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Bottom line recommendations for the treatment and management of acute otitis media. Published online: October 2016.

Bottom line recommendations for the treatment and management of acute otitis media - French. Published online: December 2016.

This flow diagram from the position statement of the Canadian Paediatric Society illustrates the management of children with suspected and confirmed acute otitis media.

Pneumatic otoscopy and cerumen removal is discussed in this video. Mastery of otoscopic examination techniques is necessary for the accurate diagnosis of otitis media.

The present position statement updates a previous Canadian Paediatric Society document released in 2009, outlining the management of acute otitis media in children six months of age and older.

This evidence-based clinical practice guideline is a revision of the 2004 acute otitis media guideline from the American Academy of Pediatrics and American Academy of Family Physicians. It provides recommendations to primary care clinicians for the management of children from 6 months through 12 years of age with uncomplicated acute otitis media.

This summary presents results of a systematic review that searched to identify any published studies comparing the effectiveness of topical antibiotics with oral antibiotics, placebo, or no treatment in children with acute otitis media presenting with ear discharge caused by spontaneous perforation of the eardrum.

The purpose of this review was to assess the effects of antibiotics for children with acute otitis media.

The purpose of this study was to determine the clinical significance of asymptomatic respiratory viral infection in infants.

The purpose of this clinical trial was to determine the extent to which antimicrobial treatment affects the course of both symptoms and signs of acute otitis media, irrespective of the apparent severity of the disease, among children 6 to 23 months of age who have been diagnosed with acute otitis media.

This randomized, double-blind, placebo-controlled study assessed the efficacy of antimicrobial treatment for acute otitis media.

Bottom line recommendations for the treatment and management of pediatric anaphylaxis - version 1.2. Published online: December 2018.

Bottom line recommendations for the treatment and management of pediatric anaphylaxis - en francais. Published online: October 2018.

This French pre-printed order (PPO) set is for management of pediatric anaphylaxis in the ED. PPO document is adaptable to your hospitals form policy. Published online: October 2018, Version 1.0.

This pre-printed order (PPO) set is for management of pediatric anaphylaxis in the ED. PPO document is adaptable to your hospitals form policy. Published online: December 2018, Version 1.1.

This document outlines the references used and team involved in the development of the anaphylaxis PedsPac. Published online: October 2018.

This point of care algorithm is to guide initial management of pediatric anaphylaxis in the Emergency Department. Published online: December 2018, Version 1.1.

This pocket card contains tips to manage pediatric patients with anaphylaxis. Published online: December 2018, Version 1.1.

This pocket card contains tips to manage pediatric patients with anaphylaxis. Published online: October 2018, Version 1.0.

This point of care algorithm is to guide initial management of pediatric anaphylaxis in the Emergency Department. Published online: October 2018, Version 1.0.

This manual has been developed for primarily non-medical people. It consists of an updated Consensus Statement and an Appendices section from the Canadian Society of Allergy and Clinical Immunology. The Consensus Statement provides recommendations for the management of anaphylaxis in the community, which are based on the most current research. The Appendices section provides resources that will help individuals at risk of anaphylaxis, educators, caregivers, and parents understand the basics of anaphylaxis.

This position statement addresses a number of questions regarding epinephrine administration/prescribing suggestions for the infant under 15kg who is at risk for anaphylaxis, including: What are possible consequences of administering a larger than recommended dose of epinephrine? Are there other ways to prescribe the recommended dose of epinephrine? What are the consequences of not administering epinephrine? What does the Canadian Society for Allergy and Clinical Immunology suggest for the infant less than 15kg?

The objective of this parameter is to update these previous versions and ultimately to improve the care of patients by providing the practicing physician with an evidence-based approach to the diagnosis and management of anaphylactic events.

The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis provide a unique global perspective on this increasingly common, potentially life-threatening disease. Recommendations made in the original WAO Anaphylaxis Guidelines remain clinically valid and relevant, and are a widely accessed and frequently cited resource. In this 2015 update of the evidence supporting recommendations in the Guidelines, new information based on anaphylaxis publications from January 2014 through mid- 2015 is summarized.

The recommendations made in this document about the management of anaphylaxis apply to anaphylaxis that occurs in an ED setting. Some of these recommendations might be different if anaphylaxis occurs in an office setting.

Anaphylaxis is a clinical emergency, and all healthcare professionals should be familiar with its recognition and acute and ongoing management. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Taskforce on Anaphylaxis. They aim to provide evidence-based recommendations for the recognition, risk factor assessment, and the management of patients who are at risk of, are experiencing, or have experienced anaphylaxis.

The illustrated World Allergy Organization (WAO) Anaphylaxis Guidelines were created in response to absence of global guidelines for anaphylaxis. They incorporate contributions from more than 100 allergy/immunology specialists on 6 continents. Recommendations are based on the best evidence available, supported by references published to the end of December 2010. The Guidelines review patient risk factors for severe or fatal anaphylaxis, co-factors that amplify anaphylaxis, and anaphylaxis in vulnerable patients, including pregnant women, infants, the elderly, and those with cardiovascular disease. They focus on the supreme importance of making a prompt clinical diagnosis and on the basic initial treatment that is urgently needed and should be possible even in a low resource environment.

