Does the Use of Multiplex PCR Contribute to the Management of Paediatric Emergency Physicians in <2-Year-old Children with Acute Respiratory Infections?

Multiplex polymerase chain reaction (PCR) is used to detect respiratory viruses in pediatric emergency departments, but its indications and interpretation of results must still be clear. In the present study, we examined the effect of detecting a viral agent with multiplex PCR on patient management. Infants and toddlers, aged between 1-24 months, who presented to the pediatric emergency department with respiratory tract infection complaints and underwent multiplex-PCR between 1 January 2014 and 28 February 2020 were included in the study. Patients with at least one agent detected were considered as the study group, and patients without detection were considered as the control group. The same design was implemented only for patients with chronic diseases. A total of 1106 patients were recruited [median age: 6.7 months (range: 2.9-13.0 months)]. Seven hundred and eighty-nine in the study group and 317 in the control group. There were no significant differences between the groups in hospital admissions (study group: 271 admissions; control group: 89 admissions; p=0.055), length of hospital stay duration [mean ± standard deviation: 3.09±7.87 days (study group) and 2.6±7.79 days (control group); p=0.045], or antibiotic use [234 patients (study group) and 77 patients (control group); p=0.078]. When these variables were examined only for those with chronic diseases, there was no difference again. Although multiplex PCR is an ideal method with high sensitivity, specificity, and cost-effectiveness, the limits of its clinical application need to be clarified. We did not observe significant differences in the treatment of patients with detected viral agents

Presentations of children to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study

During the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues. This multinational observational study aimed to study the number of children presenting to EDs across Europe during the early COVID-19 pandemic and factors influencing this and to investigate changes in severity of illness and diagnoses. Routine health data were extracted retrospectively from electronic patient records of children aged 18 years and under, presenting to 38 EDs in 16 European countries for the period January 2018 to May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRRs), using predicted counts for each site as offset to adjust for case-mix differences, were used to compare age groups, diagnoses, and outcomes. Reductions in pediatric ED attendances, hospital admissions, and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (IRR 2·26, 95% CI 1·90 to 2·70, p < 0.001) and in children aged <12 months (12 to <24 months IRR 0·86, 95% CI 0·84 to 0·89; 2 to <5 years IRR 0·80, 95% CI 0·78 to 0·82; 5 to <12 years IRR 0·68, 95% CI 0·67 to 0·70; 12 to 18 years IRR 0·72, 95% CI 0·70 to 0·74; versus age <12 months as reference group, p < 0.001). The lowering of pediatric intensive care admissions was not as great as that of general admissions (IRR 1·30, 95% CI 1·16 to 1·45, p < 0.001). Lower triage urgencies were reduced more than higher triage urgencies (urgent triage IRR 1·10, 95% CI 1·08 to 1·12; emergent and very urgent triage IRR 1·53, 95% CI 1·49 to 1·57; versus nonurgent triage category, p < 0.001). Reductions were highest and sustained throughout the study period for children with communicable infectious diseases. The main limitation was the retrospective nature of the study, using routine clinical data from a wide range of European hospitals and health systems. Reductions in ED attendances were seen across Europe during the first COVID-19 lockdown period. More severely ill children continued to attend hospital more frequently compared to those with minor injuries and illnesses, although absolute numbers fell. ISRCTN91495258 https://www.isrctn.com/ISRCTN91495258

Comparison Of Weight Estimation Methods And Evaluation Of Usability Of Broselow Luten Tape In Turkish Children

It is controversial which method is more reliable for weight estimation of a child in an emergent situation. The aim of this study is to compare different methods and to review the applicability of Broselow Luten tape for Turkish children. This study was performed prospectively in patients presenting to pediatric emergency department. Weight estimation of patients were performed by parent, physician, nurse and Broselow Luten tape. Finally actual weight and height of the patient were measured. A total of 438 patients were eligible for the study. All estimates have a reliable correlation with actual weight. However, parent estimation is better followed by Broselow Luten tape. Correlation decreases as the weight of the child increases. When emergent care of an acutely ill child is necessary, parental estimation of the weight can be used. If it is unattainable, Broselow Luten tape can be reliably used instead of other methods especially in patients with lower weight

