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Acute Otitis Media
Acute Otitis Media  Bottom Line Recommendations

Acute Otitis Media- Emergency Management in Children - Flowchart

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Children's Health Queensland Hospital and Health Service

Flowchart of emergency management in children for acute otitis media.

Otitis Media

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Bugs & Drugs

Acute Otitis Media prevention and antibiotic therapy.

Flow diagram for the management of children with suspected and confirmed acute otitis media

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Le Saux N, Robinson JL, Canadian Paediatric Society, Infectious Diseases and ...

Flow chart of criteria for management of children with suspected and confirmed acute otitis media based on symptoms of children over 6 months of age.

Bottom Line Recommendations: Acute Otitis Media

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Le Saux N, TREKK Network

Bottom Line Recommendations for diagnosis and treatment of AOM.

Recommandations de Base: Otite moyenne aigu

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Le Saux N, TREKK Network

Bottom Line Recommendations for diagnosis and treatment of AOM-French.

Videos in clinical medicine. Diagnosing otitis media--otoscopy and cerumen removal

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Shaikh N, Hoberman A, Kaleida PH, Ploof DL, Paradise JL

Video instructing how to diagnose otitis media with otoscopy and cerum removal.

Acute Otitis Media  Clinical guidelines

Clinical Practice Guideline: Acute otitis media - Emergency management in children

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Children's Health Queensland Hospital and Health Service

Children's Health Queensland Statewide Paediatric Guideline for emergency management of acute otitis media in children.

Clinical Practice Guideline: Management of acute otitis media in children six months of age and older

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Le Saux N, Robinson JL, Canadian Paediatric Society, Infectious Diseases and ...

Canadian Paediatric Society position statement on the management of acute otitis media in children aged 6 months and older.

Clinical Practice Guideline: Danish guidelines on management of otitis media in preschool children

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Heidemann CH, Lous J, Berg J, Christensen JJ, Hkonsen SJ, Jakobsen M, Johanse...

The Danish Health and Medicines Authority and the Danish Society of Otorhinolaryngology guidelines regarding the diagnostic criteria for acute otitis media and surgical treatment of recurrent AOM and chronic OME in preschool children.

Clinical Practice Guideline: The diagnosis and management of acute otitis media

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Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA,...

Evidence-based clinical practice guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians.

Acute Otitis Media  Summaries of systematic reviews

Cochrane Summary: Systemic corticosteroids for improving symptoms in children with acute middle ear infection

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Ranakusuma RW, Pitoyo Y, Safitri ED, Thorning S, Beller EM, Sastroasmoro S, D...

Objective: To assess the effects of systemic corticosteroids (oral or parenteral), with or without antibiotics, for AOM in children.

Cochrane Summary: Influenza vaccine for preventing acute otitis media (middle ear infection)

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Norhayati MN, Ho JJ, Azman MY

Objective: To assess the effectiveness of influenza vaccine in reducing the occurrence of acute otitis media in infants and children.

Cochrane Summary: Pain relievers for children with acute middle ear infection

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Sjoukes A, Venekamp RP, van de Pol AC, Hay AD, Little P, Schilder AG, Damoise...

Objective: Our primary objective was to assess the effectiveness of paracetamol (acetaminophen) or NSAIDs, alone or combined, compared with placebo or no treatment in relieving pain in children with AOM. Our secondary objective was to assess the effectiveness of NSAIDs compared with paracetamol in children with AOM.

Cochrane Summary: Antibiotics for otitis media with effusion ('glue ear') in children

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Venekamp RP, Burton MJ, van Dongen TM, van der Heijden GJ, van Zon A, Schilde...

Objective: To assess the benefits and harms of oral antibiotics in children up to 18 years with OME.

Acute Otitis Media  Overviews of systematic reviews

Evidence Summary: Are topical antibiotics an alternative to oral antibiotics for children with acute otitis media and ear discharge?

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Venekamp RP, Prasad V, Hay AD

Objective: To review the evidence comparing efectiveness of topical antibiotics with oral antibiotics, placebo, or no treatment in children with AOM presenting with ear discharge caused by spontaneous perforation of the eardrum.

Acute Otitis Media  Systematic reviews

Systematic Review: A systematic review and meta-analysis of antimicrobial resistance in paediatric acute otitis media

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Michael W. Mathera, Michael Drinnana, John D. Perryc, Steven Powellb, Janet A...

Objective: We present a comprehensive review and meta-analysis, of both the microbiology and antimicrobial resistance of AOM organisms to commonly used antimicrobial agents, with the aim of informing responsible antimicrobial stewardship.

Review: From paper to practice: Strategies for improving antibiotic stewardship in the pediatric ambulatory setting.

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Bozzella MJ, Harik N, Newland JG, Hamdy RF

Objective: The intent with this review is to provide an overview of strategies that pediatric providers can take from paper to practice.

Cochrane Systematic Review: Systemic corticosteroids for acute otitis media in children

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Ranakusuma RW, Pitoyo Y, Safitri ED, Thorning S, Beller EM, Sastroasmoro S, D...

Objective: To assess the effects of systemic corticosteroids (oral or parenteral), with or without antibiotics, for AOM in children.

Cochrane Systematic Review: Influenza vaccines for preventing acute otitis media in infants and children

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Norhayati MN, Ho JJ, Azman MY

Objective: To assess the effectiveness of influenza vaccine in reducing the occurrence of acute otitis media in infants and children.

Review: Antibiotic therapy for children with acute otitis media

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Sakulchit T, Goldman RD

Objective: Review of AOM and the evidence regarding use of antibiotics or watchful waiting to treat children at different levels of disease severity.

Cochrane Systematic Review: Paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs, alone or combined, for pain relief in acute otitis media in children

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Sjoukes A, Venekamp RP, van de Pol AC, Hay AD, Little P, Schilder AG, Damoise...

Objective: Our primary objective was to assess the effectiveness of paracetamol (acetaminophen) or NSAIDs, alone or combined, compared with placebo or no treatment in relieving pain in children with AOM. Our secondary objective was to assess the effectiveness of NSAIDs compared with paracetamol in children with AOM.

Cochrane Systematic Review: Antibiotics for otitis media with effusion in children

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Venekamp RP, Burton MJ, van Dongen TM, van der Heijden GJ, van Zon A, Schilde...

Objective: To assess the benefits and harms of oral antibiotics in children up to 18 years with OME.

Cochrane Systematic Review: Antibiotics for acute otitis media in children

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Venekamp RP, Sanders SL, Glasziou PP, Del Mar CB, Rovers MM

Objective: To assess the effects of antibiotics for children with AOM.

