Logo

 

 
 

Search

Global search | Events search | Events Calendar



Patients and Family Resources

all patients and families resources





Resources in Evidence Repository and Individual Compendia

Bottom Line Recommendations

Bottom Line: Acute Procedural Pain: Paediatric Recommendations and Implementation Toolkits

Visit

The Canadian Association of Paediatric Health Centres, Knowledge Exchange Net...

Objective: This overview is intended to summarize the systematic reviews of interventions studied to decrease paediatric pain that are currently available in the Cochrane Library. Given their unique physiology, research relevant to the management of newborns in the first month of life is not reviewed here. Four reviews relevant to the management of childrens pain are currently available

Bottom Line: Pain Ease(R): Topical anesthetic skin refrigerant (for children 4 years and older)

Visit

BC Children's Hospital

Purpose: Pain Ease spray is a vapocoolant (skin refrigerant) intended for topical application to skin and minor open wounds. It controls pain associated with injections (venipunctures, IV start) and minor surgical procedures (eg. irrigating laceration/abrasions).

Measurement Tool: Faces Pain Scale - Revised for children 4 years of age and older

Visit

International Association for the Study of Pain

Scores are from the left to the right (for the child): 0, 2, 4, 6, 8, 10 (0 for no pain at all and 10 for very, very much in pain).

UNDER REVIEW Bottom Line Recommendations: Procedural Pain

Download

Ali, S, Drendel A & TREKK Network

Bottom line recommendations for the treatment and management of procedural pain. Published online: November 2016.

Bottom Line: An Evidence-Based Approach to Minimizing Acute Procedural Pain in the Emergency Department and Beyond. Pediatr Emerg Care 2016;32(1):36-42.

Visit

Ali S, McGrath T, Drendel AL

Objective: This review article aims to provide a summary of several strategies, which are supported by definitive and systematically reviewed evidence, that can be implemented alone or in combination to reduce procedural pain and anxiety for children in the ED and beyond.

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

Visit

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: Management of Acute Symptoms Algorithm

Visit

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).

Bottom Line: Psychological Interventions

Visit

BC Children's Hospital

Even with sedation, the success of a procedure is equally reliant upon careful consideration of psychosocial aspects as it is reliant on physical aspects. A sense of mastery and control experienced by parents and children is crucial to their confidence in managing any future procedures. Reducing both pain and anxiety will facilitate effective coping.

Bottom Line: Sucrose as a procedural analgesic for infants up to 12 monts of age

Visit

BC Children's Hospital

Purpose: Oral sucrose and other sweet tasting solutions have been used for management of pain in infants for centuries. Studies done since the early 1990's have demonstrated that the administration of sucrose and non-nutritive sucking are effective non-pharmacological interventions for relief of procedural pain in neonates and infants and may help reduce pain in infants up to 12 months of age. Sucrose and non-nutritive sucking are thought to elevate pain thresholds via endogenous opioid pathways.

Chart: WHO pain wall chart for waiting rooms

Visit

World Health Organization

Is your child in pain? The doctor can help. As for pain treatment!

UNDER REVIEW: Recommandations de Base: Douleur procdurale

Download

French Bottom line recommendations for the treatment and management of procedural pain. Published online: March 2017.

Bottom Line Recommendations: Pain Treatment

Download

Ali, S, Drendel A and TREKK Network

Bottom line recommendations for pediatric pain treatment. Published online: May 2018.

Bottom Line Recommenation: Optimal pain relief for pediatric MSK injury.

Visit

Korownyk C, Young J, Michael Allan G

Evidence suggests that ibuprofen provides better single-agent relief than acetaminophen or codeine, and is at least equivalent to both acetaminophen with codeine and morphine for acute injury pain, with fewer adverse events.

Acute Otitis Media- Emergency Management in Children - Flowchart

Visit

Children's Health Queensland Hospital and Health Service

Flowchart of emergency management in children for acute otitis media.

Executive Summary: Evaluation and Management of Children and Adolescents With Acute Mental Health or Behavioral Problems. Part I: Common Clinical Challenges of Patients With Mental Health and/or Behavioral Emergencies

Visit

Chun TH, Mace SE, Katz ER, American Academy of Pediatrics Committee on Pediat...

This executive summary is an overview of the common clinical challenges pediatric caregivers face when a child or adolescent presents with a psychiatric chief complaint or emergency.

Executive Summary: Evaluation and Management of Children With Acute Mental Health or Behavioral Problems. Part II: Recognition of Clinically Challenging Mental Health Related Conditions Presenting With Medical or Uncertain Symptoms

Visit

Chun TH, Mace SE, Katz ER, American Academy of Pediatrics Committee on Pediat...

This executive summary is an overview of the common clinical challenges pediatric caregivers face when a mental health condition may be an unclear or complicating factor in a non-mental health ED presentation.

Bottom Line Recommendations: Acute Otitis Media

Download

Le Saux N, TREKK Network

Bottom Line Recommendations for diagnosis and treatment of AOM. Posted online May 2020, Version 2.1

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

Visit

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.

Clinical guidelines

Clinical Practice Guideline: AboutKidsHealth: Tools for measuring pain

Visit

Stinson, J

Objectives: To assess the level of pain felt by children through the use of pain scales and other measurement tools such as behavioural and composite measures.

Clinical Practice Guideline: Pain-Less Practice: Techniques to Reduce Procedural Pain and Anxiety in Pediatric Acute Care

Visit

Olsen, K, Weinberg, E

Purpose: This article introduces the concept of a PainLESS Practicean evidence-based, tiered approach to procedural pain and anxiety management in acute care

Clinical Practice Guideline: The recognition and assessment of acute pain in children

Visit

Royal College of Nursing

The guideline is aimed at a range of professional groups, patients and carers who may be involved in the assessment and management of childrens pain. The primary aims of this guideline are to: identify reliable and valid measures of pain intensity appropriate for neonates and preverbal infants, and verbal and non-verbal children, through a systematic search and appraisal of the literature; describe these tools to help practitioners select from these in different clinical settings; and make recommendations regarding timing and triggers for formal pain assessment.

Clincial Practice Guideline: Optimizing the treatment of pain in patients with acute presentations

Visit

American Society for Pain Management Nursing (ASPMN), Emergency Nurses Associ...

Management of pain is an essential nursing and physician responsibility. This joint position statement describes recommendations for improving pain management in health care settings.

Clincial Practice Guideline: The recognition and assessment of acute pain in children

Visit

Royal College of Nursing

The Royal College of Nursing (RCN) has previously produced a guideline on the Assessment of acute pain in children (2000). This guideline examined when pain in children should be assessed and by whom, and the use of scales and other tools that can be used to facilitate the assessment of childrens pain.

Clinical Practice Guideline: The assessment and management of acute pain in infants, children, and adolescents

Visit

American Academy of Pediatrics

Pediatricians are responsible for eliminating or assuaging pain and suffering in children when possible. To accomplish this, pediatricians need to expand their knowledge, use appropriate assessment tools and techniques, anticipate painful experiences and intervene accordingly, use a multimodal approach to pain management, use a multidisciplinary approach when possible, involve families, and advocate for the use of effective pain management in children.

Clinical Practice Guideline: Management of acute pediatric pain in the emergency department.

Visit

Ruest S,Anderson A.

This article provides a summary of recommendations for the multimodal and multidisciplinary approach to acute pediatric pain management and highlights recent research on this topic.

Clinical Practice Guideline: Management of the paediatric patient with acute head trauma

Visit

Farrell CA, Canadian Paediatric Society Acute Care Committee

The purpose of this statement is to describe issues related to head trauma in infants, children and youth, including clinical manifestations, initial management priorities, guidelines for imaging, and subsequent observation and treatment.

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

Visit

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: Good practice in postoperative and procedural pain management

Visit

Association of Paediatric Anaesthetists of Great Britain and Ireland

This themed issue starts with an outstanding review of the history of Pediatric Regional Anesthesia (PRA), written by an equally outstanding second-wave pioneer and promoter of this particular facet of pediatric anesthesia, Professor Emeritus Kester Brown.

Clinical Practice Guideline: Evidenced-based clinical practice guideline for management of newborn pain

Visit

Spence K, Henderson-Smart D, New K, Evans C, Whitelaw J, Woolnough R

Aim: To facilitate the uptake of evidence and to reduce the evidence practice gap for management of newborn pain through the development of a clinical practice guideline.

Clinical Practice Guideline: Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline

Visit

Taddio A, Appleton M, Bortolussi R, Chambers C, Dubey V, Halperin S, Hanrahan...

