Test characteristics of an automated age- and temperature-adjusted tachycardia alert in pediatric septic shock.

Abstract:

OBJECTIVES:This study aimed to create and analyze the performance of an automated triage tool alerting triage nursing staff and physicians to an abnormal heart rate consistent with septic shock in a pediatric emergency department. METHODS:A computerized best-practice alert (BPA) triage system corrected heart rate for temperature (5 beats per minute for each 1°F above 100°F or 9.6-10 beats per minute for each 1°C > 36°C) and alarmed on tachycardia. If patients appeared ill and/or had medical comorbidities predisposing them to sepsis, a "shock protocol" was activated. Sensitivity was calculated for patients clinically diagnosed with shock during the study period. RESULTS:During the study period (February to August 2010), the BPA was triggered in 4552 (11.5%) of 39,697 visits. Mean age was 5.4 years (range, 18 days to 18 years); 53% were female. The tool was 81% sensitive in identifying the 210 patients with shock. Missed patients were more likely to be previously healthy (odds ratio, 2.7; 95% confidence interval, 1.2-6.2), younger (5.7 vs 8.7 years, P = 0.004), and less likely to have a malignancy (odds ratio, 0.38; 95% confidence interval, 0.2-0.8). The tool was 89% specific; positive and negative predictive values were 4% and 99.9%, respectively. CONCLUSIONS:The BPA-automated sensitive triage tool, based solely on initial temperature and heart rate, led to the identification of most children with septic shock, even before clinical acumen and laboratory values were incorporated into the diagnostic algorithm.

journal_name

Pediatr Emerg Care

journal_title

Pediatric emergency care

authors

Cruz AT,Williams EA,Graf JM,Perry AM,Harbin DE,Wuestner ER,Patel B

doi

10.1097/PEC.0b013e318267a78a

subject

Has Abstract

pub_date

2012-09-01 00:00:00

pages

889-94

issue

9

eissn

0749-5161

issn

1535-1815

journal_volume

28

pub_type

杂志文章
  • Serotonergic or Anticholinergic Toxidrome: Case Report of a 9-Year-Old Girl.

    abstract:OBJECTIVE:The aim of this study was to report an acute onset of symptoms erroneously attributed to serotonin syndrome in a child who had been given both anticholinergic and serotonergic agents. CASE SUMMARY:A 9-year-old girl with chronic anxiety and gastrointestinal problems was prescribed oral sertraline 6.25 mg dail...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000515

    authors: Gerardi DM,Murphy TK,Toufexis M,Hanks C

    更新日期:2015-12-01 00:00:00

  • Abdominal Cerebrospinal Fluid Pseudocyst Diagnosed by Point-of-Care Ultrasound.

    abstract::Abdominal cerebrospinal fluid pseudocyst is an uncommon complication of ventriculoperitoneal shunt and is seen more commonly in the pediatric population. The diagnosis of an abdominal cerebrospinal fluid pseudocyst is typically made by ultrasonography, which demonstrates a simple or loculated fluid collection in the a...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000826

    authors: Ivan Y,Hauptman J,Marin JR

    更新日期:2016-06-01 00:00:00

  • Are Recommended Doses of Acetaminophen Effective for Children Aged 2 to 3 Years? A Pharmacokinetic Modeling Answer.

    abstract:OBJECTIVES:Acetaminophen (APAP) elixir is a widely used pediatric antipyretic medication. It has been shown that up to 30% of febrile children presenting to a large urban pediatric emergency department received inadequate APAP dosages at home with errors primarily due to age-based dosing. Parental education material in...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000665

    authors: Abourbih DA,Gosselin S,Villeneuve E,Kazim S

    更新日期:2016-01-01 00:00:00

  • The First Use of Pralidoxime in a Child With Rivastigmine Poisoning.

    abstract::The aim of this report is to describe the successful use of pralidoxime in a pediatric patient who accidentally ingested 12 mg of rivastigmine and presented to the emergency department with weakness, drowsiness, hyporeactivity to environmental stimuli, and full cholinergic syndrome. CASE:The patient presented to the ...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001086

    authors: Saz EU,Yurtseven A,Kilinç MA,Sari F,Ağin H

    更新日期:2018-10-01 00:00:00

  • Delayed presentations of congenital diaphragmatic hernia.