Systematic Review: Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis

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Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD

Objective: To systematically review the literature and, where appropriate, meta-analyse studies investigating subsequent antibiotic resistance in individuals prescribed antibiotics in primary care.

Acute Otitis Media  Key studies

Key study: Acute otitis media in children presenting to the emergency department: Is it diagnosed and managed appropriately?

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Niroshan Balasundaram, Dung Phan, Daniel Mazzoni, Elliot Duong, Amy Sweeny, C...

Objective: To describe the diagnostic and management practice in children with acute otitis media (AOM) presenting to the emergency department (ED) and compare diagnosis and management against existing guidelines.

Key study: Diagnostic Accuracy, Prescription Behavior, and Watchful Waiting Efficacy for Pediatric Acute Otitis Media

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Brinker DL Jr, MacGeorge EL, Hackman N

Objective: To assess the implications and recommendations to improve antibiotic stewardship through watchful waiting as an alternative to immediate antibiotic treatment in children with AOM.

Key study: Optimising pain management in children with acute otitis media through a primary care-based multifaceted educational intervention: study protocol for a cluster randomised controlled trial

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van Uum RT, Venekamp RP, Sjoukes A, van de Pol AC, de Wit GA, Schilder AGM, D...

Objective: We have developed a primary care-based multifaceted educational intervention to optimise pain management in children with AOM, and we trial its clinical and cost effectiveness.

Key study: Shortened Antimicrobial Treatment for Acute Otitis Media in Young Children

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Hoberman A, Paradise JL, Rockette HE, Kearney DH, Bhatnagar S, Shope TR, Mart...

Objective: Given methodologic limitations in available publications, we undertook the current trial involving children 6 to 23 months of age to determine whether limiting antimicrobial treatment to 5 days rather than using the standard 10-day regimen would afford equivalent outcomes and whether doing so also for subsequent episodes would lead to a reduction in the overall use of antimicrobial treatment, with a resulting reduction in the development of antimicrobial resistance.

Key study: Use of symptoms and risk factors to predict acute otitis media in infants

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McCormick DP, Jennings K, Ede LC, Alvarez-Fernandez P, Patel J, Chonmaitree T

Objective: The purpose of this study was to evaluate the usefulness of symptoms and other risk factors in predicting the presence of AOM in infants.

Key study: Symptomatic and asymptomatic respiratory viral infections in the first year of life: association with acute otitis media development

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Chonmaitree T, Alvarez-Fernandez P, Jennings K, Trujillo R, Marom T, Loeffelh...

Objective: This study determined the epidemiologic characteristics and etiology of asymptomatic upper respiratory tract infection in the first year of life and the association with acute otitis media complication.

Key study: Treatment of acute otitis media in children under 2 years of age

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Hoberman A, Paradise JL, Rockette HE, Shaikh N, Wald ER, Kearney DH, Colborn ...

Objective: We undertook this clinical trial 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 in whom the diagnosis of acute otitis media is quite certain.

Key study: A placebo-controlled trial of antimicrobial treatment for acute otitis media

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Thtinen PA, Laine MK, Huovinen P, Jalava J, Ruuskanen O, Ruohola A

Objective: We conducted a randomized, double-blind, placebo-controlled study of the efficacy of antimicrobial therapy in the age group with the highest incidence of acute otitis media. Our aim was to assess the efficacy of antimicrobial treatment for acute otitis media when strict diagnostic criteria are used and the antimicrobial coverage and dosage of the active treatment are adequate.

Anaphylaxis
Anaphylaxis  Bottom Line Recommendations

Bottom Line Recommendations: Anaphylaxis

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Alqurashi W and TREKK Network

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

Recommandations de Base: Anaphylaxie

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Alqurashi W and TREKK Network

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

Feuille d'Ordonnance Medicale pour L’Anaphylaxie

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PedsPac de TREKK sur l'Anaphylaxie

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: April 2019, Version 1.1.

Anaphylaxis Pre-Printed Order Set

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TREKK Anaphylaxis PedsPac

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.

Anaphylaxis References and Development Team

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TREKK Anaphylaxis PedsPac

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

Anaphylaxis Algorithm

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TREKK Anaphylaxis PedsPac

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

Anaphylaxis Pocket Card

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TREKK Anaphylaxis PedsPac

This pocket card contains tips to manage pediatric patients with anaphylaxis. Updated online: April 2019, Version 1.2.

Carte de Poche pour L’Anaphylaxie

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PedsPac de TREKK sur l'Anaphylaxie

This pocket card contains tips to manage pediatric patients with anaphylaxis. Published online: April 2019, Version 1.2.

Algorithme pour L’Anaphylaxie

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PedsPac de TREKK sur l'Anaphylaxie

This point of care algorithm is to guide initial management of pediatric anaphylaxis in the Emergency Department. Published online: April 2019, Version 1.1.

Anaphylaxis  Clinical guidelines

Clinical Practice Guideline: Anaphylaxis in Schools & Other Settings, 3rd Edition Revised

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Canadian Society of Allergy and Clinical Immunology

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.

Position Statement: CSACI position statement - epinephrine auto-injectors and children < 15 kg

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Halbrich M, Mack DP, Carr S, Watson W, Kim H

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?

Clinical Practice Guideline: Anaphylaxis--a practice parameter update 2015

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Lieberman P, Nicklas RA, Randolph C, Oppenheimer J, Bernstein D, Bernstein J,...

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.

Clinical Practice Guideline: 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines

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Simons FE, Ebisawa M, Sanchez-Borges M, Thong BY, Worm M, Tanno LK, Lockey RF...

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.

Clinical Practice Guideline: Emergency department diagnosis and treatment of anaphylaxis: a practice parameter

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Campbell RL, Li JT, Nicklas RA, Sadosty AT, Members of the Joint Task Force P...

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.

Clinical Practice Guideline: Anaphylaxis: Guidelines from the European Academy of Allergy and Clinical Immunology

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Muraro A, Roberts G, Worm M, Bil MB, Brockow K, Fernndez Rivas M, Santos AF, ...

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.

Clinical Practice Guideline: World Allergy Organization guidelines for the assessment and management of anaphylaxis

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Simons FE, Ardusso LR, Bil MB, El-Gamal YM, Ledford DK, Ring J, Sanchez-Borge...

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.

Anaphylaxis  Systematic reviews

Review: Do Corticosteroids Prevent Biphasic Anaphylaxis?

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Alqurashi W, Ellis AK

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

Comprehensive Review: Pitfalls in the use of epinephrine for anaphylaxis: patient and provider opportunities for improvement

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Cohen MB, Saunders SS, Wise SK, Nassif S, Platt MP

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

Systematic Review: Time of Onset and Predictors of Biphasic Anaphylactic Reactions: A Systematic Review and Meta-analysis

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Lee S, Bellolio MF, Hess EP, Erwin P, Murad MH, Campbell RL

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

Review: Anaphylaxis: Unique aspects of clinical diagnosis and management in infants (birth to age 2 years)

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Simons FE, Sampson HA

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

Review: Risk multipliers for severe food anaphylaxis

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Smith PK, Hourihane JO, Lieberman P

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.

