Prevalence of SARS-CoV-2 antibodies in pediatric healthcare workers.

OBJECTIVES: To determine SARS-CoV-2-antibody prevalence in pediatric healthcare workers (pHCWs). DESIGN: Baseline prevalence of anti-SARS-CoV-2-IgG was assessed in a prospective cohort study from a large pediatric healthcare facility. Prior SARS-CoV-2 testing history, potential risk factors and anxiety level about COVID-19 were determined. Prevalence difference between emergency department (ED)-based and non-ED-pHCWs was modeled controlling for those covariates. Chi-square test-for-trend was used to examine prevalence by month of enrollment. RESULTS: Most of 642 pHCWs enrolled were 31-40years, female and had no comorbidities. Half had children in their home, 49% had traveled, 42% reported an illness since January, 31% had a known COVID-19 exposure, and 8% had SARS-CoV-2 PCR testing. High COVID-19 pandemic anxiety was reported by 71%. Anti-SARS-CoV-2-IgG prevalence was 4.1%; 8.4% among ED versus 2.0% among non-ED pHCWs (p < 0.001). ED-work location and known COVID-19 exposure were independent risk factors. 31% of antibody-positive pHCWs reported no symptoms. Prevalence significantly (p < 0.001) increased from 3.0% in April-June to 12.7% in July-August. CONCLUSIONS: Anti-SARS-CoV-2-IgG prevalence was low in pHCWs but increased rapidly over time. Both working in the ED and exposure to a COVID-19-positive contact were associated with antibody-seropositivity. Ongoing universal PPE utilization is essential. These data may guide vaccination policies to protect front-line workers.

Centralization of Prehospital Triage Improves Triage of Pediatric Trauma Patients.

INTRODUCTION: This study describes the experience at a level 1 pediatric trauma center before and after the centralization of prehospital trauma triage, focusing on the rate of undertriage of trauma patients. Before centralization, emergency physicians were responsible for triaging these patients with mainly physiology-based criteria; after centralization, paramedics in a communication center performed this function using the same criteria. METHODS: This retrospective study includes 10 years of pediatric trauma registry patients at our institution, 5 years before and after centralization of prehospital triage. Rates of undertriage were calculated by both the Cribari Method and by disposition from the emergency department. Logistic regression was used to assess the effect of centralization on the incidence of undertriage while adjusting for differences in case-mix. RESULTS: Over the 10-year study period, 1862 trauma activations meeting inclusion and exclusion criteria were recorded in the trauma registry: 893 patients in the precentralization and 969 in the postcentralization groups. After centralization of the triage process, there were statistically significant decreases in the rates of undertriage from 8.7% to 4.2% (adjusted odds ratio, 0.49; 95% confidence interval, 0.33-0.73) when analyzed by the Cribari Method and from 37.7% to 27.7% when analyzed by disposition from the emergency department (adjusted odds ratio, 0.66; 95% confidence interval, 0.64-0.81). This represents a reduction in undertriage by 51.7% and 26.5%, respectively. CONCLUSIONS: Centralization of prehospital trauma triage at a level 1 pediatric trauma facility significantly reduced undertriage rates. Trauma centers should consider similar processes to improve prehospital triage.

Instant Cup of Soup: Can Kids Safely Prepare and Carry?

Scalds are a common cause of burn injury in children. Instant soup and noodle products have been identified as a common cause of pediatric burn injuries, with both the preparation process and product packaging implicated as predisposing factors. A cohort of children was observed simulating the preparation of a cup of noodle soup to identify steps in the process in which injury was mostly likely to occur. Nineteen percent of participants spilled the simulated soup onto themselves, representing potential burn injuries had the liquid been hot. The upper extremity was the most commonly affected body area and spillage occurred most commonly while the participant was transporting the cup of simulated soup. Targeted caregiver education about the potential dangers to children from instant soup and noodle products and investigation into safer packaging are needed to decrease the risk of these injuries in children.

Pediatric Scald Injuries Sustained From Instant Soup and Noodle Products.

