240 results found
Rienstra R, Nijman RG, Jorgensen R, et al., 2016, DIAGNOSTIC PERFORMANCE OF LOW RISK CRITERIA IN YOUNG FEBRILE INFANTS PRESENTING TO THE PAEDIATRIC EMERGENCY DEPARTMENT: A RETROSPECTIVE ANALYSIS, EUROPEAN JOURNAL OF PEDIATRICS, Vol: 175, Pages: 1784-1784, ISSN: 0340-6199
deCaen AR, Guerra GG, Maconochie I, 2016, Intubation During Pediatric CPR Early, Late, or Not at All?, JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol: 316, Pages: 1772-1774, ISSN: 0098-7484
MacOnochie IK, 2016, Emergency Triage and Treatment Course in primary care health centres in Guatamala, Emergency Medicine Journal, Vol: 33, ISSN: 1472-0205
Boettiger BW, Bossaert LL, Castren M, et al., 2016, Kids Save Lives ERC-Position Statement on School Children Education in the Resuscitation "Hands that help Training children is Training for Life", NOTFALL & RETTUNGSMEDIZIN, Vol: 19, Pages: 488-490, ISSN: 1434-6222
Bottiger BW, Bossaert LL, Castren M, et al., 2016, Kids Save Lives - ERC position statement on school children education in CPR. "Hands that help - Training children is training for life", RESUSCITATION, Vol: 105, Pages: A1-A3, ISSN: 0300-9572
Kemp A, Nickerson E, Trefan L, et al., 2016, Selecting children for head CT following head injury, Archives of Disease in Childhood, Vol: 101, Pages: 929-934, ISSN: 0003-9888
OBJECTIVE: Indicators for head CT scan defined by the 2007 National Institute for Health and Care Excellence (NICE) guidelines were analysed to identify CT uptake, influential variables and yield. DESIGN: Cross-sectional study. SETTING: Hospital inpatient units: England, Wales, Northern Ireland and the Channel Islands. PATIENTS: Children (<15 years) admitted to hospital for more than 4 h following a head injury (September 2009 to February 2010). INTERVENTIONS: CT scan. MAIN OUTCOME MEASURES: Number of children who had CT, extent to which NICE guidelines were followed and diagnostic yield. RESULTS: Data on 5700 children were returned by 90% of eligible hospitals, 84% of whom were admitted to a general hospital. CT scans were performed on 30.4% of children (1734), with a higher diagnostic yield in infants (56.5% (144/255)) than children aged 1 to 14 years (26.5% (391/1476)). Overall, only 40.4% (984 of 2437 children) fulfilling at least one of the four NICE criteria for CT actually underwent one. These children were much less likely to receive CT if admitted to a general hospital than to a specialist centre (OR 0.52 (95% CI 0.45 to 0.59)); there was considerable variation between healthcare regions. When indicated, children >3 years were much more likely to have CT than those <3 years (OR 2.35 (95% CI 2.08 to 2.65)). CONCLUSION: Compliance with guidelines and diagnostic yield was variable across age groups, the type of hospital and region where children were admitted. With this pattern of clinical practice the risks of both missing intracranial injury and overuse of CT are considerable.
Hansoti B, Dalwai M, Katz J, et al., 2016, Prioritising the care of critically ill children: a pilot study using SCREEN reduces clinic waiting times, BMJ Global Health, Vol: 1, ISSN: 2059-7908
Objective In low-resource settings, childhood mortality secondary to delays in triage and treatment remains high. This paper seeks to evaluate the impact of the novel Sick Children Require Emergency Evaluation Now (SCREEN) tool on the waiting times of critically ill children who present for care to primary healthcare clinics in Cape Town, South Africa.Methods We used a pre/postevaluation study design to calculate the median waiting times of all children who presented to four randomly chosen clinics for 5 days before, and 5 days after, the implementation of SCREEN.Findings The SCREEN programme resulted in statistical and clinically significant reductions in waiting times for children with critical illness to see a professional nurse (2 hours 45 min to 1 hour 12 min; p<0.001). There was also a statistically significant reduction in the proportion of children who left without being seen by a professional nurse (25.8% to 18.48%; p<0.001).Conclusions SCREEN is a novel programme that uses readily available laypersons, trained to make a subjective assessment of children arriving at primary healthcare centres, and provides a low cost, simple methodology to prioritise children and reduce waiting times in low-resource healthcare clinics.