Systematic Review: H2-antihistamines for the treatment of anaphylaxis with and without shock: a systematic review

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Nurmatov UB, Rhatigan E, Simons FE, Sheikh A

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

Cochrane Systematic Review: Glucocorticoids for the treatment of anaphylaxis

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Choo KJ, Simons FE, Sheikh A

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

Cochrane Systematic Review: Adrenaline auto-injectors for the treatment of anaphylaxis with and without cardiovascular collapse in the community

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Sheikh A, Simons FE, Barbour V, Worth A

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.

Cochrane Systematic Review: H1-antihistamines for the treatment of anaphylaxis with and without shock

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Sheikh A, ten Broek VM, Brown SG, Simons FE

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

Anaphylaxis  Key studies

Key Study: Epinephrine Use for Anaphylaxis - A Multi-Incident Analysis

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Institute for Safe Medication Practices Canada

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.

Key Study: The Risk of Recurrent Anaphylaxis

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O'Keefe A, Clarke A, St Pierre Y, Mill J, Asai Y, Eisman H, La Vieille S, Ali...

factors contributing to errors when epinephrine was

Key Study: Lacerations and Embedded Needles Caused by Epinephrine Autoinjector Use in Children

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Brown JC, Tuuri RE, Akhter S, Guerra LD, Goodman IS, Myers SR, Nozicka C, Man...

used for the treatment of anaphylaxis and to suggest

Key Study: Embedded Needles Caused by Epinephrine Autoinjector Use in Children

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Dreborg S, Wen X, Kim L, Tsai G, Nevis I, Potts R, Chiu J, Dominic A, Kim H

strategies to prevent or minimize potential harm

Key Study: Increasing visits for anaphylaxis and the benefits of early epinephrine administration: A 4-year study at a pediatric emergency department in Montreal, Canada

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Hochstadter E, Clarke A, De Schryver S, LaVieille S, Alizadehfar R, Joseph L,...

when epinephrine is used for this indication.

Key Study: Epidemiology and clinical predictors of biphasic reactions in children with anaphylaxis

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Alqurashi W, Stiell I, Chan K, Neto G, Alsadoon A, Wells G

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.

Key Study: Early treatment of food-induced anaphylaxis with epinephrine is associated with a lower risk of hospitalization

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Fleming JT, Clark S, Camargo CA Jr, Rudders SA

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.

Key Study: Patients' ability to treat anaphylaxis using adrenaline autoinjectors: a randomized controlled trial

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Umasunthar T, Procktor A, Hodes M, Smith JG, Gore C, Cox HE, Marrs T, Hanna H...

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.

Asthma
Asthma  Bottom Line Recommendations

Asthma Pocket Card

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TREKK Asthma PedsPac

This pocket card contains tips to manage pediatric patients with severe asthma. This pocket card is intended for use on patients greater or equal to 12 months of age. Published online: August 2019, Version 1.2.

Bottom Line Recommendations: Asthma

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Johnson D & TREKK Network

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

Recommandations de Base: Asthme

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Johnson D & TREKK Network

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

Asthma Pre-Printed Order Set

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TREKK Asthma PedsPac

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 greater than or equal to 12 months of age. Published online: December 2018, Version 1.0.

Asthma Algorithm

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TREKK Asthma PedsPac

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 greater than or equal to 12 months of age. Published online: April 2019, Version 1.1.

Asthma References and Development Team

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TREKK Asthma PedsPac

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

Carte de Poche d'Asthme

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PedsPac de TREKK sur d'Asthme

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: April 2019, Version 1.0.

Feuille d'Ordonnance Medicale pour d'Asthme

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PedsPac de TREKK sur d'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: April 2019, Version 1.0.

Algorithme Pediatrique pour d'Asthme

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PedsPac de TREKK sur d'Asthme

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 greater than or equal to 12 months of age. Published online: April 2019, Version 1.0.

Asthma  Clinical guidelines

Clinical Practice Guideline: Global Strategy for Asthma Management and Prevention (2014)

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GINA Science Committee,

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.

Clinical Practice Guideline: Paediatric Emergency Department Asthma Clinical Pathway (2014)

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Expert Content Working Group of the Ontario Lung Association,

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.

Clinical Practice Guideline: Guide Clinique Asthme (2014)

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Trottier, ED, Gauvin, F, Pettersen, G, Marquis, C, Ducharme, F, Lucas, N, Béd...

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.

Clinical Practice Guideline: Asthme: Algorithme status asthmaticus (2014)

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Trottier, ED, Gauvin, F, Pettersen, G, Marquis, C, Ducharme, F, Lucas, N, Béd...

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

Clinical Practice Guideline: Pediatric Asthma Assessment for Emergent/Urgent Care (2013)

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Alberta Health Services,

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

Clinical Practice Guideline: Pediatric Asthma Orders for Emergent/Urgent Care (2013)

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Alberta Health Services,

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

Clinical Practice Guideline: Pediatric Asthma Education Checklist (2013)

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Alberta Health Services,

This checklist contains education topics to review with patients/caregivers

Asthma  Summaries of systematic reviews

Cochrane Summary: Holding chambers (spacers) versus nebulisers for delivery of beta-agonist relievers in the treatment of an asthma attack (2013)

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Cates, CJ, Welsh, EJ, Rowe, BH,

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.

Cochrane Summary: Combined inhaled anticholinergics and beta2-agonists for initial treatment of acute asthma in children (2013)

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Griffiths, B, Ducharme, FM,

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.

Cochrane Summary: Inhaled corticosteroids for acute asthma following emergency department discharge (2012)

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Edmonds, ML, Milan, SJ, Brenner, BE, Camargo, CA, Rowe, BH,

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.

Cochrane Summary: Role of ketamine for management of acute severe asthma in children (2012)

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Jat, KR, Chawla, D,

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.

Cochrane Summary: What are the effects of educational interventions delivered to children and/or their families, who have experienced an emergency department visit with their asthma within the previous 12 months? (2010)

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Boyd, M, Lasserson, TJ, McKean, MC, Gibson, PG, Ducharme, FM, Haby, M,

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.

Cochrane Summary: Magnesium sulfate for treating exacerbations of acute asthma in the emergency department (2009)

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Rowe, BH, Bretzlaff, J, Bourdon, C, Bota, G, Blitz, S, Camargo, CA,

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.

