infants who presented to hospital B did not. The remainder of their care was similar. The caffeine was given as a bolus dose followed by a daily maintenance dose until there was clinical improvement. The dose was the standard dose used in premature infants with apnea as recommended by the French National Authority for Health. There were 26 patients at the study hospital that did not receive caffeine for an unknown reason. 65 patients received caffeine.
The study had several areas showing statistical significance:
In the subgroup of RSV + patients, those who did NOT receive caffeine had a higher incidence of requiring ventilatory support.
The use of high flow nasal cannula was HIGHER in the group with NO caffeine.
The use of CPAP was HIGHER in the caffeine group BUT the duration of CPAP use was shorter compared to the NO caffeine group.
The need for nutritional support was higher in the NO caffeine group.
There were a few cases of temporary tachycardia and irritability in the caffeine group which resolved several hours after the medication was given.
A larger study is needed, but in this small group, there may be an indication for caffeine outside of the NICU for infants < 8 weeks.
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This was a European study examining a screening tool to be used in the ED to indicate the need for further investigation into the concern for possible abuse. Four questions were taken from other commonly used abuse screening tools that were used outside of the ED. SCAN questions are as follows:
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Is the injury compatible with the history, and does it correspond to the child's developmental level?
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Was there an unnecessary delay in seeking medical help?
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Is the behavior/interaction of the child and caregivers appropriate?
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Are there other signals that make you doubt the safety of the child or family?
Any positive answer triggered further evaluation, starting with a complete head to toe assessment and complete history with additional tests added as warranted. This is only a screening tool and positive answers do NOT mean that abuse has occurred, but should cause you to pause and think further.
These questions showed a "moderate" performance among close to 25000 patients and the questions were comparable in children < 5 years to other/longer screening tools used in Europe.