    abstract::The delayed presentation of a congenital diaphragmatic hernia may include symptoms of acute respiratory distress or gastrointestinal obstruction. We review the presentation and management of the different types of diaphragmatic hernias. In addition, we present a case of twins with a left-sided congenital diaphragmatic...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-200108000-00013

    authors: Singh S,Bhende MS,Kinnane JM

    更新日期:2001-08-01 00:00:00

  • Physicians' Approach to Anaphylaxis in Childhood.

    abstract::Anaphylaxis is a life-threatening, severe, generalized, or systemic hypersensitivity reaction. The incidence of anaphylaxis is increasing especially in pediatric age. Our aim in this study was to investigate the knowledge and attitudes of the physicians on the diagnosis and treatment of anaphylaxis. METHODS:A questio...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000002064

    authors: Tuncel T,Sancakli O,Bag O,Cetin HS,Özdoğru EE

    更新日期:2020-02-24 00:00:00

  • Comparison of 4 Pediatric Intraosseous Access Devices: A Randomized Simulation Study.

    abstract:BACKGROUND:Obtaining intravascular access can be challenging or even impossible in several clinical situations. As an alternative, medications and fluids can be administered via the intraosseous (IO) route, which is a well-tolerated and established alternative, especially in the emergency setting. METHODS:Seventy-five...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001587

    authors: Szarpak L,Ladny JR,Dabrowski M,Ladny M,Smereka J,Ahuja S,Ruetzler K

    更新日期:2020-10-01 00:00:00

  • Pediatric EMS transport: are we treating children in a system designed for adults only?

    abstract::Unlike adults, small children and infants do not require stretchers or ambulances for transport from a prehospital scene to the emergency department (ED). This study was designed to determine the importance of this difference in patient transport needs. A Macintosh Classic computer was programmed to compare the time t...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-199202000-00003

    authors: Sacchetti A,Carraccio C,Feder M

    更新日期:1992-02-01 00:00:00

  • Presentation and evaluation of sexual misuse in the emergency department.

    abstract::Children who have been sexually abused develop a variety of emotional and physical complaints, often unrelated to the genital area. Emergency department records of children diagnosed as being sexually abused were reviewed for the period covering January 1984 through June 1985. Of 26,000 patients seen, 300 cases of sex...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-198609000-00002

    authors: Seidel JS,Elvik SL,Berkowitz CD,Day C

    更新日期:1986-09-01 00:00:00

  • Anaphylaxis management in the pediatric emergency department: opportunities for improvement.

    abstract:PURPOSE:To determine the rate, immediate treatment, and outpatient management for anaphylaxis in patients receiving care in a pediatric emergency department (ED). METHODS:This is a retrospective cross-sectional descriptive study of patients (21 years or younger) who received care for anaphylaxis for a 5-year period in...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e3181ce2e1c

    authors: Russell S,Monroe K,Losek JD

    更新日期:2010-02-01 00:00:00

  • Pediatric cyanide poisoning by fire smoke inhalation: a European expert consensus. Toxicology Surveillance System of the Intoxications Working Group of the Spanish Society of Paediatric Emergencies.

    abstract::Most fire-related deaths are attributable to smoke inhalation rather than burns. The inhalation of fire smoke, which contains not only carbon monoxide but also a complex mixture of gases, seems to be the major cause of morbidity and mortality in fire victims, mainly in enclosed spaces. Cyanide gas exposure is quite co...

    journal_title:Pediatric emergency care

    pub_type: 共识发展会议,杂志文章,实务指引

    doi:10.1097/PEC.0b013e3182aa4ee1

    authors: Mintegi S,Clerigue N,Tipo V,Ponticiello E,Lonati D,Burillo-Putze G,Delvau N,Anseeuw K,Toxicology Surveillance System of the Intoxications Working Group of the Spanish Society of Paediatric Emergencies.

    更新日期:2013-11-01 00:00:00

  • Her belly button is leaking: a case of patent urachus.

    abstract::Patent urachus is one of the least commonly seen of the urachal anomalies. In this report, we present a case of a patent urachus in a15-day-old female who presented with leakage from the umbilical site. The purpose of this article is to discuss the embryology, clinical manifestations, diagnosis, and management of pate...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000280

    authors: Sherman JM,Rocker J,Rakovchik E

    更新日期:2015-03-01 00:00:00

  • Accidental etizolam ingestion in a child.