Cochrane Summary: Early emergency department treatment of acute asthma with systemic corticosteroids (2008)

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Rowe, BH, Spooner, C, Ducharme, F, Bretzlaff, J, Bota, G,

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.

Asthma  Systematic reviews

Cochrane Systematic Review: Intravenous and nebulized magnesium sulfate for treating acute asthma in adults and children: a systematic review and meta-analysis

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Shan, Z, Rong, Y, Yang, W, Wang, D, Yao, P, Xie, J, Liu, L,

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.

Cochrane Systematic Review: Dexamethasone for acute asthma exacerbations in children: a meta-analysis (2014)

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Keeney, GE, Gray, MP, Morrison, AK, Levas, MN, Kessler, EA, Hill, GD, Gorelic...

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.

Cochrane Systematic Review: Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma (2013)

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Cates, CJ, Welsh, EJ, Rowe, BH,

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).

Cochrane Systematic Review: Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children (2013)

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Griffiths, B, Ducharme, FM,

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.

Cochrane Systematic Review: Inhaled steroids for acute asthma following emergency department discharge (2012)

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Edmonds, ML, Milan, SJ, Brenner, BE, Camargo, CA Jr, Rowe, BH,

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.

Cochrane Systematic Review: Ketamine for management of acute exacerbations of asthma in children (2012)

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Jat, KR, Chawla, D,

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.

Cochrane Systematic Review: Interventions for educating children who are at risk of asthma-related emergency department attendance (2009)

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Boyd, M, Lasserson, TJ, McKean, MC, Gibson, PG, Ducharme, FM, Haby, M,

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.

Cochrane Systematic Review: Magnesium sulfate for treating exacerbations of acute asthma in the emergency department (2000)

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Rowe, BH, Bretzlaff, JA, Bourdon, C, Bota, GW, Camargo, CA Jr,

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).

Cochrane Systematic Review: Early emergency department treatment of acute asthma with systemic corticosteroids (2000)

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Rowe, BH, Spooner, C, Ducharme, FM, Bretzlaff, JA, Bota, GW,

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

Asthma  Key studies

Key Study: The Pediatric Respiratory Assessment Measure: a valid clinical score for assessing acute asthma severity from toddlers to teenagers (2008)

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Ducharme, FM, Chalut, D, Plotnick, L, Savdie, C, Kudirka, D, Zhang, X, Meng, ...

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

Key Study: The Preschool Respiratory Assessment Measure (PRAM): a responsive index of acute asthma severity (2000)

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Chalut DS, Ducharme FM, Davis GM

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.

Bacterial Meningitis
Bacterial Meningitis  Bottom Line Recommendations

CSF interpretation

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The Royal Children's Hospital Melbourne

Guideline to help with the interpretation of CSF results for the purpose of diagnosing or excluding meningitis.

Lumbar puncture

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The Royal Children's Hospital Melbourne

Guideline for performing lumbar puncture.

Meningitis - encephalitis

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The Royal Children's Hospital Melbourne

Guideline for the assessment and management of meningitis-encephalitis.

Management of Bacterial Meningitis in Children and Young People

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Meningitis Research Foundation

Flowchart of management of bacterial meningitis in children and young people, incorporating NICE Bacterial Meningitis and Meningococcal Septicaemia Guideline CG102.

Early Recognition of Meningitis and Septicaemia

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Royal College of Nursing, Meningitis Research Foundation

Guidance for front line nurses on the early recognition of meningitis and sepsis (what to look for).

Bacterial Meningitis  Clinical guidelines

Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management

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National Institute for Health and Care Excellence

Guideline covering recognising, diagnosing and managing bacterial meningitis and meningococcal septicaemia in babies, children and young people under 16.

Guidelines for the management of suspected and confirmed bacterial meningitis in Canadian children older than one month of age

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Le Saux N; Canadian Paediatric Society, Infectious Diseases and ImmunizationC...

Statement reviewing the current epidemiology of bacterial meningitis in children beyond the neonatal period and provide guidelines for the empirical management of suspected bacterial meningitis in Canadian children.

Infants and Children: Acute Management of Bacterial Meningitis: Clinical Practice Guideline

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NSW Health

Clinical practice guidelines for the acute management of infants and children with bacterial meningitis.

Practice guidelines for the management of bacterial meningitis

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Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ

Practice guidelines to provide clinicians with recommendations for the diagnosis and treatment of bacterial meningitis.

Bacterial Meningitis  Summaries of systematic reviews

Cochrane Summary: Fluids for people with acute bacterial meningitis

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Maconochie IK, Bhaumik S

Objective: To evaluate treatment of acute bacterial meningitis with differing volumes of initial fluid administration (up to 72 hours after first presentation) and the effects on death and neurological sequelae.

Cochrane Summary: Corticosteroids for bacterial meningitis

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Brouwer MC, McIntyre P, Prasad K, Van de Beek D

Objective: To examine the effect of adjuvant corticosteroid therapy versus placebo on mortality, hearing loss and neurological sequelae in people of all ages with acute bacterial meningitis.

Summary: Can a Clinical Prediction Rule Reliably Predict Pediatric Bacterial Meningitis?

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Ostermayer DG, Koyfman A

Objective: To determine if a clinical prediction rule can reliably determine which children should be hospitalized and treated with intravenous antibiotics for bacterial meningitis.

Summary: In children with bacterial meningitis, does the addition of dexamethasone to an antibiotic treatment regimen result in a better clinical outcome than the antibiotic regimen alone?: Part A: Evidence-based answer and summary

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Fox JL

Objective: To determine the efficacy of adjuvant dexamethasone therapy in paediatric bacterial meningitis.

Bacterial Meningitis  Systematic reviews

Review: Emergency Medicine Myths: Computed Tomography of the Head Prior to Lumbar Puncture in Adults with Suspected Bacterial Meningitis - Due Diligence or Antiquated Practice?

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April MD, Long B, Koyfman A

Objective: To review the evidence regarding the utility of obtaining head CT prior to lumbar puncture in adults with suspected bacterial meningitis.

Review: Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department

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Dorsett M, Liang SY

Objective: This review discusses the clinical signs and symptoms that should lead emergency physicians to consider CNS infection, paying particular attention to the sensitivity and specificity of different clinical findings at the bedside. Subsequently, the diagnostic workup and management of patients for whom there is high clinical suspicion for CNS infection is discussed.

Cochrane Systematic Review: Fluid therapy for acute bacterial meningitis

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Maconochie IK, Bhaumik S

Objective: To evaluate treatment of acute bacterial meningitis with differing volumes of initial fluid administration (up to 72 hours after first presentation) and the effects on death and neurological sequelae.