This review analyzes the use of corticosteroids for reducing anaphylaxis severity and preventing biphasic anaphylaxis.

The purpose of this study was to identify the scope of epinephrine pitfalls and opportunities for improvement in the management of allergy emergencies.

The aim of this study was to evaluate the time of onset and predictors of biphasic anaphylactic reactions.

In this rostrum we aim to increase awareness of anaphylaxis in infancy in order to improve clinical diagnosis, management, and prevention of recurrences.

This paper reviews the factors that contribute to the risk of severe anaphylactic events and provides a framework for the ongoing management of patients at risk of severe food allergy.

The objective of this systematic review was to assess the benefits and harms of H2-antihistamines in the treatment of anaphylaxis.

We sought to assess the benefits and harms of glucocorticoid treatment during episodes of anaphylaxis.

The objective of this systematic review was to assess the effectiveness of adrenaline (epinephrine) auto-injectors in relieving respiratory, cardiovascular, and other symptoms during episodes of anaphylaxis that occur in the community.

The objective of this systematic review was to assess the benefits and harm of H1-antihistamines in the treatment of anaphylaxis.

This multi-incident analysis was conducted to identify factors contributing to errors when epinephrine was used for the treatment of anaphylaxis and to suggest strategies to prevent or minimize potential harm when epinephrine is used for this indication.

factors contributing to errors when epinephrine was

used for the treatment of anaphylaxis and to suggest

strategies to prevent or minimize potential harm

when epinephrine is used for this indication.

The objective of this study was to investigate the incidence and clinical predictors of biphasic reactions in children presenting to the emergency department (ED) with anaphylaxis.

The objective of this study was to identify factors associated with early epinephrine treatment for FIA and to specifically examine the association between early epinephrine treatment and hospitalization.

Previous work has shown patients commonly misuse adrenaline autoinjectors (AAI). It is unclear whether this is due to inadequate training, or poor device design. We undertook a prospective randomized controlled trial to evaluate ability to administer adrenaline using different AAI devices.

Bottom line recommendations for the treatment and management of asthma. Updated February 2019, Version 1.2.

Recommandations de base pour l'évaluation et la prise en charge de l'asthme.

This pre-printed order (PPO) set is for management of pediatric severe asthma in the ED. PPO document is adaptable to your hospitals form policy. This PPO is intended for use on patients > 12 months of age. Published online: December 2018, Version 1.0.

This point of care algorithm is to guide initial management of pediatric severe asthma in the Emergency Department. This algorithm is intended for use on patients > 12 months of age. Published online: December 2018, Version 1.0.

This pocket card contains tips to manage pediatric patients with severe asthma. This pocket card is intended for use on patients > 12 months of age. Published online: December 2018, Version 1.0.

This document outlines the references used and team involved in the development of the asthma PedsPac. Published online: December 2018, Version 1.0.

The GINA Science Committee reviews published research on asthma management and prevention, evaluates the impact of asthma research, and provides yearly updates to guidance documents. See Chapter 4, Part D: Management of Asthma Exacerbations in the Emergency Department.

The P-EDACP is for patients aged 1 to 17 years presenting with wheeze and/or cough who have a history of asthma and/or prior history of wheezing. Additional tools include medication guidelines and pre-printed physicians orders (PPO) for each of the four severity levels, a patient education checklist, and discharge instructions with integrated prescription.

This French language webpage created by the Centre Hospitalier Universitaire Sainte-Justine, provides guidelines, pathways and order sheets for treating acute asthma in emergency departments.

This French language pathway created by the Centre Hospitalier Universitaire Sainte-Justine, provides guidance on treating pediatric patients with severe status asthmaticus.

Assessment sheets for pediatric asthma patients, includes PRAM Scoring instructions.

These orders contain recommendations based on PRAM Score for children aged 12 months - 18 years with a diagnosis of asthma

This checklist contains education topics to review with patients/caregivers

Review question: When someone is having an asthma attack is it as safe and effective to use a spacer instead of a nebuliser? Background: During an asthma attack, the airways (tubes in the lungs) narrow making breathing difficult. The initial response to an asthma attack is to treat with a drug that can open up the airways and make breathing easier. These drugs are called bronchodilators and in this review we are looking specifically at a class of bronchodilators called beta-agonists (for example salbutamol). These drugs can be taken straight from an inhaler, but during an asthma attack they are easier to take using either a spacer or a nebuliser. A spacer is a hollow chamber. A puff of drug from an inhaler is added to the chamber and then the person breathes in and out normally (also described as tidal breathing), from a mouthpiece on the chamber. A nebuliser is a machine with a mask that goes over the person's mouth and nose and through which a constant stream of drug and air (or oxygen) is breathed in and out normally. What evidence did we find? We found 39 clinical trials involving 1897 children and 729 adults. Thirty-three of the trials were conducted in an emergency room (or emergency department) and community settings (such as a GP's surgery), and six trials were on inpatients (people in hospital) with acute asthma (207 children and 28 adults). Overall we judged the quality of the evidence to be moderate. What do the studies tell us? Taking beta-agonists through either a spacer or a nebuliser in the emergency department did not make a difference to the number of adults being admitted to hospital, whilst in children we can be fairly confident that nebulisers are not better than spacers at preventing admissions. In children, the length of stay in the emergency department was significantly shorter when the spacer was used instead of a nebuliser. The average stay in the emergency department for children given nebulised treatment was 103 minutes. Children given treatment via spacers spent an average of 33 minutes less. In adults, the length of stay in the emergency department was similar for the two delivery methods. However the adult studies were conducted slightly differently which may have made it more difficult to show a difference in the length of stay in the emergency department. Because all the adult studies used a so-called "double-dummy" design, the adults received a spacer AND a nebuliser (either beta-agonist in a spacer and a dummy nebuliser or vice versa) which meant both groups of people were in the emergency department for as long as it took to take both treatments. Lung function tests were also similar for the two delivery methods in both adults and children. Pulse rate was lower in children taking beta-agonists through a spacer (mean difference 5% baseline), and there was a lower risk of developing tremor. Conclusion: Metered-dose inhalers with a spacer can perform at least as well as wet nebulisation in delivering beta-agonists in children with acute asthma, but we are less certain about the results in adults.

