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Suicide rates and frequency of pediatric emergency department (ED) visits for suicidal thoughts and behaviors have increased among Black preadolescents in the United States in recent years. This study examined whether characteristics of ED visits and treatment management of preadolescents with suicidal thoughts and behaviors differed by race. An electronic medical record query identified patients ages 8–12 (N=504) who visited a pediatric ED with a psychiatric-related chief complaint in 2019. The authors examined suicidal thoughts and behaviors that were reported with the Ask Suicide-Screening Questions tool, ED clinical impression, and ED disposition overall and by race. Compared with other racial groups, Black preadolescents were less likely to report suicidal thoughts, despite equivalent lifetime histories of suicide attempts, and were more likely to be brought to the ED by police and discharged (instead of being admitted to inpatient psychiatric care). Research to better understand racial disparities in suicide risk among preadolescents can inform prevention efforts. [ABSTRACT FROM AUTHOR]

Head injuries are a leading cause of death and disability in children, accounting for numerous emergency department (ED) visits. It is unclear how the COVID-19 pandemic has influenced healthcare utilization for pediatric head injuries. We hypothesize that the proportion of ED visits attributable to head injury and severity will increase during the COVID-19 era. Retrospective study using electronic health record data to compare proportion and severity of head injury for children 0-21 years of age from three urban mid-Atlantic EDs in the pre-COVID-19 era (March-June 2019) and COVID-19 era (March-June 2020). Controlling for confounders, logistic regression analyses assessed ORs of head injury outcomes. The χ2 analyses identified differences in patient characteristics. The proportion of head injury visits within the ED population significantly increased during the COVID-19 era (adjusted OR (aOR)=1.2, 95% CI 1.1 to 1.4). Proportion of visits requiring hospitalization for head injury increased by more than twofold in the COVID-19 era (aOR=2.3, 95% CI 1.3 to 4.3). Use of head CT imaging did not significantly change in the COVID-19 era (aOR=1.0, 95% CI 0.7 to 1.6). The proportion of ED visits and hospitalizations for head injury increased during the COVID-19 era. This could be due to changes in the level of supervision and risk exposures in the home that occurred during the pandemic, as well as differences in postinjury care, level of awareness regarding injury severity, and threshold for seeking care, all of which may have influenced pediatric healthcare utilization for head injuries. [ABSTRACT FROM AUTHOR]

Aim: Paediatric emergency departments (ED) nationwide experience a shared burden of boarding mental health patients. Whilst boarding, some patients have a change in disposition from hospitalization to discharge home. This phenomenon raises concern because EDs often have scarce resources for mental health patients. We sought to understand which patient and clinical factors are associated with a change in disposition outcome. Methods: A nested age‐sex‐race frequency‐matched case–control study was conducted including paediatric patients who presented to an urban PED for mental healthcare over a 36‐month period. Control patients included patients admitted to an inpatient psychiatric facility, whilst case patients were those discharged home. Descriptive statistics and multivariable logistic regression analyses were performed to compare groups. Results: Case patients were more likely to receive intramuscular Haloperidol (OR 2.2 [CI 1.1–4.4]) for agitation and a psychiatric consult (OR 2.3 [1.4–3.9]) whilst boarding. Case patients were also more likely to present with behavioural concerns (OR 1.8 [CI 1.1–3.1]) and have additional complexities such as medical comorbidities (OR 1.8 [CI 1.1–2.9]) or suicidal ideation/attempt (OR 2.6 [CI 1.1–6.1]). Amongst the most common themes for disposition change was improved patient status (58.8%). Conclusion: These findings suggest that boarding mental health patients have different disposition outcomes and thus may benefit from patient‐specific treatment interventions. Given that patients' statuses may change during the boarding period prompting discharge to home, more focus should be directed to developing brief evidence‐based practises that may be implemented in the ED and effectively bridge the gap to outpatient mental health services. [ABSTRACT FROM AUTHOR]

This study sought to determine the proportion of children with long bone fractures who undergo duplicate radiographic imaging after transfer to a pediatric trauma center (PTC) for further management. The secondary objective was to explore provider rationale and diagnostic yield of repeat X-rays. This was a single-site, retrospective cohort study conducted at a PTC. All patients, aged 0-21 years, who were transferred to the PTC for management of a long bone fracture were included. Electronic medical records were reviewed to determine the proportion of children who had repeat radiographic imaging and the provider rationale for obtaining this. T-test and Χ2 analyses were used to compare patients who had repeat X-rays with those who did not. During the study period, 309 patients (63% male, mean age 7.2±4.3 years) were transferred from 30 referring hospitals. Of these, 43% (n=133) underwent repeat radiographs. Patient age (p=0.9), gender (p=0.7), fracture location (p=0.19), and type of referring emergency department (pediatric vs general, p=0.3) were not significantly associated with repeat imaging. Rationale for repeat imaging could be ascertained in 31% of cases (n=41); the most common reasons were request by orthopedist (17%, n=23) and suboptimal original imaging (10%, n=13). Repeat imaging at the PTC did not reveal new or additional diagnoses in any case. Nearly half of the children in our study population undergo repeat and likely unnecessary imaging. Strategies to reduce repeat radiographs should be developed, as redundant imaging exposes patients to additional radiation and increases medical expense. [ABSTRACT FROM AUTHOR]

Objective. Activated charcoal (AC) is a potentially beneficial intervention for some toxic ingestions. When administered within one hour, it can reduce absorption of toxins by up to 75%. This study evaluated whether pediatric emergency department (ED) patients arriving by ambulance receive AC more quickly than patients arriving by alternative modes of transport. Methods. This was a retrospective review of AC administration in children in a large, urban pediatric ED from January 2000 until January 2006. Patients aged 0-18 years were identified from pharmacy billing codes and the National Capital Poison Center's database. Charts were reviewed for age, gender, triage acuity, disposition, transportation mode, triage time, and time of AC administration; analysis of variance (ANOVA) controlling for these covariates tested the equality of mean time intervals. Results. Pharmacy billing codes identified 394 cases, and poison center records identified 34 cases. Three hundred fifty-one patients met the inclusion criteria. One hundred thirty-eight (39%) were male; 216 (61%) were female. Two-hundred twenty-one (63%) patients were aged 5 years and under; in this subset, 116 were male and 105 were female. Twenty-one (6%) patients were aged 6-12 years; nine were male and 12 were female. One hundred nine (31%) patients were aged 13-18 years; 13 were male and 96 were female. One hundred eighteen (34%) arrived by emergency medical services (EMS). Time from triage to charcoal administration in patients transported via EMS was a mean of 65 minutes (standard deviation [SD] = 44 minutes). Time for the alternative transport group was a mean of 70 minutes (SD = 40 minutes) (p = 0.59). In the subset of patients triaged as most acute and arriving by EMS, time to charcoal administration was a mean of 42 minutes (SD = 22 minutes); time to AC in the alternative transport group was a mean of 67.8 minutes (SD = 42 minutes) (p = 0.013). Conclusion. The sickest patients arriving by EMS had a faster time from triage to AC administration. However, when comparing patients of all triage categories, EMS arrival alone did not influence time to AC administration. Furthermore, the interval from triage to charcoal administration was often insufficiently long. This suboptimal timing of charcoal administration demonstrates the need for reevaluation of triage and prehospital practices. [ABSTRACT FROM AUTHOR]