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Cefdinir is a third-generation oral cephalosporin used frequently in the pediatric population. The most common side effects of cefdinir are diarrhea, nausea and dyspepsia. The side effect of turning the stool color to red and giving a bloody appearance, which is alarming for both families and physicians, is very rare. In this case report, we discussed 4 cases who referred to the emergency department with bloody stool due to the use of cefdinir. The important conclusion to be drawn from this case report is to know the rare side effects of commonly used drugs such as cefdinir. This will save time and resources and prevent unnecessary interventions on the patient.

This study analyzed the utility of the systemic immune-inflammation index (SII) in predicting serious bacterial infections (SBIs) in infants with fever without a source (FWS).Infants (aged 1-4 months) evaluated in the pediatric emergency department for FWS were divided into two groups:The study included 223 infants with a mean age of 76.65 ± 25.42 days; 62 (27.8%) of them were included in the SBI group, and all of them were diagnosed with a urinary tract infection (UTI). The hospitalization rate and length of hospital stay were significantly higher in UTI patients (p 0.001 for each). The mean SII was 795.76 ± 475.85 in the SBI group and 318.24 ± 300.70 in the non-SBI group, and there was a significant difference between the groups (p 0.001). In diagnosis of SBI, the area under the curve values were found to be 0.89 [95% confidence interval (CI): 0.85-0.94] for C-reactive protein (CRP), 0.86 (95% CI: 0.81-0.91) for absolute neutrophil count (ANC), 0.84 (95% CI: 0.78-0.89) for the SII, and 0.81 (95% CI: 0.74-0.87) for WBC. In the multivariate logistic regression analysis, high CRP and SII values were found to be predictive factors for UTI without bacteremia (p 0.001 and p = 0.008, respectively).We found that high CRP and SII values could be predictive for UTI without bacteremia in infants with FWS. The SII may be preferred because it can be easily calculated using the hemogram results, is not accompanied by extra costs, and does not require further blood collection.

Pediatric stroke is a neurological emergency. Knowing the predictive clinical markers for childhood stroke will help in early diagnosis and patient management. This study aims to (1) evaluate patients admitted to the pediatric emergency department (PED) with acute neurological signs and/or symptoms who underwent neuroimaging and (2) determine the clinical warning signs for the early recognition of stroke.One hundred one patients aged 1 month to 18 years who were admitted with stroke-related neurological signs and symptoms and underwent neuroimaging in the PED were retrospectively analyzed using the file record system. As a result of these imaging tests, the characteristics of patients with stroke and nonstroke were compared.The mean age of the 92 included patients was 10.7 (SD, 4.5) years. Among the admission symptoms of the patients, a significant difference was observed only in terms of speech disorder, whereas a significant difference was found in the examination results for altered consciousness and dysarthria. The incidences of hemiplegia and hemiparesis were higher in the stroke group, but they were not statistically significant. The median duration of time from symptom onset to PED admission was 240 minutes (interquartile range, 30-1440 minutes). The mean time from PED admission to magnetic resonance imaging in the stroke group was 2.3 (SD, 0.7) hours, which was significantly shorter than for the nonstroke group (4.9 [SD, 1.2] hours, P = 0.002).Childhood stroke is a neurological emergency that requires a multidisciplinary approach. Early stroke diagnosis is vital for treatment and prognosis. With respect to sudden neurological deficits, particularly dysarthria, altered consciousness, hemiplegia, and hemiparesis, should alert clinicians to stroke. In addition, interdepartmental cooperation is essential both in the rapid recognition of stroke and the treatment and follow-up processes.

BACKGROUND Acute appendicitis is the most common reason for abdominal surgery in children. The aim of this study was to evaluate the utility of biomarkers in predicting complicated appendicitis (CA). METHODS Patients having a diagnosis of acute appendicitis who underwent operations were retrospectively determined, and the utility of biomarkers in predicting CA was evaluated. RESULTS A total of 251 patients were included in the study. The mean age was 130.9 ± 48.8 months, 148 of the cases (59%) were simple appendicitis, and 103 (41%) were CA. The C-reactive protein (CRP) levels, immature granulocyte (IG) percentage, white blood cell counts, and absolute neutrophil counts were significantly higher in the CA patients. The bilirubin levels and neutrophil to lymphocyte ratios were not useful for predicting CA. The best area under the curve (AUC) values to predict CA were with the IG percentage and CRP level (0.82), the IG percentage [odds ratio (OR) 9.36, 95% CI (4.94-17.75), p