Flow-Volume Curve In The Diagnosis And Follow-Up Of Intrathoracic Airway Obstruction

Spirometry is an easy method to measure lung function and to show pathophysiology. It assists not only to determine the severity of bronchial obstruction in asthma but also to differentiate the characteristics of the intrathoracic diseases narrowing the central airways. Different types of benign and malignant tumors of the trachea may cause emergence of symptoms of airway obstruction. Herein a patient who had been initially diagnosed with asthma but later on shown to have intratracheal myofibroblastic tumor is presented. The importance of flow-volume curve in both initial diagnosis of the mass and in the detection of recurrence is discussed

Medicolegal Evaluation Of A Maternal Filicide Attempt: A Case Report

Filicide mainly refers to the murder of a child by his/her parents. Even though filicide is a rare event, outcome of filicide is more severe compared to other types of murders. In this report, we aim to discuss the factors in which the case of a woman who attempted to kill her 2.5-year-old daughter along with the demographical characteristics. Twenty-nine-year-old mother attempted to kill her daughter by hanging. Even though the victim did not die as the mother, regretted her action the triggers and the plot of the case discussed within the filicide framework. Therefore, the presented case report would contribute to the understanding of the nature of the filicide, and it might bring a different perspective, because of the different development process of filicide, sharing the disorder and interwoven motivations between the child and mother. In this respect, we aim to draw attention of pediatricians, child psychiatrists and forensic pathologists about the importance of filicide.WoSScopu

Home Accident Or Physical Abuse: Evaluation Of Younger Children Presenting With Trauma, Burn And Poisoning In The Pediatric Emergency Department

Most cases of physical abuse and neglect refer to pediatric emergency clinics, and these patients are diagnosed as only home accidents. Cases that cannot be diagnosed and managed correctly are again exposed to severe trauma and consequently, they may die. The aim of this study is to evaluate the physical abuse and neglect in children younger than three years of age, admitted to the pediatric emergency department with the complaints of trauma, burn, drug poisoning and/or caustic ingestion. This prospective study included 132 patients who were admitted to the pediatric emergency department. Children were classified into three groups as "no abuse", "suspected abuse" and "abused" after being evaluated with a standard form. Additionally, suspected abuse and abused cases were evaluated once again by "The Team of Child Abuse and Neglect Evaluation, Research and Treatment" in Hacettepe University, Ihsan Dogramaci Children's Hospital. The frequency of the suspected abuse or abused cases in all burn, trauma and poisoning cases was found to be 7.5%. It was noticed that 65 of the patients (49.2%) were physically neglected considering the mechanism of occurrence of events. Unplanned pregnancy, absence of prenatal follow-up, high number of siblings, previous physical abuse in the family, absence of witness during the event, and hospitalization were statistically significant differences between no abuse and suspected abuse or abused cases (p<0.05). Moreover, age group and income were significant risk factors in the logistic regression model for the patients who were thought to be suspected abuse/abused in univariate analyses (age group: Odds ratio (OR) 0.279, 95% confidence interval (CI) 0.085-0.723, p=0.0049; income: OR 2.323, 95% CI 1.052-6.198, p=0.0345). In conclusion, most cases of physical abuse and neglect are referred to the pediatric emergency clinics, and these patients are misdiagnosed as home accidents. The physicians working in the emergency department should be informed and trained in recognizing the cases of abuse and neglect, making the differential diagnosis, identifying the high-risk families and appropriate physical and psychological treatment for the abused and neglected children.WoSScopu

Congenital Mirror Movements In Gorlin Syndrome: A Case Report With Dti And Functional Mri Features

Congenital mirror movements are rare conditions that define the inability to perform unimanual movements. Gorlin syndrome, also known as nevoid basal cell carcinoma syndrome, is a genetic disorder with multiple nevi predisposing to basal cell carcinoma, odontogenic keratocysts, and skeletal malformations. Herein we report on an adolescent patient with Gorlin syndrome and coexisting congenital mirror movements. To our knowledge, this is the first patient in the literature who has both of these very rare conditions.WoSScopu