Severe outcomes among youths with SARS-CoV-2 infections are poorly characterized.
To estimate the proportion of children with severe outcomes within 14 days of testing positive for SARS-CoV-2 in an ...emergency department (ED).
This prospective cohort study with 14-day follow-up enrolled participants between March 2020 and June 2021. Participants were youths aged younger than 18 years who were tested for SARS-CoV-2 infection at one of 41 EDs across 10 countries including Argentina, Australia, Canada, Costa Rica, Italy, New Zealand, Paraguay, Singapore, Spain, and the United States. Statistical analysis was performed from September to October 2021.
Acute SARS-CoV-2 infection was determined by nucleic acid (eg, polymerase chain reaction) testing.
Severe outcomes, a composite measure defined as intensive interventions during hospitalization (eg, inotropic support, positive pressure ventilation), diagnoses indicating severe organ impairment, or death.
Among 3222 enrolled youths who tested positive for SARS-CoV-2 infection, 3221 (>99.9%) had index visit outcome data available, 2007 (62.3%) were from the United States, 1694 (52.6%) were male, and 484 (15.0%) had a self-reported chronic illness; the median (IQR) age was 3 (0-10) years. After 14 days of follow-up, 735 children (22.8% 95% CI, 21.4%-24.3%) were hospitalized, 107 (3.3% 95% CI, 2.7%-4.0%) had severe outcomes, and 4 children (0.12% 95% CI, 0.03%-0.32%) died. Characteristics associated with severe outcomes included being aged 5 to 18 years (age 5 to <10 years vs <1 year: odds ratio OR, 1.60 95% CI, 1.09-2.34; age 10 to <18 years vs <1 year: OR, 2.39 95% CI 1.38-4.14), having a self-reported chronic illness (OR, 2.34 95% CI, 1.59-3.44), prior episode of pneumonia (OR, 3.15 95% CI, 1.83-5.42), symptoms starting 4 to 7 days prior to seeking ED care (vs starting 0-3 days before seeking care: OR, 2.22 95% CI, 1.29-3.82), and country (eg, Canada vs US: OR, 0.11 95% CI, 0.05-0.23; Costa Rica vs US: OR, 1.76 95% CI, 1.05-2.96; Spain vs US: OR, 0.51 95% CI, 0.27-0.98). Among a subgroup of 2510 participants discharged home from the ED after initial testing and who had complete follow-up, 50 (2.0%; 95% CI, 1.5%-2.6%) were eventually hospitalized and 12 (0.5%; 95% CI, 0.3%-0.8%) had severe outcomes. Compared with hospitalized SARS-CoV-2-negative youths, the risk of severe outcomes was higher among hospitalized SARS-CoV-2-positive youths (risk difference, 3.9%; 95% CI, 1.1%-6.9%).
In this study, approximately 3% of SARS-CoV-2-positive youths tested in EDs experienced severe outcomes within 2 weeks of their ED visit. Among children discharged home from the ED, the risk was much lower. Risk factors such as age, underlying chronic illness, and symptom duration may be useful to consider when making clinical care decisions.
Objectives
To describe the rate of intensive care unit (ICU) admission, type of ventilation support provided and risk factors for ICU admission in infants with bronchiolitis.
Design
Retrospective ...review of hospital records and Australia and New Zealand Paediatric Intensive Care (ANZPIC) registry data for infants 2–12 months old admitted with bronchiolitis.
Setting
Seven Australian and New Zealand hospitals. These infants were prospectively identified through the comparative rehydration in bronchiolitis (CRIB) study between 2009 and 2011.
