The latest medical research on Paediatric Emergency Medicine

Dengue has emerged as the most widely spread mosquito-borne disease, hyperendemic in India. Although severe dengue occurs only in a small proportion of cases, delays in the recognition and management can result in significant morbidity and mortality. Risk stratification of children in the emergency care and identifying those at risk for worsening during hospital stay facilitates optimum utilization of health care resources. The objective of our study was to develop and validate a scoring model to predict the development of severe dengue in hospitalized children by identifying risk factors present in them at the time of admission in emergency department.

A retrospective study of consecutive children aged 1 month to 18 years admitted with serologically confirmed dengue from January 2019 through December 2021 was conducted. Analysis of clinical and laboratory parameters of children resulted in the development of a comprehensive predictive scoring model. This model was internally validated prospectively on 107 children presenting with nonsevere dengue in the emergency care.

A total of 743 children with confirmed dengue were studied out of which 216 (29.1%) had severe dengue. Presence of third spacing (odds ratio [OR] 3.74, 95% confidence interval [CI] 1.088-7.42, P < 0.001), tender hepatomegaly (OR 1.62, 95% CI 1.04-2.52, P < 0.032), respiratory distress (OR 3.50, 95% CI 1.89-6.51, P < 0.001), and moderate (OR 3.51, 95% CI 1.82-6.74, P < 0.001) to severe (OR 4.76, 95% CI 2.59-8.76, P < 0.001) elevation of aspartate aminotransferase were independent risk factors found to be associated with development of severe dengue. A score ≥7 had a specificity of 87%, negative predictive value of 86%, and overall diagnostic accuracy of 78.5% for predicting severe dengue.

The dengue severity scoring model was found to have reasonable diagnostic accuracy in predicting severe disease prior to hospitalization. However, more studies are required to validate the score in different emergency care settings with varied pediatric populations.

The aim of the study is to determine if there is a correlation between perceived staff workload, measured by the NASA Task Load Index (TLX), and the National Emergency Department Overcrowding Scale (NEDOCS) in a pediatric ED.

We collected staff questionnaires in a large, urban pediatric ED to assess perceived workload on each of six different TLX subscales, which we weighted evenly to create an overall estimate of workload. We evaluated the correlation between individual TLX responses and NEDOCS overall and by staff subgroup. Additionally, we analyzed: (1) the correlation between mean TLX responses and NEDOCS within a given hour and (2) the performance of a logistic regression model, using TLX as a predictor for "severely overcrowded," as measured by NEDOCS.

Four hundred one questionnaires between 6/2018 and 1/2019 demonstrated significant variation between concurrently collected TLX responses and an overall poor correlation between perceived workload and NEDOCS (R2 0.096 [95% confidence interval, 0.048-0.16]). TLX responses by subgroups of fellows (n = 4, R2 0.96) and patient financial advisors (n = 15, R2 0.58) demonstrated the highest correlation with NEDOCS. Taking mean TLX responses within a given hour, during periods with NEDOCS >60 (extremely busy or overcrowded), a polynomial trend line matched the data best (R2 0.638). On logistic regression, the TLX predicts "severely overcrowded" with an area under the curve of the receiver operating characteristic of 0.731.

NEDOCS does not have a strong correlation with individual responses on questionnaires of perceived workload for staff in a pediatric ED. NEDOCS, as a measure of overcrowding, may be better correlated with perceived workload during periods with elevated crowding or when interpreted categorically as yes/no "severely overcrowded".

To examine the real-world impact of continuous glucose monitoring (CGM) use on glycemic management and health care resource utilization (HCRU) in people with diabetes in a large US-insured population.

This retrospective observational study used Aetna administrative claims data from a cohort of fully insured commercial and Medicare Advantage beneficiaries with diabetes and with coverage for medical and pharmacy benefits. The index date was the first CGM pharmacy or medical claim observed between January 1, 2019, and December 31, 2021. Change in hemoglobin A1c was calculated using values from 3 months before and the latest values 10-12 months after the index date. HCRU was measured 12 months before and after the index date. Data were analyzed by the following patient groups: type 1 diabetes, type 2 diabetes (T2D) on intensive insulin therapy, T2D on basal-only insulin therapy, and T2D not on insulin therapy.

Data from 7,336 patients (74% T2D, mean age 57 years, 42% Medicare-insured, 54% male, 56% White) were analyzed. Beneficiaries with available A1c data (n = 1,063) showed a significant improvement in A1c after CGM initiation (-0.7%, P < 0.0001), including -0.9% change in the T2D not on insulin group (n = 264). For the overall cohort, the number of patients with diabetes-related hospitalizations and emergency department visits decreased significantly by 67% and 40%, respectively (P < 0.0001 for both).

This study showed that CGM use was associated with clinically meaningful improvements in A1c and reduced HCRU, suggesting potential for population-level clinical benefits, especially for patients not using insulin.

Rib fractures are common in trauma patients, often leading to complications such as pneumonia and prolonged hospitalization. Surgical Stabilization of Rib Fractures (SSRF) has become increasingly prevalent in treating severe cases. However, traditional approaches, like posterolateral thoracotomy, are invasive and cause significant muscle damage. Recently, muscle-sparing minimally invasive techniques have been introduced, yet they still require advanced reduction and fixation techniques to avoid complications. This study presents an "ultra" minimally invasive SSRF (uMI-SSRF) technique designed to minimize surgical wounds and soft tissue damage while maintaining the benefits of rib fixation.

This study involved 76 patients with multiple rib fractures treated using the uMI-SSRF technique between August 2021 and December 2023. Preoperative chest tomography with 3D reconstruction was used for surgical planning. The technique employed small incisions (3-5 cm), muscle-sparing approaches, and advanced fixation techniques. Data on patient demographics, intraoperative details, and postoperative outcomes were collected.

The mean patient age was 58 years, with 66% being male. On average, patients had 6.4 fractured ribs, and 3.5 ribs with 3.88 plates were fixed per surgery, achieving a fixation/fracture ratio of 59%. The average wound length was 4.2 cm, with a mean operation time of 122 min. Most patients required only one incision (74%). The median hospital length of stay was 7 days, with a pneumonia rate of 5%. No wound infections or implant-related complications were observed.

The uMI-SSRF technique effectively reduces wound size and soft tissue damage in rib fracture stabilization while maintaining high fixation quality. This method shows promise for improving patient outcomes, reducing recovery time, and minimizing complications. Further studies with larger sample sizes and comparisons with other methods are warranted to verify the advantages of uMI-SSRF.