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Emergency Medicine

Evolution of the Youth Crisis Stabilization Unit
 Evolution of the Youth Crisis Stabilization Unit 1024 538 Mary Bates, PhD
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An alternative to inpatient hospitalization for youth experiencing a mental health crisis and their families sees success at Nationwide Children’s.   The Youth Crisis Stabilization Unit (YCSU) is an inpatient psychiatric setting at Nationwide Children’s for children and adolescents experiencing a mental health crisis. Over the last 12 years, the YCSU has grown from a…

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Ask a Specialist: When Should Primary Care Providers Refer Dental Injuries to the Emergency Department?
 Ask a Specialist: When Should Primary Care Providers Refer Dental Injuries to the Emergency Department? 150 150 Ehsan N. Azadani, DDS, MS
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An expert reveals the most common red flag dental injuries that should be referred to the ED and what precautions PCPs can take before sending the child.   The most time-sensitive dental injury is the avulsion of a permanent tooth; that is, when the permanent tooth is completely knocked out of its socket (and the…

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Examining Pediatric Injury-Related Emergency Department Vistis During the COVID-19 Pandemic
 Examining Pediatric Injury-Related Emergency Department Vistis During the COVID-19 Pandemic 480 320 JoAnna Pendergrass, DVM
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During the first year of the COVID-19 pandemic, the frequency of pediatric injury-related visits to the emergency department decreased, while injury severity increased. The COVID-19 pandemic caused disruptions not only on a global scale but also for individuals, particularly children. Pandemic-related closures of school and extracurricular activities significantly impacted the daily routines of children and…

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BRUE: What Is It? How Is It Treated?
 BRUE: What Is It? How Is It Treated? 1024 575 Abbie Miller
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BRUE –brief resolved unexplained event – whether you pronounce it brew-EE or brOO, it might be a term you haven’t run across since medical school. In a recent resident-led episode of PediaCast CME, Meghan Fennell, MD, and Vanessa Thiel, MD, break down everything you need to know about BRUE. Listen to the PediaCast CME Episode…

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Moving Emergency Medicine Research Forward
 Moving Emergency Medicine Research Forward 1024 614 Abbie Miller
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Utilizing exception from informed consent studies and a national network of emergency medicine experts, clinician-scientists are advancing research to uncover best practices and improve care. Exception from informed consent (EFIC) is a special rule set utilized by the U.S. Food and Drug Administration (FDA) to support research in emergency situations. The word exception is particularly…

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Right Care, Right Place, Right Time? Frequency and Duration of Boarding for Pediatric Mental Health Conditions at Acute Care Hospitals
 Right Care, Right Place, Right Time? Frequency and Duration of Boarding for Pediatric Mental Health Conditions at Acute Care Hospitals 150 150 Lauren Dembeck
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Mental health boarding durations significantly exceed standards by the Joint Commission, and youth receive minimal mental health services in these acute care settings. This study calls for increased awareness, dedicated resources and research to improve mental health care for youths in these settings. According to the results of a national survey conducted, in part by…

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What is “Dry Drowning,” and How Do I Talk to Parents About It?
 What is “Dry Drowning,” and How Do I Talk to Parents About It? 1024 683 Daniel Scherzer, MD and Bema Bonsu, MD
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The concern about so called “dry drowning” (which is not an actual medical phrase; neither is “secondary drowning”) is based on the fear that a child can unexpectedly succumb to respiratory problems some unpredictable time after swimming. This fear has been exacerbated by media reports dramatizing events without fully explaining them. The concept that dry…

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Calls to Poison Centers About High-Powered Magnets Increased by 444% After Ban Lifts
 Calls to Poison Centers About High-Powered Magnets Increased by 444% After Ban Lifts 1024 521 Laura Dattner
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cube made of ball magnets in the palm of a hand

High-powered magnets are small, shiny and made from powerful rare earth metals. Since they started showing up in children’s toys in the early 2000s and then later in desk sets in 2009, high-powered magnets have caused thousands of injuries and are considered to be among the most dangerous ingestion hazards in children. When more than one…

