Paracetamol overdose in Danish children and adolescents during the Covid-19 restrictions.

INTRODUCTION: To assess the effect of long-term isolation on the mental state of Danish youth. This study aimed to investigate trends in paracetamol overdoses among people under 18 years of age in Denmark during Covid-19 restrictions as an indicator of mental health. METHODS: All patients under the age of 18 years presenting with paracetamol overdose at one of the 18 paediatric departments in Denmark from 2016 to 2021 were included. They were identified in all Danish hospital databases using specific diagnostic codes. RESULTS: From 2016 to 2021, a total of 3,217 people under 18 years of age were admitted for paracetamol overdose. Among these, 86% (n = 2,755) were girls and 14% (n = 462) were boys. During 2020, a slight (7%) decrease in admissions was observed among both boys and girls compared with the preceding four-year mean value. In 2021, the number of overdoses among girls exceeded by 35% the former all-time high from 2016. Furthermore, the number of overdoses among girls exceeded the pre-four-year period mean value by 43%. Among boys, an 8% increase was seen from the highest ever previous value recorded in 2019 and a 23% increase compared with the previous four-year mean value. CONCLUSIONS: During the first year of restrictions, a slight decrease in paracetamol overdoses was observed, possibly associated with limited accessibility. The second year showed a considerable increase in paracetamol overdoses, which may imply an affected mental state among youth during the prolonged lockdown restrictions as seen in previous epidemics. Therefore, further studies are warranted to develop a pandemic preparedness plan to protect general mental health. FUNDING: None. TRIAL REGISTRATION: Not relevant.

Video Tutorials to Empower Caregivers of Ill Children and Reduce Health Care Utilization: A Randomized Clinical Trial.

Importance: Young children often fall ill, leading to concern among their caregivers and urgent contact with health care services. Objective: To assess the effectiveness and safety of video tutorials to empower caregivers in caring for acutely ill children. Design, Setting, and Participants: Caregivers calling the out-of-hours Medical Helpline 1813 (MH1813), Emergency Medical Services Capital Region, Denmark, and their children aged 0.5 to 11.9 years were randomized to video tutorials (intervention) or telephone triage by a nurse or physician (control) from October 2020 to December 2021 and followed up for 72 hours blinded to the intervention. Data were analyzed from March to July 2022. Intervention: The intervention group had the call disconnected before telephone triage and received video tutorials on managing common symptoms in acutely ill children and when to seek medical help. Caregivers could subsequently call MH1813 for telephone triage. Main outcomes and measures: The primary outcome was caregivers' self-efficacy, reported in an electronic survey the following day. Secondary outcomes were satisfaction, child status, assessment by a general practitioner or physician at the hospital, telephone triage, and adverse events during the 72-hour follow-up period. Results: In total, 4686 caregivers and children were randomized to intervention (2307 participants) or control (2379 participants), with a median (IQR) child age of 2.3 (1.3-5.1) years and 53% male distribution in both groups (2493 participants). Significantly more caregivers in the intervention group reported high self-efficacy (80% vs 76%; crude odds ratio [OR], 1.30; 95% CI, 1.01-1.67; P = .04). The intervention group received fewer telephone triages during follow-up (887 vs 2374 in the control group). Intention-to-treat analysis showed no difference in secondary outcomes, but per-protocol subanalysis showed fewer hospital assessments when caregivers watched video tutorials (27% vs 35%; adjusted OR, 0.67; 95% CI, 0.55-0.82). Randomization to video tutorials did not increase adverse outcomes. Conclusions and relevance: In this randomized clinical trial, offering caregivers video tutorials significantly and safely increased self-efficacy and reduced use of telephone triage. Children had fewer hospital assessments when caregivers watched videos. This suggests a future potential of health care information to empower caregivers and reduce health care utilization. Trial Registration: ClinicalTrials.gov Identifier: NCT04301206.

Video triage in calls concerning children with fever at an out-of-hours medical helpline: a prospective quality improvement study.