Our objective was to develop a clinical practice guideline, based on systematic reviews of the literature, as interpreted by experts, to assist clinicians in managing procedure-related pain and distress among children undergoing vaccine injections.

Clinical Practice Guideline: Relief of pain and anxiety in pediatric patients in emergency medical systems

Visit

Fein JA, Zempsky WT, Cravero JP, Committee on Pediatric Emergency Medicine an...

Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a childs and familys reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction.

Clinical Practice Guideline: Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures.

Visit

Trottier ED,Dor-Bergeron MJ,Chauvin-Kimoff L,Baerg K,Ali S.

Purpose: This statement focuses on infants (excluding care provided in the NICU), children, and youth who are undergoing common, minor but painful medical procedures

Clincal Practice Guideline: Prevention and Management of Procedural Pain in the Neonate: An Update

Visit

Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine

Purpose: This statement updates previous recommendations with new evidence on the prevention, assessment, and treatment of neonatal procedural pain.

Clinical Practice Guideline: Effective Management of Pain and Anxiety for the Pediatric Patient in the Emergency Department.

Visit

Young VB

A summary of what to expect with pediatric patients experiencing pain and anxiety.

Clinical Pathway: Alberta Health Services Acute Childhood Vomiting & Diarrhea Pathway

Visit

Alberta Health Services

This pathway, developed for Alberta Health Services, is intended for children between 3 months and 10 years of age with vomiting and/or diarrhea with or without accompanying nausea, fever or abdominal pain.

Clinical Practice Guideline: Prevention and management of acute gastroenteritis (AGE) in children aged 2 months to 18 years

Visit

Cincinnati Children's Hospital Medical Center,

Developed by Cincinnati Children's Hospital Medical Center. Published: December 2011.

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

Visit

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.

Clinical Practice Guideline: European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: up

Visit

Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H, Europ...

These guidelines update and extend evidence-based indications for the management of children with acute gastroenteritis in Europe.

Clinical Practice Guideline: Emergency department use of oral ondansetron for acute gastroenteritis-related vomiting in infants and children

Visit

Cheng A

This article examines evidence for the use of oral ondansetron for acute gastroenteritis-related vomiting in infants and children, and provides a recommendation for treatment based on the evidence-based review.

Clinical Practice Guideline: Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy

Visit

King CK, Glass R, Bresee JS, Duggan C, Centers for Disease Control and Preven...

This report reviews the historical background and scientific basis of oral rehydration therapy and provides a framework for assessing and treating infants and children who have acute diarrhea.

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

Visit

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: Evaluation and Management of Children and Adolescents With Acute Mental Health or Behavioral Problems. Part I: Common Clinical Challenges of Patients With Mental Health and/or Behavioral Emergencies

Visit

Chun TH, Mace SE, Katz ER, American Academy of Pediatrics Committee on Pediat...

Part 1 of the report discusses the common clinical issues that may be encountered in caring for children and adolescents presenting to the emergency department or primary care setting with a mental health condition or emergency.

Clinical Practice Guideline: Evaluation and Management of Children With Acute Mental Health or Behavioral Problems. Part II: Recognition of Clinically Challenging Mental Health Related Conditions Presenting With Medical or Uncertain Symptoms

Visit

Chun TH, Mace SE, Katz ER, American Academy of Pediatrics Committee on Pediat...

Part 2 of the report discusses the challenges a pediatric clinician may face when evaluating patients with a mental health condition, which may be contributing to or a complicating factor for a medical or indeterminate clinical presentation.

Clinical Practice Guideline: Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition

Visit

Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, Carson S, Ch...

Published in 2012, these guidelines reflect updated information from the first edition published in 2003. Thisdocument is endorsed by the American Academy of Pediatrics-Section on Neurological Surgery, American Association of Neurological Surgeons/Congress of Neurological Surgeons, Child Neurology Society, European Society of Pediatric and Neonatal Intensive Care, Neurocritical Care Society, Pediatric Neurocritical Care Research Group, Society of Critical Care Medicine, The Paediatric Intensive Care Society (UK), Society for Neuroscience in Anesthesiology and Critical Care, and the World Federation of Pediatric Intensive and Critical Care Societies.

Clinical Practice Guideline: Use of probiotics for management of acute gastroenteritis: a position paper by the ESPGHAN Working Group for Probiotics and Prebiotics

Visit

Szajewska H, Guarino A, Hojsak I, Indrio F, Kolacek S, Shamir R, Vandenplas Y...

This document provides recommendations for the use of probiotics for the treatment of acute gastroenteritis in previously healthy infants and children based on a systematic review of previously completed systematic reviews and of randomized controlled trials (RCTs) published subsequently to these reviews.

Acute management of croup in the emergency department

Visit

Ortiz-Alvarez O,

Acute management of croup in the emergency department.

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

Visit

NSW Health

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

Summaries of systematic reviews

Cochrane Summary: Intranasal fentanyl for the treatment of children in acute pain

Visit

Murphy A, O'Sullivan R, Wakai A, Grant TS, Barrett MJ, Cronin J, McCoy SC, Ho...

Background: Pain is the most common reason why patients are seen in emergency departments (EDs). The challenging nature of treating children in acute severe pain is reflected in the medical literature by poor pain management in this population. We reviewed evidence on the effect of intranasal fentanyl (INF) (a strong pain relief drug, similar to morphine) compared with any other pain-relieving technique for treatment of children in acute severe pain. Study characteristics: We included studies with children (younger than 18 years of age) suffering from acute severe pain as a result of injury or medical illness. The target intervention was INF administered for pain relief compared with any other drug intervention for pain relief (e.g. intravenous morphine) or non-drug intervention (e.g. limb splinting, wound dressing) provided in the emergency setting. The evidence is current to January 2014. Key results: We identified three studies that included 313 children with acute severe pain resulting from broken bones of the upper and lower limbs. These trials compared INF versus morphine administered by a needle into a muscle (intramuscular morphine) or via a drip into a vein (intravenous morphine), as well as standard concentration INF versus high concentration INF. The collective study population in these trials consisted of children three to 15 years of age. Males accounted for approximately two-thirds of the overall study population. The review concluded that INF may be an effective analgesic for the treatment of children in acute moderate to severe pain, and its administration appears to cause minimal distress to children; however, the evidence is insufficient to permit judgement of the effects of INF compared with intramuscular or intravenous morphine. No serious adverse events (e.g. opiate toxicity, death) were reported. Limitations: Limitations of this review include the following: Few studies (three) were eligible for inclusion; no study examined the use of INF in children younger than three years of age; no study included children with pain resulting from a "medical" cause (e.g. abdominal pain seen in appendicitis); and all eligible studies were conducted in Australia. Consequently, the findings may not be generalizable to other healthcare settings, to children younger than three years of age and to those with pain from a "medical" cause.

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

Visit

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: Sweet-tasting solutions for needle-related pain in infants up to one year of age

Visit

Kassab M, Foster JP, Foureu M, Fowle C

The use of needles that break the skin and cause pain is a common practice around the world with babies aged between one month and 12 months (Appendix 4). In thisreviewwe were interested in whether giving babies sugar-based solutions to taste when the needle breaks the skin will help reduce their pain. We found 14 separate studies that had asked this question. However, the differences between the studies were often too great to let us combine their findings. Overall, the studies show that different types of sugar-based solutions were effective but we were not able to confidently assert that there is strong evidence for this treatment in reducing pain. We did find some evidence that babies may not cry for as long if given sugar-based solutions. Thisreviewis broadly in agreement with two other reviews, one asking this question in younger children, and one in older children. There is a need for better studies in this field.

Cochrane Summary: Psychological interventions for needle-related procedural pain and distress in children and adolescents

Visit

Birnie KA, Noel M, Chambers CT, Uman LS, Parker JA

To assess the efficacy of psychological interventions for needlerelated procedural pain and distress in children and adolescents.

Cochrane Summary: Breastfeeding or breast milk for procedural pain in neonates

Visit

Shah PS, Herbozo C, Aliwalas LL, Shah VS

Breastfeeding provides pain relief for newborn babies undergoing painful procedures. Medicine for pain relief is commonly given for major painful procedures, but may not be given for minor painful procedures such as blood sampling (by heel prick orvenepuncture). There are different forms of non-pharmacological strategies that may be used to reduce pain in babies, such as holding, swaddling them, sucking on a pacifier, or giving sweet solutions (such as sucrose or glucose). Different studies done in babies have shown that breastfeeding is a good way to reduce the pain babies feel when subjected to minor painful procedures. These studies have been done in full-term babies and they have shown that breastfeeding is effective by demonstrating that it reduces babies' crying time and reduces different pain scores that have been validated for babies. Breast milk given by syringe has not shown the sameefficacyas breastfeeding itself. No studies have been done in premature babies, and so new studies are needed to determine if the use of supplemental breast milk in these small babies is effective in reducing their pain.

