Clinical presentation, triggers, co-morbidities and management of anaphylaxis in the elderly: A cross-sectional study.

Background: Anaphylaxis is a life-threatening, systemic allergic reaction. This study aims to compare anaphylactic triggers, clinical presentation and management between elderly (≥65 years old) and non-elderly adults.

Methods: Data from the Cross-Canada Anaphylaxis Registry (C-CARE) from April 2011 to May 2024 was collected, spanning five emergency departments (EDs) and one emergency medical service (EMS) across three Canadian provinces.

Resistant in children.

Question: A 5-year-old child was seen in our clinic with a clinical presentation consistent with community-acquired pneumonia. She was prescribed a course of amoxicillin and azithromycin, but remained febrile and returned to the clinic 3 days later. The family just returned from a trip to Japan.

Interhospital variation in the management of Brief Resolved Unexplained Events (BRUE) in infants: A Canadian multicenter cohort study.

Background: Guidelines on Brief Resolved Unexplained Event (BRUE) only provide recommendations for infants categorized at lower risk. However, most infants fall into the higher-risk category, leaving management decisions to individual clinicians and contributing to variation in care.

Objectives: Describe interhospital variation in BRUE management and determine whether higher resource utilization improves detection of serious underlying diagnoses.

Specialty Consultations and Diagnostic Testing Accuracy After Brief Resolved Unexplained Events: A Multicenter Observational Study.

Objectives: Current BRUE guidelines focus on lower-risk infants (approximately 5%), leaving management strategies for the majority undefined. We aimed to evaluate the diagnostic yield and accuracy of tests and subspecialist consultations among all infants with BRUE.

Methods: In this retrospective cohort (2017-2021) across 11 Canadian hospitals, we included 1042 infants with BRUE.

Accidental cannabis ingestion in young children.

Question: A 3-year-old girl was brought to my office by her caregiver because she was not acting like herself. She was excessively sleepy, difficult to rouse, and had poor balance. The caregiver reported cannabis products in the home in the form of gummies the caregiver takes for sleep and anxiety.

All-terrain vehicle injuries in children and adolescents.

Question: I know that all-terrain vehicles (ATVs) are commonly used for recreational purposes, and that recently an adolescent was injured while driving one. What are the dangers of ATV use among adolescents, and what are some preventative measures to recommend to families in my clinic to reduce ATV-related injuries in children?

Answer: There is a disproportionately high rate of ATV accidents in children compared with adults, and the safety of ATVs has become a public health concern in recent years because of their association with increased pediatric morbidity and mortality. Children account for more than one-third of ATV-related hospitalizations and they are at an increased risk of head injuries compared with adults.

External Validation of Brief Resolved Unexplained Events Prediction Rules for Serious Underlying Diagnosis.

Importance: The American Academy of Pediatrics (AAP) higher-risk criteria for brief resolved unexplained events (BRUE) have a low positive predictive value (4.8%) and misclassify most infants as higher risk (>90%). New BRUE prediction rules from a US cohort of 3283 infants showed improved discrimination; however, these rules have not been validated in an external cohort.

Characteristics of a revised quick sequential organ failure assessment score (RqSOFA) to predict in-hospital mortality of patients visiting the emergency department via ambulance: an observational cohort study.

The National Early Warning Score (NEWS), Quick Sequential Organ Failure Assessment (qSOFA), and modified qSOFA (MqSOFA) are scoring systems that rely on vital signs. However, NEWS is time-consuming, qSOFA has low sensitivity, and MqSOFA includes a difficult calculation. To address these issues, we developed the Revised qSOFA score (RqSOFA) that consists of percutaneous oxygen saturation, oxygen usage, Simple Shock Index, and the parameters of qSOFA.

Identifying serious underlying diagnoses among patients with brief resolved unexplained events (BRUEs): a Canadian cohort study.

Objective: To describe the demographics and clinical outcomes of infants with brief resolved unexplained events (BRUE).

Design: A retrospective cohort study.

Setting: 11 centres within the Canadian Paediatric Inpatient Research Network.

Management of anaphylaxis after pre-hospital epinephrine use in children with food-induced anaphylaxis.

Background: Previous guidelines recommend prompt epinephrine administration, followed by observation in the emergency department (ED). The need for transfer in all cases of anaphylaxis has recently been challenged.

Objective: To evaluate the need for additional ED treatment among children with anaphylaxis who received prehospital epinephrine.

A national survey of children's experiences and needs when attending Canadian pediatric emergency departments.

Background: Optimizing a child's emergency department (ED) experience positively impacts their memories and future healthcare interactions. Our objectives were to describe children's perspectives of their needs and experiences during their ED visit and relate this to their understanding of their condition.

Methods: 514 children, aged 7-17 years, and their caregivers presenting to 10 Canadian pediatric EDs completed a descriptive cross-sectional survey from 2018-2020.

Screen time and sleep in children.

Question: I continue to hear concerns from parents in my practice about the frequent use of light-emitting devices by their children. I have also found that many children suffer from sleep disturbances. What are the effects of screen time on sleep, and what are some best practices for sleep hygiene and screen use among children?

Answer: Screen time is higher now than before the onset of the COVID-19 pandemic, and knowledge about the effects of screen time is evolving.

The acute care burden of asthma in children was profoundly reduced during the COVID-19 pandemic: A multi-centre Canadian retrospective study.

Objectives: Asthma is a chronic lung condition that can be exacerbated when triggered by viruses. Pandemic public health restrictions aimed to reduce COVID-19 transmission indirectly effected other circulating viruses. This study assessed the impact of the pandemic and associated public health measures on acute paediatric asthma across four tertiary sites in three Canadian provinces.

Should you test for urinary tract infection in children with respiratory symptoms?

Question: An 8-month-old boy presented to our clinic with a 3-day history of fever. He has had a cough and rhinorrhea since the onset of the fever, and his 4-year-old sibling has recently had cough and cold symptoms. I have heard that the presence of respiratory symptoms means that urinary tract infection (UTI) is less likely.

Clinical characteristics and management of pediatric egg-induced anaphylaxis: A cross-sectional study.

Background: Egg is the third most common food allergy in children; however, data on pediatric egg-induced anaphylaxis are sparse.

Objective: To describe the clinical characteristics, management, and outcomes of pediatric egg-induced anaphylaxis.

Methods: Children presenting with anaphylaxis were recruited from 13 emergency departments as part of the Cross-Canada Anaphylaxis Registry, from which data on anaphylaxis triggered by egg were extracted.

Treatment Delay of Febrile Urinary Tract Infections Among Infants With Respiratory Symptoms.

Objective: To evaluate whether antibiotic treatment of febrile urinary tract infection (UTI) is delayed in febrile infants with respiratory symptoms compared with those without.

Study Design: Data of infants 2-24 months of age diagnosed with UTI from March 1, 2012 to May 31, 2023 were collected from our hospital's medical charts and triage records. Patients with known congenital anomalies of the kidney and urinary tract or a history of febrile UTI were excluded.

Management of acute supraventricular tachycardia in children.

Question: Recently, a 3-year-old patient in my practice urgently needed to go to the emergency department. The patient was found to have supraventricular tachycardia (SVT) and needed immediate treatment with adenosine. What evidence is currently available for management of SVT in children?

Answer: Supraventricular tachycardia is a common cardiac condition in the pediatric population that manifests as a narrow QRS complex tachycardia on electrocardiography.