Results
Of 3884 infants identified, 3589 charts were available for analysis. Of 204 (5.7%) infants with bronchiolitis admitted to ICU, 162 (79.4%) received ventilation support. Of those 133 (82.1%) received non‐invasive ventilation (high flow nasal cannula HFNC or continuous positive airway pressure CPAP) 7 (4.3%) received invasive ventilation alone and 21 (13.6%) received a combination of ventilation modes. Infants with comorbidities such as chronic lung disease (OR 1.6 95% CI 1.0–2.6), congenital heart disease (OR 2.3 1.5–3.5), neurological disease (OR 2.2 1.2–4.1) or prematurity (OR 1.5 1.0–2.1), and infants 2–6 months of age (OR 1.5 1.1–2.0) were more likely to be admitted to ICU. Respiratory syncitial virus positivity did not increase the likelihood of being admitted to ICU (OR 1.1 95% CI 0.8–1.4). HFNC use changed from 13/53 (24.5% 95% CI 13.7–38.3) patient episodes in 2009 to 39/91 (42.9% 95% CI 32.5–53.7) patient episodes in 2011.
Conclusion
Admission to ICU is an uncommon occurrence in infants admitted with bronchiolitis, but more common in infants with comorbidities and prematurity. The majority are managed with non‐invasive ventilation, with increasing use of HFNC.
Objective
Bronchiolitis is the most common lower respiratory tract infection in infants and the leading cause of hospitalisation. We aimed to assess whether intravenous hydration (IVH) was more ...cost‐effective than nasogastric hydration (NGH) as a planned secondary economic analysis of a randomised trial involving 759 infants (aged 2–12 months) admitted to hospital with a clinical diagnosis of bronchiolitis and requiring non‐oral hydration. No Australian cost data exist to aid clinicians in decision‐making around interventions in bronchiolitis.
Methods
Cost data collections included hospital and intervention‐specific costs. The economic analysis was reduced to a cost‐minimisation study, focusing on intervention‐specific costs of IVH versus NGH, as length of stay was equal between groups. All analyses are reported as intention to treat.
Results
Intervention costs were greater for IVH than NGH ($113 vs $74; cost difference of $39 per child). The intervention‐specific cost advantage to NGH was robust to inter‐site variation in unit prices and treatment activity.
Conclusion
Intervention‐specific costs account for <10% of total costs of bronchiolitis admissions, with NGH having a small cost saving across all sites.
Objective
Paediatric head injury is a common presentation to the ED. North American studies demonstrate increasing use of computed tomography (CT) brain scan (CTB) to investigate head injury. No such ...data exists for Australian EDs. The aim of this study was to describe CTB use in head injury over time in eight Australian EDs.
Methods
Retrospective ED electronic database and medical imaging database audit was undertaken for the years 2001–2010 by International Classification of Diseases (ICD) 9 or 10 code for head injury in children <16 years. EDs and medical imaging departments of eight hospitals in Australia (five tertiary referral and three mixed departments). Data for ED presentations with head injury, and all CTB performed by medical imaging were merged to obtain a data set of CTB performed within 24 h for head injury‐related attendances to the ED. Descriptive and comparative analysis of CTB rates was performed.
Results
The rate of CTB over the decade was 10.2% (95% confidence interval (CI) 9.9–10.5). The annual rate varied from 9.5% (95% CI 8.2–10.9) to 12.5% (95% CI 11.2–13.9). CTB use did not increase over time. Median year of age at time of CT scan was 4 years, with an interquartile range of 1.5–9.4 years. Overall there was a 9.2% increase in the CTB scan rate for every additional year of age at presentation (95% CI 6.6–12.1; P < 0.001).
Conclusion
CTB use in head injuries did not increase during the study period, and rates of CTB were less than reported for North America.
Abstract The EpiNet project has been established to facilitate investigator-initiated clinical research in epilepsy, to undertake epidemiological studies, and to simultaneously improve the care of ...patients who have records created within the EpiNet database. The EpiNet database has recently been adapted to collect detailed information regarding status epilepticus. An incidence study is now underway in Auckland, New Zealand in which the incidence of status epilepticus in the greater Auckland area (population: 1.5 million) will be calculated. The form that has been developed for this study can be used in the future to collect information for randomized controlled trials in status epilepticus. This article is part of a Special Issue entitled "Status Epilepticus".
