Prevalence of serious bacterial infections and performance of inflammatory markers in febrile infants with and without proven viral illness.

Background: Febrile infants ≤90 days old with proven viral infections who may have concurrent serious bacterial infections (SBIs) remain a diagnostic dilemma. We aimed to compare the prevalence of SBIs and evaluate the performance of inflammatory markers in predicting SBIs, between infants with and without proven viral illness.

Methods: We conducted a secondary analysis of febrile infants ≤90 days old presenting with temperature ≥38°C to a tertiary paediatric emergency department in Singapore between 1 December 2017 and 31 July 2022.

Prospective observational study to assess the performance accuracy of clinical decision rules in children presenting to emergency departments with possible cervical spine injuries: the Study of Neck Injuries in Children (SONIC).

Introduction: Paediatric cervical spine injury (CSI) is uncommon but can have devastating consequences. Many children, however, present to emergency departments (EDs) for the assessment of possible CSI. While imaging can be used to determine the presence of injuries, these tests are not without risks and costs, including exposure to radiation and associated life-time cancer risks.

Physical, psychological, cognitive, social health outcomes, and health-related quality of life in out-of-hospital cardiac arrest survivors and their caregivers: Protocol of the quality cardiac arrest survivorship cohort study (QualiCAS).

Background: Out-of-hospital cardiac arrest (OHCA) is an emergency with historically low survival rates. Advances in resuscitation and post-resuscitation care have improved survival, precipitating greater scientific interest in OHCA patients' survivorship. However, there is insufficient high-quality population-based long-term survivorship data and limited research on the impact of OHCA sequelae on survivors' caregivers.

Establishing normative values for short-term heart rate variability indices in healthy infants in the emergency department.

Background: Heart rate variability (HRV) has been used as a marker of cardiovascular health and a risk factor for mortality in the adult and paediatric populations, and as an indicator of neonatal sepsis. There has been an increasing interest in using short-term (5 minutes) HRV to identify infants ≤90 days of life with serious bacterial infections. However, there has not been any normative data range reported for short-term HRV indices in this infant population.

Clinical Outcomes of Hypertonic Saline vs Mannitol Treatment Among Children With Traumatic Brain Injury.

Importance: The use of hypertonic saline (HTS) vs mannitol in the control of elevated intracranial pressure (ICP) secondary to neurotrauma is debated.

Objective: To compare mortality and functional outcomes of treatment with 3% HTS vs 20% mannitol among children with moderate to severe traumatic brain injury (TBI) at risk of elevated ICP.

Design, Setting, And Participants: This prospective, multicenter cohort study was conducted between June 1, 2018, and December 31, 2022, at 28 participating pediatric intensive care units in the Pediatric Acute and Critical Care Medicine in Asia Network (PACCMAN) and the Red Colaborativa Pediátrica de Latinoamérica (LARed) in Asia, Latin America, and Europe.

Barriers and facilitators in the implementation of a child restraint system discharge programme in Singapore: a qualitative study.

Objective: Child restraint systems (CRS) are essential in preventing injury during road traffic collisions, yet neonatal CRS discharge programmes are lacking worldwide. Trained healthcare providers have reported a lack of confidence in providing CRS advice during discharge. We aimed to study the barriers and facilitators in implementing a formal neonatal CRS discharge programme through the lens of healthcare providers.

Glass injuries seen in a paediatric tertiary hospital in Singapore: An epidemiology study.

Lacerations rank as the most common paediatric injury that requires a physician evaluation. Glass is a frequent cause of such lacerations, however there is currently little to no information on this. Hence, this paper aims to describe the burden and characteristics of such injuries in Singapore.

International Consensus Definition of 'Sport & Exercise' in Toddlers and Young Children, Children, and Adolescents.

Aim: The study aim was to develop an age-appropriate definition of sport and exercise in children and adolescents for use in concussion research and management.

Methods: A modified Delphi methodology, with three rounds and consensus defined a priori as ≥ 80% agreement.