BACKGROUND: Parents often contact out-of-hours services due to worry concerning febrile children, despite the children rarely being severely ill. As telephone triage of children is challenging, many children are referred to hospital assessment. This study investigated if video triage resulted in more children staying at home. Secondary aims included safety, acceptability and feasibility of this new triage tool. METHODS: In this prospective quality improvement study, nurse call-handlers enrolled febrile children aged 3 months-5 years to video or telephone triage (1:1), with follow-up within 48 h after call. The setting was an out-of-hours call-center for non-urgent illness in Copenhagen, Denmark, receiving over 1 million calls annually and predominately staffed by registered nurses. Main outcome measure was difference in number of children assessed at hospital within 8 h after call between video-and telephone triage group. Rates of feasibility, acceptability and safety (death, lasting means, transfer to intensive care unit) were compared between the triage groups. RESULTS: There was no difference in triage outcome (home care vs. hospital referral) or number of patients assessed at hospital between triage groups. However, more video triaged patients received in-hospital treatment, testing and hospitalization. CONCLUSION: Video triage was feasible to conduct, acceptable to parents and as safe as telephone triage. The study did not show that more children stayed at home after video triage, possibly because the allocation strategy was not upheld, as video triage sometimes was chosen in cases of complex and severe symptoms, and this likely has changed study outcome. TRIAL REGISTRATION: Clinicaltrials.gov.: Id NCT04074239. Registered 2019-08-30. https://clinicaltrials.gov/ct2/show/study/NCT04074239.

Video triage of children with respiratory symptoms at a medical helpline is safe and feasible-a prospective quality improvement study.

BACKGROUND: Young children are among the most frequent patients at medical call centers, even though they are rarely severely ill. Respiratory tract symptoms are among the most prevalent reasons for contact in pediatric calls. Triage of children without visual cues and through second-hand information is perceived as difficult, with risks of over- and under-triage. OBJECTIVE: To study the safety and feasibility of introducing video triage of young children with respiratory symptoms at the medical helpline 1813 (MH1813) in Copenhagen, Denmark, as well as impact on patient outcome. METHODS: Prospective quality improvement study including 617 patients enrolled to video or standard telephone triage (1:1) from February 2019-March 2020. Data originated from MH1813 patient records, survey responses, and hospital charts. Primary outcome was difference in patients staying at home eight hours after the call. Secondary outcomes weas hospital outcome, feasibility and acceptability. Adverse events (intensive care unit admittance, lasting injuries, death) were registered. Logistic regression was used to test the effect on outcomes. The COVID-19 pandemic shut the study down prematurely. RESULTS: In total, 54% of the included patients were video-triaged., and 63% of video triaged patients and 58% of telephone triaged patients were triaged to stay at home, (p = 0.19). Within eight and 24 hours, there was a tendency of fewer video-triaged patients being assessed at hospitals: 39% versus 46% (p = 0.07) and 41% versus 49% (p = 0.07), respectively. At 24 hours after the call, 2.8% of the patients were hospitalized for at least 12 hours. Video triage was highly feasible and acceptable (>90%) and no adverse events were registered. CONCLUSION: Video triage of young children with respiratory symptoms at a medical call center was safe and feasible. Only about 3% of all children needed hospitalization for at least 12 hours. Video triage may optimize hospital referrals and increase health care accessibility.

"We can't do without it": Parent and call-handler experiences of video triage of children at a medical helpline.