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No More Sitting in the Dark?
 No More Sitting in the Dark? 1024 728 Laura Dattner
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A new study from the Center for Injury Research and Policy, Sports Medicine and Emergency Medicine is the first to document objectively self-paced physical and cognitive activity post-concussion among youth. The results suggest they may be able to engage in physical and cognitive activity as soon as tolerated post-concussion. Clinical guidelines for managing concussion in…

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Early Intervention is Key to Avoid Hospitalization for Cyclic Vomiting Syndrome
 Early Intervention is Key to Avoid Hospitalization for Cyclic Vomiting Syndrome 1024 683 Mary Bates, PhD
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Health care provider talking to male teen patient

Study finds that waiting to go to the emergency department for treatment increases likelihood of hospitalization. Cyclic vomiting syndrome is a functional gastrointestinal disorder characterized by periodic episodes of intense nausea and vomiting lasting hours to days. During episodes, some children become very sick and require emergency department care and hospitalization to manage symptoms and…

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The New Emergency Department — for Behavioral Health
 The New Emergency Department — for Behavioral Health 1024 575 Katie Brind'Amour, PhD, MS, CHES
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How pediatric hospitals are creatively tackling the unique care needs of a growing population of youths in crisis. From attention deficit disorder to anxiety or depression, mental health conditions affect about 1 in every 5 children. While some of these cases resolve, many children go on to adulthood with mental or behavioral health disorders, and…

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Distal Radius Physeal Bar and Ulnar Overgrowth: Indications for Treatment
 Distal Radius Physeal Bar and Ulnar Overgrowth: Indications for Treatment 1024 575 Julie Samora, MD, PhD
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Julie Samora, MD

Distal radius fractures are among the most common fractures in pediatrics. Although most heal without complication, some result in partial or complete physeal arrest. Risk factors for distal radius growth arrest include physeal fractures, ischemia, infection, radiation, tumor, blood dyscrasias, burns, frostbite and repetitive stress.  The distal radius physis is responsible for 75% of the…

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Study Finds Rising Rate of Mental Health Visits Among Youth to Emergency Departments
 Study Finds Rising Rate of Mental Health Visits Among Youth to Emergency Departments 480 320 Kaitlin Hall
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Highest jump was among 15- to 17-year-olds and more pronounced in girls; Dramatic increases in self-harm and substance use as reasons for ED visits. While the number of pediatric emergency department (ED) visits across the nation has remained stable over the last 10 years, visits for mental health disorders have risen 60% and the rate…

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From Clinician Ideas to Commercially-Available Clinical Devices
 From Clinician Ideas to Commercially-Available Clinical Devices 150 150 Kevin Mayhood
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Pressure wounds were a common complication following a tracheostomy, often resulting in advanced-stage wounds, national studies showed. Nationwide Children’s Hospital was no different but Kris Jatana, MD, and Charles Elmaraghy, MD, surgeons in the Department of Otolaryngology, knew they could improve these outcomes. Brendan Boyle, MD, and Alex Green, DO, were fellows in the Division…

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Reducing Asthma-Related Emergency Department Visits
 Reducing Asthma-Related Emergency Department Visits 480 320 Abbie Miller
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Through serial interventions and teamwork, the initiative reduced asthma-related ED utilization rates by nearly 4% per year at a time when national rates were rising. Numerous studies have demonstrated that quality improvement (QI) methodologies improve asthma outcomes. However, moving that success from individual patients to a large population is challenging. In a recent study published…

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Study Shows Three-Day Intensive Crisis Intervention is Associated with Reduced Suicidality in Adolescents
 Study Shows Three-Day Intensive Crisis Intervention is Associated with Reduced Suicidality in Adolescents 150 150 Jeb Phillips
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When an adolescent is acutely suicidal and cannot safely remain in the community, inpatient psychiatric hospitalization is the traditional intervention. But a lack of appropriate facilities across the United States, combined with an increasing demand for inpatient psychiatric services, means many young people who are at critical risk often cannot get the help they need.…