    abstract::Etizolam (ETZ) is an antidepressive thienodiazepine drug that is used worldwide. The most frequent adverse effects in adults are drowsiness and muscle weakness, and this can rarely cause paradoxical excitation; however, no information exists on intoxication in children. Furthermore, evidence bearing on its safety in c...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/01.pec.0000280511.13537.bd

    authors: Kato Z,Nakamura M,Funato M,Kuwabara H,Kondo N

    更新日期:2007-07-01 00:00:00

  • A systematic review and meta-analysis of new interventions for peripheral intravenous cannulation of children.

    abstract:OBJECTIVE:Establishing intravenous access in children is often challenging for health professionals. Multiple attempts at peripheral intravenous cannulation (PIVC) cause increased pain and delayed delivery of therapy. Our objective was to synthesize and evaluate the best evidence for novel interventions designed to imp...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,meta分析,评审

    doi:10.1097/PEC.0b013e3182999bcd

    authors: Heinrichs J,Fritze Z,Klassen T,Curtis S

    更新日期:2013-07-01 00:00:00

  • Reasons for nonurgent pediatric emergency department visits: perceptions of health care providers and caregivers.

    abstract:OBJECTIVES:This study aimed to determine the most important reasons for pediatric nonurgent (NU) emergency department (ED) visits as perceived by caregivers, primary care pediatricians (PCPs), and ED personnel and to assess the differences among these 3 groups in perceived reasons and solutions to NUED visits. METHODS...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e31823f2412

    authors: Salami O,Salvador J,Vega R

    更新日期:2012-01-01 00:00:00

  • Intussusception: a supplement to the mnemonic for coma.

    abstract::Expected clinical manifestations of intussusception include paroxysmal abdominal pain, vomiting, abdominal mass, and with time, rectal bleeding. We report a case where lethargy and vomiting are the presenting complaints. Diagnostic delay was encountered for this infant who had altered sensorium without accompanying pa...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-198706000-00015

    authors: McCabe JB,Singer JI,Love T,Roth R

    更新日期:1987-06-01 00:00:00

  • Atlanto-Axial Subluxation After Adenoidectomy.

    abstract::Atlanto-axial subluxation is a rare but potentially serious complication after otolaryngological procedures. We are describing a case of a 4-year-old child who developed atlanto-axial subluxation of the cervical spine after adenoidectomy. Our patient underwent adenoidectomy and, 18 days later, presented to the emergen...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001154

    authors: Gross IT,Bahar-Posey L

    更新日期:2017-06-01 00:00:00

  • Normal pulmonary function after baby powder inhalation causing adult respiratory distress syndrome.

    abstract::We report a case of baby powder inhalation (BPI), causing adult respiratory distress syndrome (ARDS) in a 16-month-old girl, with follow-up after six years. Pulmonary function studies in the child and her monozygotic twin, used as a control, were normal. The testing consisted of diffusing capacity to carbon monoxide a...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-198903000-00014

    authors: Reyes de la Rocha S,Brown MA

    更新日期:1989-03-01 00:00:00

  • Infective Uvulitis in a Child.

    abstract::Infective uvulitis is a rare condition in children. In this report, we describe the case of a 4-year old-patient who presented a group A Streptococcus pharyngitis with uvulitis. No signs of epiglottitis were detected at nasal fibroscopy. She recovered rapidly with intravenous antibiotic therapy and 2 days of corticost...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000002258

    authors: De Pieri C,Valentini E,Pusiol A,Passone E,Gamalero L,Cogo PE

    更新日期:2020-10-07 00:00:00

  • A Curiously Rare Case of Septic Shock From Clostridium difficile Colitis.

    abstract::This case provides the first report of a young healthy child presenting in septic shock from Clostridium difficile colitis. This child had no identifiable risk factors for C. difficile, raising the suspicion for a hypervirulent strain. Once infection was recognized and treated appropriately, the child made a full reco...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000000496

    authors: Loftus KV,Wilson PM

    更新日期:2017-08-01 00:00:00

  • Injuries sustained during flipping--a new fad activity.

    abstract::This article describes a small series of injuries resulting from a new fad activity among children in Baltimore. "Flipping" involves jumping from an elevated surface and executing an aerial flip, with the intent to land upright. Because this activity takes place frequently on hard surfaces such as concrete, injuries o...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-199304000-00010

    authors: Goepp JG,Walker A,Flowers M,Calimano A,Smith D

    更新日期:1993-04-01 00:00:00

  • Clinical Impact of Rapid Intravenous Rehydration With Dextrose Serum in Children With Acute Gastroenteritis.