Background: In an asthma attack, the airways (small tubes in the lungs) narrow because of inflammation (swelling), muscle spasms and mucus secretions. Other symptoms include wheezing, coughing and chest tightness. This makes breathing difficult. Reliever inhalers typically contain short-acting beta2-agonists (SABAs) that relax the muscles in the airways, opening the airways so that breathing is easier. Anticholinergic drugs work by opening the airways and decreasing mucus secretions. Review question: We looked at randomised controlled trials to find out whether giving inhaled anticholinergics plus SABAs (instead of SABAs on their own) in the emergency department provides benefits or harms in children having an asthma attack. Key results: We found that children with a moderate or severe asthma attack who were given both drugs in the emergency department were less likely to be admitted to the hospital than those who only had SABAs. In the group receiving only SABAs, on average 23 out of 100 children with acute asthma were admitted to hospital compared with an average of 17 (95% CI 15 to 20) out of 100 children treated with SABAs plus anticholinergics. Taking both drugs was also better at improving lung function. Taking both drugs did not seem to reduce the possibility of another asthma attack. Fewer children treated with anticholinergics reported nausea and tremor, but no significant group difference was observed for vomiting. Quality of the evidence and further research: Most of the studies were in preschool- and school-aged children; three studies also included a small proportion of infants under 18 months of age, although there was no evidence that inclusion of these infants with wheezy episodes affected the results. Nine trials (45%) were at a low risk of bias and we regarded the evidence for hospitalisation as high quality. Physicians can administer the dose of anticholinergic and SABA in several different ways; as a single dose, or as a certain number of doses or more flexibly. Most of the trials gave the children two or three doses and we think that more research is needed to improve characterization of children that benefit from, and the most effective number and frequency of doses of, anticholinergic treatment.

Acuteasthma is a common cause of visits toemergencydepartments (ED) and the majority of patients are treated and discharged home. Some people will have arelapseofacuteasthma within two weeks of being discharged after apparently successful treatment. Beta2-agonist drugs are used to open the muscles in the airways and corticosteroids drugs are used to reduce inflammation of the swollen airways.Corticosteroidscan be inhaled (ICS) or swallowed as a tablet (so-calledoralcorticosteroids). ICS may reduceadverse effectsand get to the airways more directly thanoralcorticosteroids. Thisreviewof trials found that there was insufficient evidence that inhaling corticosteroids as well as taking the drugs orally is better thanoraluse alone, afteremergencydepartment treatment for an asthma attack. There is also insufficient evidence that taking ICS alone is as good as taking them orally, although there is some evidence to support using ICS alone for mild asthma attacks afteremergencydepartment discharge. Moreresearchis needed.

Children frequently visit theemergencydepartment foracuteexacerbation of asthma. Some of these children fail to respond tostandard treatment(corticosteroids and bronchodilators) with increasedmorbidity. Ketamine has bronchodilatory properties and may be useful foracuteexacerbation of asthma. We evaluated theefficacyof ketamine for management of severeacuteasthma in children who had not responded to standardtherapy. We found, through systematic search, only onestudywhere investigators assessed the usefulness of ketamine for management of severeacuteasthma in children. While this singlestudysuggested that there is a lack of evidence for usefulness of ketamine inacuteexacerbation of asthma in children, more trials are needed regarding the use of ketamine inacuteasthma before more specific recommendations can be made.

Asthma care for children in our society is common and costly. There is now evidence that educationalinterventionfor children who have attended theemergencydepartment for asthma lowers theriskof the need for futureemergencydepartment visits and hospital admissions. Thisreviewlooked at studies which compared usual care for asthma to more intensive educational programmes and the results showed astatistically significantreduction in the treatment groups needing subsequentemergencydepartment visits or hospital admissions. We were not able to determine the most effective type, duration or intensity ofeducationthat should be offered to children to offer the best asthma outcomes.

