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In this systematic review, authors identified clinical practice guideline (CPG) recommendations with moderate to high quality evidence that can be used by the ED practitioner to help in the care of pediatric patients with mild traumatic brain injury (mTBI).

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Clinical Practice Guideline Recommendations in Pediatric Mild Traumatic Brain Injury: A Systematic Review. Ann Emerg Med. 2023 Dec 22:S0196-0644(23)01381-1. doi: 10.1016/j.annemergmed.2023.11.012. Epub ahead of print.

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In febrile infants with SARS-CoV-2 infection, current risk stratification tools for identifying invasive bacterial infections (IBIs) demonstrate high negative predictive values at the cost of decreased sensitivity.

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Inflammatory Markers in Febrile Young Infants With and Without SARS-CoV-2 Infections. Pediatrics. 2024;153(2):e2023063857. doi:10.1542/peds.2023-063857

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This prospective study identified a handful of clinical features associated with radiographic pneumonia in young febrile infants, including elevated procalcitonin and/or absolute neutrophil count, respiratory distress, and positive viral testing.

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Radiographic pneumonia in young febrile infants presenting to the emergency department: secondary analysis of a prospective cohort study. Emerg Med J. 2023;41(1):13-19. Published 2023 Dec 22. doi:10.1136/emermed-2023-213089.

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When providing respiratory support to preterm infants with a facemask, avoid excessive force on the face that is associated with apnea and bradycardia.

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Exerted force on the face mask in preterm infants at birth is associated with apnoea and bradycardia. Resuscitation. 2024;194:110086.

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This prospective multi-center stepped wedge trial found that routine molecular multiplex testing for all children who presented to pediatric EDs with acute gastroenteritis detected more clinically relevant pathogens (2.1% to 15%) and led to an adjusted 21% decrease in return visits.

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Clinical Impact of Multiplex Molecular Diagnostic Testing in Children With Acute Gastroenteritis Presenting to an Emergency Department: A Multicenter Prospective Study. Preprint. medRxiv. 2023;2023.07.27.23293208. Published 2023 Jul 31. doi:10.1101/2023.07.27.23293208

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Given a substantial increase in the number of children who have accidental ingestion of THC-based products, these authors advocate for consideration of early urine drug screen testing on children who present with altered mental status or neurological symptoms.

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Urine Toxicology Test for Children With Altered Mental Status. Pediatrics. 2023. Nov 1;152(5):e2022060861Doi: 10.1542/peds.

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This systematic review and meta-analysis of almost 4,000 febrile infants ≤ 90 days old diagnosed with COVID-19 indicated that these patients have a low prevalence of invasive bacterial infection (IBI), especially the subgroup >28 days old.

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A conservative (SpO₂ 88-92%) oxygenation target resulted in a small but significant greater probability of better outcome compared to a liberal (SpO₂ >94%) target in children admitted to the PICU on invasive mechanical ventilation.

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Conservative versus liberal oxygenation targets in critically ill children (Oxy-PICU): a UK multicentre, open, parallel-group, randomised clinical trial. Lancet. 2023 Dec 1:S0140-6736(23)01968-2. doi: 10.1016/S0140-6736(23)01968-2. Epub ahead of print.

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These are the top articles from 2023. Enjoy!

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While removing low risk amoxicillin allergies in the pediatric ED setting by direct oral challenge (DOC) may be effective, numerous factors play a role in reliable implementation.

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Multisite Oral Amoxicillin Challenges During Pediatric Emergency Department Visits. JAMA Pediatr. 2023 Oct 2:e233659. doi: 10.1001/jamapediatrics.2023.3659. Online ahead of print.