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Calls to U.S. Poison Control Centers for Natural Psychoactive Substances Increasing, Driven by Rising Marijuana Exposures
 Calls to U.S. Poison Control Centers for Natural Psychoactive Substances Increasing, Driven by Rising Marijuana Exposures 150 150 Laura Dattner
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Researchers encourage states legalizing marijuana to implement poison prevention strategies Natural substances with psychoactive effects have been used by people for religious, medicinal and recreational purposes for millennia. Lack of regulation has led to an increase in their availability, especially online. Some psychoactive substances may be appealing to recreational users because of the perception they…

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Increased Number of Pediatric Eye Injuries From Nonpowder Firearms
 Increased Number of Pediatric Eye Injuries From Nonpowder Firearms 150 150 Laura Dattner
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BB guns accounted for most of the injuries; Researchers highlight importance of protective eyewear, and call for stricter, more consistent safety legislation. Nonpowder firearms have long been marketed to children and teenagers as toys or “starter” firearms and include BB, pellet, airsoft and paintball guns. A new study conducted by researchers at the Center for Injury…

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Health Care Leaders Offer Interim Guidelines on Vaping and EVALI Care
 Health Care Leaders Offer Interim Guidelines on Vaping and EVALI Care 150 150 Mary Bates, PhD
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While investigations are ongoing, an interim report offers clinical guidance regarding vaping-associated lung injuries. Centers for Disease Control (CDC), the Food and Drug Administration (FDA), state and local health departments, and public health and clinical partners are looking into a multistate outbreak of lung injury associated with the use of electronic cigarette (e-cigarette), or vaping,…

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Screening for Cervical Spine Risk Factors Could Reduce CT Scans by Half
 Screening for Cervical Spine Risk Factors Could Reduce CT Scans by Half 150 150 Kevin Mayhood
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Study finds identifiable risk factors that ED staff can use for evaluation, avoiding over 100,000 unnecessary scans annually. An estimated 8 million children suffer blunt trauma annually, and while cervical spine injury (CSI) is serious, it is uncommon. Screening children suffering from blunt trauma for CSI risk factors could cut unnecessary computed tomography (CT) scans…

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Most Seymour Fractures Can be Effectively Treated in the Emergency Room
 Most Seymour Fractures Can be Effectively Treated in the Emergency Room 150 150 Katie Brind'Amour, PhD, MS, CHES
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After decades of unclear optimal management for Seymour fractures, evidence suggests orthopedic surgeons need not treat all of these cases in the operating room. Seymour fractures — open fractures of the distal phalanx with a juxta-epiphyseal pattern — were long managed nonsurgically following their namesake’s landmark study from the 1960s that asserted the risks of…

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Why Preteens in the ED Should be Screened for Suicide Risk
 Why Preteens in the ED Should be Screened for Suicide Risk 480 320 Kevin Mayhood
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Screening revealed that 7% of 10-to-12-year-olds who came to three children’s hospital emergency departments for medical complaints such as headache, back pain or seizures, were at risk for suicide, a recent study found. More than half of children in the same age group presenting to the emergency department with psychiatric complaints such as depression, violent…

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National Survey of Emergency Department Management of Self-Harm Highlights Successes, Room for Improvement
 National Survey of Emergency Department Management of Self-Harm Highlights Successes, Room for Improvement 150 150 Abbie Miller
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Only 15 percent of hospitals surveyed routinely provided all recommended safety planning elements. Approximately half a million patients in the United States arrive in emergency departments (EDs) after deliberate self-harm annually. In the short term following the ED visit, these patients are at high risk for repeated self-harm and suicide. In a study published [today]…

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Child Sex Trafficking in the U.S. is Real — and a New Tool can Help Doctors Identify Victims
 Child Sex Trafficking in the U.S. is Real — and a New Tool can Help Doctors Identify Victims 150 150 Katie Brind'Amour, PhD, MS, CHES
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Researchers exploring the alarmingly high prevalence of child sex trafficking in the United States have validated a practical tool for identifying victims in multiple health care settings. At least one in every 10 minors visiting emergency departments, child advocacy centers and teen clinics for sexual trauma or assault are victims of child sex trafficking, according…

