Clinical Characteristics Associated with Bacteremia in Non‐Neutropenic Pediatric Oncology Patients with Indwelling Central Venous Catheters
Risha Li Moskalewicz, MD, FAAP
- Fever and neutropenia for oncologic patients has established guidelines – but non-neutropenic patients do not
- Fever + ANC ≥500 + CVC = what are risk factors for bacteremia?
- 8.5% had positive blood cultures – coagulase negative staph/Staph epic was most common
- OR=0.38 with URI Sx
- OR=5.4 external tunneled/externalized CVC
- NS >20ml/kg also increased odds, as did neuroblastoma and other solid cancers
Bottom line: External/tunneled CVC, neuroblastoma or other solid tumors and receiving >20mL/kg NS had higher odds of positive blood culture when febrile but non-neutropenic
Feasibility of the Digital Retinography System (DRS) Camera in the Pediatric Emergency Department
Yaron Ivan, MD, FAAP
- The Digital Retinography System can give you a high quality image as studied previously in Ophtho settings
- Providers were highly satisfied with the image quality
- It was a bit easier to get images in patents aged 9-12 years versus 5-8 years
- The sample was convenience based on likelihood of compliance – NOT on headache and eye trauma kids
- Also low kappa between secondary reviewer – who viewed later on a computer monitor
Bottom line: It is feasible to use the Digital Retinography System for patients >5 years in the Pediatric Emergency Department – further study is warranted.
The Accuracy of the Yale Observation Scale Score and Unstructured Clinician Suspicion to Identify Febrile Infants Aged <=60 Days with Serious Bacterial Infections
Lise E. Nigrovic, MD, MPH, FAAP
- How good is the Yale observation Score (original study by McCarthy et al.) at identifying SBI in infants ≤60 days?
- Enrolled 4147 (90% no SBI) – 445 had an SBI (8% UTI, 2% bacteremia, 0.5% meningitis)
- The majority of patients had a perfect Yale score as 6, 90% had <10 – which is normal
- Yale score for any SBI = AOC 0.53, invasive SBI (blood or meningitis) is 0.61 – recall that AOCs for WBC 0.7 and ANC 0.78
- Clinician risk assessment was somewhat better – but still not too good
Bottom line: The Yale Observation score or unstructured clinical observation are neither sensitive nor specific for assessing risk of SBI
Triage Administration of Ondansetron for Pediatric Vomiting Associated with Improved Outcomes
Robyn Wing, MD, FAAP
- Ondansetron reduces the risk of more vomiting, risk for IV fluids and risk for admission in children with vomiting and gastroenteritis
- We are using it more without careful consideration to the right patients to get it
- Investigated early administration of ondansetron to patients with vomiting in triage (not just gastro)
- Outcomes included ED length of stay
- Triage ondansetron patients had total LOS 17 minutes shorter, and 47 minutes shorter in the main ED (once you got roomed)
- Triage patients also had lower risk of IV fluids, admit and 72 hour return rate
- Sub analysis of gastroenteritis alone mirrored that of the group as a whole
Bottom line: Ondansetron administered in triage shortened the ED length of stay as well as ue of IV fluids, admission rates and 72 hour return rate.
Developing a Pediatric Cervical Spine Injury Risk Assessment Tool: Methods for Collecting Paired Observations from Prehospital and ED Providers
Fahd A. Ahmad, MD, MSCI
- In blunt trauma there are no pre-hospital criteria for assessing risk of cervical spine injury (CSI)
- Overall only 1-2% have CSI after blunt trauma, but 80% are immobilized
- The authors described how to collect pre-hospital and ED provider information regarding risk factors for CSI
- The main goal was to create an infrastructure to gather data in the future
Bottom line: Collection is ongoing and analysis is forthcoming, but robust data collection may assist in eventually developing guidance for CSI risk assessment both in and out of the hospital.
Early Volume Expansion Improves the Outcome of Shigatoxin‐Associated Hemolytic Uremic Syndrome: Data from the North Italian HUS Network
Gianluigi Ardissino, MD, PhD
- Hemolytic uremic syndrome is due to shiga toxin producing E .coli – leads to hemolysis, kidney involvement and thrombocytopenia
- Leading cause of AKI in previously healthy children
- Hemoconcentration is a risk factor for neurologic sequelae
- Is volume expansion useful in HUS? The investigators gave IV fluids + oral allowed for target weight 7-10% above ideal body weight
- Patients that were volume expanded had lower peak serum creatine, BUN and LDH
- Volume expansion saw less need for renal replacement therapy, RR=0.75 (95% CI, 0.59-0.96) p=0.005
- Also fewer days in hospital and PICU, and less long term sequelae
Bottom line: Volume expansion of patients with STEC HUS to 7-10% above ideal body weight is associated with decreased risk of need for dialysis. Protocols are needed to define the amount of fluid.
Increasing J‐Tip Utilization for IV Placement‐Related ED Pain Management: A Quality Improvement Project
Shobhit Jain, MBBS, FAAP
- J-Tip is a compressed air powered subcutaneous injection device that can be harnessed to inject lidocaine without a needle – with results in 1-3 minutes
- Investigators used QI process and methodology to increase use of the J-Tip device for IV placement
- Success rates did not change with use of the J-Tip vs not on first attempt
Bottom line: J-Tip can inject lidocaine without needles into tissues prior to IV sticks to reduce pain and won’t change likelihood of success rate.