In an asthma attack, the airways (passages to the lungs) narrow from muscle spasms and swelling (inflammation). Bronchodilator drugs (reliever inhalers) can be used to relax the muscles and open the airways, and corticosteroid drugs to reduce the inflammation. Magnesium sulfate is a drug that can also affect muscles, and may reduce inflammation as well. It can be given through a drip in the veins (intravenously). Thereviewof trials found thatintravenousmagnesium sulfate in addition to bronchodilators seems to be safe and beneficial for people with severe asthma attacks, or those for whom bronchodilators are not working.

In an asthma attack, the airways (passages to the lungs) narrow from muscle spasms and swelling (inflammation). Bronchodilators (reliever inhalers to open up the lungs and airways) can be used for the spasms, and corticosteroids for the swelling.Corticosteroidscan be inhaled, or taken by mouth (orally) or through a drip into the veins (intravenously). Thereviewof trials found thatsystemic(oralorintravenous) corticosteroids reduce the need for people with asthma attacks to stay in hospital, with fewadverse effects.

This systematic review and meta-analysis was conducted to estimate the effects of intravenous and nebulized magnesium sulfate on treating adults and children with acute asthma.

This systematic review and meta-analysis aimed to determine whether intramuscular or oral dexamethasone is equivalent or superior to a 5-day course of oral prednisone or prednisolone. The primary outcome of interest was return visits or hospital readmissions.

Objectives: To assess the effects of holding chambers (spacers) compared to nebulisers for the delivery of beta(2)-agonists for acute asthma. This review includes a total of 1897 children and 729 adults in 39 trials. Thirty-three trials were conducted in the emergency room and equivalent community settings, and six trials were on inpatients with acute asthma (207 children and 28 adults).

Objectives: To determine whether the addition of inhaled anticholinergics to SABAs provides clinical improvement and affects the incidence of adverse effects in children with acute asthma exacerbations.

Objectives: To determine the effectiveness of ICS on outcomes in the treatment of acute asthma following discharge from the ED. To quantify the effectiveness of ICS therapy on acute asthma following ED discharge, when used in addition to, or as a substitute for, systemic corticosteroids.

Objectives: To evaluate the efficacy of ketamine compared to placebo, no intervention or standard care for management of severe acute asthma in children who had not responded to standard therapy.

Objectives: To conduct a systematic review of the literature and update the previous review as to whether asthma education leads to improved health outcomes in children who have attended the emergency room for asthma.

Objectives: To examine the effect of additional intravenous magnesium sulfate in patients with acute asthma managed in the emergency department. Seven trials were included (5 adult, 2 pediatric).

Objectives: To determine the benefit of treating patients with acute asthma with systemic corticosteroids within an hour of presenting to the emergency department (ED).

To determine the performance characteristics of the Preschool Respiratory Assessment Measure (PRAM) in preschool and school-aged children with acute asthma.

To elaborate and validate a Preschool Respiratory Assessment Measure (PRAM) that would accurately reflect the severity of airway obstruction and the response to treatment in young patients with asthma.

Bottom line recommendations for the treatment and management of bronchiolitis. Updated April 2017

Bottom line recommendations for the treatment and management of bronchiolitis - en francais.

This guideline is a revision of the clinical practice guideline, Diagnosis and Management of Bronchiolitis, published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted. Each key action statement indicates level of evidence, benefit-harm relationship, and level of recommendation.

The goals of this statement are to build on the comprehensive peer-reviewed AAP statement by incorporating new evidence published over the past eight years, while providing the clinician with recommendations to help guide diagnosis, monitoring and management of previously healthy children one to 24 months of age who present with signs of bronchiolitis.

Evidence summary for the treatment and management of bronchiolitis.

This review summarizes evidence on the effect of antibiotics on clinical outcomes in children with bronchiolitis.

This review summarizes the evidence about the effect of bronchodilators in infants with bronchiolitis.

Objective: To examine clinically relevant short-term safety outcomes related to acute single or recurrent systemic short-term (<2 weeks) corticosteroid use based on systematic reviews of acute respiratory conditions.

Objective: to assess the effects of nebulised hypertonic ( 3%) saline solution in infants with acute viral bronchiolitis.

Objective: to review the efficacy and safety of systemic and inhaled glucocorticoids in children with acute viral bronchiolitis.

This updated overview of reviews aims to synthesize evidence from the Cochrane Database of Systematic Reviews (CDSR) on the effectiveness and safety of 11 pharmacologic and non-pharmacologic treatments to improve bronchiolitis symptoms in outpatient, inpatient and intensive care populations.

Objective: to examine the efficacy and safety of epinephrine in children less than two with acute viral bronchiolitis.

Objective: The objective of this study was to assess the efficacy and safety of nebulized hypertonic saline (HS) in infants with acute bronchiolitis.

Objective: to evaluate the effectiveness of antibiotics for bronchiolitis in children under two years of age compared to placebo or other interventions.

Objective: to assess the effects of bronchodilators on clinical outcomes in infants (0 to 12 months) with acute bronchiolitis.

Objective: to review the efficacy and safety of systemic and inhaled glucocorticoids in children with acute viral bronchiolitis.

Objective: to assess the effects of nebulised hypertonic ( 3%) saline solution in infants with acute viral bronchiolitis.

Objective: to examine the efficacy and safety of epinephrine in children less than two with acute viral bronchiolitis.