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Saving Constipation Treatment Costs With a Bowel Management Program
 Saving Constipation Treatment Costs With a Bowel Management Program 1024 575 Jeb Phillips
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Simple illustrated diagram of the GI track with organs colorized and body outline and background in blue

A protocolized approach significantly reduced ED visits and hospital admissions for children with chronic constipation – and became a driver for surgical referrals. If hospitals are willing to foot the bill for staffing and start-up costs, a structured bowel management program for children with chronic severe constipation likely saves both individual and institutional health care…

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How to Reduce Unnecessary Antibiotic Use for UTI in Urgent Cares
 How to Reduce Unnecessary Antibiotic Use for UTI in Urgent Cares 150 150 Jeb Phillips
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A quality improvement project shows children with negative urine cultures take antibiotics they don’t need. Even before a urine culture confirms the diagnosis, urgent care physicians often prescribe antibiotics when children present with symptoms of urinary tract infection (UTI). Early treatment is important for relief of symptoms and prevention of complications. But what if the…

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Emergency Departments Can Help Prevent Suicide
 Emergency Departments Can Help Prevent Suicide 150 150 Brianne Moore
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Secondary screenings, safety plans and phone follow-ups are key to reducing death by suicide. Suicide is the tenth leading cause of death in the United States and has increased in incidence 27 percent from 1999 to 2015. Interestingly, up to 40 percent of individuals who die by suicide visit an emergency department (ED) in the…

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Human Trafficking: How many victims have you treated?
 Human Trafficking: How many victims have you treated? 1024 575 Abbie Miller
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Data shows that health care providers may be coming into contact with victims and those at risk with more frequency than expected. How many victims have you treated? The answer is probably higher than you think. According to a report published in the Annals of Health Law, 88 percent of sex trafficking survivors reported contact with…

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From Military Zones to Pediatric Trauma Centers, Implementing Massive Transfusion Protocols
 From Military Zones to Pediatric Trauma Centers, Implementing Massive Transfusion Protocols 150 150 Abbie Miller
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While military and adult research has shown massive transfusion protocols to be lifesaving, implementation and validation in pediatrics lags. When someone is critically injured with life-threatening bleeding, the primary objective of the care team is to stop the bleeding and replace the lost blood. Historically, children in this situation were administered red blood cells (RBCs)…

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Childhood Kidney Stones: Their Surprising Connection to Future Disease
 Childhood Kidney Stones: Their Surprising Connection to Future Disease 150 150 Jeb Phillips
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Once thought to be an adult condition, urinary stone disease is increasingly found in children – and may be related to the development of cardiovascular disease, chronic kidney disease and low bone density. By one well-regarded estimate, the risk of developing urinary stone disease in childhood doubled between 1997 and 2012. That’s worrying enough on…

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Hidden Victims
 Hidden Victims 150 150 Dave Ghose
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Pediatricians acknowledge the emerging public health challenge of child commercial sexual exploitation. Public health officials no longer think that human trafficking is just a problem in the developing world. Increasing awareness has focused attention on the exploitation of children in the United States, showing that medical professionals can uncover problems in their own backyards. “I…

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The Dilemma of Undertriaged Trauma Cases
 The Dilemma of Undertriaged Trauma Cases 150 150 Katie Brind'Amour, PhD, MS, CHES
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Nationally, at least one in three children ages 5 and under with major trauma receive their definitive care at a level III trauma center or non-trauma center, according to arecent study in the American Journal of Emergency Medicine. Among children ages 6 to 17, the frequency of undertriage decreases to one in every four major trauma…

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1 in 8 Children Exposed to Violence 5 or More Times in a Year
 1 in 8 Children Exposed to Violence 5 or More Times in a Year 150 150 Tiasha Letostak, PhD
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The average pediatric subspecialist sees two to four child polyvictims each day. What can physicians do to help these children and their families? According to the National Survey of Children’s Exposure to Violence (NatSCEV), 60 percent of children have directly experienced or indirectly witnessed at least one act of violence in the previous year. Nearly…

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