Cochrane Summary: Nerve blocks for initial pain management of thigh bone fractures in children

Visit

Black KJ, Bevan CA, Murphy NG, Howard JJ

Fractures (breaks) of the thigh bone can be very painful, particularly when a child arrives in a stressful emergency environment and is undergoing assessment. Moving the child to get X-rays or transferring the child to a special bed to support the leg in traction (keeping the leg straight) can cause additional pain, as can placing traction (a pulling force) on the broken thigh. This means that prompt provision of pain relief is an essential part of initial emergency management. This review investigated whether a nerve block, involving the injection of a freezing/numbing medication at the top of the thigh, would provide more effective pain relief than pain medicine given by mouth or into a vein (intravenously, e.g. morphine). We searched several medical databases and trial registries up to January 2013 and contacted researchers. We found one study that looked at the comparison we were interested in. This study was potentially biased, mainly because the care providers, parents and children were aware of the type of pain relief the children received. The study was small, involving 55 children aged 16 months to 15 years, and showed that the children who received one of the two main types of nerve block tended to have less pain after 30 minutes than those who received intravenous morphine for initial pain control. The nerve blocks led to some pain and redness at the injection site in a few cases, while intravenous morphine caused more serious problems such as depressed breathing (lack of oxygen), excessive sleepiness and vomiting in a small number of children. Moreover, children who had nerve blocks continued to have lower pain scores over a six-hour period with less need for additional pain relief. There was insufficient evidence to determine whether children or parents were more satisfied with one method of pain relief than the other. Use of resources (e.g. nursing time, cost of medications) was not measured. The quality of the study included in this review was low and so these conclusions are not certain. Further well designed studies investigating whether nerve blocks are more effective and safer than other means of pain relief are needed.

Cochrane Summary: Local anaesthesia (numbing medicine) that is directly applied to the skin can provide pain control for repair of skin lacerations

Visit

Tayeb BO, Eidelman A, Eidelman CL, McNicol ED, Carr DB

To assess whether benefits of noninvasive topical anaesthetic application occur at the expense of decreased analgesic efficacy. To compare the efficacy of various singlecomponent or multicomponent topical anaesthetic agents for repair of dermal lacerations. To determine the clinical necessity for topical application of the ester anaesthetic, cocaine.

Cochrane Summary: Skin-to-skin care with newborns cuts down procedural pain

Visit

Johnston C, Campbell-Yeo M, Disher T, Benoit B, Fernandes A, Streiner D, Ingl...

The primary objectives were to determine the effect of SSC alone on pain from medical or nursing procedures in neonates compared to no intervention, sucrose or other analgesics, or additions to simple SSC such as rocking; and to determine the effects of the amount of SSC (duration in minutes), method of administration (e.g. who provided the SSC) of SSC in reducing pain from medical or nursing procedures in neonates

Cochrane Summary: Nonpharmacological management of infant and young child procedural pain

Visit

Pillai Riddell RR, Racine NM, Gennis HG, Turcotte K, Uman LS, Horton RE, Ahol...

We examined 13 different types of commonly investigated non-pharmacological treatments (excluding breastmilk, sucrose, and music) to determine theirefficacyfor pain reactions after an acutely painful procedure (right after the needle ('pain reactivity') and less immediate pain reactions ('immediate pain-related regulation').Fifty-onerandomizedcontrolled trials were included involving 3396 participants. For preterm infants, there was sufficient evidence to recommend kangaroo care, sucking-related interventions, and swaddling/facilitated tucking interventions for both pain reactivity and immediate pain-related regulation. For neonates, there was sufficient evidence to recommend sucking-related interventions as an effective treatment for pain reactivity and immediate pain-related regulation.Rocking/holding was also found to be efficacious for neonatal immediate pain-related regulation.For older infants, there were no treatments reviewed that demonstrated sufficient evidence. Due to significant differences in the magnitude of treatment effects among studies (heterogeneity), some analyses that found a lack of treatment effect need to be interpreted with caution.

Cochrane Summary: Sweet taste to ease injection needle pain in children aged one to 16 years

Visit

Harrison D, Yamada J, Adams-Webber T, Ohlsson A, Beyene J, Stevens B

This is an updated version of the original Cochrane review published in Issue 10, 2011: Sweet tasting solutions for reduction of needle-related procedural pain in children aged one to 16 years. We re-ran the search in October 2014. Review question: Do sweet tasting solutions reduce pain during needles in children aged from one to 16 years, compared to no treatment, water, other non-sweet solutions, or other interventions such as non-nutritive sucking (babies) or sweet foods or chewing gum (children), topical anaesthetics, music, and distraction? Background: Small amounts of sweet tasting sugar solutions given orally to babies before and during painful needles significantly reduces distress. However it was not known if the same pain-reducing effects of sweet solutions occurred in children older than one year of age. We therefore examined studies looking at pain-reducing effects of sweet solutions such as sucrose or glucose for painful needle procedures in children aged one to 16 years. Search date: We searched the literature for published and unpublished studies up to October 2014. Study characteristics: We found six studies focused on young children aged one to four years; two of these studies were included in the original review and four were new studies. The two studies included in the original review used a low concentration of sucrose, just 12%, which is not considered sweet enough for the pain reducing effects. Three of the four new studies were small pilot studies, conducted to inform full trials, and only one study of sweet solutions in young children included large numbers of children. When we compared results of all six studies, only two showed that sugar water (sucrose) reduced pain during injections. However, the four studies that showed no effect all included small numbers of children, therefore they were not considered large enough to detect significant differences in pain. Further well conducted trials with large enough numbers of young children are needed to work out if sweet taste effectively reduces their pain and distress during needles. For older school-aged children, there were two studies published by the same author, both of which were included in the original review. Neither study showed that sweet taste helped to reduce pain. As other studies show that strategies such as distraction and topical anaesthetics can effectively reduce needle pain in school-aged children, further studies of sweet taste for pain management in school-aged children are not warranted. Study funding sources: Of the six studies including young children, two did not acknowledge receipt of research funding. For the remaining four: a state-wide nursing fund supported two of the pilot studies, an internal research institute provided support for the remaining pilot study and another study was supported in part by a Maternal and Child Health grant. The two studies including school-aged children, conducted by the same author, were supported by a grant from the Canadian Institutes of Health Research.

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

Visit

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)

Visit

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)

Visit

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

Visit

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)

Visit

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.

Cochrane Summary: Anti-sickness medication for vomiting in acute stomach upsets in children

Visit

Fedorowicz Z, Jagannath VA, Carter B

Vomiting caused byacutegastroenteritis is very common in children and adolescents. Treatment of vomiting in children withacutegastroenteritis can be problematic and there is lack of agreement among clinicians on the indications for the use of antiemetics. There have also been concerns expressed about apparently unacceptable levels of side effects with some of the older generation of antiemetics. The small number of included trials provided evidence which appeared to favour the use of antiemetics overplaceboto reduce the number of episodes of vomiting due to gastroenteritis in children. A singleoraldose of ondansetron given to children with mild to moderate dehydration cancontrolvomiting, avoid hospitalization andintravenousfluid administration which would otherwise be needed. There were no major side effects other than a few reports of increased frequency of diarrhea.

Cochrane Summary: Topical analgesia for acute otitis media

Visit

Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C

Antibiotics make little difference to children with an uncomplicated ear infection and ear pain. Some advocate ear drops with local anaesthetic such as amethocaine, benzocaine or lidocaine. Five trials (391 participants) were identified; two compared anaesthetic drops to placebo (inactive) drops; and three compared anaesthetic drops to herbal ear drops. There was no strong evidence that herbal ear drops were effective, but anaesthetic drops did provide better pain relief than the inactive drops. Only one trial looked at adverse reactions and reported no cases of ringing in the ears or unsteadiness when walking and three cases of very mild dizziness. Children in all the trials experienced a rapid, short-term reduction in pain after using ear drops. It is hard to know if this was the result of the natural course of the illness; the placebo effect of receiving treatment; the soothing effect of any liquid in the ear or the pharmacological effects of the ear drops themselves. Nevertheless, there is some evidence that when combined with oral pain medication, anaesthetic ear drops may help to relieve pain more rapidly in children aged three to 18 years. More good-quality trials are needed.