Objectives: to evaluate and compare the efficacy and safety of bronchodilators and steroids, alone or combined, for the acute management of bronchiolitis in children aged less than 2 years.

Objectives: Bronchiolitis is the most common lung infection in infants and treatment focuses on management of respiratory distress and hypoxia. High-flow warm humidified oxygen (HFWHO) is increasingly used, but has not been rigorously studied in randomised trials. This study aimed to examine whether HFWHO provided enhanced respiratory support, thereby shortening time to weaning off oxygen

This randomized, double-blind, placebo-controlled, clinical trial with a factorial design at multiple sites was undertaken to determine whether treatment with nebulized epinephrine, a short course of oral dexamethasone, or both resulted in a clinically important decrease in hospital admissions among infants with bronchiolitis who were seen in the emergency department.

The goal of this study was to determine the effectiveness of a single dose of oral dexamethasone in infants with moderate-to-severe bronchiolitis.

Objectives: to determine the proportion of radiographs inconsistent with bronchiolitis in children with typical presentation of bronchiolitis and to compare rates of intended antibiotic therapy before radiography versus those given antibiotics after radiography.

Bottom line recommendations for the treatment and management of concussion. Updated: August 2018.

Bottom line recommendations for the treatment and management of concussion - en francais. Updated: August 2018.

The Child SCAT5 is a standardized tool for evaluating concussions designed for use by physicians and licensed healthcare professionals. The Child SCAT5 is to be used for evaluating Children aged 5 to 12 years. For athletes aged 13 years and older, please use the SCAT5.

The SCAT5 is a standardized tool for evaluating concussions designed for use by physicians and licensed healthcare professionals. The SCAT5 is to be used for evaluating athletes aged 13 years and older. For children aged 12 years or younger, please use the Child SCAT5.

This document is intended to guide health care professionals in diagnosing and managing pediatric concussion. See Page 48 of this document for the Management of Acute Symptoms Algorithm (Tool 2.1).

Episode 3:Dr. Rahim Valani and Dr. Jennifer Riley discuss their approach to the workup and management of both minor and major Pediatric Head Injury. They review two recent landmark studies (Kupperman PECARN & CATCH studies) describing clinical decision rules for performing CT head in minor pediatric head injury, as well as practical tips on instructing parents regarding back to sport activities after discharge. In major pediatric head injury, they discuss key clinical pearls on managing blood pressure, the use of hypertonic saline and managing raised intracranial pressure in the treatment of major head injury. Published online: April 2010. 

The ACE is intended to provide an evidence-based clinical protocol to conduct an initial evaluation and diagnosis of patients (both children and adults) with known or suspected mild traumatic brain injury.

The 2017 Concussion in Sport Group (CISG) consensus statement is designed to build on the principles outlined in the previous statements and to develop further conceptual understanding of sport-related concussion (SRC) using an expert consensus-based approach.

This document is intended to guide health care professionals in diagnosing and managing pediatric concussion.

The purpose of this document is to provide recommendations based on current evidence that will help registered nurses, advanced practice nurses, and institutions provide safe and effective care to injured patients with a mild traumatic brain injury.

This summary answers the question: In paediatric patients with minor head injury, GCS (Glasgow Coma Score) 15 and no focal neurological deficit does a normal computed tomography brain scan allow safe discharge?

This is a systematic review of factors that might be associated with, or influence, clinical recovery from sport-related concussion

The objective of this systematic review was to evaluate the evidence regarding rest and active treatment/rehabilitation following sport-related concussion (SRC).

Objective: To synthesize the best available evidence regarding psychosocial consequences of mild traumatic brain injury (MTBI) in children.

Objective: To identify predictors of persistent concussion symptoms (PCS) in children following concussion.

This systematic review investigated the effectiveness of interventions initiated in acute settings for patients who experience mild traumatic brain injury.

This study aimed to identify clinical decision rules for children with minor head injury and compare their diagnostic accuracy for detection of intracranial injury (ICI) and injury requiring neurosurgical intervention (NSI).

Objectives: To (a) identify post-concussion symptom scales appropriate for children and adolescents in sports; (b) review evidence for reliability and validity; and (c) recommend future directions for scale development.

Methods: This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. Physicians completed standardized assessment forms before CT, including clinical predictors of the rule. The primary outcome was neurosurgical intervention and the secondary outcome was brain injury on CT. We calculated test characteristics of the rule and used recursive partitioning to further refine the rule.

Objective: To derive and validate a clinical risk score for persistent postconcussion symptoms among children presenting to the emergency department.

Objective: To determine the effect of cognitive activity level on duration of post-concussion symptoms.

Objective: To evaluate the diagnostic accuracy of clinical decision rules and physician judgment for identifying clinically important traumatic brain injuries in children with minor head injuries presenting to the emergency department.

Objective: To determine the acute predictors associated with the development of postconcussion syndrome (PCS) in children and adolescents after mild traumatic brain injury.

Objective: To test the hypothesis that children with a previous history of concussion have a longer duration of symptoms after a repeat concussion than those without such a history.

Objective: To describe how children and youths perform leisure activities, 1 year after a mild traumatic brain injury (MTBI).

