ABSTRACT
Contexte: Plus de 90 % des cas d'ingestions de corps etrangers en pediatrie se produisent a domicile. Notre hypothese etait que le temps supplementaire passe par les enfants a domicile durant la pandemie COVID-19 serait associe a une augmentation du nombre de cas d'ingestions de corps etrangers et leur severite. Nos objectifs etaient de comparer l'incidence d'ingestions pediatriques de corps etrangers et le taux de cas severes (hospitalisation, complications ou interventions par endoscopie) avant et pendant la pandemie. Methodes: Toutes les consultations pediatriques au CHU Sainte-Justine de Montreal pour ingestion de corps etrangers entre mars 2018 et fevrier 2020 (pre-pandemie) ainsi qu'entre mars 2020 et fevrier 2021 (pandemie) ont ete incluses (n=614). L'incidence d'ingestions de corps etrangers a ete calculee en rapportant le nombre de cas au nombre de visites aux urgences selon les periodes. Les differences entre les deux groupes ont ete analysees par un test T de Student ou Chi-carre. Resultats: L'age median des patients etait de 3,5 ans [(interquartile: 1,6-5,9);54 % garcons]. Le nombre mensuel moyen de cas (min-max) durant la pandemie [20,0 (12-28)] etait significativement plus eleve qu'avant la pandemie [15,5 (8-24)] (p=0,02). Le taux d'incidence a double, passant de 23,2 pour 10 000 visites aux urgences en pre-pandemie a 51,6 pour 10 000 visites pendant la pandemie (p=0,0002). Pres d'un quart de la cohorte a du etre hospitalise. Le taux d'hospitalisations (>1 jour) est reste stable entre les deux periodes: 6,95 % pre-pandemie et 7,08 % pendant la pandemie. Les taux d'endoscopies (21,3 %) et de complications (4,6 %) etaient similaires entre les deux periodes. Discussion/Conclusion: L'incidence d'ingestions de corps etrangers au CHU Sainte-Justine a augmente significativement durant la pandemie comparativement aux deux annees precedentes. Les taux eleves de cas severes, bien que stables durant la pandemie, temoignent de l'impact considerable des ingestions de corps etrangers en pediatrie. Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets.Copyright © 2022
ABSTRACT
BACKGROUND: Acute gastroenteritis is an important reason for emergency department (ED) consultation in children. Ondansetron is reported to be effective in reducing vomiting in children with gastroenteritis, leading to less intravenous rehydration and hospital admission. OBJECTIVE(S): The aim of this study was to assess the effectiveness of triage nurse-initiated administration of ondansetron for children with suspected gastroenteritis in the paediatric ED to reduce the number of patients requiring observation following the first physician assessment. DESIGN/METHODS: This was a randomized controlled trial performed in a tertiary care paediatric ED. All children 6 months to 17 years old who presented to the ED with at least four episodes of non-billous, non-bloody vomiting in the previous 24 hours and the last vomiting occurring within the previous 2h were eligible. The intervention consisted of administration of a liquid formulation of an adapted to weight dose of ondansetron at triage compared to a color- and taste-matched placebo. The primary outcome was the number of patients requiring observation after the first physician's evaluation. Secondary outcomes were the number of episodes of vomiting after receiving the intervention, length of stay in the ED, comfort, and the proportion of children who returned for a medical visit within 48 hours. A sample size of 248 participants was initially identified to have a power of 90% to find a 20% difference in the proportion of children needing observation following physician evaluation. RESULT(S): Because of multiple external factors, including the COVID-19 pandemic, recruitment was stopped before the expected sample size was reached. A total of 91 patients were included and randomized to receive ondansetron (n= 44) or a placebo (n=47) just after triage. The baseline characteristics of the participants was similar between the two groups. A total of 40 (45%) participants were discharged immediately after the first evaluation by the treating physician. This was similar for both groups 44% vs. 45%;(95% CI for the difference -20 to 19%). There was no difference between the two groups for the total length of stay (median 232 vs. 227 minutes;p= 0.677) and for the length of stay after being seen by the physician (72 vs. 68 minutes;p=0.821). There was no statistical difference between the two groups in the number of vomiting episodes (difference of 15%;95% CI -2, 31), and proportion of participants needing a rescue medication (difference: 19%;95%CI:-0.6 to 36%) or an intravenous rehydration (difference: 8;95%CI:-6, 22). CONCLUSION(S): This study failed to demonstrate any benefit in using ondansetron at triage for children with presumed gastroenteritis.
