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Background and aims

In Catalonia, with a 1.3milion children population, the paediatric interhospital transport is performed by a specific team integrated by a paediatrician, a nurse and a paramedic technician. The aim of the study was to analyse the characteristics and outcomes of the transports.

Methods

Retrospective observational study. Data from all services accomplished by the Hospital Sant Joan de Deu transport unit from January 2017 to December 2018 were included.

Results

1321 services were reviewed. Median distance to the issuing hospital was 40km (IQR 12-90). Median time required for stabilising the patient was 37minutes (IQR 28-50.8). 848(64.1%) patients were transferred to a third level paediatric or neonatal intensive care units.

There were 839(63.5%) males, and the median age was 1.8months (IQR 0.1-16.5), with 567(42.9%) newborns. 274(21.1%) of the patients had a comorbidity.

Respiratory diseases were the main reason for transport (n=558,42.2%), and 246(44%) were bronchiolitis. 819 patients(62%) needed respiratory support during transport; 356 (43.5%) non-invasive ventilation and 195(23.8%) mechanical ventilation.

From all patients transferred with non-invasive ventilation which was possible the follow-up (n=111), only 18 (5.1%) required intubation in the hospital.

During the transport, 26 patients(2%) were unstable, 5(0.5%) presented cardiac arrest, and 1(0.1%) was exitus. In the receiving hospital, 14 patients(1.1%) were exitus.

Conclusions

Our study shows that if the paediatric transport is performed by a specialised-trained team, patients are safe transfered, specially when they have a respiratory disease. The stabilisation of the patient was appropiate, with low taxes of complications during transport, leading to a low mortality.

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Background: Airway intubation is a high-risk procedure in the paediatric population. Training ED healthcare providers is challenging because it is rare. Success and adverse events (AEs) could be due to patients’ illness, the person intubating, and hospital factors.

Objectives: 1) Describe paediatric intubations in an adult community-based hospital, with primary outcomes being first-pass success (FPS) and AEs. 2) Determine what factors are associated with intubation success and AEs.

Design/Method: retrospective chart review of patients < 18 years intubated in the ED between Jan 1, 2006 and Mar 31, 2017. Analysis: descriptive and two-group comparative statistics, p<0.05 significant.

Results: n=121 intubations occurred in the ED over the 10-year period. Mean (standard deviation) age 6.9 (6.8) years. FPS occurred in n=76 (62.8%), with no significant difference in FPS rate between pediatricians or anaesthetists vs. all other providers (p=0.319, p=0.278 respectively). There was n=22 (18.2) minor AEs (e.g. air leak, facial injury), n=3 (2.5) major AEs (cardiac arrest, hypoxemia). There were no significant differences in any physiological variable between those who had FPS or AEs vs. not.

Conclusion: Pediatric Intubations in an adult community-based hospital was rare. Success rate of intubation on first attempt was low with mainly minor AEs. There was no significant difference in FPS between the type of health professional intubating, nor between those with or without AEs. These results will inform the development of tools and education for paediatric advanced airway management in adult community-based hospitals, and may enhance patient outcomes in the ED.

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Background and aims: The highly variable practices observed regarding the early detection and diagnostic workup of suspected child physical abuse suggest there is room for improvement. We aimed at systematically investigating if guidelines discrepancies could contribute to these heterogeneous practices.

Methods: We retrieved national guidelines of countries with advanced economies via MEDLINE, Web of Science, and websites of professional societies or health agencies. We compared the definitions of sentinel injuries and the imaging and biological tests recommended for the diagnostic workup of suspicion of physical abuse in children ≤2 years old.