Aim: Patient selection and management of rapid sequence intubation (RSI) application in the emergency department can be challenging for clinicians. In this study, we aimed to describe the demographic information, clinical characteristics, and medical conditions of the patients who underwent RSI in our hospital’s pediatric emergency department and to present patient management strategies.Methods: Cases between 1 month to 18 years old who underwent RSI in the emergency department between January 2021 and January 2022 were analyzed retrospectively.Results: Eleven patients; 7 girls (63,6%) and 4 boys (36,4%) were included in the study. The median age of the patients was 6(2-15) [minimum (min)-maximum (max)]. The median time from symptom onset to presentation was 120 minutes (min-max 15 minutes-2 weeks). RSI indications were trauma (n=5), intracranial mass (n=4), ventriculoperitoneal shunt dysfunction (n=1), and refractory status epilepticus (n=1). All patients had focal neurological deficits on examination. Glasgow Coma Scale median score was 8 (min-max 4-15). The first neuroimaging method was cranial tomography in ten (90.9%) patients. Intracranial hemorrhage was present in 45.4% (5 patients) of the patients. No complications were observed in any of the patients during the RSI application. One patient died due to intracranial hemorrhage and shunt dysfunction. Neurological deficits (dysarthria, gait disturbance, hemiparesis, and visual impairment) were detected in five patients during their first-month follow-up.Conclusion: This retrospective study identified critically ill children who were admitted to the emergency department with acute neurological symptoms and underwent RSI to prevent increased intracranial pressure and further brain damage., Amaç: Acil serviste hasta seçimi ve hızlı seri entübasyon (HSE) uygulamasının yönetimi klinisyenler için zor olabilir. Bu çalışmada hastanemiz çocuk acil servisinde HSE yapılan hastaların demografik ve klinik özelliklerini ile hasta yönetim stratejilerinin değerlendirilmesi amaçlandı.Yöntemler: 1 Ocak 2021 ile 1 Ocak 2022 tarihleri arasında çocuk acil servisinde HSE uygulanan 18 yaşından küçük hastalar çalışmaya dâhil edildi.Bulgular: Çalışmaya 11 hasta dâhil edildi. Hastaların medyan yaşı 6 (2-15) idi [minimum (min)-maksimum (maks)], 7’si kızdı (%63,6). Semptom başlangıcından başvuruya kadar geçen süre medyan değeri 120 dakikaydı (min-maks 15 dakika-2 hafta). HSE endikasyonları travma (n=5), kafa içi kitle (n=4), ventriküloperitoneal şant disfonksiyonu (n=1), dirençli status epileptikus (n=1) idi. Hastaların Glasgow Koma skala skorları ortanca değeri 8 (min-maks 4-15) idi. Hastaların tamamında fokal nörolojik defisit mevcuttu. İlk nörogörüntüleme yöntemi 10 (%90.9) hastada kraniyal tomografiydi ve beş hastada (%45,4) intrakraniyal kanama mevcuttu. HSE’ye bağlı hiçbir hastada komplikasyon izlenmedi. Hastalardan ikisi exitus oldu (intrakraniyal kanama ve şant disfonksiyonu nedeniyle). Birinci ay kontrollerinde beş hastada dizartri, yürüme bozukluğu, hemiparezi, görme bozukluğu gibi nörolojik defisitler tespit edildi.Sonuç: Bu retrospektif çalışma, akut nörolojik semptomlarla acil servise başvuran ve kafa içi basıncının artmasını ve daha fazla beyin hasarını önlemek için HSE uygulanan kritik hasta çocukları tanımladı.

It is mentioned that the acute renal angina index (aRAI), a new concept, can be used in emergency departments to calculate and accurately predict the risk of developing acute kidney injury (AKI). The aims of the study included: to evaluate the predictive performance of the aRAI (AKI risk classification tool) in predicting AKI in the pediatric emergency department.Patients who met the criteria for systemic inflammatory response syndrome were examined. AKI was defined with creatinine N1.5× baseline 24-72 hours after hospitalization. aRAI and original RAI scores were calculated for patients and were shown as renal angina positive (RA+) above a population-derived threshold. The performance of aRAI in predicting AKI compared to changes in creatinine and original RAI was evaluated.In total, 241 eligible subjects were enrolled. The median age of the patients was 17 months (min-max 1-192). AKI developed in 60 (24.8%) of the patients. According to the aRAI, 76 (31.5%) of 241 patients were RA(+). The aRAI had an NPV of 1.00 and an AUC of 0.948 (0.914-0.983) for the prediction of AKI. Sensitivity was 95% for the aRAI as compared to 48% for an elevation in SCr noted to be at least two times greater than the baseline while in the PED and 61% for original RAI.The aRAI is easily computable, does not depend on complex computational or derivation methods, and is universally accessible. We confirm and extend the findings of previous study reporting the performance of RAI for early prediction of AKI.