This study of concussed adolescents sought to determine if a computer-based neurocognitive assessment (Immediate Postconcussion Assessment and Cognitive Test [ImPACT]) performed on patients who present to the emergency department (ED) immediately following head injury would correlate with assessments performed 3 to 10 days postinjury and if ED neurocognitive testing would detect differences in concussion severity that clinical grading scales could not.

Objectives: To identify the specific service needs of adolescents with mild traumatic brain injury (MTBI) and those of their parents through the perspective of expert service providers as well as to compare it to the perspective of adolescents and their parents obtained in a prior study.

Objective: To compare the visuomotor response times of children after a mild traumatic brain injury (mTBI) with those of noninjured children matched for age, sex, and premorbid level of physical activity.

This document summarizes causes, symptoms, and management of cyanosis in newborns.

Objective: To standardise the initial management of neonates with duct dependent congenital heart disease.

This document relates to the acute management of infants presenting acutely with collapse and/or cyanosis suggestive of congenital heart defect.

Objective: To assess the performance of pulse oximetry as a screening method for the detection of critical congenital heart defects in asymptomatic newborn babies.

Objective: This review focuses on the recognition and initial management of patients with undiagnosed congenital heart disease presenting to the ED and touches on considerations for postoperative infants and children with complex congenital heart disease.

Objective: This article presents an approach for identification of infants with congenital heart disorders.

Objective: To review our experience of a low initial dose of PGE1 treatment in early newborns with congenital heart disease and patent ductus arteriosus (PDA)-dependent pulmonary flow.

This publication provides an overview of the presentations of congenital heart defects, and makes diagnosis and management recommendations for emergency physicians.

Objective: To determine the effect of average SpO(2) range and oxygen administration during neonatal transport on clinical markers of cardiovascular instability.

Objective: To give a general picture of the diagnostic approach to a multitude of heart defects.

This document describes the pretransport and transport management of infants receiving prostaglandin E(1) infusion for congenital heart disease and compares transport complications among unintubated and electively intubated infants.

Objective: To address the evaluation and management of pediatric patients with congenital heart defects in the context of the evidence available from the medical literature.

This study presents the results of an evaluation of transporting, by a nonspecialized emergency medical service, neonates with known or suspected cardiac abnormalities.

This document discusses the potential challenges in recognizing cyanosis, including the presence of higher concentrations of fetal hemoglobin, and its oxygen binding characteristics.

Objective: To evaluate the safety of transporting newborn infants with suspected duct dependent congenital heart disease (CHD) treated with prostaglandin E1 (PGE1) without routine mechanical ventilation.

This document discusses the most common causes of cyanotic and acyanotic heart disease in infants.

General clinicians and junior paediatricians may have little experience of interpreting paediatric electrocardiograms. Although the basic principles of cardiac conduction and depolarisation are the same as for adults, age related changes in the anatomy and physiology of infants and children produce normal ranges for electrocardiographic features that differ from adults and vary with age. Awareness of these differences is the key to correct interpretation of paediatric electrocardiograms.

This document addresses some of the principles on which resuscitation and stabilisation of the symptomatic neonate with congenital heart disease may be based.

Objective: To determine the prevalence and clinical significance of murmurs detected during routine neonatal examination.

This retrospective review of critically ill infants 0 to 28 days of age presenting with either bacterial sepsis or meningitis or a congenital obstructive left heart syndrome (COLHS), identifies historical, physical, or laboratory findings which might differentiate the two groups at presentation.

This study reports experience with low-dose prostaglandin E1 (PGE1) treatment of 91 newborns with ductus dependent congenital heart disease (CHD).

Flowchart of evaluation and management of functional constipation in children.

This guideline covers diagnosing and managing constipation in children and young people up to 18. It provides strategies to support the early identification and timely, effective treatment of constipation which will help improve outcomes for patients. It does not cover constipation caused by a specific condition.

These clinical practice guidelines cover the description, etiology, diagnosis and management of constipation in children.

This article provides a description, assessment, and analysis of each functional gastrointestinal intestinal disorder that affects the neonate/toddler age group.

This summary article about the Rome IV diagnostic criteria describes the the field of functional gastrointestinal disorders, distinguishes them from motility and structural disorders, discusses the changes from the Rome III criteria, reviews the Rome committee process, provides a biopsychological pathophysiological conceptualization of functional gastrointestinal disorders, and offers an approach to patient care.

The Rome criteria provide symptom-based guidelines by which child and adolescent functional gastrointestinal disorders (FGID) can be diagnosed.

These emergency department guidelines cover the background, assessment and management of constipation in children.

This pathway is for use with children aged 1-18 years old with no underlying disease or cormorbidity who have been diagnosed with functional constipation.

These clinical practice guidelines cover the definition, etiology and pathophysiology, diagnosis, differential diagnosis and treatment of constipation in infants younger than six months, and also in children six months and older.

This evidence-based guideline provides recommendations for the evaluation and treatment of children withfunctionalconstipation to standardize and improve their quality of care. In addition, 2 algorithms were developed, one for the infants under 6 months of age and the other for older infants and children.