Lillitos PJ, Hadley G, Maconochie I, 2016, Can paediatric early warning scores (PEWS) be used to guide the need for hospital admission and predict significant illness in children presenting to the emergency department? An assessment of PEWS diagnostic accuracy using sensitivity and specificity, EMERGENCY MEDICINE JOURNAL, Vol: 33, Pages: 329-337, ISSN: 1472-0205
Carasco CF, Fletcher P, Maconochie I, 2016, Review of commonly used age-based weight estimates for paediatric drug dosing in relation to the pharmacokinetic properties of resuscitation drugs, BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Vol: 81, Pages: 849-856, ISSN: 0306-5251
Trefan L, Houston R, Pearson G, et al., 2016, Epidemiology of children with head injury: a national overview, Archives of Disease in Childhood, Vol: 101, Pages: 527-532, ISSN: 0003-9888
Background The National Confidential Enquiry describes the epidemiology of children admitted to hospital with head injury.Method Children (<15 years old) who died or were admitted for >4 h with head injury were identified from 216 UK hospitals (1 September 2009 to 28 February 2010). Data were collected using standard proformas and entered on to a database. A descriptive analysis of the causal mechanisms, child demographics, neurological impairment, CT findings, and outcome at 72 h are provided.Results Details of 5700 children, median age 4 years (range 0–14.9 years), were analysed; 1093 (19.2%) were <1 year old, 3500 (61.4%) were boys. There was a significant association of head injury with social deprivation 39.7/100 000 (95% CI 37.0 to 42.6) in the least deprived first quintile vs. 55.1 (95% CI 52.1 to 58.2) in the most deprived fifth quintile (p<0.01). Twenty-four children died (0.4%). Most children were admitted for one night or less; 4522 (79%) had a Glasgow Coma Scale score of 15 or were Alert (on AVPU (Alert, Voice, Pain, Unresponsive)). The most common causes of head injury were falls (3537 (62.1%); children <5 years), sports-related incidents (783 (13.7%); median age 12.4 years), or motor vehicle accidents (MVAs) (401 (7.1%); primary-school-aged children). CT scans were performed in 1734 (30.4%) children; 536 (30.9%) were abnormal (skull fracture and/or intracranial injury or abnormality): 269 (7.6%) were falls, 82 (10.5%) sports related and 100 (25%). A total of 357 (6.2%) children were referred to social care because of child protection concerns (median age 9 months (range 0–14.9 years)).Conclusions The data described highlight priorities for targeted age-specific head injury prevention and have the potential to provide a baseline to evaluate the effects of regional trauma networks (2012) and National Institute of Health and Care Excellence (NICE) head injury guidelines (2014), which were revised after the study was completed.
Alisic E, Hoysted C, Kassam-Adams N, et al., 2016, Psychosocial Care for Injured Children: Worldwide Survey among Hospital Emergency Department Staff, The Journal of Pediatrics, Vol: 170, Pages: 227-233.e6, ISSN: 0022-3476
Monsieurs G, Nolan JP, Bossaert LL, et al., 2016, Summary of European Resuscitation Council Guidelines for Resuscitation 2015 (vol 18, pg 1, 2015), NOTFALL & RETTUNGSMEDIZIN, Vol: 19, Pages: 54-55, ISSN: 1434-6222
Hodkinson P, Argent A, Wallis L, et al., 2016, Pathways to care for critically ill or injured children: a cohort study from first presentation to healthcare services through to admission to intensive care or death, PLOS One, Vol: 11, ISSN: 1932-6203
PurposeCritically ill or injured children require prompt identification, rapid referral and quality emergency management. We undertook a study to evaluate the care pathway of critically ill or injured children to identify preventable failures in the care provided.MethodsA year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation to healthcare services until paediatric intensive care unit (PICU) admission or emergency department death, using expert panel review of medical records and caregiver interview. Main outcomes were expert assessment of overall quality of care; avoidability of severity of illness and PICU admission or death and the identification of modifiable factors.ResultsThe study enrolled 282 children, 252 emergency PICU admissions, and 30 deaths. Global quality of care was graded good in 10% of cases, with half having at least one major impact modifiable factor. Key modifiable factors related to access to care and identification of the critically ill, assessment of severity, inadequate resuscitation, and delays in decision making and referral. Children were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 185 (74%) of children, and death prior to PICU admission was avoidable in 17/30 (56.7%) of children.ConclusionsThe study presents a novel methodology, examining quality of care across an entire system, and highlighting the complexity of the pathway and the modifiable events amenable to interventions, that could reduce mortality and morbidity, and optimize utilization of scarce critical care resources; as well as demonstrating the importance of continuity and quality of care.