Results: We identified fifteen guidelines published in ten countries. The definition of sentinel injuries was given by only two and was consistent (mainly: bruises, intraoral injuries or fractures). All guidelines recommended systematic radiological skeletal survey but differed on the use of complementary bone scintigraphy. Seven guidelines recommended systematic head computed tomography (CT) ± magnetic resonance imaging (MRI) based on CT results. Spinal MRI was not mentioned in four guidelines, should be done systematically for three guidelines, and should be performed only if a head MRI is performed in others. Two guidelines recommended parathyroid hormone and 25-hydroxy-vitamin D laboratory tests systematically, and four others recommended doing these tests on a case-by-case basis according to the clinical context.

Conclusions: We identified between-guidelines discrepancies that do not seem attributable to variations in the epidemiology of child physical abuse or tests accessibility. These findings allow identifying priorities for well-designed systematic reviews or original diagnostic accuracy studies to standardise guidelines and practices.

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Aims

UK national guidelines recommend FeverPAIN and/or Centor scoring systems guide paediatric antibiotic use in suspected bacterial tonsillopharyngitis. We aimed to establish national utilisation of FeverPAIN/Centor, and whether their use rationalises antibiotic prescriptions.

Methods

We retrospectively reviewed 666 presentations to a tertiary Paediatric Emergency Department coded as tonsillitis, upper respiratory tract infection, scarlett fever or quinsy. The unit does not utilise FeverPAIN/Centor. We compared the rate of antibiotic prescription by clinician choice alone against retrospectively calculated FeverPAIN/Centor scores for each presentation.

We contacted 155 English Emergency Departments to ascertain their use of FeverPAIN or Centor criteria.

Results

117 patients (17.6%) were prescribed antibiotics by clinician choice. Those who would have received antibiotics by FeverPAIN criteria (score ≥4) numbered 125 (18.7%) and by Centor criteria (score ≥3) numbered 111 (16.7%).

Only 56% of patients actually prescribed antibiotics had a FeverPAIN score ≥4 or Centor score ≥3.

Children with Centor score ≥3 had a 79% chance of being prescribed antibiotics if they had tonsillar exudate, compared to 27% without it. For FeverPAIN this was 79% and 20% respectively.

30 emergency departments reported using Centor, 32 FeverPAIN and 11 a combination of both (total 73 units = 47%)

Conclusions

Whilst the number of prescriptions was similar whether FeverPAIN/Centor were used or not, the individual patients recieving antibiotics were a different cohort. The presence of exudate markedly increases antibiotic likelihood despite having the same FeverPAIN/Centor score. With over half of units not using FeverPAIN/Centor, there is significant national variability regarding which children receive antibiotics.

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Aims and objectives: Hypertonic saline (HTS) boluses are used in children with severe traumatic brain injury (TBI) with little published efficacy data. We aimed to quantify the effects of 3% HTS boluses on intracranial pressure (ICP), cerebral perfusion pressure (CPP), serum sodium, serum chloride, blood pressure, urine output and CO₂ in children.

Methods: A retrospective study of TBI patients admitted to a regional neurosurgical children’s intensive care who had been intravenously administered boluses of 5mL/Kg 3% sodium chloride, given as directed during standard care. All data were collected for 8 hours around each bolus and collated for analysis using paired Wilcoxon signed-rank and Pearsons correlation.

Results: 51 children were admitted from 2012 to 2019, receiving a total of 156 boluses of HTS. ICP significantly decreased by 6mmHg (P<0.01) and CPP increased by 4mmHg (p=0.0031) 1-hour post bolus. These effects persisted for 3 hours with ICP 5mmHg lower, and for 4 hours with CPP 3mmHg higher. ICP change was not associated with pre-dose serum sodium concentration. Serum sodium, chloride, and urine output all increased. No clear trends in expiratory CO₂ or blood pressure were found.

Conclusions: Hypertonic saline is an effective osmolar therapy for reducing ICP and increasing CPP in children. “53-53” is a suitable guide - 5ml/kg of 3% HTS will on average decrease ICP by at least 5mmHg for 3 hours. Pre-bolus serum sodium concentration is not correlated with effect size. Further research should investigate the long-term outcomes in children and compare these effects between bolus and continuous therapy.