Cochrane Systematic Review: Corticosteroids for acute bacterial meningitis

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Brouwer MC, McIntyre P, Prasad K, Van de Beek D

Objective: To examine the effect of adjuvant corticosteroid therapy versus placebo on mortality, hearing loss and neurological sequelae in people of all ages with acute bacterial meningitis.

Review: Early lumbar puncture in adult bacterial meningitis--rationale for revised guidelines

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Glimker M, Johansson B, Bell M, Ericsson M, Blckberg J, Brink M, Lindquist L,...

Objective: Revised Swedish guidelines regarding early lumbar puncture (LP) are presented, and the background documentation and reasons for omitting impaired consciousness, new onset seizures, and immunocompromised state as contraindications to LP are discussed.

Systematic Review: Does this child have bacterial meningitis? A systematic review of clinical prediction rules for children with suspected bacterial meningitis

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Kulik DM, Uleryk EM, Maguire JL

Objective: Our aim was to systematically identify and review the quality and performance of published clinical prediction rules (CPRs) for children with suspected bacterial meningitis.

Systematic Review: Meta-analysis of bacterial meningitis score validation studies

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Nigrovic LE, Malley R, Kuppermann N

Objective: The study objective of the present work was to calculate the performance of the Bacterial Meningitis Score by performing a meta-analysis of all published validation studies.

Systematic Review: Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: a meta-analysis

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Sakushima K, Hayashino Y, Kawaguchi T, Jackson JL, Fukuhara S

Objective: Our study's purpose was to assess the utility of CSF lactate in differentiating bacterial meningitis from aseptic meningitis.

Systematic Review: Clinical features suggestive of meningitis in children: a systematic review of prospective data

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Curtis S, Stobart K, Vandermeer B, Simel DL, Klassen T

Objective: To seek evidence supporting accuracy of clinical features of pediatric bacterial meningitis.

Review: Lumbar puncture and brain herniation in acute bacterial meningitis: a review

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Joffe AR

Objective: There has been controversy regarding the risk of cerebral herniation caused by a lumbar puncture (LP) in acute bacterial meningitis (ABM). This review discusses in detail the issues involved in this controversy.

Bacterial Meningitis  Key studies

Key study: Cranial CT, Lumbar Puncture, and Clinical Deterioration in Bacterial Meningitis: A Nationwide Cohort Study

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Costerus JM, Brouwer MC, Sprengers MES, Roosendaal SD, van der Ende A, van de...

Objective: In 2006, we started a prospective cohort study to identify and characterize host genetic traits and bacterial genetic factors controlling occurrence and outcome of bacterial meningitis (MeninGene). Here, we report data from this study, focusing on complications of LP in adults with community-acquired bacterial meningitis and the role of cranial CT prior to LP.

Key study: Lumbar Puncture Performed Promptly or After Neuroimaging in Acute Bacterial Meningitis in Adults: A Prospective National Cohort Study Evaluating Different Guidelines

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Glimker M, Sjlin J, kesson S, Naucler P

Objective: The aim was to evaluate the effect on outcome of adherence to European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), and Swedish guidelines regarding neuroimaging before LP.

Key study: Cranial Imaging Before Lumbar Puncture in Adults With Community-Acquired Meningitis: Clinical Utility and Adherence to the Infectious Diseases Society of America Guidelines

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Salazar L, Hasbun R

Objective: The main objectives of this study were to identify the adherence of clinicians to IDSA guidelines regarding cranial imaging in patients with CAM, to evaluate the clinical and prognostic differences between those patients with and without an indication for cranial imaging, and to assess the clinical impact in management in those with abnormal intracranial findings with or without altered mental status as their sole indication for imaging.

Key study: Adult bacterial meningitis: earlier treatment and improved outcome following guideline revision promoting prompt lumbar puncture

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Glimker M, Johansson B, Grindborg , Bottai M, Lindquist L, Sjlin J

Objective: Despite guideline emphasis on early treatment, performing CT prior to LP implies a risk of delayed treatment and unfavorable outcome. Therefore, Swedish guidelines were revised in 2009, deleting impaired mental status as a contraindication for LP without prior CT scan. The aim of the present study was to evaluate the guideline revision.

Key study: Prevalence and predictors of bacterial meningitis in young infants with Fever without a source

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Martinez E, Mintegi S, Vilar B, Martinez MJ, Lopez A, Catediano E, Gomez B

Objective: Our objectives were to analyze the prevalence and microbiology of bacterial meningitis in this group and its prevalence in relation to clinical and laboratory risk factors.

Key study: Outcomes of invasive meningococcal disease in adults and children in Canada between 2002 and 2011: a prospective cohort study

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Sadarangani M, Scheifele DW, Halperin SA, Vaudry W, Le Saux N, Tsang R, Betti...

Objective: The objectives of this study were to describe the outcomes following invasive meningococcal disease (IMD) in a prospective cohort of children and adults, and to identify specific risk factors for death and development of neurological and nonneurological complications.

Key study: Distinguishing between bacterial and aseptic meningitis in children: European comparison of two clinical decision rules

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Dubos F, Korczowski B, Aygun DA, Martinot A, Prat C, Galetto-Lacour A, Casado...

Objective: To compare the performance of two of these CDRs for children: the Bacterial Meningitis Score (BMS) and the Meningitest.

Key study: Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis

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Nigrovic LE, Kuppermann N, Macias CG, Cannavino CR, Moro-Sutherland DM, Schem...

Objective: To validate the Bacterial Meningitis Score in the era of widespread pneumococcal conjugate vaccination.

Key study: Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment

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Kanegaye JT, Soliemanzadeh P, Bradley JS

Objective: We conducted a retrospective review of children with bacterial meningitis to describe the rate at which parenteral antibiotic pretreatment sterilizes CSF cultures.

Key study: Cerebrospinal fluid findings in aseptic versus bacterial meningitis

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Negrini B, Kelleher KJ, Wald ER

Objective: To assess 1) the characteristics of the CSF differential in aseptic versus bacterial meningitis, 2) the influence of duration of illness on the CSF differential, and 3) the role of the CSF differential in discriminating between aseptic versus bacterial meningitis.

Key study: A comparison of ceftriaxone and cefuroxime for the treatment of bacterial meningitis in children

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Schaad UB, Suter S, Gianella-Borradori A, Pfenninger J, Auckenthaler R, Berna...

Objective: To compare ceftriaxone with cefuroxime for the treatment of meningitis, we conducted a study in which 106 children with acute bacterial meningitis were randomly assigned to receive either ceftriaxone (100 mg per kilogram of body weight per day, administered intravenously once daily; n = 53) or cefuroxime (240 mg per kilogram per day, administered intravenously in four equal doses; n = 53).