Maconochie IK, Bhaumik S, 2016, Fluid therapy for acute bacterial meningitis, COCHRANE DATABASE OF SYSTEMATIC REVIEWS, ISSN: 1469-493X
Marlow R, Mytton J, Maconochie IK, et al., 2015, Trends in admission and death rates due to paediatric head injury in England, 2000-2011, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 100, Pages: 1136-1140, ISSN: 0003-9888
Monsieurs KG, Nolan JP, Bossaert LL, et al., 2015, The European Resuscitation Council Guidelines for Resuscitation 2015, NOTFALL & RETTUNGSMEDIZIN, Vol: 18, Pages: 655-747, ISSN: 1434-6222
Price CL, Brace-McDonnell SJ, Stallard N, et al., 2015, Performance characteristics of five triage tools for major incidents involving traumatic injuries to children, Injury-International Journal of the Care of the Injured, Vol: 47, Pages: 988-992, ISSN: 1572-3461
Context Triage tools are an essential component of the emergency response to a major incident. Although fortunately rare, mass casualty incidents involving children are possible which mandate reliable triage tools to determine the priority of treatment.ObjectiveTo determine the performance characteristics of five major incident triage tools amongst paediatric casualties who have sustained traumatic injuries.Design, setting, participantsRetrospective observational cohort study using data from 31,292 patients aged less than 16 years who sustained a traumatic injury. Data were obtained from the UK Trauma Audit and Research Network (TARN) database.Interventions Statistical evaluation of five triage tools (JumpSTART, START, CareFlight, Paediatric Triage Tape/Sieve and Triage Sort) to predict death or severe traumatic injury (injury severity score >15).Main outcome measures Performance characteristics of triage tools (sensitivity, specificity and level of agreement between triage tools) to identify patients at high risk of death or severe injury.ResultsOf the 31,292 cases, 1029 died (3.3%), 6842 (21.9%) had major trauma (defined by an injury severity score >15) and 14,711 (47%) were aged 8 years or younger. There was variation in the performance accuracy of the tools to predict major trauma or death (sensitivities ranging between 36.4 and 96.2%; specificities 66.0–89.8%). Performance characteristics varied with the age of the child. CareFlight had the best overall performance at predicting death, with the following sensitivity and specificity (95% CI) respectively: 95.3% (93.8–96.8) and 80.4% (80.0–80.9). JumpSTART was superior for the triaging of children under 8 years; sensitivity and specificity (95% CI) respectively: 86.3% (83.1–89.5) and 84.8% (84.2–85.5). The triage tools were generally better at identifying patients who would die than those with non-fatal severe injury.ConclusionThis statistical evaluation has demonstrated variab
De Caen AR, Aickin R, Maconochie IK, et al., 2015, Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (Reprinted from Circulation, vol 132, pg S177-S203, 2015), PEDIATRICS, Vol: 136, Pages: S88-S119, ISSN: 0031-4005
Burrows P, Trefan L, Houston R, et al., 2015, Head injury from falls in children younger than 6 years of age, Archives of Disease in Childhood, Vol: 100, Pages: 1032-1037, ISSN: 0003-9888