Cochrane Summary: Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children

Visit

Shaikh N, Borrell JL, Evron J, Leeflang MM

In some children with urinary tract infection (UTI), the infection is localized to the bladder (lower urinary tract). In others, bacteria ascend from the bladder to the kidney (upper urinary tract). Only children with upper urinary tract involvement are at risk for developing permanent kidney damage. If non-invasive biomarkers could accurately differentiate children with lower urinary tract disease from children with upper urinary tract disease, treatment and follow-up could potentially be individualized. Accordingly, we examined the usefulness of three widely available blood tests (procalcitonin, C-reactive protein, erythrocyte sedimentation rate) in differentiating upper from lower urinary tract disease. We found 24 relevant studies of which 17 provided data for our primary outcome. Six studies (434 children) provided data for the procalcitonin test; 13 studies (1638 children) provided data for the C-reactive protein test, and six studies (1737 children) provided data for the erythrocyte sedimentation rate test. We found all three tests to be sensitive (summary sensitivity values ranged from 86% to 95%), but not very specific (summary specificity values ranged from 38% to 71%). None of the tests were accurate enough to allow clinicians to confidently differentiate upper from lower urinary tract disease.

Cochrane Summary: Fluids for people with acute bacterial meningitis

Visit

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

Visit

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)

Visit

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 Overview: The Cochrane Library and procedural pain in children: an overview of reviews

Visit

Curtis S, Wingert A, Ali S

Objective: To summarize Cochrane reviews assessing the effects of various interventions used for pain in non-neonatal children undergoing painful medical procedures.

Cochrane Summary: Sucrose for analgesia in newborn infants undergoing painful procedures

Visit

Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A

The secondary objectives were to determine the safety of SSC care for relieving procedural pain in infants; and to compare the SSC effect in different postmenstrual age subgroups of infants.

Cochrane Overview: Treatment of acute gastroenteritis in children: an overview of systematic reviews of interventions commonly used in developed countries

Visit

Freedman SB, Ali S, Oleszczuk M, Gouin S, Hartling L

The purpose of this overview is to critically evaluate the evidence currently available in the Cochrane Database of Systematic Reviews regarding the efficacy and safety of commonly considered treatment options in children with acute gastroenteritis.

Evidence Summary: Towards evidence based medicine for paediatricians. Question 3. Does the administration of glucagon improve the rate of radiological reduction in children with acute intestinal intussusception?

Visit

Cachat F, Ramseyer P,

This summary examines the relationship between glucagon and the rate of radiological reduction for acute intestinal intussusception.

Overviews of systematic reviews

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

Visit

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

Visit

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.

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

Visit

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.

Blood-clot promoting drugs for acute traumatic injury

Visit

Ker K, Robert, I, Shakur H, Coats TJ,

This is an update of an existing Cochrane review, the last version was published in 2012.

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

Visit

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.

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

Visit

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.

Systematic reviews

Cochrane Systematic Review: Hydromorphone for acute and chronic pain

Visit

Quigley C

OBJECTIVES: This review explores and assesses the evidence for the efficacy of hydromorphone in the management of pain.

Cochrane Systematic Review: Diclofenac for acute pain in children

Visit

Standing JF, Savage I, Pritchard D, Waddington M

OBJECTIVES: 1) Assess the efficacy of diclofenac for acute pain in children. 2) Assess the safety of diclofenac for short-term use in children. 3) Identify gaps in the evidence to direct future research.

Systematic Review: Pediatric clinical practice guidelines for acute procedural pain: a systematic review

Visit

Lee GY, Yamada J, Kyololo O, Shorkey A, Stevens B

Objective: To systematically review the quality of existing practice guidelines for acute procedural pain in children and provide recommendations for their use.

Cochrane Systematic Review: Intranasal fentanyl for the management of acute pain in children

Visit

Murphy A, O'Sullivan R, Wakai A, Grant TS, Barrett MJ, Cronin J, McCoy SC, Ho...

Objective: We identified and evaluated all randomized controlled trials (RCTs) and quasi-randomized trials to assess the effects of intranasal fentanyl (INF) versus alternative analgesic interventions in children with acute pain, with respect to reduction in pain score, occurrence of adverse events, patient tolerability, use of "rescue analgesia," patient/parental satisfaction and patient mortality.

Systematic Review: Opioid analgesia for acute abdominal pain in children: A systematic review and meta-analysis

Visit

Poonai N, Paskar D, Konrad SL, Rieder M, Joubert G, Lim R, Golozar A, Uledi S...

Objectives: There are long-held concerns that analgesia in patients with acute abdominal pain may obscure the physical examination and lead to missing a diagnosis of appendicitis. Despite evidence to the contrary, analgesia continues to be underutilized and suboptimally dosed in children with acute abdominal pain. The objective of this systematic review and meta-analysis was to determine if opioids provide analgesia without an increase in side effects and appendicitis-related complications.

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

Visit

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.

Systematic Review: Digital Technology Distraction for Acute Pain in Children: AMeta-analysis

Visit

Michelle Gates,Lisa Hartling,Jocelyn Shulhan-Kilroy,Tara MacGregor,Samantha G...

Objective:To determine the effect of digital technology distraction on pain and distress in children experiencing acutely painful conditions or procedures.

Systematic Review: Clinical efficacy of virtual reality for acute procedural pain management: A systematic review and meta-analysis

Visit

Evelyn Chan, Samantha Foster , Ryan Sambell , Paul Leong

There is no comprehensive, high-quality systematic review that specifically assesses the efficacy of virtual reality on acutely painful healthcare interventions, nor has there been any quantitative data synthesis on this topic. We therefore conducted a systematic review and meta analysis to appraise the quality of published literature and to synthesize data for acute pain scores.

Systematic Review: How Safe Are Common Analgesics for the Treatment of Acute Pain for Children? A Systematic Review.

Visit

Hartling L, Ali S, Dryden DM, Chordiya P, Johnson DW, Plint AC, Stang A, McGr...

We examined evidence comparing the safety profiles of three groups of oral medications, acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids, to manage acute nonsurgical pain in children (<18 years) treated in ambulatory settings

Cochrane Systematic Review: Aerosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)

Visit

Afshari A, Brok J, Mller AM, Wetterslev J

OBJECTIVES: To systematically assess the benefits and harms of aerosolized prostacyclin in critically ill patients with ALI and ARDS.

Cochrane Systematic Review: High-frequency ventilation versus conventional ventilation for treatment of acute lung injury and acute respiratory distress syndrome

Visit

Sud S, Sud M, Friedrich JO, Wunsch H, Meade MO, Ferguson ND, Adhikari NK

OBJECTIVES: To determine clinical and physiological effects of high frequency oscillation (HFO) in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) compared to conventional ventilation.

Cochrane Systematic Review: Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) and acute lung injury in children and adults

Visit

Afshari A, Brok J, Mller AM, Wetterslev J. Inhaled nitric oxide for acute re...

OBJECTIVES: To systematically assess the benefits and harms of INO in critically ill patients with AHRF.

Cochrane Systematic Review: Adjusting the pH of lidocaine for reducing pain on injection

Visit

Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R

OBJECTIVES: The objective of this review was to determine if adjusting the pH of lidocaine had any effect on pain resulting from non-intravascular injections in adults and children. We tested the hypothesis that adjusting the pH of lidocaine solution to a level closer to the physiologic pH reduces this pain.

Cochrane Systematic Review: Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery

Visit

Andreae MH, Andreae DA

OBJECTIVES: To compare local anaesthetics and regional anaesthesia versus conventional analgesia for the prevention of persistent pain six or 12 months after surgery.

Cochrane Systematic Review: Conservative interventions for treating exercise-related musculotendinous, ligamentous and osseous groin pain

Visit

Almeida MO, Silva BN, Andriolo RB, Atallah AN, Peccin MS

OBJECTIVES: To assess the effects (benefits and harms) of conservative interventions for treating exercise-related musculotendinous, ligamentous and osseous groin pain.

Cochrane Systematic Review: Pharmacotherapy for patellofemoral pain syndrome

Visit

Heintjes E, Berger MY, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW

OBJECTIVES: This review aims to summarise the evidence of effectiveness of pharmacotherapy in reducing anterior knee pain and improving knee function in people with PFPS.

Cochrane Systematic Review: Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood

Visit

Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C, Martin AE

OBJECTIVES: To determine the effectiveness of medication for recurrent abdominal pain in school-age children.

Cochrane Systematic Review: Antidepressants for the treatment of abdominal pain-related functional gastrointestinal disorders in children and adolescents

Visit

Kaminski A, Kamper A, Thaler K, Chapman A, Gartlehner G

OBJECTIVES: The primary objectives were to conduct a systematic review to evaluate the efficacy and safety of antidepressants for the treatment of abdominal pain-related FGIDs in children and adolescents.