    abstract:OBJECTIVES:We designed a study to compare rapid intravenous rehydration based on 0.9% normal saline (NS) or on NS + glucose 2.5% serum (SGS 2.5%) in patients with dehydration secondary to acute gastroenteritis. Our hypothesis is that the addition of glucose 2.5% serum (SGS 2.5%) to 0.9% saline solution could reduce the...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/PEC.0000000000001064

    authors: Sendarrubias M,Carrón M,Molina JC,Pérez MÁ,Marañón R,Mora A

    更新日期:2018-12-01 00:00:00

  • Delirium Upon Presentation to the Pediatric Emergency Department: A Case Series.

    abstract::The following cases describe children who presented to the emergency department (ED) with a constellation of symptoms consistent with delirium. In each case, there was no identified inciting cause (eg, fever, medications) other than the presence of influenza. All children had variable workups, with 2 children undergoi...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0000000000001175

    authors: Augenstein JA,Klein EJ,Traube C

    更新日期:2018-08-01 00:00:00

  • The acceptability of mental health screening in a pediatric emergency department.

    abstract:OBJECTIVES:The purposes of the study were (1) to assess the acceptability of mental health screening in the pediatric emergency department (ED) for children and their parents; (2) to measure providers' perceptions on whether screening has an impact on patient care; and (3) to determine the impact of screening status on...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e318222554e

    authors: Williams JR,Ho ML,Grupp-Phelan J

    更新日期:2011-07-01 00:00:00

  • The pediatric assessment triangle: a novel approach for the rapid evaluation of children.

    abstract::The Pediatric Assessment Triangle (PAT) has become the cornerstone for the Pediatric Education for Prehospital Professionals course, sponsored by the American Academy of Pediatrics. This concept for emergency assessment of children has been taught to more than 170,000 health care providers worldwide. It has been incor...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e3181d6db37

    authors: Dieckmann RA,Brownstein D,Gausche-Hill M

    更新日期:2010-04-01 00:00:00

  • Grunting respirations in infants and children.

    abstract::Grunting respirations are recognized as a sign of serious illness in infants and children, but have not been well studied beyond the newborn period. We present three illustrative cases and the results of a descriptive study which elucidates the causes of grunting in infants and children and suggests guidelines for ass...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/00006565-199506000-00004

    authors: Poole SR,Chetham M,Anderson M

    更新日期:1995-06-01 00:00:00

  • Randomized controlled trial of ultrasound-guided peripheral intravenous catheter placement versus traditional techniques in difficult-access pediatric patients.

    abstract:OBJECTIVES:We hypothesized that the use of ultrasound guidance would improve the success rate of peripheral intravenous catheter placement in pediatric patients with difficult access in a pediatric emergency department (ED). Our secondary hypotheses were that ultrasound guidance would reduce the number of attempts, the...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/PEC.0b013e31819a8946

    authors: Doniger SJ,Ishimine P,Fox JC,Kanegaye JT

    更新日期:2009-03-01 00:00:00

  • Return visits to the emergency department among febrile children 3 to 36 months of age.

    abstract:OBJECTIVES AND METHODS:The aim of the present retrospective, cross-sectional, descriptive study was to determine the characteristics of febrile 3- to 36-month-old children who were admitted to the emergency department (ED) with the chief complaint of fever and returned with the same complaint within 72 hours (returning...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e31823a3e86

    authors: Klein-Kremer A,Goldman RD

    更新日期:2011-12-01 00:00:00

  • Baking soda: a potentially fatal home remedy.

    abstract::We present a case of a six-week-old infant who developed life-threatening complications after unintentional sodium bicarbonate intoxication. Baking soda was being used by the mother as a home remedy to "help the baby burp." A review of the literature regarding the use (or misuse) of baking soda follows. Our patient, a...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章,评审

    doi:

    authors: Nichols MH,Wason S,Gonzalez del Rey J,Benfield M

    更新日期:1995-04-01 00:00:00

  • Derivation of the DIVA score: a clinical prediction rule for the identification of children with difficult intravenous access.

    abstract:OBJECTIVE:To develop a clinical prediction rule that would be easy to apply and be useful for predicting success or failure of peripheral intravenous line insertion in children. METHODS:This was a prospective cohort study of children aged 0 to 21 years undergoing peripheral intravenous placement by staff nurses in a p...

    journal_title:Pediatric emergency care

    pub_type: 杂志文章

    doi:10.1097/PEC.0b013e3181666f32

    authors: Yen K,Riegert A,Gorelick MH

    更新日期:2008-03-01 00:00:00