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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: closed (20 January 2024) | Viewed by 6905

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Special Issue Editor

Prof. Dr. Itai Shavit

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Guest Editor

Division of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem 9112001, Israel
Interests: pediatric emergency medicine; sedation; acute pain; simulation

Special Issue Information

Dear Colleagues,

The Journal of Clinical Medicine is pleased to announce the solicitation of articles in the Special Issue of 'Clinical Advances in Pediatric Emergency Medicine'.

Itai Shavit, MD, Chair of the Division of Pediatrics of the Hadassah Hebrew University Medical Center, has agreed to serve as Guest Editor. On behalf of the Editorial Board, we invite submissions from all aspects of this field, including, but not limited to: Medical Emergencies, Surgical Emergencies, Major and Minor trauma, Toxicology, Pain and Sedation, Airway management, Triage, Child Maltreatment, Quality Improvement, Clinical Decision Rules, and Clinical Pathways.

The Journal strives to publish studies of high impact, novelty, originality, and quality that we believe will be of the greatest interest to our readers who represent all areas of Emergency Care in children. The Journal of Clinical Medicine is committed to reporting studies on clinical effectiveness in Pediatric Emergency Medicine. This includes traditional randomized and non-randomized trials, studies with adaptive trial designs, observational studies, meta-analyses, diagnostic studies, cohort studies, and epidemiological studies. We are particularly interested in studies that are likely to influence patterns of care in pediatric emergency medicine.

Prof. Dr. Itai Shavit
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

pediatric prehospital care
Pediatric trauma
pediatric emergency medicine
pediatric patients
pediatric urgent care
child life services

Published Papers (6 papers)

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Research

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13 pages, 1105 KiB

Open AccessArticle

Injury Pattern and Current Early Clinical Care of Pediatric Polytrauma Comparing Different Age Groups in a Level I Trauma Center

by Anna Schuster, Lisa Klute, Maximilian Kerschbaum, Jürgen Kunkel, Jan Schaible, Josina Straub, Johannes Weber, Volker Alt and Daniel Popp

J. Clin. Med. 2024, 13(2), 639; https://doi.org/10.3390/jcm13020639 - 22 Jan 2024

Viewed by 832

Abstract

Introduction: Pediatric polytrauma is a complex condition with unique characteristics and requirements for early clinical care. This study aimed to analyze the injury patterns, early clinical care, and outcomes of pediatric polytrauma patients in a Level I trauma center. The focus was on evaluation between different age groups and the recognition of injuries as potential factors influencing outcomes. Methods: A prospective cohort study model of pediatric polytrauma patients (ISS ≥ 16) was conducted over a 13-year period, stratified by age groups (Group A: 0–5 years; Group B: 6–10 years; Group C: 11–15 years; and Group D: 16–18 years). A comparison of the groups was conducted to examine variations in early clinical care, trauma mechanisms, distribution of affected body regions (as per AIS and ISS criteria), and trauma-related mortality. Additionally, factors contributing to mortality were evaluated. Results: The median age of patients was 16 years, with a male predominance (64.7%). The Injury Severity Score (ISS) varied across age groups, with no significant difference. The 30-day mortality rate was 19.0%, with no significant age-related differences. Trauma mechanisms varied across age groups, with motor vehicle accidents being the most common mechanism in all age groups except 0–5 years, where falls were prevalent. Analysis of injury patterns by AIS body regions indicated that head trauma was a significant predictor of mortality (Hazard Ratio 2.894, p < 0.001), while chest, abdominal, and extremity trauma showed no significant association with mortality. Multiple regression analysis identified the ISS and preclinical GCS as valid predictors of mortality (p < 0.001 and p = 0.006, respectively). Conclusions: While age-related differences in injury severity and clinical interventions were limited, head trauma emerged as a critical predictor of mortality. Early recognition and management of head injuries are crucial in improving outcomes. Additionally, the ISS and preclinical GCS were identified as valid predictors of mortality, emphasizing the importance of early assessment and resuscitation. A tailored approach to pediatric polytrauma care, considering both age and injury patterns, might contribute to survival benefits in this vulnerable population. Full article

(This article belongs to the Special Issue Clinical Advances in Pediatric Emergency Medicine)

