ABSTRACT
PURPOSE: Primary cardiac events are rare in children. There is little information in the literature regarding the most appropriate emergency department (ED) management of this type of pediatric patient, especially with regard to medication use. SUMMARY: This case highlights the pediatric ED evaluation and treatment of sudden collapse in a child with an ultimate diagnosis of hypertrophic cardiomyopathy. Cardiac disorders represent 2% to 6% of cases of pediatric syncope presenting to EDs, particularly if there are previous prodromal symptoms and/or a history of exertion. Evaluation should include electrocardiogram, chest radiograph, and echocardiogram if available. Management should focus on decreasing the potential for a recurring arrhythmia while maintaining cardiac preload, which can be worsened with certain medication use. CONCLUSIONS: Although primary cardiac events in children are rare, a high index of suspicion should be maintained especially with a history of prodromal symptoms or collapse during exertion. If cardiac etiology is suspected, deliberate management should be used to exclude a treatment that could be detrimental. This case report provides an initial assessment and recommendations for management of these patients.
Subject(s)
Cardiomyopathy, Hypertrophic, Familial/complications , Cardiomyopathy, Hypertrophic, Familial/diagnosis , Syncope/etiology , Cardiomyopathy, Hypertrophic, Familial/genetics , Carrier Proteins/genetics , Child , Echocardiography , Electrocardiography , Emergency Medical Services , Emergency Service, Hospital , Heart Ventricles/diagnostic imaging , Humans , Magnetic Resonance Imaging, Cine , Male , Mutation , Sarcomeres/genetics , Stroke VolumeABSTRACT
Sudden cardiac arrest (SCA) in the pediatric population is a rare and potentially devastating occurrence. An understanding of the differential diagnosis for the etiology of the cardiac arrest allows for the most effective emergency care and provides the patient with the best possible outcome. Pediatric SCA can occur with or without prodromal symptoms and may occur during exercise or rest. The most common cause is arrhythmia secondary to an underlying channelopathy, cardiomyopathy, or myocarditis. After stabilization, evaluation should include electrocardiogram, chest radiograph, and echocardiogram. Management should focus on decreasing the potential for recurring arrhythmia, maintaining cardiac preload, and thoughtful medication use to prevent exacerbation of the underlying condition. The purpose of this review was to provide the emergency physician with a concise and current review of the incidence, differential diagnosis, and management of pediatric patients presenting with SCA.
Subject(s)
Cardiopulmonary Resuscitation/methods , Death, Sudden, Cardiac/etiology , Emergency Treatment/methods , Child, Preschool , Death, Sudden, Cardiac/prevention & control , Diagnosis, Differential , Disease Management , Humans , PediatricsABSTRACT
OBJECTIVES: Acute appendicitis is common in the pediatric population and is difficult to diagnose in adolescent females. The validated Pediatric Appendicitis Score (PAS) has unclear utility in female adolescents. The purpose of this study is to determine the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the PAS for female adolescents compared to all other patients. METHODS: This study examined a retrospective observational cohort of patients ages 3 to 21 years in a pediatric emergency department with prospectively assigned PAS from an existing database. We compared the sensitivity, specificity, PPV, and NPV of the PAS for acute appendicitis among female adolescent patients (13 to 21 years) and all other patients. RESULTS: Of the 1,228 patients enrolled, 901 (73.4%) had a complete PAS. Among the 901 patients, 249 (27.6%) had pathology-proven appendicitis, 494 (54.8%) were female, and 272 (30.2%) were adolescent females. At a cutoff of ≥8, the PAS showed a specificity of 89% for adolescent females and 78% for all other patients (p < 0.001), although the specificities did not differ at a cutoff of ≥7. At both cutoffs, the PPVs were poor in both groups. At a cutoff of ≥3, the PAS showed similar sensitivities in both groups. At a cutoff of <3, the NPVs did not significantly differ between groups. CONCLUSION: At a cutoff of ≥8 (although not ≥7), the PAS demonstrated a higher specificity among female adolescents compared to all other patients. The PPV for both cutoffs in both groups were poor. At a cutoff of ≥3, sensitivities were equivalent. The NPV for a cutoff of <3 was acceptable but similar in both groups. While sensitivities were similar to previously reported, specificities in both groups were lower. This highlights the need for further investigation of the PAS's performance in specific subpopulations.