These guidelines are published in English and French, and cover the description, etiology, diagnosis and management, including long-term treatments and behavioural modifications and education, for functional constipation in children.

This summary addresses the questions: What are the effectiveness and side effects of osmotic and stimulant laxatives used for the treatment of functional childhood constipation?

This is a review of current guidelines for diagnosing and managing idiopathic constipation in children.

The objective of this systematic review was to evaluate the efficacy and safety of osmotic and stimulant laxatives used to treat functional childhood constipation.

The objective of this systematic review was to investigate the efficacy and safety of pre-, pro- and synbiotics in the treatment of pediatric functional constipation.

This review discusses the evaluation and management of functional constipation in the pediatric population and provides a summary of drug treatment options.

This systematic review aimed to answer the following clinical questions: What are the effects of fibre for children with chronic constipation? What are the effects of probiotics for children with chronic constipation?

This review covers the description, etiology, diagnosis and management of irritable bowel syndrome in children.

The objective of this systematic review was to assess the effects of behavioural and/or cognitive interventions for the management of faecal incontinence in children.

The objectives of this systematic review were to summarize the evidence and assess the reported quality of studies concerning nonpharmacologic treatments for childhood constipation, including fiber, fluid, physical movement, prebiotics, probiotics, behavioral therapy, multidisciplinary treatment, and forms of alternative medicine.

This systematic review aimed to answer the following clinical questions: What are the effects of treatments for children with chronic constipation? What are the effects of treatments for clearing the bowel in children with faecal impaction?

The purpose of this review was to discuss the diagnosis and management of pediatric constipation by nurse practitioners in primary care.

The objective of this systematic review was to investigate and summarise the quantity and quality of the current evidence for the effect of laxatives and dietary measures on functional childhood constipation.

The objective of this study was to evaluate the association between abdominal radiograph performance and emergency department (ED) revisits with important alternate diagnosis among children with constipation.

This study aimed to compare the effectiveness of pelvic physiotherapy (PPT) vs standard medical care (SMC) in children with functional constipation.

The objectives of this study were to evaluate among parents of infants and toddlers the agreement between parental report and the Bristol Stool Scale (BSS) in assessing stool consistency and the effect of both methods on determining the prevalence of functional constipation (FC) according to the Rome III criteria.

The objective of this study was to evaluate whether follow-up by phone or self-management through Web-based information improved treatment outcomes for childhood functional constipation.

This phase two clinical trial evaluated the efficacy of suppositories containing free fatty acids (FFA) compared with Klyx docusate sodium and sorbitol enemas for treating constipation in children.

The objectives of this longitudinal study were to describe the clinical characteristics of children with bowel dysfunction and to examine the effects of bowel dysfunction on patient outcomes in children with and without vesicoureteral reflux.

The objective of this study was to evaluate the safety and efficacy of polyethylene glycol-electrolyte solution vs polyethylene glycol-3350 for the treatment of fecal impaction in pediatric patients.

The aim of the study was to evaluate the effectiveness and safety of 2 different polyethylene glycol (PEG) doses for the maintenance treatment of functional constipation in children.

The aim of this study was to assess the effectiveness of a high-dose oral protocol using polyethylene glycol with electrolytes (PEG + E) (Movicol Rx) combined with sodium picosulphate (SP) (Dulcolax SP Rx) in faecal impaction in children presenting to a suburban clinic.

The primary objective of this study was to compare the gastrointestinal (GI) symptoms and worry of pediatric patients with functional GI disorders (FGIDs) and organic GI diseases to healthy controls utilizing the Pediatric Quality of Life Inventor (PedsQL) Gastrointestinal Symptoms and Worry Scales for patient self-reports ages 5-18 years and parent proxy-reports for ages 2-18 years. The secondary objective was to compare FGIDs and organic GI diseases to each other.

The objective of this study was to evaluate the success and complication rates of administering milk and molasses enemas in the ED.

The objectives of this study were to determine the proportion of children diagnosed with constipation assigned a significant alternative diagnosis within 7 days (misdiagnosis), if there was an association between abdominal radiograph (AXR) performance and misdiagnosis, and if there were features that might identify children with misdiagnoses.

The primary objective of this study was to determine whether enema administration is associated with 7-day emergency department (ED) revisits for persistent symptoms of pediatric constipation. Secondary objectives focused on assessing other predictors of ED revisits.

This multicenter, randomized, placebo-controlled, double-blind, phase 3 trial aimed to evaluate the efficacy and safety of prucalopride in children (6 months to 18 years old) with functional constipation.

This study aimed to compare efficacy of enema versus polyethylene glycol (PEG) 3350 for pediatric fecal impaction treatment.

The purpose of this study was to determine the safety and efficacy of routine milk and molasses enemas (MME) compared with sodium phosphate enemas for the treatment of constipation in the pediatric emergency department (ED). A secondary objective included the identification of factors associated with enema selection in the pediatric ED.

This study tested the hypothesis that enemas and polyethylene glycol (PEG) would be equally effective in treating rectal fecal impaction (RFI) but enemas would be less well tolerated and colonic transit time (CTT) would improve during disimpaction.

This randomized controlled trial compared the effects of additional treatment with rectal enemas (intervention) with conventional treatment alone (oral laxatives, control) in severely constipated children.