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10 pages, 251 KiB

Open AccessArticle

The Impact of Parental Presence on Invasive Procedures in the Pediatric Emergency Department: A Prospective Study

by Saar Hashavya, Naama Pines-Shwartz, Noa Guzner, Lea Ohana Sarna Cahan and Itai Gross

J. Clin. Med. 2023, 12(17), 5527; https://doi.org/10.3390/jcm12175527 - 25 Aug 2023

Cited by 1 | Viewed by 759

Abstract

Parental presence during invasive pediatric procedures is controversial, and its benefits are under-researched. The objective of this study was to assess the effects of parental presence during invasive procedures on the parents themselves and the physician performing the procedure. This prospective study was conducted at a single tertiary center in Jerusalem, Israel. During 10 shifts, all physicians and the families of patients who underwent invasive procedures in the pediatric emergency department (PED) were asked to fill in questionnaires related to their experiences. A total of 98 parental questionnaires and 101 physician questionnaires were collected. The most commonly performed procedures were laceration repair (65%) and abscess drainage (18%). Sedation was required in 75% of cases. In total, 73% of the cited family members were present during these procedures. The main reason for refusing to allow family members access was the physicians’ concern that the procedure would be hard for parents to watch. However, in more than 85% of cases, the physicians felt that the presence of a family member contributed to the success of the procedure, augmented the child’s sense of safety and lessened the family members’ feelings of anxiety. All parents who opted to be present during the procedure felt very satisfied, compared to 67% of parents who were not present (p < 0.0001). When asked if, in retrospect, they would have made the same decision, 100% of the parents who were present during the procedure indicated that they would have made the same decision, compared to only 68% of the parents who were not present (p < 0.001). Overall, these findings highlight the positive effects of parental presence during invasive procedures performed in the PED, even when procedures were performed under sedation. Encouraging parental attendance during invasive procedures may, thus, enhance family-centered practices in the PED. Full article

(This article belongs to the Special Issue Clinical Advances in Pediatric Emergency Medicine)

9 pages, 398 KiB

Open AccessArticle

Serious Bacterial Infections in Preterm Infants: Should Their Age Be “Corrected”?

by Mohamad Hadhud, Itai Gross, Noa Hurvitz, Lea Ohana Sarna Cahan, Zivanit Ergaz, Giora Weiser, Noa Ofek Shlomai, Smadar Eventov Friedman and Saar Hashavya

J. Clin. Med. 2023, 12(9), 3242; https://doi.org/10.3390/jcm12093242 - 1 May 2023

Cited by 2 | Viewed by 957

Abstract

Adjusting the chronological age of preterm infants according to their gestational age is a widely accepted practice in the field of neurodevelopment. It has been suggested for the assessment of preterm infants with suspected infection, but has been poorly validated. Correcting for chronological age is especially critical in infants with a chronological age above 3 months, but a corrected age below 3 months due to the differences in assessment protocols. This study assessed the difference in incidence of serious bacterial infection (SBI) according to chronological and corrected age in preterm infants. A retrospective analysis of pediatric emergency department (PED) presentations was conducted for all 448 preterm infants born in between January 2010 and August 2019. Of the 448 preterm infants, 204 (46%) presented at one of 3 PEDs in Jerusalem, Israel, during their first year of life. Overall, 141 (31.4%) presented with fever and were included in the study. The infants were divided into 3 age groups: 1—corrected age >3 months; 2—chronological age >3 months, but corrected age <3 months; 3—chronological and corrected age <3 months. SBI was diagnosed in 2.6%, 16.7%, and 33.3% of the infants in groups 1, 2 and 3, respectively; (p < 0.01, p = 0.17, p < 0.001). The incidence of SBI in the control group of 300 term infants <3 months presenting to the PED due to fever was 15.3%. Preterm infants with a corrected age <3 months are at increased risk for SBI, similarly to term infants <3 months of age. Age correction should thus be considered for preterm infants presenting with fever. Full article

(This article belongs to the Special Issue Clinical Advances in Pediatric Emergency Medicine)