Bronchiolitis
Bronchiolitis  Bottom Line Recommendations

Bottom Line Recommendations: Bronchiolitis

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Plint, A & TREKK Network

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

Recommandations de Base: La Bronchiolite

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Plint, A & TREKK Network

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

Bronchiolitis  Clinical guidelines

Clinical Guideline: Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis

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Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, J...

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.

Clinical Guideline: Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age

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Canadian Paediatric Society

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.

Bronchiolitis  Overviews of systematic reviews

Overview of Systematic Reviews: Evidence Summary: Bronchiolitis

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Alberta Research Centre for Health Evidence (ARCHE)

Evidence summary for the treatment and management of bronchiolitis.

Cochrane Summary: Antibiotics for bronchiolitis in children under two years of age

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Farley R, Spurling GK, Eriksson L, Del Mar CB

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

Cochrane Summary: Bronchodilators for bronchiolitis for infants with first-time wheezing

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Gadomski AM, Scribani MB

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

Overview of Systematic Reviews: The Cochrane Library and safety of systemic corticosteroids for acute respiratory conditions in children: An overview of reviews

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Fernandes RM, Oleszczuk M, Woods CR, Rowe BH, Cates CJ, Hartling L.

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.

Cochrane Summary: Hypertonic saline solution administered via nebuliser for acute bronchiolitis in infants

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Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP

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

Cochrane Summary: Glucocorticoids for acute viral bronchiolitis in infants and young children under two years of age

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Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson ...

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

Overview of Systematic Reviews: The Cochrane Library and the treatment of bronchiolitis in children: An overview of reviews

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Bialy L, Foisy M, Smith M, Fernandes RM

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.

Cochrane Summary: Epinephrine for acute viral bronchiolitis in children less than two years of age

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Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC, Klassen...

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

Bronchiolitis  Systematic reviews

Systematic Review: Nebulized hypertonic saline for acute bronchiolitis: A systematic review

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Zhang L, Mendoza-Sassi RA, Klassen TP, Wainwright C.

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

Systematic Review: Antibiotics for bronchiolitis in children under two years of age

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Farley R, Spurling GK, Eriksson L, Del Mar CB

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

Systematic Review: Bronchodilators for bronchiolitis

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Gadomski AM, Scribani MB

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

Systematic Review: Glucocorticoids for acute viral bronchiolitis in infants and young children

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Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson ...

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

Systematic Review: Nebulised hypertonic saline solution for acute bronchiolitis in infants

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Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP

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

Systematic Review: Epinephrine for bronchiolitis

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Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC, Klassen...

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

Systematic Review: Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis

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Hartling L, Fernandes RM, Bialy L, Milne A, Johnson D, Plint A, Klassen TP, V...

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.

Bronchiolitis  Key studies

Key Study: High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): An open, phase 4, randomised controlled trial

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Kepreotes E, Whitehead B, Attia J, Oldmeadow C, Collison A, Searles A, Goddar...

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

Key Study: Epinephrine and dexamethasone in children with bronchiolitis

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Plint AC, Johnson DW, Patel H, Wiebe N, Correll R, Brant R, Mitton C, Gouin S...

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.

Key Study: A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis

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Corneli HM, Zorc JJ, Mahajan P, Shaw KN, Holubkov R, Reeves SD, Ruddy RM, Mal...

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

Key Study: Evaluation of the utility of radiography in acute bronchiolitis

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Schuh S, Lalani A, Allen U, Manson D, Babyn P, Stephens D, MacPhee S, Mokansk...

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.

Burns
Burns  Bottom Line Recommendations

Paediatric Burn Assessment

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Victorial Adult Burns Service at the Alfred

Burns management guidelines for pediatric burn assessment.

Paediatric Burn Guidelines

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Women's and Children's Hospital

Pediatric burn guidelines reference chart.

Pediatric Burn Referrals

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UBC Division of Plastic Surgery

UBC Division of Plastic Surgery: Pediatric burn referrals.

Burns Centre Consultation Guidelines

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CritiCall Ontario

Guidelines for burns centre consultations.

Burns  Clinical guidelines

Burns / management of burn wounds

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The Royal Children's Hospital Melbourne

Guideline for the management of burn wounds.

ISBI Practice Guidelines for Burn Care

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ISBI Practice Guidelines Committee; Steering Subcommittee; Advisory Subcommittee

ISBI 2014-2016 Practice guidelines for burn care.

Burns  Summaries of systematic reviews

Cochrane Summary: Antiseptics for Burns

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Norman G, Christie J, Liu Z, Westby MJ, Jefferies JM, Hudson T, Edwards J, Mo...

Objective: To assess the effects and safety of antiseptics for the treatment of burns in any care setting.

Cochrane Summary: Antibiotics to prevent burn wounds becoming infected

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Barajas-Nava LA, Lpez-Alcalde J, Roqu i Figuls M, Sol I, Bonfill Cosp X

Objective: To assess the effects of antibiotic prophylaxis on rates of burn wound infection.

Cochrane Summary: Dressings for treating superficial and partial-thickness burns

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Wasiak J, Cleland H, Campbell F, Spinks A

Objective: To assess the effects of burn wound dressings on superficial and partial thickness burns.

Burns  Systematic reviews

Systematic Review: Comparative study of Silver Sulfadiazine with other materials for healing and infection prevention in burns: A systematic review and meta-analysis

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Nmia HH, Carvalho VF, Isaac C, Souza F, Gemperli R, Paggiaro AO

Objective: The aim of this systematic review with meta-analysis was to compare the effect of Silver Sulfadiazine (SSD) with other new dressings, with or without silver, on healing and infection prevention in burns.

Review: Burn Care for Children

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Sheridan RL

Objective: To provide an understanding of the practice of outpatient small burn care, and to present the concepts of inpatient burn care and long-term burn aftercare.

Review: Emergency management of burns: part 1

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Stiles K

Objective: The aim of this article is to give an overview of burns trauma, and to describe the initial assessment and management of patients with these injuries in emergency departments (EDs). Part 1 of 2.

Review: Emergency management of burns: part 2

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Stiles K

Objective: The aim of the two articles is to enhance emergency clinicians knowledge and confidence in burn management, and to build awareness of the life-changing implications of the initial clinical interventions in burn care. Part 2 of 2.

Review: Emergency Care of Pediatric Burns

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Strobel AM, Fey R

Objective: To review emergency care, management and prevention of pediatric burns.

Systematic Review: A systematic review and meta-analysis of clinical outcomes associated with nanocrystalline silver use compared to alternative silver delivery systems in the management of superficial and deep partial thickness burns

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Nherera LM, Trueman P, Roberts CD, Berg L

Objective: The purpose of this systematic review and meta-analysis was to assess the clinical effectiveness of nanocrystalline silver compared to alternative silver delivery systems (silver sulphadiazine [SSD] and silver nitrate) in adults and children with superficial and deep partial thickness burns.