Results: Thirty-one participants (13 male, 18 female) from 13 countries, including clinical psychologists, epidemiologists, implementation scientists, neurologists, neuropsychologists, neurosurgeons, paediatric emergency physicians, paediatricians, physiotherapists, rehabilitation physicians, speech-language pathologists, and sports medicine physicians came to a consensus that sport-related paediatric concussion extends beyond the sporting arena, and includes the school yard, playground, park, street, recreational site, and home; excludes non-accidental violence, assault, and passenger vehicle road trauma; may include falls; and age-group terminology includes Toddlers and Young Children (1-4 years), Children (5-12 years), and Adolescents (13 to < 18 years).

Evaluating C-Reactive Protein and Procalcitonin Discordance Among Febrile Infants at Risk of Serious Bacterial Infections.

Aim: We aimed to investigate the prevalence and factors associated with C-reactive protein (CRP) and procalcitonin (PCT) discordance in febrile infants with serious bacterial infections (SBIs).

Methods: We performed a retrospective review of febrile infants ≤ 90 days old presenting to the emergency department between December 2018 and June 2023. We compared conservative and pragmatic thresholds for PCT (< 0.

An Audit of a Modified Pediatric Early Warning Scoring System in a Tertiary Pediatric Hospital.

Objective: Pediatric early warning systems identify patients at risk for deterioration. We aimed to determine if a locally adapted pediatric early warning system [KK hospital early warning score (KEWS)] can distinguish patients who require transfer from general ward to high dependency unit (HDU) or PICU, from those who do not.

Methods: We conducted a retrospective case-control single-center audit.

FedDSS: A data-similarity approach for client selection in horizontal federated learning.

Background And Objective: Federated learning (FL) is an emerging distributed learning framework allowing multiple clients (hospitals, institutions, smart devices, etc.) to collaboratively train a centralized machine learning model without disclosing personal data. It has the potential to address several healthcare challenges, including a lack of training data, data privacy, and security concerns.

Evaluation of unplanned reattendances to the pediatric emergency department - a five-year study.

Background: Unplanned reattendances (UR) are an important quality indicator in the emergency department (ED). Understanding the risk factors associated with UR can aid clinicians in optimizing the allocation of time and resources, as well as targeted counselling for this specific group of patients. In this study, we aimed to compare patient characteristics between children who attended a pediatric emergency department (ED) with unplanned reattendances (UR) and those without UR.

Investigating urinary characteristics and optimal urine white blood cell threshold in paediatric urinary tract infection: A prospective observational study.

Introduction: While the definitive diagnosis of urinary tract infection (UTI) requires a positive urine culture, the likelihood of UTI can be determined by urinalysis that includes white blood cell (WBC) count. We aimed to determine the optimal urine WBC threshold in urinalysis to predict UTIs in children presenting at the emergency department (ED).

Method: We performed a prospective observational study in the ED at KK Women's and Children's Hospital for children below 18 years old who underwent both urine microscopy and urine cultures, between 10 January and 7 November 2022.

2021 NEDI-Singapore study: an updated inventory of emergency department characteristics.

Introduction: The last national emergency department (ED) inventory was performed in 2007, and major changes in population demographics, healthcare needs and infrastructure have since occurred. We sought to obtain an updated inventory of EDs in Singapore to identify and describe changes in their characteristics and capabilities across the years.

Methods: In 2021, the National Emergency Department Inventories (NEDI) instrument was administered to the leadership of Singapore EDs.

Global emergency medicine research priorities: a mapping review.

Recognizing and prioritizing research areas in emergency care is crucial for generating evidence and advancing research programs, aiming to enhance health outcomes for both individuals and populations. The objective of this review is to document global clinical and nonclinical research priorities. The Emergency Medicine Education and Research by Global Experts network, consisting of 22 sites across six continents, conducted a mapping review of publications on emergency medicine research priorities (2000-2022) across seven databases.

Med-MGF: multi-level graph-based framework for handling medical data imbalance and representation.