Cochrane Systematic Review: Oxcarbazepine for neuropathic pain

Visit

Zhou M, Chen N, He L, Yang M, Zhu C, Wu F

OBJECTIVES: To determine the benefits and harms of oxcarbazepine for different forms of neuropathic pain.

Cochrane Systematic Review: EMLA and Amethocaine for reduction of children's pain associated with needle insertion

Visit

Lander JA, Weltman BJ, So SS

OBJECTIVES: To compare the topical anaesthetics amethocaine and an eutectic mixture of local anaesthetics (EMLA) in terms of anaesthetic efficacy, ease of needle insertion and adverse events when used for intravenous cannulation and venipuncture in children.

Cochrane Systematic Review: Local anaesthetic sympathetic blockade for complex regional pain syndrome

Visit

Stanton TR, Wand BM, Carr DB, Birklein F, Wasner GL, O'Connell NE

OBJECTIVES: To assess the efficacy of LASB for the treatment of pain in CRPS and to evaluate the incidence of adverse effects of the procedure.

Cochrane Systematic Review: Non-pharmacological management of infant and young child procedural pain

Visit

Pillai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, A...

OBJECTIVES: To assess the efficacy of non-pharmacological interventions for infant and child (up to three years) acute pain, excluding breastmilk, sucrose, and music. Analyses accounted for infant age (preterm, neonate, older) and pain response (pain reactivity, pain-related regulation).

Cochrane Systematic Review: NSAIDS or paracetamol, alone or combined with opioids, for cancer pain

Visit

McNicol E, Strassels SA, Goudas L, Lau J, Carr DB

OBJECTIVES: To assess the effects of NSAIDs, alone or combined with opioids, for the treatment of cancer pain.

Cochrane Systematic Review: Oral morphine for cancer pain

Visit

Wiffen PJ, Wee B, Moore RA

OBJECTIVES: To determine the efficacy of oral morphine in relieving cancer pain, and assess the incidence and severity of adverse effects.

Cochrane Systematic Review: Pharmacologic interventions for treating phantom limb pain

Visit

Alviar MJ, Hale T, Dungca M

OBJECTIVES: This review aims to summarize the evidence of effectiveness of pharmacologic interventions in treating PLP.

Cochrane Systematic Review: Sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age

Visit

Kassab M, Foster JP, Foureur M, Fowler C

OBJECTIVES: To determine the effectiveness of sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age compared with no treatment, placebo, other sweet-tasting solutions, or pharmacological or other non-pharmacological pain-relieving methods.

Systematic Review: A systematic review of vapocoolants for reducing pain from venipuncture and venous cannulation in children and adults

Visit

Hogan ME, Smart S, Shah V, Taddio A

Our aim was to systematically review the literature regarding the analgesic effectiveness of vapocoolants in children and adults.

Review: Relief of pain and anxiety in pediatric patients in emergency medical systems

Visit

Fein JA, Zempsky WT, Cravero JP, Committee on Pediatric Emergency Medicine an...

Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a child's and family's reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction.

Cochrane Systematic Review: Sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age

Visit

Kassab M, Foster JP, Foureur M, Fowler C

Objectives: To determine the effectiveness of sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age compared with no treatment, placebo, other sweet-tasting solutions, or pharmacological or other non-pharmacological pain-relieving methods.

Cochrane Systematic Review: Breastfeeding or breast milk for procedural pain in neonates

Visit

Shah PS, Herbozo C, Aliwalas LL, Shah VS

Objectives: The primary objective was to evaluate the effectiveness of breastfeeding or supplemental breast milk in reducing procedural pain in neonates. The secondary objective was to conduct subgroup analyses based on the type of control intervention, gestational age and the amount of supplemental breast milk given.

Cochrane Systematic Review: Sweet tasting solutions for reduction of needle-related procedural pain in children aged one to 16 years

Visit

Harrison D, Yamada J, Adams-Webber T, Ohlsson A, Beyene J, Stevens B

Objectives: To determine the efficacy of sweet tasting solutions or substances for reducing needle-related procedural pain in children beyond one year of age.

Cochrane Systematic Review: Non-pharmacological management of infant and young child procedural pain

Visit

Pillai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, Ah...

Objectives: To assess the efficacy of non-pharmacological interventions for infant and child (up to three years) acute pain, excluding breastmilk, sucrose, and music. Analyses accounted for infant age (preterm, neonate, older) and pain response (pain reactivity, pain-related regulation).

Systematic Review: Music for pain and anxiety in children undergoing medical procedures: a systematic review of randomized controlled trials

Visit

Klassen JA, Liang Y, Tjosvold L, Klassen TP, Hartling L

Objective: The aim of this study was to conduct a systematic review of the efficacy of music therapy (MT) on pain and anxiety in children undergoing clinical procedures.

Review: Clinical implications of unmanaged needle-insertion pain and distress in children

Visit

Kennedy RM, Luhmann J, Zempsky WT

This review summarizes the evidence for the importance of managing pediatric procedural pain and methods for reducing venous access pain.

Review: Needle pain in children: contextual factors

Visit

Walco GA

Pediatric pain experiences result from a complex interplay of genetic, experiential, and developmental factors. These elements, as they relate to needle-stick procedures and other relevant painful phenomena, are explored in this article so that the context of possible interventions may be more fully appreciated. Clinical implications are discussed incorporating ethical perspectives.

Review: Pharmacologic approaches for reducing venous access pain in children

Visit

Zempsky WT

A variety of pharmacologic options are available to clinicians who want to provide effective and safe topical local anesthesia to children undergoing venous access procedures. These options can be distinguished on the basis of how they deliver active drug through the impermeable outer layer of skin, the stratum corneum, to pain receptors located in the dermis and epidermis. Three general methodologies are typically used to bypass the stratum corneum: direct injection of local anesthetics, usually via a small-gauge hypodermic syringe; passive diffusion from topical creams or gels; and active needle-free drug strategies that enhance the rate of drug passage into the dermis and epidermis.

Cochrane Systematic Review: Nerve blocks for initial pain management of femoral fractures in children

Visit

Black KJ, Bevan CA, Murphy NG, Howard JJ

Objectives: To assess the effects (benefits and harms) of femoral nerve block (FNB) or fascia iliaca compartment block (FICB) for initial pain management of children with fractures of the femur (thigh bone) in the pre-hospital or in-hospital emergency setting, with or without systemic analgesia.

Systematic Review: A systematic review of faces scales for the self-report of pain intensity in children

Visit

Tomlinson D, von Baeyer CL, Stinson JN, Sung L

Objectives: To summarize and systematically review faces pain scales most commonly used to obtain self-report of pain intensity in children for evaluation of reliability and validity and to compare the scales for preference and utility.

Systematic Review: Pain management and sedation for children in the emergency department

Visit

Atkinson P, Chesters A, Heinz P

We provide an overview of published evidence to help clinicians assess, manage, and minimise pain in children presenting to hospital.

Systematic Review: Psychometric properties of the numerical rating scale to assess self-reported pain intensity in children and adolescents: A systematic review

Visit

Castarlenas E, Jensen MP, von Baeyer CL, Mir J.

Objective: The Numerical Rating Scale-11 (NRS-11) is one of the most widely used scales to assess self-reported pain intensity in children, despite the limited information on its psychometric properties for assessing pain in pediatric populations. Recently, there has been an increase in published findings regarding the strengths and weaknesses of the NRS-11 as a measure of pain in youths. The purpose of this study was to review this research and summarize what is known regarding the reliability and validity of the NRS-11 as a self-report measure of pediatric pain intensity.

Cochrane Systematic Review: Psychological interventions for needlerelated procedural pain and distress in children and adolescents

Visit

BirnieKA, NoelM, ChambersCT, UmanLS, ParkerJA

Objectives: To provide an update to our 2006 review assessing the efficacy of psychological interventions for needle-related procedural pain and distress in children and adolescents.

Systematic Review: Vapocoolant spray versus placebo spray/no treatment for reducing pain from intravenous cannulation: A meta-analysis of randomized controlled trials.

Visit

Zhu Y,Peng X,Wang S,Chen W,Liu C,Guo B,Zhao L,Gao Y,Wang K,Lou F.

Objectives:The objective of our meta-analysis is to compare the effectiveness of vapocoolant spray and placebo spray/no treatment for pain reduction during intravenous cannulation.