BACKGROUND: Pediatric out-of-hours calls are common, as parents worry and seek reassurance and shared responsibility. Nevertheless, most children assessed in this context are not seriously ill. Conventional telephone triage lacks visual cues and is further limited by third part communication in calls concerning children. We investigated implementation of video triage in two previous studies. The aim of the present study was to investigate 1) How video triage versus telephone triage in children was experienced by parents and call-handlers, and 2) call-handlers' evaluation of the video triage projects. METHODS: We triangulated data from surveys and interviews in five sub-studies. Sub-study 1: Parents' experience of video triage reported in closed-ended questionnaire items using quantitative analysis; Sub-study 2: Parents' experience of video triage reported as questionnaire free-text using qualitative content analysis; Sub-study 3: Call-handlers' experience of video triage reported in closed-ended questionnaire items using quantitative analysis; and Sub-studies 4 and 5: Individual interviews of call-handlers' experience of 1) video triage using thematic analysis and 2) the video triage project using process evaluation. RESULTS: Most parents' comments regarding video triage were positive (n = 164, 83%). Video triage was perceived as reassuring and reducing the likelihood of misunderstandings and unnecessary hospital visits. Call-handlers experienced that video triage improved patient assessment and caller reassurance. Some call-handlers complained that the time allocated for study participation was inadequate and requested a more accessible video set-up. Both parents and call-handlers were significantly more satisfied and reassured after video triage than after telephone triage and suggested video triage as a permanent option. CONCLUSION: Video triage was appreciated by parents and call-handlers and was recommended as a permanent option. The call-handlers suggested that designated time for participation in the studies would have been desirable in this busy call-center. We recommend video triage as a contemporary solution in out-of-hours service.

[Anaphylaxis in children and adults].

In this review, we discuss anaphylaxis, which is a severe allergic condition with potentially life-threatening symptoms from airways or circulation and often associated with skin symptoms. First-line treatment is intramuscular adrenaline given by autoinjector for rapid administration. Initial dose for children less than 25 kg is 0.15 mg and for children ≥ 25 kg and adults 0.3 mg. Repeated smaller doses of adrenaline is to be preferred. Patients with severe anaphylaxis will need an IV access for fluid replacement and supplementary oxygen. Antihistamines and steroids are only second-line treatment after adrenaline administration.

Poor compliance with antimicrobial guidelines for childhood pneumonia.

INTRODUCTION: Antimicrobial stewardship programmes recommend use of narrow-spectrum antibiotics as first-line treatment of childhood pneumonia in secondary care. The primary aim of the present study was to assess whether current guidelines are followed. A secondary aim was to assess if tracheal aspiration is a useful tool in the diagnostic process of suspected childhood pneumonia. METHODS: This was a retrospective descriptive single-centre cohort study. Children between three months and 17 years with a pneumonia diagnosis were included. The children were divided into two groups based on whether or not they had been treated with antibiotics (TWA) by their general practitioner. We obtained information on blood samples, treatment and microbial findings. Finally, we compared the use of antibiotics and the microbiological diagnosis of children TWA prior to admittance with those of drug-naïve children (DN). RESULTS: Guidelines were followed in 55% (n = 78) of the cases, which is comparable to results reported by other studies. Tracheal aspiration culture identified a bacterial pathogen in 54% (n = 77) of the cases; Haemophilus influenzae was the most prevalent. A larger percentage of tracheal aspirations was positive in the TWA group than in the DN group (66%; n = 31 versus 48%; n = 46). CONCLUSIONS: Compliance with local guidelines was comparable to findings reported in similar single-centre studies. Airway aspiration may be a useful supplement to other investigations. FUNDING: none. TRIAL REGISTRATION: not relevant.

[Epidural abscess secondary to sinusitis].

Approximately 0.5-2% of upper viral infections are com-licated by secondary acute bacterial sinusitis and may in rare cases evolve into more serious complications such as meningitis and intracranial abscess. Symptoms are often subtle and nonspecific as fever, headache, scalp tenderness, nausea and altered mental status. In this case report of a 12-year-old boy with an epidural abscess secondary to sinusitis we intend to increase the knowledge to these rare, but potentially life-threatening complications to ensure the optimal and timely treatment.

[Multiple mini interviews before the occupation of main training posts in paediatrics]. / Multiple miniinterview før besættelse af pædiatriske hoveduddannelsesstillinger er gennemførlige.

