Welcome to the 9th EAPS Congress Programme Scheduling
The congress will officially run on Barcelona Time (GMT+2)
To convert the congress times to your local time Click Here
RISK FACTORS FOR FAILURE OF CLOSED FOREARM FRACTURE REDUCTION IN THE PEDIATRIC EMERGENCY DEPARTMENT
- Neta Cohen (Israel)
Abstract
Background and Aims
It is widely accepted that nonoperative treatment is the primary approach to most forearm shaft fractures in children.The indication for a non-operative or an operative management of forearm shaft fractures is a matter of prevailing controversy. We aimed to explore risk factors for failure of forearm fracture closed reduction in the pediatric emergency department (ED), and to suggest indications for initial surgery.
Methods
This retrospective cohort study included all patients aged 0-18 years who presented to our pediatric ED with an extra articular forearm fracture treated with closed reduction between 5/2017 and 4/2021. We explored risk factors for procedural failure, defined as a need for surgical intervention within 6 weeks of the closed reduction attempt.
Results
Of 375 patients (median age 8.1 years, 294 males [78.2%]), 44 patients (11.7%) sustained a reduction failure, of whom 42 (95.5%) had both radius and ulna fractures. Of the 259 patients with fractures of both bones, the following parameters were independent predictors for reduction failure: refracture (adjusted odds ratio [aOR] 17.6, p < 0.001), open fracture (aOR 10.1 , p = 0.007), midshaft fracture (aOR 2.6, p = 0.004), radial translation rate≥37% in either plane (aOR 5.1, p = 0.004), and age ≥10 years (aOR 2.9, p = 0.01).
Conclusions
Most pediatric forearm fractures can be successfully managed by closed reduction in the ED. Two-bone fractures had the strongest association with reduction failure. We propose a risk score for reduction failure which can serve as a decision-making tool.
OPIOIDS SAFETY IN PEDIATRIC PROCEDURAL SEDATION WITH KETAMINE
- Neta Cohen (Israel)
Abstract
Background and Aims
Ketamine is the most commonly used agent for pediatric procedural sedation in the emergency department (ED). Previous research on ketamine related adverse events is inconsistent, particularly regarding its safety with concomitant use of opioids. We aimed to explore risk factors of ketamine-related adverse events in children undergoing procedural sedation in the emergency department (ED), with focus on safety of pre- and intra-procedural opioids.
Methods
We conducted a retrospective cohort study of all children 0-18 years old who underwent procedural sedation with intravenous ketamine alone, or in combination with an opioid, at a tertiary-care pediatric emergency department between June 1st, 2018, to August 31st, 2020. We explored predictors of serious adverse events (SAEs), desaturation or respiratory intervention, and vomiting.
Results
Of 1,164 included children (694 males, 59.6%; median age 5.0 years [IQR 2.0-8.0]), 80 (6.8%) vomited, 63 (5.4%) had a desaturation or required respiratory interventions and six (0.5%) had SAEs. Pre- and intra-procedural opioids were not independent predictors of sedation-related adverse events. A concurrent respiratory illness (aOR 3.73 [95% CI 1.31-10.60], P=0.01), dental procedure (aOR 3.05 [1.25-7.21],P=0.01) and a higher total ketamine dose (aOR 1.75 [1.21-2.54],P=0.003) were independent predictors of desaturation or respiratory interventions. A higher total ketamine dose (aOR 1.86 [1.16-2.98],P=0.01) and older age (aOR 1.15[1.07-1.24],P<0.001), were independent predictors of vomiting.
Conclusions
Pre- and intra-procedural opioids do not increase the likelihood of sedation-related adverse events. SAEs are rare during pediatric procedural sedation with ketamine in the ED.