This study aimed to establish the efficacy and best starting dose of polyethylene glycol (PEG)3350 in the short-term treatment of children with functional constipation.

The aim of this study was to evaluate the clinical effectiveness of behavioral therapy with laxatives compared with conventional treatment in treating functional constipation in childhood.

The aim of this study was to evaluate the clinical validity and applicability of the Paris Consensus on Childhood Constipation Terminology (PACCT) versus the Rome II criteria for pediatric functional defecation disorders (FDDs).

The objective of this study was to describe variation in emergency department evaluation and treatment of children with constipation and characteristics and treatments associated with improvement.

The objective of this study were to assess the efficacy and safety of polyethylene glycol 3350 plus electrolytes (PEG+E) for the treatment of chronic constipation in children.

The aim of this study was to compare 2 laxatives, namely, polyethylene glycol 3350 without electrolytes and milk of magnesia, evaluating the efficacy, safety, acceptance, and 1-year outcomes.

The objectives of this study were to describe the clinical characteristics of children presenting to the ED with constipation and the ED interventions; to measure short-term symptom resolution at 48 hours and 7 days after the ED visit; and to identify predictive factors associated with poor symptom resolution at 48 hours and 7 days after the ED visit.

This pre-printed order (PPO) set is for management of the critically ill neonate in the ED. PPO document is adaptable to your hospitals form policy. This PPO is intended for use on patients ~ 28 days of age (corrected age). Published: December 2018, Version 1.0.

This point of care algorithm is to guide initial management of critically ill neonates in the Emergency Department. This algorithm is intended for use on patients ~ 28 days of age (corrected age). Published: December 2018, Version 1.0.

Bottom line recommendations for the treatment and management of croup. Published online: October 2016.

Bottom line recommendations for the treatment and management of croup- French. Published online: October 2014.

Summary of Alberta Clinical Practice Guideline document. Published: 2003; Last revised; 2008.

Developed by Alberta Clinical Practice Guideline Working Group. Published: 2003; Last revised: 2008.

Objective: To provide evidence to guide clinicians in their treatment of patients with croup by determining the effectiveness of glucocorticoids and to identify areas requiring future research. Published online: January 2012; Evidence current to: July 2010.

Objective: To assess the efficacy (measured by croup scores, rate of intubation and health care utilization such as rate of hospitalization) and safety (frequency and severity of side effects) of nebulized epinephrine versus placebo in children with croup, evaluated in an emergency department (ED) or hospital setting. Published online: October 2013; Evidence current to: July 2013.

Objective: To synthesize the evidence currently in the Cochrane Database of Systematic Reviews (CDSR) related to the clinical effectiveness and applicability of four treatments for croup - glucocorticoids, epinephrine, heliox and humidified air. Published: December 2010.

The purpose of this document is to describe the effectiveness of four treatment options, based on a 2012 Overview of Reviews. Published online: 2014.

Objective: To examine the effect of heliox on relieving symptoms and distress, determined by a croup score (a tool for measuring the severity of croup) or clinical assessment variables, through comparisons with placebo or active treatment(s) in children with croup. Published: February 2010; Evidence current to: June 2009.

Objective: To assess the efficacy (measured by croup scores, rate of intubation and health care utilization such as rate of hospitalization) and safety (frequency and severity of side effects) of nebulized epinephrine versus placebo in children with croup, evaluated in an emergency department (ED) or hospital setting. Published: October 2013; Evidence current to: July 2013.

Objective: To assess the efficacy of humidified air in the treatment of croup. Published: January 2006; Evidence current to: January 2006.

Objective: To provide evidence to guide clinicians in their treatment of patients with croup by determining the effectiveness of glucocorticoids and to identify areas requiring future research. Published: January 2011; Evidence current to: July 2010.

Objective: This review will address the diagnosis and management of croup in children, specifically focusing on clinical assessment of disease severity to guide management decisions.

Objective: To determine whether a significant difference in the clinical Westley croup score exists in children with moderate to severe croup who were admitted to the emergency department and who received either 100% humidity or 40% humidity via nebulizer or blow-by humidity. Published: 2006.

Objective: The primary outcome was a return to a medical care provider for croup within seven days after treatment. The secondary outcome was the presence of ongoing symptoms of croup on days 1, 2, and 3 after treatment. Other outcomes included economic costs, hours of sleep lost by the child, and stress on the part of the parent in relation to the child's illness. Published: 2004.

Objective: Steroid use for the treatment of croup has been supported by several studies, although few have addressed the use of oral dexamethasone for outpatient management. The efficacy of oral (PO) versus intramuscular (IM) dosing of dexamethasone in the outpatient treatment of moderate croup are compared in this study. Published: 2000.

Objective: To study how budesonide compares with dexamethasone, the conventional therapy for croup, and whether either reduces the rate of hospitalization. Published: 1998.

Objective: To determine the effectiveness of 3 glucocorticoid regimens in patients with croup. Published: 1998.

Objective: To compare the efficacy of oral dexamethasone and inhaled budesonide in children hospitalized with croup, using a three-way, double blind, randomized, placebo-controlled clinical trial design. Published: 1995.