Background and Objective. Scald burns are a major cause of pediatric burn injuries. Instant soups have been identified as one source of these injuries. This study aims to quantify and characterize these injuries in pediatric patients. Methods. Ten-year query of National Electronic Injury Surveillance System (NEISS) database identified instant soup- and noodle-related scald burns in children aged 4 to 12 years. Data included patient demographics, injured body part, case narratives, and emergency department disposition. Results. A total of 4518 cases were identified, yielding an estimate of 9521 cases/year in the United States. Younger children were affected more than the older. Trunk was the most commonly burned body area. Approximately 10% of injuries required admission or transfer for further care. Conclusion. Instant soup and noodle products are a common cause of pediatric scald burns, potentially injuring 25 children per day in the United States and leading to high rates of health care utilization.

Comparison of a Smartphone Otoscope and Conventional Otoscope in the Diagnosis and Management of Acute Otitis Media.

Acute otitis media (AOM) is a leading cause of health encounters and antimicrobial prescriptions in children worldwide. We assessed (1) the rates of antimicrobial prescribing by pediatric emergency department clinicians using a smartphone otoscope device as compared with a conventional otoscope and (2) clinician acceptability of the smartphone device. We conducted a randomized control study in children's hospital emergency departments over 6 months. More than 1500 encounters were analyzed. The odds of prescribing antibiotics after being given a diagnosis of AOM by clinicians assigned to the smartphone group was 11% higher than the conventional group (18.8% vs 18.0%, odds ratio = 1.106, P = .600). Eight (73%) of the 11 physicians in the smartphone group preferred the smartphone device over the conventional otoscope. Use of a smartphone otoscope for detection of AOM in a pediatric emergency department setting did not lead to an increased likelihood of AOM diagnosis.

Adult patients in the pediatric emergency department: presentation and disposition.

BACKGROUND: Pediatric emergency departments (PEDs) are intended to care for acutely ill and injured children. Adult patients sometimes present to these facilities as well. Some of these are young adults still under the care of pediatric specialists, but older adults and those not under the care of specialists may seek care and may challenge pediatric care providers. Understanding the spectrum of adult illness encountered in the PED may help ensure optimum care for this patient population. OBJECTIVE: This study aimed to describe the presentations of adult patients in 2 high-volume PEDs of a pediatric health care system. METHODS: This is a retrospective review of electronic medical record to identify all visits for patients 21 years or older between 2008 and 2010. Patient demographics, reason for visit, diagnosis, and treatment details were identified. RESULTS: The combined PEDs recorded 417,799 total visits with 1097 patients 21 years or older; 188 of these were still followed by pediatric specialists. For the 907 remaining, the mean age was 36.5.years (range, 21-88 years); 73% were female. Fifty-one percent of the patients were triaged into the highest acuity levels. Fifty-seven percent of the patients were transferred to adult facilities for definitive care. There were no deaths among these patients at either PED, but 2 patients did require intubation and 1 received a period of chest compressions. Reason for presenting to the PED included on-site visitor (45%), mistakenly presented to children's hospital (34%), and hospital employee (21%). The most common presenting complaints were neurologic conditions, trauma/acute injuries, and chest pain. CONCLUSIONS: Adult patients in PEDs are rare but have relatively high acuity and often require transfer. Pediatric emergency department clinicians should have adequate, ongoing training to capably assess and stabilize adult patients across a spectrum of illness presentation.

Effects of immigration enforcement legislation on Hispanic pediatric patient visits to the pediatric emergency department.

OBJECTIVE: To compare the visits by Hispanic patients to the pediatric emergency department (PED) before and after passage of Georgia House Bill 87 (HB87). This bill grants local law enforcement the authority to enforce immigration laws. METHODS: A retrospective chart review of all Hispanic patients who presented to the PED in a 4-month period after implementation of HB87 in 2011 was conducted and compared with the same period in 2009 and 2010. Data compared included patient acuity score, disposition, payer status, and demographics. RESULTS: Fewer Hispanic patients presented to the ED after passage of the bill (18.3% vs 17.1%, P < .01), more patients were high acuity, and more patients were admitted to the hospital. CONCLUSION: The Hispanic population was the only group to see a decrease in visits and increase in acuity in the post-bill period. These results suggest potential adverse health effects on members of a specific group as a result of immigration legislation.