Cochrane Systematic Review: Topical anaesthetics for pain control during repair of dermal laceration

Visit

TayebBO, EidelmanA, EidelmanCL, McNicolED, CarrDB

Objectives: To compare the efficacy and safety of infiltrated local anaesthetics with those of topical local anaesthetics for repair of dermal lacerations and to evaluate the efficacy and safety of various single or multi-component topical anaesthetics to identify cocaine-free topically applied local anaesthetics that may provide equivalent analgesia to those containing cocaine.

Systematic Review: Sweet Solutions to Reduce Procedural Pain in Neonates: AMeta-analysis

Visit

Denise Harrison,Catherine Larocque,Mariana Bueno,Yehudis Stokes,Lucy Turner,B...

Objective: To review all trials evaluating sweet solutions for analgesia in neonates and to conduct cumulative meta-analyses (CMAs) on behavioral pain outcomes.

Cochrane Systematic Review: Breastfeeding for procedural pain in infants beyond the neonatal period

Visit

Harrison D, Reszel J, Bueno M, et al.

Objectives:To determine the effect of breastfeeding on procedural pain in infants beyond the neonatal period (first 28 days of life) up to one year of age compared to no intervention, placebo, parental holding, skin-to-skin contact, expressed breast milk, formula milk, bottle feeding, sweet-tasting solutions (e.g. sucrose or glucose), distraction, or other interventions.

Cochrane Systematic Review: Nonpharmacological management of infant and young child procedural pain

Visit

Pillai RiddellRR, RacineNM, GennisHG, TurcotteK, UmanLS, HortonRE, Ahola Kohu...

Objectives: To assess the efficacy of non-pharmacological interventions for infant and child (up to three years) acute pain, excluding breastmilk, sucrose, and music. Analyses accounted for infant age (preterm, neonate, older) and pain response (pain reactivity, pain-related regulation).

Systematic Review: The effectiveness of virtual reality distraction for pain reduction:a systematic review

Visit

Kevin M Malloy , Leonard S Milling

This article provides a comprehensive review of controlled research on the effectiveness of virtual reality (VR) distraction for reducing pain.

Systematic Review: Recommendations for selection of self-report pain intensity measures in children and adolescents: a systematic review and quality assessment of measurement properties.

Visit

Birnie KA, Hundert AS, Lalloo C, Nguyen C, Stinson JN

Objectives: Our aim was to review the measurement properties of single-item self-report pain intensity measures in children 3 to 18 years old. A secondary aim was to develop evidence-based recommendations for measurement of child and adolescent self-report of acute, postoperative, and chronic pain.

Systematic Review: Pain Management of Pediatric Musculoskeletal Injury in the Emergency Department: A Systematic Review.

Visit

Le May S,Ali S,Khadra C,Drendel AL,Trottier ED,Gouin S,Poonai N.

Objective. To systematically review the most effective pain management for children presenting to the emergency department with musculoskeletal injuries.

Review: Treating abdominal pain in children: what do we know?

Visit

Ali S, Sli H

Abdominal pain is a common reason for emergency department visits in the United States. Failure to treat children's pain has long been considered substandard and unethical. Within the emergency department setting, pain has been repeatedly shown to be undertreated. Analgesic medications are suboptimally used for children with abdominal pain because of a wide variety of causes. To our knowledge, there is no standard of care for the treatment of such pain. As such, several recent studies have set out to determine the most appropriate methods to address this gap in knowledge. The proceeding article will attempt to review the literature as it pertains to severe acute abdominal pain, biliary colic, renal colic, and dysmenorrhea.

Review: Pediatric pain management in the emergency department

Visit

Bauman BH, McManus JG

In this article, the authors review the history of ED pediatric pain management and sedation, discuss special considerations in pediatric pain assessment and management, review various pharmacologic and nonpharmacologic methods of alleviating pain and anxiety, and present ideas to improve the culture of the pediatric ED, so that it can achieve the goal of becoming pain-free.

Review: Analgesics for the treatment of pain in children

Visit

Berde CB, Sethna NF

Studies over the past 15 years suggest that neonates, infants, and children can receive analgesia and anesthesia safely, with proper age-related adjustments in clinical practice and dosing. Although the emphasis in this review is on the pharmacologic management of pain, several nonpharmacologic approaches, including hypnosis and related cognitive behavioral approaches, have had good efficacy in children with acute or chronic pain.5,6 Making the hospital environment a less terrifying place may reduce anxiety and fear, which can themselves exacerbate pain.7 Conversely, nonpharmacologic approaches should not be used as an excuse to withhold appropriate analgesics.

Systematic Review: Effectiveness of Probiotics in Children with Functional Abdominal Pain Disorders and Functional Constipation: A Systematic Review

Visit

Wegh CAM,Benninga MA,Tabbers MM

The objective of this study was to investigate the effect of probiotics on functional abdominal pain disorders (FAPD) and functional constipation (FC).

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

Visit

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

Visit

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 Systematic Review: Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents

Visit

Fedorowicz Z, Jagannath VA, Carter B

This systematic review assesses the safety and effectiveness of antiemetics on gastroenteritis induced vomiting in children and adolescents.

Cochrane Systematic Review: Continuous negative extrathoracic pressure or continuous positive airway pressure compared to conventional ventilation for acute hypoxaemic respiratory failure in children

Visit

Shah PS, Ohlsson A, Shah JP.

Objectives: To assess the effectiveness of CNEP or Ni-CPAP compared to conventional ventilation in children (at least one month old and less than 18 years of age) with AHRF due to non-cardiogenic causes for improving the mortality or morbidity associated with AHRF.

Cochrane Systematic Review: Decongestants and antihistamines for acute otitis media in children

Visit

Coleman C, Moore M.

Objectives: To determine the efficacy of decongestant and antihistamine therapy in children with AOM on outcomes of AOM resolution, symptom resolution, medication side effects, and complications of AOM.

Cochrane Systematic Review: Decongestants, antihistamines and nasal irrigation for acute sinusitis in children

Visit

Shaikh N, Wald ER, Pi M.

Objectives: To systematically review the efficacy of decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis. We considered the following four interventions: 1) decongestants versus placebo or no medication, 2) antihistamines versus placebo or no medication, 3) decongestant and antihistamine combination versus placebo or no medication, 4) nasal irrigation versus no irrigation. The primary outcomes of the review were symptom resolution (improvement in symptom score from enrolment to day five and overall symptom burden (as measured by average symptom scores while on therapy).

Cochrane Systematic Review: Honey for acute cough in children

Visit

Oduwole O, Meremikwu MM, Oyo-Ita A, Udoh EE.

Objectives: To evaluate the effectiveness of honey for acute cough in children in ambulatory settings.

Cochrane Systematic Review: Inhaled corticosteroids during acute bronchiolitis in the prevention of post-bronchiolitic wheezing

Visit

Blom DJ, Ermers M, Bont L, van Woensel JB, Van Aalderen WM.

Objectives: The objective of this review was to evaluate the effect of inhaled corticosteroids, started during the acute phase of bronchiolitis, on the prevention of post-bronchiolitic wheezing.

Cochrane Systematic Review: Intranasal steroids for acute sinusitis

Visit

Zalmanovici Trestioreanu A, Yaphe J.

Objectives: We examined whether intranasal corticosteroids (INCS) are effective in relieving symptoms of acute sinusitis in adults and children.

Cochrane Systematic Review: Once or twice daily versus three times daily amoxicillin with or without clavulanate for the treatment of acute otitis media

Visit

Thanaviratananich S, Laopaiboon M, Vatanasapt P.

Objectives: To compare the effectiveness of one or two daily doses with three or four daily doses of amoxicillin, with or without clavulanate, for the treatment of AOM in children; and to compare complication rates and adverse reactions.

Cochrane Systematic Review: Over-the-counter (OTC) medications for acute cough in children and adults in ambulatory settings

Visit

Smith SM, Schroeder K, Fahey T.

Objectives: To assess the effects of oral OTC cough preparations for acute cough in children and adults.

Cochrane Systematic Review: Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults

Visit

Chang CC, Cheng AC, Chang AB.

Objectives: To evaluate the efficacy of OTC cough medications as an adjunct to antibiotics in children and adults with pneumonia.

Cochrane Systematic Review: Pelargonium sidoides extract for treating acute respiratory tract infections

Visit

Timmer A, Gnther J, Motschall E, Rcker G, Antes G, Kern WV.

Objectives: To assess the efficacy and safety of P. sidoides for the treatment of ARIs in children and adults.

Cochrane Systematic Review: Probiotics for preventing acute upper respiratory tract infections

Visit

Hao Q, Lu Z, Dong BR, Huang CQ, Wu T.