The risk of serious head injury (HI) from a fall in a youngchild is ill defined. The relationship between the objectfallen from and prevalence of intracranial injury (ICI) orskull fracture is described.Method Cross-sectional study of HIs from falls in children(<6 years) admitted to UK hospitals, analysed according tothe object fallen from and associated Glasgow Coma Score(GCS) or alert, voice, pain, unresponsive (AVPU) and CTscan results.Results Of 1775 cases ascertained (median age18 months, 54.7% boys), 87% (1552) had a GCS=15/AVPU=alert. 19.3% (342) had a CT scan: 32% (110/342)were abnormal; equivalent to 5.9% of the overallpopulation, 16.9% (58) had isolated skull fractures and13.7% (47) had ICI (49% (23/47) had an associated skullfracture). The prevalence of ICI increased with neurologicalcompromise; however, 12% of children with a GCS=15/AVPU=alert had ICI. When compared to falls fromstanding, falls from a person’s arms (233 children (meanage 1 year)) had a significant relative OR for a skullfracture/ICI of 6.94 (95% CI 3.54 to 13.6), falls from abuilding (eg, window or attic) (mean age 3 years) OR 6.84(95% CI 2.65 to 17.6) and from an infant or child product(mean age 21 months) OR 2.75 (95% CI 1.36 to 5.65).Conclusions Most HIs from a fall in these childrenadmitted to hospital were minor. Infants, dropped from acarer’s arms, those who fell from infant products, awindow, wall or from an attic had the greatest chance ofICI or skull fracture. These data inform prevention and theassessment of the likelihood of serious injury when theobject fallen from is known.
de Lucas N, Phillips B, Rodríguez-Nuñez A, et al., 2015, Paediatric Out-of-Hospital-cardiac arrests and Emergency Department-cardiac arrests: Factors associated with survival to discharge and improved neurological outcome, Resuscitation, Vol: 96, Pages: 133-133, ISSN: 0300-9572
de Lucas N, Phillips B, Rodríguez-Nuñez A, et al., 2015, E-PEDCARE: First results of an international prospective registry of pediatric Out-of-Hospital and Emergency Department Cardiac Arrest, Resuscitation, Vol: 96, Pages: 36-37, ISSN: 0300-9572
Morley PT, Lang E, Aickin R, et al., 2015, Part 2: Evidence Evaluation and Management of Conflicts of Interest 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, CIRCULATION, Vol: 132, Pages: S40-S50, ISSN: 0009-7322
Hazinski MF, Nolan JP, Aickin R, et al., 2015, Part 1: Executive Summary 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, CIRCULATION, Vol: 132, Pages: S2-S39, ISSN: 0009-7322
de Caen AR, Maconochie IK, Aickin R, et al., 2015, Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, CIRCULATION, Vol: 132, Pages: S177-S203, ISSN: 0009-7322
Perkins GD, Handley AJ, Koster RW, et al., 2015, European Resuscitation Council Guidelines for Resuscitation 2015 Section 2. Adult basic life support and automated external defibrillation, RESUSCITATION, Vol: 95, Pages: 81-99, ISSN: 0300-9572
Greif R, Lockey AS, Conaghan P, et al., 2015, European Resuscitation Council Guidelines for Resuscitation 2015 Section 10. Education and implementation of resuscitation, RESUSCITATION, Vol: 95, Pages: 288-301, ISSN: 0300-9572
Maconochie IK, Bingham R, Eich C, et al., 2015, European Resuscitation Council Guidelines for Resuscitation 2015 Section 6. Paediatric life support, RESUSCITATION, Vol: 95, Pages: 223-248, ISSN: 0300-9572
Morley PT, Lang E, Aickin R, et al., 2015, Evidence evaluation and management of conflicts of interest 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations, RESUSCITATION, Vol: 95, Pages: E33-E41, ISSN: 0300-9572
Nolan JP, Hazinski MF, Aickin R, et al., 2015, Executive summary 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations, RESUSCITATION, Vol: 95, Pages: E1-E31, ISSN: 0300-9572
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.