Background: Modeling patient data, particularly electronic health records (EHR), is one of the major focuses of machine learning studies in healthcare, as these records provide clinicians with valuable information that can potentially assist them in disease diagnosis and decision-making.

Methods: In this study, we present a multi-level graph-based framework called MedMGF, which models both patient medical profiles extracted from EHR data and their relationship network of health profiles in a single architecture. The medical profiles consist of several layers of data embedding derived from interval records obtained during hospitalization, and the patient-patient network is created by measuring the similarities between these profiles.

Impact of neonatal sepsis on neurocognitive outcomes: a systematic review and meta-analysis.

Introduction: Sepsis is associated with neurocognitive impairment among preterm neonates but less is known about term neonates with sepsis. This systematic review and meta-analysis aims to provide an update of neurocognitive outcomes including cognitive delay, visual impairment, auditory impairment, and cerebral palsy, among neonates with sepsis.

Methods: We performed a systematic review of PubMed, Embase, CENTRAL and Web of Science for eligible studies published between January 2011 and March 2023.

Delayed presentation is associated with serious bacterial infections among febrile infants: A prospective cohort study.

Introduction: Febrile young infants are at risk of serious bacterial infections (SBIs), which are potentially life-threatening. This study aims to investigate the association between delayed presentation and the risk of SBIs among febrile infants.

Method: We performed a prospective cohort study on febrile infants ≤90 days old presenting to a Singapore paediatric emergency department (ED) between November 2017 and July 2022.

Caregiver reported long-term outcomes in children with major trauma and traumatic brain injuries: A single-centre retrospective study.

Introduction: We aim to investigate the functional outcomes and long-term health-related quality of life (HRQOL) in children with major trauma associated with traumatic brain injury (TBI).

Method: We performed a retrospective review of records among patients >2 and ≤16 years old in a tertiary paediatric hospital between January 2014 and October 2019 with major trauma (Injury Severity Score of ≥16) and TBI of all severities. We recorded each child's Glasgow Outcome Scale-Extended Pediatric Version (GOS-E Peds) at 12 months post-injury and Pediatric Quality of Life Inventory (PedsQL) scores at 6 and 12 months post-injury based on the parent proxy-report scales.

A two-phased study on the use of remote photoplethysmography (rPPG) in paediatric care.

Background: Advancements in medical technologies have led to the development of contact-free methods of haemodynamic monitoring such as remote photoplethysmography (rPPG). rPPG uses video cameras to interpret variations in skin colour related to blood flow, which are analysed to generate vital signs readings. rPPG potentially ameliorates problems like fretfulness and fragile skin contact associated with conventional probes in children.

Validation of motor component of Glasgow coma scale in lieu of total Glasgow coma scale as a pediatric trauma field triage tool.

Introduction: Prehospital trauma triage and disability assessment of pediatric patients can be challenging on the field, especially in the pre-verbal age group. It would be useful if the same triage tool and criteria can be used for both adults and children to risk-stratify the need of higher acuity of trauma care.

Study Objective: We aimed to investigate if using only the motor component of Glasgow Coma Scale (mGCS), as a quick field trauma triage tool, was non-inferior to total GCS (tGCS), and if mGCS <6 was non-inferior to tGCS <14, in predicting the need for intensive care or mortality in the pediatric population.

Protocol for the diagnostic performance of C reactive protein, procalcitonin and interleukin-6 for serious bacterial infections among children ≤36 months old presenting with fever without source: a systematic review and meta-analysis.

Introduction: The management of fever without source in children ≤36 months old remains a diagnostic challenge as the underlying aetiologies can vary from self-limiting viral infections to serious bacterial infections (SBIs). Biomarkers such as C reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6) have varying thresholds in the prediction of SBIs due to differences in SBI definitions, SBI prevalence, patient characteristics and timing of presentation. This protocol describes a systematic review and meta-analysis that aims to determine the thresholds at which CRP, PCT and IL-6 can perform optimally in distinguishing the presence of SBIs in children ≤36 months old, as well as to determine their performances in early detection of bacterial infections within 48 hours of fever onset.