Objectives: To assess the effectiveness and safety of probiotics for preventing acute URTIs.

Cochrane Systematic Review: Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections

Visit

Schuetz P, Mller B, Christ-Crain M, Stolz D, Tamm M, Bouadma L, Luyt CE, Wolf...

Objectives: The aim of this systematic review based on individual patient data was to assess the safety and efficacy of using procalcitonin for starting or stopping antibiotics over a large range of patients with varying severity of ARIs and from different clinical settings.

Cochrane Systematic Review: Rapid viral diagnosis for acute febrile respiratory illness in children in the Emergency Department

Visit

Doan Q, Enarson P, Kissoon N, Klassen TP, Johnson DW.

Objectives: To determine the effect of rapid viral testing in the ED on the rate of precautionary testing, antibiotic use, and length of ED visit.

Cochrane Systematic Review: Saline nasal irrigation for acute upper respiratory tract infections

Visit

Kassel JC, King D, Spurling GK.

Objectives: To evaluate the efficacy of saline nasal irrigation in treating the symptoms of acute URTIs.

Cochrane Systematic Review: Short-course antibiotics for acute otitis media

Visit

Kozyrskyj A, Klassen TP, Moffatt M, Harvey K.

Objectives: To determine the effectiveness of a short course of antibiotics (less than seven days) in comparison to a long course of antibiotics (seven days or greater) for the treatment of AOM in children.

Cochrane Systematic Review: Short-term late-generation antibiotics versus longer term penicillin for acute streptococcal pharyngitis in children

Visit

Altamimi S, Khalil A, Khalaiwi KA, Milner RA, Pusic MV, Al Othman MA.

Objectives: To summarize the evidence regarding the efficacy of two to six days of newer oral antibiotics (short duration) compared to 10 days of oral penicillin (standard duration) in treating children with acute GABHS pharyngitis.

Cochrane Systematic Review: Steam inhalation or humidified oxygen for acute bronchiolitis in children up to three years of age

Visit

Umoren R, Odey F, Meremikwu MM.

Objectives: To evaluate the effect of steam inhalation or humidified oxygen to relieve respiratory distress and to evaluate adverse events in children up to three years old with acute bronchiolitis.

Cochrane Systematic Review: Systemic corticosteroids for acute sinusitis

Visit

Venekamp RP, Thompson MJ, Hayward G, Heneghan CJ, Del Mar CB, Perera R, Glasz...

Objectives: To assess the effects of systemic corticosteroids on clinical response rates and to determine adverse effects and relapse rates of systemic corticosteroids compared to placebo or standard clinical care in children and adults with acute sinusitis.

Cochrane Systematic Review: Topical analgesia for acute otitis media

Visit

Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C.

Objectives: To assess the effectiveness of topical analgesia for AOM.

Cochrane Systematic Review: Addition of intravenous beta2-agonists to inhaled beta2-agonists for acute asthma

Visit

Travers AH, Milan SJ, Jones AP, Camargo CA Jr, Rowe BH.

Objectives: To determine the benefit of adding intravenous (IV) beta(2)-agonists to inhaled beta(2)-agonist therapy for acute asthma treated in the emergency department.

Cochrane Systematic Review: Antibiotics for acute asthma

Visit

Graham V, Lasserson T, Rowe BH.

Objectives: To determine the efficacy of antibiotics prescribed in the treatment of acute asthma

Cochrane Systematic Review: Antibiotics for persistent cough or wheeze following acute bronchiolitis in children

Visit

McCallum GB, Morris PS, Chang AB.

Objectives: To determine the effectiveness of antibiotics compared to a control (no treatment or placebo) for persistent respiratory symptoms (within six months), following acute bronchiolitis.

Cochrane Systematic Review: Anticholinergic therapy for acute asthma in children

Visit

Teoh L, Cates CJ, Hurwitz M, Acworth JP, van Asperen P, Chang AB.

Objectives: To determine the effectiveness of only inhaled anticholinergic drugs (i.e. administered alone), compared to a control in children over the age of two years with acute asthma.

Cochrane Systematic Review: Combined inhaled anticholinergics and beta2-agonists for initial treatment of acute asthma in children

Visit

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: Commercial versus home-made spacers in delivering bronchodilator therapy for acute therapy in children

Visit

Rodriguez C, Sossa M, Lozano JM.

Objectives: The aim of this review was to compare the response to inhaled beta-2 agonists delivered through metered-dose inhaler using home-made spacers, to the use of commercially produced spacers, in children with acute exacerbations of wheezing or asthma.

Cochrane Systematic Review: Corticosteroids for hospitalised children with acute asthma

Visit

Smith M, Iqbal S, Elliott TM, Everard M, Rowe BH.

Objectives: To determine the benefit of systemic corticosteroids (oral, intravenous, or intramuscular) compared to placebo and inhaled steroids in acute paediatric asthma.

Cochrane Systematic Review: Corticosteroids for preventing relapse following acute exacerbations of asthma

Visit

Rowe BH, Spooner CH, Ducharme FM, Bretzlaff JA, Bota GW.

Objectives: To determine the benefit of corticosteroids (oral, intramuscular, or intravenous) for the treatment of asthmatic patients discharged from an acute care setting (i.e. usually the emergency department) after assessment and treatment of an acute asthmatic exacerbation.

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

Visit

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).

Cochrane Systematic Review: Early use of inhaled corticosteroids in the emergency department treatment of acute asthma

Visit

Edmonds ML, Milan SJ, Camargo CA Jr, Pollack CV, Rowe BH.

Objectives: To determine the benefit of ICS for the treatment of patients with acute asthma managed in the emergency department (ED).

Cochrane Systematic Review: Heliox for non-intubated acute asthma patients

Visit

Rodrigo G, Pollack C, Rodrigo C, Rowe BH.

Objectives: To determine the effect of the addition of heliox to standard medical care on the course of acute asthma, as measured by pulmonary function testing and clinical endpoints.

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

Visit

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.

Cochrane Systematic Review: Inhaled magnesium sulfate in the treatment of acute asthma

Visit

Powell C, Dwan K, Milan SJ, Beasley R, Hughes R, Knopp-Sihota JA, Rowe BH.

Objectives: To determine the efficacy of inhaled MgSO(4) administered in acute asthma on pulmonary functions and admission rates.Specific aims: To quantify the effects of inhaled MgSO(4) i) in addition to inhaled (2)-agonist, ii) in comparison to inhaled (2)-agonist alone or iii) in addition to combination treatment with inhaled (2) -agonist and ipratropium bromide.

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

Visit

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: Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators

Visit

Mitra A, Bassler D, Goodman K, Lasserson TJ, Ducharme FM.

Objectives: To determine if the addition of intravenous aminophylline produces a beneficial effect in children with acute severe asthma receiving conventional therapy.

Cochrane Systematic Review: Intravenous beta2-agonists for acute asthma in the emergency department

Visit

Travers A, Jones AP, Kelly K, Barker SJ, Camargo CA, Rowe BH.

Objectives: To determine the benefit of intravenous (IV) beta2-agonists for severe acute asthma treated in the emergency department.

Cochrane Systematic Review: Intravenous beta2-agonists versus intravenous aminophylline for acute asthma

Visit

Travers AH, Jones AP, Camargo CA Jr, Milan SJ, Rowe BH.

Objectives: To compare the benefit of IV beta(2)-agonists versus IV aminophylline for acute asthma treated in the emergency department and in patients admitted to hospital with acute severe asthma.

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

Visit

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: Leukotriene receptor antagonists in addition to usual care for acute asthma in adults and children

Visit

Watts K, Chavasse RJ.

Objectives: To determine if the addition of a leukotriene receptor antagonist (LTRA) produces a beneficial effect in children and adults with acute asthma who are currently receiving inhaled bronchodilators and systemic corticosteroids.

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

Visit

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.

Cochrane Systematic Review: Oral corticosteroids for bronchiectasis (stable and acute exacerbations)

Visit

Lasserson T, Holt K, Greenstone M.

Objectives: To determine the efficacy of oral corticosteroids in acute and stable bronchiectasis

Cochrane Systematic Review: Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle

Visit

Lenza M, Belloti JC, Gomes Dos Santos JB, Matsumoto MH, Faloppa F

OBJECTIVES: To evaluate the effectiveness of different methods of surgical treatment for acute fracture or non-union of the middle third of the clavicle.

Cochrane Systematic Review: Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home

Visit

Johnson A, Sandford J, Tyndall J

OBJECTIVES: To determine the effectiveness of providing written health information in addition to verbal information for patients and/or significant others being discharged from acute hospital settings to home.