Review: Pediatric burn resuscitation: past, present, and future

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Romanowski KS, Palmieri TL

Objective: To discuss the history of fluid resuscitation, current resuscitation practices, and future directions of resuscitation for the pediatric burn population.

Review: Pediatric Burn Resuscitation

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Palmieri TL

Objective: The purpose of this article is to provide a foundation for initial assessment and management in burned children.

Review: Optimizing emergency management to reduce morbidity and mortality in pediatric burn patients

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Haines E, Fairbrother H

Objective: This article reviews methods for accurate classification and management of the full range of burns seen in pediatric patients.

Cochrane Systematic Review: Antibiotic prophylaxis for preventing burn wound infection

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Barajas-Nava LA, Lpez-Alcalde J, Roqu i Figuls M, Sol I, Bonfill Cosp X

Objective: To assess the effects of antibiotic prophylaxis on rates of burn wound infection.

Review: Use of Acticoat dressings in burns: what is the evidence?

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Khundkar R, Malic C, Burge T

Objective: To determine the level of evidence available in the literature in view of recent increased usage of Acticoat dressings in burns.

Review: Critical care of the burn patient: the first 48 hours

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Latenser BA

Objective: The goal of this concise review is to provide an overview of some of the most important resuscitation and monitoring issues and approaches that are unique to burn patients compared with the general intensive care unit population.

Burns  Key studies

Key study: Delayed Healing Associated with Silver Sulfadiazine Use for Partial Thickness Scald Burns in Children

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Raymond SL, Zecevic A, Larson SD, Ruzic A, Islam S

Objective: The purpose of this study was to compare outcomes of three different dressings for pediatric partial-thickness scald burns.

Key study: Effectiveness of aspiration or deroofing for blister management in patients with burns: A prospective randomized controlled trial

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Ro HS, Shin JY, Sabbagh MD, Roh SG, Chang SC, Lee NH

Objective: To determine which treatment is the best option when encountering blisters while treating burn patients.

Key study: A Randomized Controlled Study of Silver-Based Burns Dressing in a Pediatric Emergency Department

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Brown M, Dalziel SR, Herd E, Johnson K, Wong She R, Shepherd M

Objective: This study sought to determine whether silver sodium carboxymethyl cellulose dressing is a superior treatment to nanocrystalline silver-coated polyethylene dressing in pediatric patients with partial thickness burns.

Key study: Randomized controlled trial of three burns dressings for partial thickness burns in children

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Gee Kee EL, Kimble RM, Cuttle L, Khan A, Stockton KA

Objective: This study compared the effects of three silver dressing combinations on small to medium size acute partial thickness burns in children, focusing on re-epithelialization time, pain and distress during dressing changes.

Key study: Discrepancy in Initial Pediatric Burn Estimates and Its Impact on Fluid Resuscitation

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Goverman J, Bittner EA, Friedstat JS, Moore M, Nozari A, Ibrahim AE, Sarhane ...

Objective: To evaluate the differences between initial TBSA estimates and its impact on fluid resuscitation at an American Burn Associationverified pediatric burn center.

Caring for Children with Developmental and Intellectual Disabilities
Caring for Children with Developmental and Intellectual Disabilities  Bottom Line Recommendations

Bottom Line Recommendations: Caring for Children with Developmental and Intellectual Disabilities in the ED

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Hanlon-Dearman, A, Stevenson, M and TREKK Network

Bottom line recommendations for caring for children with developmental and intellectual disabilities in the ED. Published online: March 2019, v 1.0.

Concussion
Concussion  Bottom Line Recommendations

Bottom Line Recommendations: Concussion

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Zemek R & TREKK Network

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

Recommandations de Base: Commotion cérébrale (TCC léger)

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Zemek R and TREKK Network

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

Bottom Line: The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5)

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Davis GA, Purcell L, Schneider KJ, Yeates KO, Gioia GA, Anderson V, Ellenboge...

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.

Bottom Line: The Sport Concussion Assessment Tool 5th Edition (SCAT5)

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Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, Makdiss...

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.

Bottom Line: Management of Acute Symptoms Algorithm

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Ontario Neurotrauma Foundation

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).

Emergency Medicine Cases Podcast: Pediatric head injury

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Dr. Rahim Valani and Dr. Jennifer Riley

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. 

Bottom Line: Acute Concussion Evaluation (ACE): Physician/Clinician Office Version

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Goia G, Collins M

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.

Concussion  Clinical guidelines

Guidelines: Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016

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McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, Cantu RC, Cas...

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.

Guidelines: Guidelines for Diagnosing and Managing Pediatric Concussion: Recommendations for Health Care Professionals

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Zemek R, Duval S, Dematteo C, Solomon B, Keightley M, Osmond M

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

Guidelines: Care of the Patient with mild traumatic brain injury

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West TA, Bergman K, Biggins MS, French B, Galletly J, Hinkle JL, Morris J

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.

Concussion  Overviews of systematic reviews

Evidence Summary: Management of paediatric minor head injuries. Safe discharge?

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Hunter F

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?

Concussion  Systematic reviews

Systematic Review: Predictors of clinical recovery from concussion: a systematic review

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Iverson GL, Gardner AJ, Terry DP, Ponsford JL, Sills AK, Broshek DK, Solomon GS

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

Systematic Review: Rest and treatment/rehabilitation following sport-related concussion: a systematic review

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Schneider KJ, Leddy JJ, Guskiewicz KM, Seifert T, McCrea M, Silverberg ND, Fe...

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

Systematic Review: Psychosocial consequences of mild traumatic brain injury in children: results of a systematic review by the International Collaboration on Mild Traumatic Brain Injury Prognosis

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Keightley ML, Ct P, Rumney P, Hung R, Carroll LJ, Cancelliere C, Cassidy JD

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

Systematic Review: Prognosticators of persistent symptoms following pediatric concussion: a systematic review

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Zemek RL, Farion KJ, Sampson M, McGahern C

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

Systematic Review: Interventions provided in the acute phase for mild traumatic brain injury: a systematic review

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Gravel J, D'Angelo A, Carrire B, Crevier L, Beauchamp MH, Chauny JM, Wassef M...

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

Systematic Review: Clinical decision rules for children with minor head injury: a systematic review

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Pickering A, Harnan S, Fitzgerald P, Pandor A, Goodacre S

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).

Systematic Review: Which symptom assessments and approaches are uniquely appropriate for paediatric concussion?

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Gioia GA, Schneider JC, Vaughan CG, Isquith PK

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.

Concussion  Key studies

Key Study: Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department

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Osmond MH, Klassen TP, Wells GA, Davidson J, Correll R, Boutis K, Joubert G, ...