ABSTRACT
BACKGROUND: Nasopharyngeal (NP) swabs have been recommended to detect SARS-CoV-2 since the beginning of the COVID-19 pandemic, but are reported to be at least moderately painful. OBJECTIVE(S): To evaluate the efficacy of intranasal vaporized lidocaine compared to a sham treatment in reducing pain in children undergoing a NP swab in the Emergency Department (ED). DESIGN/METHODS: A randomized double-blinded clinical trial was conducted in a pediatric ED. Both participants and the researcher evaluating the primary outcome were blinded. Children 6 to 17 years old requiring a NP swab were eligible. Participants were randomly allocated to receive intranasal lidocaine or a sham treatment prior to their NP swab. The primary outcome measure was pain during the swab as assessed by the visual analog scale. Secondary outcome measures were pain using the verbal numeric rating scale, fear using the children fear scale, and side effects of the intervention. RESULT(S): Eighty-eight participants were enrolled: 45 to the lidocaine group and 43 to the control group. The mean visual analog scale scores for pain were 46 mm in the lidocaine group and 53 mm in the control group (mean difference 7 mm;95%CI -5 to 19 mm). The numeric rating scale and children fear scale were not statistically different between groups. No serious adverse events were observed. Fear prior to the test and younger age were associated with higher pain scores. CONCLUSION(S): Intranasal lidocaine administered prior to NP swabs in the ED did not lower pain scores for school-aged children and youth.
ABSTRACT
Background Foreign Body Ingestions (FBI), sometimes associated with severe complications, are a common reason for emergency unit visits in children. In Quebec, since March 2020, the restrictions in response to the COVID-19 pandemic have increased the time children spend at home. We hypothesized that this could contribute to a rise in FBI incidence and severity. Aims The primary objective of our study was to evaluate the incidence as well as the clinical presentation of FBI cases seen at CHU Sainte-Justine Children’s Hospital in Montreal (CHUSJ) during the COVID-19 pandemic as compared to the two previous years. Our secondary objectives were to estimate the rate of severe FBI (involving hospitalisations and/or complications) and to evaluate the nature of the foreign bodies that were ingested. Methods All children referred to or who presented at CHUSJ for FBI between March 2018 and February 2020 (pre-pandemic) as well as between March 2020 and February 2021 (pandemic) were included (n=690). Cases of food impaction were excluded (n=78). Incidence of FBI was calculated by dividing the number of FBI cases by the total number of emergency department visits per period. Differences between the two groups were analyzed by Student T test or Chi-square test. Results Between March 2018 and February 2021, 612 patients (median age 3.5 years (1.6–5.9);54% male) were eligible. The mean monthly number of FBI cases (min-max) in 2020–2021 was 18.6 (9–28), significantly higher than the year 2018 [16.6 (8–22)] and the year 2019 [15.5 (9–24)];p=0.04. The incidence rate of FBI doubled during the pandemic as compared to the prepandemic group: respectively 57.5/10,000 emergency department visits and 23.2/10,000 visits (p=0.002). Almost one fourth of the cohort was hospitalized. The hospitalization rate (>1 day) was similar between the 2 periods: 8.8% before the pandemic and 7.1% during the pandemic. Digestive endoscopy was performed in 21.5% of cases, a rate similar before and during the pandemic. A total of 3.3% of the children developed complications related to FBI. This rate remained stable between the two periods. The most frequently ingested objects were coins (25.0%), toys (10.8%), button batteries (10.6%), magnets (6.2%), and jewellery (6.2%). There was no significant difference in the nature of FB ingested between the 2 periods although the number of magnet ingestions increased during the pandemic (18 per year vs 10 per year). Conclusions The incidence of FBI increased significantly during the pandemic in comparison with the two previous years. The high hospitalization and complications rates, although stable during the pandemic, underline the significant impact of pediatric FBI. Funding Agencies None