Features of COVID-19 post-infectious cytokine release syndrome in children presenting to the emergency department.

The 2019 coronavirus disease (COVID-19) has not appeared to affect children as severely as adults. However, approximately 1 month after the COVID-19 peak in New York City in April 2020, cases of children with prolonged fevers abruptly developing inflammatory shock-like states have been reported in Western Europe and the United States. This case series describes four previously healthy children with COVID-19 infection confirmed by serologic antibody testing, but negative by nasopharyngeal RT-PCR swab, presenting to the Pediatric Emergency Department (PED) with prolonged fever (5 or more days) and abrupt onset of hemodynamic instability with elevated serologic inflammatory markers and cytokine levels (IL-6, IL-8 and TNF-α). Emergency physicians must maintain a high clinical suspicion for this COVID-19 associated post-infectious cytokine release syndrome, with features that overlap with Kawasaki Disease (KD) and Toxic Shock Syndrome (TSS) in children with recent or current COVID-19 infection, as patients can decompensate quickly.

Reduction of Radiography with Point-of-Care Elbow Ultrasonography for Elbow Trauma in Children.

OBJECTIVES: To determine whether point-of-care elbow ultrasound (US), with history and physical examination, can decrease radiography for patients with elbow trauma. Secondary outcomes included evaluation of pediatric emergency department (PED) length of stay (LOS) and test performance characteristics. STUDY DESIGN: This was a prospective study of patients up to age 21 years with elbow trauma necessitating radiography. After clinical examination and before radiography, pediatric emergency physicians performed elbow ultrasonography of the posterior fat pad and determined whether radiography was required. All patients underwent elbow radiography and received clinical follow-up. Times for US and radiography were recorded. RESULTS: A total of 100 patients with a mean age of 7.9 years were enrolled, 42 of whom had a fracture. In 23 patients, the physician determined that radiography could be eliminated. Elbow US combined with clinical suspicion for fracture had a sensitivity of 100% (95% CI, 92%-100%). Elbow US took a median of 3 minutes (IQR, 2-5 minutes), and completion and interpretation of elbow radiography took a median of 60 minutes (IQR, 43-84 minutes). The overall sensitivity of elbow US was 88% (95% CI, 75%-96%). CONCLUSIONS: Elbow US has a high sensitivity to rule out fracture and is best used in patients with a low clinical suspicion of fracture. The use of conventional radiography and PED LOS may be reduced in patients with a low clinical concern for fracture and normal elbow US.