Amaç: Ebeveynlerin kronik hastalığı olan çocuğa sahip olması yaşam kalitelerini ve ruhsal durumlarını olumsuz etkilemektedir. Çalışmamızda, kronik hastalığı olan ve önceden sağlıklı akut hastalık ile acil servise başvuran çocukların annelerinde sürekli ve durumluk kaygı düzeyleri ile depresyon düzeylerinin belirlenmesi ve bunu etkileyen faktörlerin değerlendirmesi amaçlanmıştır. Gereç-Yöntem: Çalışmamız prospektif kesitsel bir çalışmadır. Çocuk Acil Kliniğine önceden sağlıklı ve akut hastalık ile başvuran çocukların anneleri ile kronik hastalığı olan çocukların anneleri çalışmaya dahil edildi. Beck Depresyon Ölçeği (BDÖ) ve Durumluk-Sürekli Kaygı Envanteri (State Trait Anxiety Inventory-STAI) çalışmaya katılan tüm annelere uygulandı. Olguların sosyodemografik verileri sosyodemografik veri toplama formu ile elde edildi. Mann-Whitney-U, Ki-kare ve tek yönlü Anova testleri ile post-hoc analizlerde Tukey HSD istatiksel analizler için kullanıldı. Bulgular: Çalışmaya 101 (%49) kronik ve 105 (%51) akut hastalığı olan çocukların anneleri dahil edildi. Akut ve kronik hasta grupları arasında sürekli kaygı düzeyi ve BDÖ puanları arasında ise anlamlı farklılık saptanmıştır (sırasıyla p=0,004 ve p=0,001). Durumluk kaygı düzeyi puanlarında anlamlı farklılık saptanmamıştır (p=0,778). Hastalar BDÖ’nin kesme puanı (17 puan) dikkate alınarak muhtemel depresyon açısından ikiye ayrıldığında kronik hastalığı olan çocukların annelerinde akut hastalığı olan çocukların annelerine göre yüksek risk altında oldukları saptanmıştır (χ 2=8,641; p=0,004). Sonuç: Çalışmamızın sonuçlarında kronik hastalığı olan çocukların annelerinde sürekli kaygı düzeyleri ve depresif belirti oranları önceden sağlıklı ve akut nedenle acil servise başvuran çocuk annelerine göre anlamlı yüksek tespit edilmiştir. Kronik grup ebeveynlerin eğitim ve sosyoekonomik düzeylerinin daha düşük olduğu saptanmıştır. Kronik hastalığı olan çocukların ebeveynleri ruhsal etkilenim açısından değerlendirilmeli, depresyon ve anksiyete gibi bozukluklar tespit edildiğinde psikolojik yardım almaları sağlanmalıdır.

Kounis syndrome is defined as a hypersensitivity coronary disease consisting of an allergic, anaphylactic or anaphylactoid reaction combined with acute coronary syndrome [1]. To our knowledge, case...

Introduction Serious bacterial infections (SBI) are major causes of mortality and morbidity in children. The aim of this study was to determine the accuracy of the immature granulocyte (IG) percentage in predicting SBI. Methods Patients admitted to the pediatric emergency department with fever were divided into two groups: with SBI and with non-SBI. White blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP), and the percentage of IG value were recorded, and their accuracy in predicting SBI was evaluated. Results Sixty-one (14.3%) patients fell into the SBI group and 367 (85.7%) were with non-SBI. Mean IG percentage among SBI patients was 0.84 ± 1.21 and 0.27 ± 0.20 for with non-SBI patients (P = .001). Based on disease, the highest IG percentage was found in patients diagnosed with sepsis (IG 3.7 ± 3.5%) and with bacterial meningitis (IG 1.6 ± 1.3%). The area under the curve (AUC) of IG percentage to predict SBI was 0.83 with 95% confidence interval (CI) [0.78-0.88]; WBC was 0.76 (95% CI 0.70-0.83); ANC was 0.73 (95% CI 0.67-0.80), and CRP was 0.79 (95% CI 0.73-0.85). When infection markers were compared to the most appropriate cut-off values in predicting SBI, IG percentage showed the highest sensitivity and specificity. When the cut-off value was determined as >0.35 for IG percentage, sensitivity was 75.4% and specificity was 76.6% in predicting SBI. Conclusion Patients with SBI had a higher IG percentage. Compared to other biomarkers, IG percentage had higher sensitivity and specificity in predicting SBI.

Background: The aim of this study was to evaluate the application of the rapid influenza antigen test and the contribution of the test result to patient management in febrile infants aged 29‒90 days. Methods: The medical records of febrile infants without a focus who presented during influenza seasons from 2017‒2019 were analyzed retrospectively. The study was carried out in the Department of Pediatric Emergency, Dr. Sami Ulus Maternity and Children’s Training and Research Hospital. The demographic characteristics, clinical and laboratory findings, and management of the patients were examined. The patients were divided into two groups as ‘with’ and ‘without’ testing based on whether a rapid influenza antigen test was performed or not. Test results were categorized as positive or negative. Serious bacterial infection (SBI) risk and patient management were evaluated according to test results. Results: A total of 173 patients (110 males/63 females) were evaluated. The influenza test was performed in 94 (54.3%) patients, and 31.9% were positive. SBI was present in 8.7% of all patients. The mean values of white blood cell (WBC), absolute neutrophil, platelet count, C-reactive protein (CRP) and, lumbar puncture, hospitalization, and initiation of antibiotic therapy were significantly lower in the positive group compared to the negative and without testing groups (P