Interviews are mandatory in Denmark when selecting doctors for training positions. We used multiple mini interviews (MMI) at four recruitment rounds for the main training posts in paediatrics. In total, 125 candidates were evaluated and assessed by CV and MMI (4-5 stations). Reliability for individual stations in MMI assessed by Cronbach's alpha was adequate (0.63-0.92). The overall reliability assessed by G-theory was lower, suggesting that different skills were tested. The acceptability was high. Our experiences with MMI suggest good feasibility and reliability. An increasing number of stations may improve the overall reliability.

Changing epidemiology of pediatric Staphylococcus aureus bacteremia in Denmark from 1971 through 2000.

BACKGROUND: Staphylococcus aureus is known to be a leading cause of bacteremia in childhood, and is associated with severe morbidity and increased mortality. To determine developments in incidence and mortality rates, as well as risk factors associated with outcome, we analyzed data from 1971 through 2000. METHODS: Nationwide registration of S. aureus bacteremia (SAB) among children and adolescents from birth to 20 years of age was performed. Data on age, sex, source of bacteremia, comorbidity and outcome were extracted from discharge records. Rates were population adjusted and risk factors for death were assessed by multivariate logistic regression analysis. RESULTS: During the 30-year study period, 2648 cases of SAB were reported. Incidence increased from 4.6 to 8.4 cases per 100,000 population and case-mortality rates decreased from 19.6% to 2.5% (P = 0.0001). Incidence in the infant age group (<1 year) were 10- to 17-fold greater compared with that in the other age strata and mortality rate was twice as high. Hospital-acquired infections dominated the infant group, accounting for 73.9%-91.0% versus 39.2%-50.5% in the other age groups. By multivariate analysis, pulmonary infection and endocarditis for all age groups, comorbidity for the older than 1 year, and hospital-acquired infections for the oldest group were independently associated with an increased risk of death. CONCLUSIONS: Mortality rates associated with SAB decreased significantly in the past 3 decades, possibly because of new and improved treatment modalities. However, incidence rates have increased significantly in the same period, underscoring that S. aureus remains an important invasive pathogen.

Immunisation with aluminium-containing vaccine of a child with itching nodule following previous vaccination.

Vaccination of children with aluminium sensitisation against diphtheria and tetanus presents a problem, since vaccine without aluminium against these potentially serious infectious diseases is no longer available. This case report presents a 7-month-old boy who, after his second immunisation with DTaP-IPV, developed an itching injection site nodule. Before being tested for aluminium sensitisation, he was vaccinated again with DTaP-IPV without developing any reactions. This third vaccine dose was administered intramuscularly.

Erythema multiforme minor following vaccination with paediatric vaccines.

We present 2 cases of erythema multiforme following a combined tetanus and diphtheria revaccination and a combined diphtheria, tetanus, acellular pertussis inactivated polio and Haemophillus influenzae type B vaccine respectively, suggesting vaccines containing diphtheria and tetanus toxoids as a potential precipitating factor to erythema multiforme.

[Varicella disease and varicella vaccine. A literature review]. / Skoldkoppesygdom og -vaccine. En litteraturgennemgang.

Varicella is an infectious childhood disease. A safe and effective vaccine is accessible. The varicella disease usually takes a mild course but studies performed outside Denmark reveal a considerable occurrence of complications. There is no Danish account of morbidity and mortality following infection with varicella-zoster virus. According to experience from the USA, the introduction of routine vaccination will result in a decreasing incidence of the disease and will also reduce the frequency of complications caused by the disease. In addition, it will give indirect protection of non-vaccinated individuals (herd immunity). Introducing vaccination against varicella involves a potential risk of changing the epidemiology of the disease. Moreover, routine vaccination may affect the frequency and the severity of herpes zoster. Experience from the USA will give us a better basis of deciding whether vaccination against varicella should be implemented or not in the Danish childhood vaccination programme.