Trauma association of Canada Pediatric Subcommittee National Pediatric Cervical Spine Evaluation Pathway: consensus guidelines.

BACKGROUND: The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote "best practices" and improve patient outcomes. In 2006, The Trauma Association of Canada Pediatric Committee set out to create an evidence-based, national pediatric cervical spine (c-spine) clearance guideline based on the literature, existing algorithms from each pediatric trauma center and from expert opinion from across Canada. METHODS: A review of the literature took place in September 2006 using the PubMed database. Search criteria were "cervical spine," "c-spine," "clearance," and "trauma." Limits that were applied were "Languages: English," "Humans," "Type of Article: Meta-Analysis, Practice Guidelines, Randomized Control Trial, Review," and "Ages: all child 0-18 years." These search criteria were repeated in December 2007, April 2009, and October 2009. A total of 248 articles were identified. Existing guidelines were identified and their practices examined as models of care. Two draft guidelines were created for discussion: one for the pediatric patient with a reliable clinical examination and the other for the pediatric patient with an unreliable clinical examination. Via email, telephone, and two national videoconferences, the content of the guidelines was reviewed, discussed, and amended. The final article was prepared and circulated for author input until consensus was reached. RESULTS: A consensus was reached on two pathways to evaluate the pediatric cervical spine: a patient with a reliable clinical examination and a patient with an unreliable examination. CONCLUSION: Presented herein are the consensus Trauma Association of Canada, National Pediatric Cervical Spine Evaluation Pathways for the patient with a reliable clinical examination, and the patient with and unreliable clinical examination.

Intranasal fentanyl versus placebo for pain in children during catheterization for voiding cystourethrography.

BACKGROUND: Voiding cystourethrogram (VCUG) is a common procedure at pediatric tertiary care centres that can be painful as it involves a urinary catheter. Currently there are no widely utilized protocols for non-topical medications to decrease pain that children feel during catheterization. OBJECTIVE: To determine if intranasal (IN) fentanyl is effective at decreasing pain that children feel during catheterization of VCUG when compared with sterile water. MATERIALS AND METHODS: We performed a double-blind randomized controlled trial, using IN fentanyl (2 microg/kg) compared to placebo (sterile water,) in children 4-8 years of age scheduled for elective VCUG in one urban pediatric tertiary center. RESULTS: Using the Face Pain Score-Revised, children receiving IN fentanyl scored 2.58 (1.93-3.25 95% CI) while those receiving sterile water scored 2.86 (2.20-3.51 95% CI) showing no statistically significant difference. There were no adverse events. CONCLUSIONS: Although we were unable to show a statistically significant difference between our study and control groups, we believe that this may be due to technique (positioning, delivery device) and timing of administration of IN fentanyl as well as multi-factorial causes of distress during VCUG. Future studies investigating alternative delivery techniques of IN fentanyl for analgesia during VCUG may yield more promising results.

Polyethylene glycol 3350 without electrolytes for treatment of childhood constipation.

UNLABELLED: ABSTRACT QUESTION: I have come across many pediatric patients with functional constipation. Is polyethylene glycol 3350 without electrolytes a safe and effective long-term treatment option for these patients? ANSWER: Functional constipation is a common and often difficult problem for parents and families to deal with. Polyethylene glycol 3350 is a safe and effective long-term laxative in pediatric populations, but there are limited studies for its use in children younger than 2 years of age.