Approach to Pediatric Trauma Care.

This article reviews the current trends and management of trauma care for children. With traumatic injury being the leading cause of morbidity and mortality in children, it is important for all clinicians to be familiar with the proper care of these patients. This includes, but is not limited to, when pediatric trauma patients initially present to medical facilities ranging from outpatient medical offices and urgent care facilities to adult trauma centers. The goal of this review article is to discuss the proper assessment, stabilization, resuscitation, and, ultimately, the disposition of pediatric trauma patients. [Pediatr Ann. 2023;52(4):e135-e138.].

Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics.

Importance: Bruising caused by physical abuse is the most common antecedent injury to be overlooked or misdiagnosed as nonabusive before an abuse-related fatality or near-fatality in a young child. Bruising occurs from both nonabuse and abuse, but differences identified by a clinical decision rule may allow improved and earlier recognition of the abused child. Objective: To refine and validate a previously derived bruising clinical decision rule (BCDR), the TEN-4 (bruising to torso, ear, or neck or any bruising on an infant <4.99 months of age), for identifying children at risk of having been physically abused. Design, Setting, and Participants: This prospective cross-sectional study was conducted from December 1, 2011, to March 31, 2016, at emergency departments of 5 urban children's hospitals. Children younger than 4 years with bruising were identified through deliberate examination. Statistical analysis was completed in June 2020. Exposures: Bruising characteristics in 34 discrete body regions, patterned bruising, cumulative bruise counts, and patient's age. The BCDR was refined and validated based on these variables using binary recursive partitioning analysis. Main Outcomes and Measures: Injury from abusive vs nonabusive trauma was determined by the consensus judgment of a multidisciplinary expert panel. Results: A total of 21 123 children were consecutively screened for bruising, and 2161 patients (mean [SD] age, 2.1 [1.1] years; 1296 [60%] male; 1785 [83%] White; 1484 [69%] non-Hispanic/Latino) were enrolled. The expert panel achieved consensus on 2123 patients (98%), classifying 410 (19%) as abuse and 1713 (79%) as nonabuse. A classification tree was fit to refine the rule and validated via bootstrap resampling. The resulting BCDR was 95.6% (95% CI, 93.0%-97.3%) sensitive and 87.1% (95% CI, 85.4%-88.6%) specific for distinguishing abuse from nonabusive trauma based on body region bruised (torso, ear, neck, frenulum, angle of jaw, cheeks [fleshy], eyelids, and subconjunctivae), bruising anywhere on an infant 4.99 months and younger, or patterned bruising (TEN-4-FACESp). Conclusions and Relevance: In this study, an affirmative finding for any of the 3 BCDR TEN-4-FACESp components in children younger than 4 years indicated a potential risk for abuse; these results warrant further evaluation. Clinical application of this tool has the potential to improve recognition of abuse in young children with bruising.

A Case Report of Neonatal Supraventricular Tachycardia Resolved with Single-Syringe Adenosine.

INTRODUCTION: Supraventricular tachycardia (SVT) is a condition requiring emergency care in neonates. CASE REPORT: We describe a successfully treated case of neonatal SVT in a four-week-old neonate using the novel adenosine administration method. This technique is potentially easier to facilitate and does not require equipment such as a stopcock. Adenosine 0.2 milligrams per kilogram was drawn up into a syringe containing 0.9% sodium chloride to a total volume of 3 milliliters. Once administered, the patient had near-immediate return to normal sinus rhythm without sequelae. CONCLUSION: This case demonstrates that the single-syringe method appears potentially safe and effective in neonates.

Pediatric left-without-being-seen patients: what happens to them after they leave the pediatric emergency department?

OBJECTIVES: The objective of this study was to evaluate what happens to the children who leave without being seen (LWBS) in an urban Pediatric Emergency Department (PED). METHODS: Patient advocates contacted families whose children LWBS in the PED via phone call and utilized a standardized questionnaire to interview them regarding medical care sought after leaving the PED. Questions asked included the following: Was further medical care sought by the family for the child? If so, where was the care obtained? Did the patient no longer require care? The family was also asked if the advocate could help make an appointment for medical care for the child. RESULTS: From April 2009 to September 2011, 3874 LWBS patients from the PED at the University of Chicago Comer Children's Hospital were called by patient advocates. Sixty-five percent (n = 2521) of these children's families were reached by phone. More than 50% of patients contacted sought medical care elsewhere, planned to seek care, or had scheduled an appointment for follow-up medical care. When contacted, 21% of the families felt that no further medical appointment/care was needed, and 23% refused assistance. CONCLUSIONS: Left-without-being-seen rates continued to be an ongoing issue for physicians in the PED. More than half of the contacted patients who LWBS were cared for elsewhere either on the day of the visit or later. This information obtained provides an initial look into understanding what happens to an urban PED patient population that leaves before receiving care in the PED.