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Review

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10 pages, 246 KiB

Open AccessReview

Cardiac POCUS in Pediatric Emergency Medicine: A Narrative Review

by Eric Scheier

J. Clin. Med. 2023, 12(17), 5666; https://doi.org/10.3390/jcm12175666 - 31 Aug 2023

Cited by 1 | Viewed by 1644

Abstract

Purpose of this Review: The cardiac point of care ultrasound (POCUS) is among the most impactful examinations in the evaluation of an ill child. This paper will review the English-language literature on cardiac POCUS in the pediatric emergency department (PED), the adult emergency literature with relevance to pediatric emergency, and other pediatric cardiac studies outside pediatric emergency with relevance to PED detection of potentially emergent pediatric cardiac pathology. Recent findings: Pediatric emergency physicians can reliably detect decreased left-sided systolic function and pericardial effusion using POCUS. Case reports show that pediatric emergency physicians have detected right-sided outflow tract obstruction, aortic root dilatation, and congenital cardiac disease using POCUS. Training for pediatric cardiac POCUS competency is feasible, and cardiac POCUS does not increase the burden on cardiology resources to the PED. Summary: While cardiac pathology in children is relatively rare, pediatric cardiac POCUS can incorporate a broad curriculum beyond systolic function and the presence of pericardial fluid. Further research should assess pediatric emergency physician performance in the identification of a broader range of cardiac pathology. Full article

(This article belongs to the Special Issue Clinical Advances in Pediatric Emergency Medicine)

9 pages, 240 KiB

Open AccessReview

Analgesia and Sedation of Pediatric Patients with Major Trauma in Pre-Hospital and Emergency Department Settings—A Narrative Review

by Neta Cohen, Daniel M. Cohen, Egidio Barbi and Itai Shavit

J. Clin. Med. 2023, 12(16), 5260; https://doi.org/10.3390/jcm12165260 - 12 Aug 2023

Viewed by 1192

Abstract

Children who sustain major injuries are at risk of receiving insufficient pain relief and sedation, which can have physical and psychological repercussions. Heightened emotional distress can increase the likelihood of developing symptoms of post-traumatic stress. Providing sufficient analgesia and sedation for children with major trauma presents specific challenges, given the potential for drug-related adverse events, particularly in non-intubated patients. The current literature suggests that a relatively low percentage of pediatric patients receive adequate analgesia in pre-hospital and emergency department settings following major trauma. There are only sparse data on the safety of the provision of analgesia and sedation in children with major trauma in the pre-hospital and ED settings. The few studies that examined sedation protocols in this context highlight the importance of physician training and competency in managing pediatric airways. There is a pressing need for prospective studies that focus upon pediatric major trauma in the pre-hospital and emergency department setting to evaluate the benefits and risks of administering analgesia and sedation to these patients. The aim of this narrative review was to offer an updated overview of analgesia and sedation management in children with major trauma in pre-hospital and ED settings. Full article

(This article belongs to the Special Issue Clinical Advances in Pediatric Emergency Medicine)

Other

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5 pages, 207 KiB

Open AccessBrief Report

Clinical Characteristics and Management of Snake Bite Injuries in the Jerusalem Area

by Itai Gross, Aus Maree, David Rekhtman, Waseem Mujahed, Saar Hashavya and Jacob Assaf

J. Clin. Med. 2023, 12(12), 4132; https://doi.org/10.3390/jcm12124132 - 19 Jun 2023

Cited by 1 | Viewed by 821

Abstract

Venomous snake bites can constitute medical emergencies, and without immediate care may be life-threatening. This study describes the characteristics and management of patients suffering from snake bite injuries (SNIs) in the Jerusalem area. A retrospective analysis of all patients who were admitted to the Hadassah Medical Center emergency departments (EDs) due to SNIs between 1 January 2004 and 31 March 2018 was conducted. During this period, 104 patients were diagnosed with SNIs, of whom 32 (30.7%) were children. Overall, 74 (71.1%) patients were treated with antivenom, 43 (41.3%) were admitted to intensive care units, and 9 (8.6%) required treatment with vasopressors. No mortality was recorded. On ED admission, none of the adult patients presented with an altered mental state compared to 15.6% of the children (p < 0.00001). Cardiovascular symptoms were observed in 18.8% and 5.5% of the children and adults, respectively. Fang marks appeared in all of the children. These findings underscore the severity of SNIs and the differences in clinical presentation between children and adults in the Jerusalem region. Full article

(This article belongs to the Special Issue Clinical Advances in Pediatric Emergency Medicine)

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