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The diaphragm is the major muscle of inspiration accounting for approximately 70% of the inspired tidal volume. Point-of-care diaphragmatic ultrasound offers the ability to quantitatively assess diaphragmatic function, perform serial evaluations over time, and visualize structures above and below the diaphragm. Although interest in point-of-care ultrasound (POCUS) of the diaphragm is developing in the emergency medicine, assessment of the diaphragm and its function is not recognized as a core application by national organizations or expert guidelines. As a result, it is infrequently performed ..read more

Purpose Diagnosis of acute appendicitis is more difficult in children aged 0–4 years due to atypical clinical presentation, leading to delay in diagnosis and higher incidence of complications. Nonvisualization of the appendix on ultrasound increases diagnostic challenge. We examined the utility of standardized reporting of sonographic secondary signs of appendicitis in children younger than 5 years with nonvisualization of the appendix. Methods A retrospective cohort study of children younger than 5 years who underwent appendectomy following nonvisualization of the appendix on ultrasound from ..read more

Context Family-centered care is a critical component of critical care interfacility and medical retrieval transport (MRT) services. These services provide a critical bridge for a physiologically and psychologically unique population often best served in specialized, tertiary centers. Caregivers often wish to accompany patients during MRT. However, there is currently little research on the impact of caregiver accompaniment on MRT. Objective The aim of the study is to determine: 1) What are caregiver attitudes to accompanied and unaccompanied MRT? 2) What are healthcare provider attitudes to car ..read more

Introduction Scorpion envenomation is a leading cause of envenomation in our region. Antivenom has been used successfully to treat the systemic manifestations of envenomations inflicted by toxic scorpions. Toxic scorpions common in our area include Leiurus quinquestriatus, Androctonus australis, and Buthus occitanus. This study describes the outcomes of children envenomated by these scorpions, and treated with SCORPIFAV, a polyvalent scorpion antivenom F(ab’)2 (equine), used since 2016 at our institution. Methods A retrospective chart review of all children admitted with symptoms and signs of ..read more

Objectives The aims of the study are to characterize children with mental and behavioral health conditions (MBH) transported by emergency medical services (EMS) and examine differences in patient, emergency department (ED), and EMS transport characteristics based on restraint interventions during EMS transport. Methods This is a retrospective cohort study of EMS patients with MBH crises, aged 5–18, transported to 2 pediatric EDs over 9 years. Demographic and ED data were collected electronically; EMS data were extracted manually from prehospital care records. Field interventions studied includ ..read more

Objective To examine differences in pediatric fracture prevalence, severity, and mechanisms of injury before and during the COVID-19 pandemic. Methods This is a subanalysis of data from a multicenter, cross-sectional study of all injury-related visits to 40 urban pediatric emergency departments (EDs) for children younger than 18 years occurring January 2019–December 2020. ED visits for injuries including fractures were identified by International Classification of Diseases, Tenth Revision codes. Comparative analyses of patient demographics, fracture prevalence, severity, and mechanisms of inju ..read more

Objective Controversy exists surrounding which agents best provide analgesia in children with fractures. Prior studies have demonstrated that ED visits for fracture-related pain have the highest rates of opioid prescribing. Studies have also found that NSAIDs are equivalent at controlling acute fracture-related pain. In a time when one must balance the risk of inadequate pain control with potential opioid misuse, providers have little data to guide them in terms of the best recommendations for adequate pain control at home. Methods This prospective observational study investigates parental pai ..read more

Point-of-care ultrasound (POCUS) can expedite the diagnosis of pediatric abdominal pathologies including appendicitis and intussusception. In this patient series, we present cases from multiple pediatric emergency departments that demonstrate the use of POCUS in the diagnosis of trichobezoars in children. POCUS findings include the presence of an intragastric hyperechoic mass or a hyperechoic arch and associated posterior acoustic shadowing. These findings in the appropriate clinical context should prompt further diagnostic imaging and/or surgical consultation for removal ..read more

Background It is unknown which factors are associated with chest radiograph (CXR) and antibiotic use for suspected community-acquired pneumonia (CAP) in children. We evaluated factors associated with CXR and antibiotic preferences among clinicians for children with suspected CAP using case scenarios generated through artificial intelligence (AI). Methods We performed a survey of general pediatric, pediatric emergency medicine, and emergency medicine attending physicians employed by a private physician contractor. Respondents were given 5 unique, AI-generated case scenarios. We used generalized ..read more