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.

Key Study: Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED

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Zemek R, Barrowman N, Freedman SB, Gravel J, Gagnon I, McGahern C, Aglipay M,...

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

Key Study: Effect of cognitive activity level on duration of post-concussion symptoms

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Brown NJ, Mannix RC, O'Brien MJ, Gostine D, Collins MW, Meehan WP III

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

Key Study: Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study

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Easter JS, Bakes K, Dhaliwal J, Miller M, Caruso E, Haukoos JS

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.

Key Study: Predicting postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the emergency department

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Babcock L, Byczkowski T, Wade SL, Ho M, Mookerjee S, Bazarian JJ

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

Key Study: Time interval between concussions and symptom duration

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Eisenberg MA, Andrea J, Meehan W, Mannix R

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.

Key Study: Mild traumatic brain injury: a description of how children and youths between 16 and 18 years of age perform leisure activities after 1 year

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Jonsson C, Andersson EE

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

Key Study: Identifying neurocognitive deficits in adolescents following concussion

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Thomas DG, Collins MW, Saladino RA, Frank V, Raab J, Zuckerbraun NS

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.

Key Study: Identifying the specific needs of adolescents after a mild traumatic brain injury: a service provider perspective

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Swaine BR, Gagnon I, Champagne F, Lefebvre H, Friedman D, Atkinson J, Feldman D

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.

Key Study: Visuomotor response time in children with a mild traumatic brain injury

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Gagnon I, Swaine B, Friedman D, Forget R

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.

Congenital Heart Defect
Congenital Heart Defect  Bottom Line Recommendations

Bottom Line: Approach to cyanotic congenital heart disease in the newborn

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Cheung C

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

Congenital Heart Defect  Clinical guidelines

Clinical Practice Guideline: Duct dependant congenital heart disease

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Brierley J, National Health Service Children's Acute Transport Service

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

Clinical Practice Guideline: Resuscitation of blue baby and the use of prostaglandins

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Linney M, Gnapragassam J, Wilson P, Rodd I

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

Congenital Heart Defect  Systematic reviews

Systematic Review: Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis

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Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer AK

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

Congenital Heart Defect  Key studies

Overview of studies: Congenital Heart Disease In Pediatric Patients: Recognizing The Undiagnosed And Managing Complications In The Emergency Department

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Judge P, Meckler G

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.

Key Study: The Critically Ill Infant with Congenital Heart Disease

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Strobel, AM & Lu, N.

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

Key Study: Reappraisal of the prostaglandin E1 dose for early newborns with patent ductus arteriosus-dependent pulmonary circulation

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Huang FK, Lin CC, Huang TC, Weng KP, Liu PY, Chen YY, Wang HP, Ger LP, Hsieh KS

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.

Key Study: Congenital heart disease

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Dolbec K, Mick NW

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

Key Study: Impact of oxygen saturation targets and oxygen therapy during the transport of neonates with clinically suspected congenital heart disease

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Shivananda S, Kirsh J, Whyte HE, Muthalally K, McNamara PJ

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

Key Study: Approach to diagnosing congenital cardiac disorders

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Hartas GA, Tsounias E, Gupta-Malhotra M

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

Key Study: To intubate or not to intubate? Transporting infants on prostaglandin E1

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Meckler GD, Lowe C

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.

Overview of studies: Emergency presentation of congenital heart disease in children

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EB Medicine

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.

Key Study: Lessons from transporting newborn infants with known or suspected congenital heart disease

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Bouchut JC, Teyssedre S

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

Key Study: Evaluation and management of the cyanotic neonate

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Steinhorn RH

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

Key Study: Transporting newborn infants with suspected duct dependent congenital heart disease on low-dose prostaglandin E1 without routine mechanical ventilation

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Browning Carmo KA, Barr P, West M, Hopper NW, White JP, Badawi N

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.

Key Study: Cardiac emergencies in the first year of life

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Yee L

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

Key Study: ABC of clinical electrocardiography: Paediatric electrocardiography

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Goodacre S, McLeod K

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.

Key Study: Management of the neonate with symptomatic congenital heart disease

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Penny DJ, Shekerdemian LS

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

Key Study: Prevalence and clinical significance of cardiac murmurs in neonates

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Ainsworth S, Wyllie JP, Wren C

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

Key Study: Differentiation of systemic infection and congenital obstructive left heart disease in the very young infant

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Pickert CB, Moss MM, Fiser DH

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.

Key Study: Evaluation of low dose prostaglandin E1 treatment for ductus dependent congenital heart disease

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Kramer HH, Sommer M, Rammos S, Krogmann O

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

Constipation
Constipation  Bottom Line Recommendations

Bottom Line Recommendations: Constipation

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Eltorki, M., Landry, P.and TREKK Network

Bottom line recommendations for the treatment and management of pediatric constipation - version 1.0. Published online: May 2019.

Recommandations de Base: Constipation

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Eltorki, M., Landry, P.and TREKK Network

Bottom line recommendations for the treatment and management of pediatric constipation - French, version 1.0. Published online: July 2019.

Bottom Line: Flowchart of evaluation and management of functional constipation in children

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Koppen IJ, Lammers LA, Benninga MA, Tabbers MM

Flowchart of evaluation and management of functional constipation in children.

Constipation  Clinical guidelines

Guidelines: Constipation in Children and Young People: Diagnosis and Management

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National Institute for Health and Care Excellence

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.

Guidelines: Constipation

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Royal Children's Hospital Melbourne

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

Guidelines: Childhood Functional Gastrointestinal Disorders: Neonate/Toddler

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Benninga MA, Faure C, Hyman PE, St James Roberts I, Schechter NL, Nurko S

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

Guidelines: Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV

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Drossman DA

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.

Guidelines: Functional Disorders: Children and Adolescents

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Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M

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

Guidelines: Constipation

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Kids Health WA

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

Guidelines: Management of Functional Constipation

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SickKids

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.

Guidelines: Evaluation and treatment of constipation in children and adolescents

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Nurko S, Zimmerman LA

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.

Guidelines: Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN

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Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, Staiano A...

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.

Guidelines: Managing functional constipation in children

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Rowan-Legg A; Canadian Paediatric Society, Community Paediatrics Committee

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.

Constipation  Overviews of systematic reviews

Cochrane Summary: Laxatives for the management of childhood constipation

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Gordon M, MacDonald JK, Parker CE, Akobeng AK, Thomas AG

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?

Guideline Summary: Idiopathic constipation in children clinical practice guidelines

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Paul SP, Broad SR, Spray C

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

Constipation  Systematic reviews

Cochrane Systematic Review: Osmotic and stimulant laxatives for the management of childhood constipation

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