Objective
Pain is a common feature of ED presentations and the timely provision of adequate analgesia is important for patient care. However, there is currently no New Zealand data with respect to ...this indicator of care quality. The present study aimed to provide a baseline for the quality of care with respect to the provision of timely and adequate analgesia in New Zealand EDs.
Methods
The present study is a secondary analysis of data initially collected for the Shorter Stays in Emergency Department Study, using a retrospective chart review of 1685 randomly selected ED presentations (2006–2012) from 26 New Zealand public hospital EDs.
Results
Of the 1685 charts randomly selected, 1547 (91%) were reviewed from 21 EDs. There were 866 ED presentations with painful conditions, of whom 132 (15%) did not have pain recorded, 205 (24%) did not receive pain relief and 19 (2%) did not have time of analgesia documented leaving 510 (59%) for the analysis of time to analgesia. Four hundred and fifty‐seven (53%) did not have pain well documented sufficiently to assess adequacy, leaving 277 (32%) for the analysis of adequacy of analgesia. The median (interquartile range) time to analgesia was 62 (30–134) min and the provision of adequate analgesia was 141/277 (51%, 95% CI: 45–57%); however, there was some variation between hospitals for both outcomes.
Conclusion
Although these outcomes are on a par with other countries, this baseline audit has shown both poor documentation and variation in the provision of timely and adequate pain relief in New Zealand EDs, with room for improvement with respect to this quality indicator.
Background Head injuries in children are responsible for a large number of emergency department visits. Failure to identify a clinically significant intracranial injury in a timely fashion may result ...in long term neurodisability and death. Whilst cranial computed tomography (CT) provides rapid and definitive identification of intracranial injuries, it is resource intensive and associated with radiation induced cancer. Evidence based head injury clinical decision rules have been derived to aid physicians in identifying patients at risk of having a clinically significant intracranial injury. Three rules have been identified as being of high quality and accuracy: the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) from Canada, the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) from the UK, and the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury developed by the Pediatric Emergency Care Applied Research Network (PECARN) from the USA. This study aims to prospectively validate and compare the performance accuracy of these three clinical decision rules when applied outside the derivation setting. Methods/design This study is a prospective observational study of children aged 0 to less than 18 years presenting to 10 emergency departments within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) research network in Australia and New Zealand after head injuries of any severity. Predictor variables identified in CATCH, CHALICE and PECARN clinical decision rules will be collected. Patients will be managed as per the treating clinicians at the participating hospitals. All patients not undergoing cranial CT will receive a follow up call 14 to 90 days after the injury. Outcome data collected will include results of cranial CTs (if performed) and details of admission, intubation, neurosurgery and death. The performance accuracy of each of the rules will be assessed using rule specific outcomes and inclusion and exclusion criteria. Discussion This study will allow the simultaneous comparative application and validation of three major paediatric head injury clinical decision rules outside their derivation setting. Trial registration The study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR)- ACTRN12614000463673 (registered 2 May 2014). Keywords: Head injury, Clinical decision rule, Computed tomography, Validation
The specialty of emergency medicine in Australasia is coming of age. As part of this maturation there is a need for high‐quality evidence to inform practice. This article describes the development of ...the New Zealand Emergency Medicine Network, a collaboration of committed emergency care researchers who share the vision that New Zealand/Aotearoa will have a world‐leading, patient‐centred emergency care research network, which will improve emergency care for all, so that people coming to any ED in the country will have access to the same world‐class emergency care.
Reports the inaugural meeting of the New Zealand Emergency Medicine Network (NZEMN), 6 Nov 2013. Outlines the core principles behind the vision and values adopted by this community of emergency ...medicine (EM) specialists. Notes the two studies chosen to be the first research project for the NZEMN. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
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