Sore throat accounts for a whopping 7.3 million outpatient pediatric visits. Group A Streptococcus (GAS) accounts for 20-30% of pharyngitis cases with the rest being primarily viral in etiology. However, clinically differentiating viral versus bacterial causes of pharyngitis is difficult and we, as providers, often don’t get it right. In addition, antimicrobial resistance is increasing.. So who do we test and when do we treat for strep throat? The 2012 Infectious Diseases Society of America (IDSA) guideline on GAS pharyngitis helps answer these questions.(more…)
New PECARN Febrile Infant Rule: A 3-Variable Approach for Ages 29-60 Days | Interview with Dr. Kuppermann
The diagnosis and risk stratification of febrile young infants continues to present a clinical challenge. Serious bacterial infection (SBI) rates in infants ≤60 days have continued to be reported between 8-13%. Despite several different classification rules and pathways, we continue to struggle to accurately delineate which infants have SBI and which do not. A paper titled “A Clinical Prediction Rule to Identify Febrile Infants 60 days and Younger at Low Risk for Serious Bacterial Infections” was published in JAMA Pediatrics in February of 2019.1 The authors sought to derive a new clinical prediction rule for infants with fever. The research was conducted as part of the Pediatric Emergency Care Applied Research Network (PECARN). We discussed this publication with lead author Dr. Nathan Kuppermann on a podcast and summarize our discussion below.
The reported accuracy of the urinalysis (UA) for diagnosing urinary tract infections (UTI) is febrile infants ≤ 60 days has been widely variable. Some guidelines specifically exclude these patients due to this variability or recommend urine culture as the primary test.1
Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger, published in Pediatrics in February of 2018, addressed this topic head-on.2 The authors sought to evaluate the accuracy of the UA by analyzing data in a planned secondary analysis of a prospectively collected data set, as part of the Pediatric Emergency Care Applied Research Network (PECARN). We review this publication and present a behind-the-scenes podcast interview with lead author Dr. Leah Tzimenatos.
Insulin does MANY things in the body, but the role we care about in the Emergency Department is glucose regulation. Insulin allows cells to take up glucose from the blood stream, inhibits liver glucose production, increases glycogen storage, and increases lipid production. When insulin is not present, such as in patients with Type 1 diabetes mellitus (DM), all of the opposite effects occur.
The first recording from Little Patients, Big Medicine: the Pediatric Emergency Medicine (PEM) Podcast. This is an exciting interview with Dr. Halden Scott, a PEM physician at Children’s Hospital Colorado, about the use of lactate measurement in pediatric sepsis. Dr. Scott is one of the premier pediatric sepsis researchers, with a specific focus on the use of lactate measurement in the ED. We talk about the Sepsis-3 definitions and whether pediatrics will eventually follow them, Dr. Scott’s previous work on lactate use in the pediatric ED, and her new article published in March of 2017 on the association between elevated lactate in the ED and 30-day mortality in children. 1–6
Just as in adults, pediatric sepsis is a complex topic with continued research. In the United States, there are an estimated 75,000 cases per year of pediatric severe sepsis with an in-hospital mortality of 5-10%.1,2 This is one of the deadliest conditions treated in children. In addition, after the Rory Staunton case, New York State passed regulations requiring all hospitals to have pediatric specific recognition, treatment, and data reporting systems. Several other states have adopted, or are considering, similar requirements. Thus it is critical that emergency physicians understand at least the basics of pediatric sepsis management.