Should This Article Change My Practice? Ran Goldman, MD BC Children s Hospital University of British Columbia

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1 Should This Article Change My Practice? Ran Goldman, MD BC Children s Hospital University of British Columbia

2 Febrile Seizures Pulled Elbow Asthma Abdominal Trauma Looking Good

3 Prolonged Febrile Seizures

4 Prolonged Febrile Seizures Question : Should we stop febrile seizures? Seinfeld S et al. Epilepsia Feb 6

6 Prolonged Febrile Seizures Febrile Seizures are frequent (6m 6y) Extremely stressful for parents Reassurance is important Febrile status epilepticus is often first seizure Should febrile seizures stopped with meds? Seinfeld S et al. Epilepsia Feb 6

7 Prolonged Febrile Seizures 199 subjects 1m 6y Prospective, multicenter study Febrile seizure or series of seizures > 30m No standardized treatment protocol Seinfeld S et al. Epilepsia Feb 6

8 Prolonged Febrile Seizures 179/199 received antiepileptic drugs 1 drug in 140 (70%) Median time from seizure to drug 30 m If given medication before ED seizure duration 81 m No meds 95 m First dose to end of seizure 38m Seinfeld S et al. Epilepsia Feb 6

9 Prolonged Febrile Seizures Febrile Seizure Epilepticus : Rarely stops spontaneously Resistant to medications Earlier onset of treatment results in shorter total seizure duration. Prehospital meds may improve outcome Seinfeld S et al. Epilepsia Feb 6

10 Inhaling in Asthma

12 Inhaling in Asthma Question : Which one is best to deliver bronchodilators in children Nebulizer or metered dose inhalers with a holding chamber (spacer)? Cates CJ Et al. Cochrane Database Syst Rev Sep 13;9:CD000052

13 Inhaling in Asthma Systematic Review RCT in adults and children Asthma, excluding life threatening Cates CJ Et al. Cochrane Database Syst Rev Sep 13;9:CD000052

14 Inhaling in Asthma 39 RCTs 1897 children and 729 adults 33 trials in ED and community 6 in inpatients (207 children) Cates CJ Et al. Cochrane Database Syst Rev Sep 13;9:CD000052

15 0.71 Chamber Nebulizer

16 Save 33 min Chamber Nebulizer

17 Chamber Nebulizer

18 Inhaling in Asthma Spacers may be slightly better in children Outcomes were not significantly better in either method when treatments were repeated and titrated to the response of the participant. Cates CJ Et al. Cochrane Database Syst Rev Sep 13;9:CD000052

19 Pulled Elbow Reduction

21 Pulled Elbow Reduction Question : What is the best method to reduce a pulled elbow? García Mata S, Hidalgo Ovejero A. J Pediatr Orthop Dec 6.

22 Pulled Elbow Reduction Hyperpronation or Supination flexion García Mata S, Hidalgo Ovejero A. J Pediatr Orthop Dec 6.

23 Pulled Elbow Reduction Randomized, prospective study 115 patients Mean age 3m 2y García Mata S, Hidalgo Ovejero A. J Pediatr Orthop Dec 6.

24 Pulled Elbow Reduction 97% reduction First attempt 101/115 (88%) Hyperpronation (94%) or Supination flexion (80%) (P=0.0243) Failed first attempt had previous attempts : o 100% of treatment failures from Hyperpronation group; o 80% of failures from Supination flexion group García Mata S, Hidalgo Ovejero A. J Pediatr Orthop Dec 6.

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26 Abdominal Trauma

27 Abdominal Trauma Question : Can we identify children at low risk for severe abdominal trauma, and avoid a CT? Holmes et al. PECARN. Annals of Emergency Medicine. Volume 62 p e2, Aug 2013

29 Abdominal Trauma Rule derivation trial Multicenter USA ED staff physicians documents history and physical exam CT (if done) results recorded later Interpreted by a radiologist Holmes et al. PECARN. Annals of Emergency Medicine. Volume 62 p e2, Aug 2013

35 Abdominal Trauma The prediction rule (7 items) : no evidence of abdominal wall trauma or seat belt sign GCS score > 13 no abdominal tenderness no evidence of thoracic wall trauma no complaints of abdominal pain no decreased breath sounds no vomiting Holmes et al. PECARN. Annals of Emergency Medicine. Volume 62 p e2, Aug 2013

36 What Not To Wear

38 What Not To Wear Question : What is the best outfit to wear in the emergency department when examining kids? Nibhanipudi KV et al. Clin Pediatr (Phila) Jul;52(7):593 8

39 What Not To Wear 450 parents Survey in the ED Mostly Females Mostly Spanish speaking New York Nibhanipudi KV et al. Clin Pediatr (Phila) Jul;52(7):593 8

40 What Not To Wear Nibhanipudi KV et al. Clin Pediatr (Phila) Jul;52(7):593 8

41 What Not To Wear Nibhanipudi KV et al. Clin Pediatr (Phila) Jul;52(7):593 8

42 What Not To Wear Like physicians who wear hospital scrubs (410/450 or 91%) and short hair (430/450 = 96%) Like sneakers (430/450 = 96%) compared with dress shoes, Like men with moustaches/beards and glasses (450/450 = 100%) Not like female physicians with makeup and high heels Nibhanipudi KV et al. Clin Pediatr (Phila) Jul;52(7):593 8

Evaluation of Children with Blunt Abdominal Trauma. James F. Holmes, MD, MPH UC Davis School of Medicine

Evaluation of Children with Blunt Abdominal Trauma James F. Holmes, MD, MPH UC Davis School of Medicine Objectives Epidemiology of intra-abdominal injury (IAI) Physical examination findings with IAI Laboratory