Cochrane Systematic Review: Blood transfusions for treating acute chest syndrome in people with sickle cell disease

Visit

Alhashimi D, Fedorowicz Z, Alhashimi F, Dastgiri S

OBJECTIVES: To assess the effectiveness of blood transfusions, simple and exchange, for treating ACS by comparing improvement in symptoms and clinical outcomes against standard care.

Cochrane Systematic Review: Inhaled nitric oxide for acute chest syndrome in people with sickle cell disease

Visit

Al Hajeri A, Serjeant GR, Fedorowicz Z

OBJECTIVES: To assess the effectiveness of inhaled nitric oxide for treating acute chest syndrome by comparing improvement in symptoms and clinical outcomes against standard care.

Cochrane Systematic Review: Interventions for acute auricular haematoma

Visit

Jones SE, Mahendran S

OBJECTIVES: To assess the effectiveness of treatment options in acute auricular haematoma.

Cochrane Systematic Review: Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children

Visit

Appleton R, Macleod S, Martland T

OBJECTIVES: To review the evidence comparing the efficacy and safety of midazolam, diazepam, lorazepam, phenobarbitone, phenytoin and paraldehyde in treating acute tonic-clonic convulsions and convulsive status epilepticus in children treated in hospital.

Cochrane Systematic Review: Anti-inflammatory treatment for carditis in acute rheumatic fever

Visit

Cilliers A, Manyemba J, Adler AJ, Saloojee H

OBJECTIVES: To assess the effects of anti-inflammatory agents such as aspirin, corticosteroids, immunoglobulin and pentoxifylline for preventing or reducing further heart valve damage in patients with acute rheumatic fever.

Cochrane Systematic Review: Early versus Delayed Refeeding for Children with Acute Diarrhoea

Visit

Gregorio GV, Dans LF, Silvestre MA

OBJECTIVES: To compare the efficacy and safety of early and late reintroduction of feeding in children with acute diarrhoea.

Cochrane Systematic Review: Probiotics for treating acute infectious diarrhoea

Visit

Allen SJ, Martinez EG, Gregorio GV, Dans LF

OBJECTIVES: To assess the effects of probiotics in proven or presumed acute infectious diarrhoea.

Cochrane Systematic Review: Polymer-based oral rehydration solution for treating acute watery diarrhoea

Visit

Gregorio GV, Gonzales ML, Dans LF, Martinez EG

OBJECTIVES: To compare polymer-based ORS with glucose-based ORS for treating acute watery diarrhoea.

Cochrane Systematic Review: Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children

Visit

Hahn S, Kim S, Garner P. Reduced osmolarity oral rehydration solution for tr...

OBJECTIVES: To compare reduced osmolarity ORS with WHO standard ORS in children with acute diarrhoea.

Cochrane Systematic Review: Antifibrinolytic drugs for acute traumatic injury

Visit

Roberts I, Shakur H, Ker K, Coats T; CRASH-2 Trial collaborators

OBJECTIVES: To quantify the effects of antifibrinolytic drugs on mortality, vascular occlusive events, surgical intervention and receipt of blood transfusion after acute traumatic injury.

Cochrane Systematic Review: Bradykinin beta-2 receptor antagonists for acute traumatic brain injury

Visit

Ker K, Blackhall K

OBJECTIVES: The objective was to assess the safety and effectiveness of beta-2 receptor antagonists for TBI.

Cochrane Systematic Review: Hyperventilation therapy for acute traumatic brain injury

Visit

Schierhout G, Roberts I

OBJECTIVES: To quantify the effect of hyperventilation on death and neurological disability following head injury.

Cochrane Systematic Review: Progesterone for acute traumatic brain injury

Visit

Ma J, Huang S, Qin S, You C

OBJECTIVES: To assess the effectiveness and safety of progesterone in people with acute TBI.

Cochrane Systematic Review: Steroids for acute spinal cord injury

Visit

Bracken MB

OBJECTIVES: To review randomized trials of steroids for human acute spinal cord injury.

Cochrane Systematic Review: Dipyrone for acute primary headaches

Visit

Ramacciotti AS, Soares BG, Atallah AN

OBJECTIVES: To determine the effectiveness and safety of dipyrone for acute primary headaches in adults and children.

Cochrane Systematic Review: Antibiotics for acute pyelonephritis in children

Visit

Hodson EM, Willis NS, Craig JC

OBJECTIVES: To determine the benefits and harms of different antibiotic regimens for the treatment of acute pyelonephritis in children.

Cochrane Systematic Review: Bicarbonate versus lactate solutions for acute peritoneal dialysis

Visit

Bai ZG, Yang K, Tian J, Ma B, Liu Y, Jiang L, Tan J, Liu TX, Chi I

OBJECTIVES: To look at the benefits and harms of bicarbonate versus lactate solutions in acute PD.

Cochrane Systematic Review: Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children

Visit

Michael M, Hodson EM, Craig JC, Martin S, Moyer VA

OBJECTIVES: The objective of this review was to assess the benefits and harms of short-course (2-4 days) compared to standard duration (7-14 days) oral antibiotic treatment for acute UTI in children.

Cochrane Systematic Review: Anticholinergics for neuroleptic-induced acute akathisia

Visit

Rathbone J, Soares-Weiser K

OBJECTIVES: To review anticholinergic drugs for neuroleptic-induced acute akathisia.

Cochrane Systematic Review: Aloe vera for treating acute and chronic wounds

Visit

Dat AD, Poon F, Pham KB, Doust J

OBJECTIVES: To determine the effects of Aloe vera-derived products (for example dressings and topical gels) on the healing of acute wounds (for example lacerations, surgical incisions and burns) and chronic wounds (for example infected wounds, arterial and venous ulcers).

Cochrane Systematic Review: Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents

Visit

Fedorowicz Z, Jagannath VA, Carter B

OBJECTIVES: To assess the safety and effectiveness of antiemetics on gastroenteritis induced vomiting in children and adolescents.

Cochrane Systematic Review: Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease

Visit

Chalumeau M, Duijvestijn YC

OBJECTIVES: The objective was to assess the efficacy and safety and to establish a benefit-risk ratio of acetylcysteine and carbocysteine as symptomatic treatments for acute upper and lower RTIs in paediatric patients without chronic broncho-pulmonary disease.

Cochrane Systematic Review: Advising patients to increase fluid intake for treating acute respiratory infections

Visit

Guppy MP, Mickan SM, Del Mar CB, Thorning S, Rack A

OBJECTIVES: To answer the following questions.1. Does recommending increased fluid intake as a treatment for acute respiratory infections improve duration and severity of symptoms? 2. Are there adverse effects from recommending increased fluids in people with acute respiratory infections? 3. Are any benefits or harms related to site of infection (upper or lower respiratory tract) or a different severity of illness?

Cochrane Systematic Review: Antibiotics for acute otitis media in children

Visit

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

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

Cochrane Systematic Review: Antibiotics for the common cold and acute purulent rhinitis

Visit

Kenealy T, Arroll B

OBJECTIVES: To determine the efficacy of antibiotics compared with placebo for reducing general and specific nasopharyngeal symptoms of acute upper respiratory tract infections (URTIs) (common colds). To determine if antibiotics have any influence on the tcomes for acute purulent rhinitis and acute clear rhinitis lasting less than 10 days before the intervention. To determine whether there are significant adverse outcomes associated with antibiotic therapy for participants with a clinical diagnosis of acute URTI or acute purulent rhinitis.

Cochrane Systematic Review: Antibiotics for the prevention of acute and chronic suppurative otitis media in children

Visit

Leach AJ, Morris PS

OBJECTIVES: To determine the effectiveness of long-term antibiotics (for longer than six weeks) in preventing any AOM, AOM with perforation and C

Cochrane Systematic Review: Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old

Visit

Roqu i Figuls M, Gin-Garriga M, Granados Rugeles C, Perrotta C

OBJECTIVES: The main objective was to determine the efficacy of chest physiotherapy in infants aged less than 24 months old with acute bronchiolitis. A condary objective was to determine the efficacy of different techniques of chest physiotherapy (for ample, vibration and percussion and passive forced exhalation).

Cochrane Systematic Review: Chest radiograph for acute lower respiratory infections

Visit

Swingler GH, Zwarenstein M

OBJECTIVES: To assess the effects of chest radiography on clinical outcome in acute lower respiratory infections.

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

Visit

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

Objectives: To assess the effects of nebulised hypertonic ( 3%) saline solution in infants with viral bronchiolitis.

Systematic Review: Corticosteroids for acute traumatic brain injury

Visit

Alderson P, Roberts I

To quantify the effectiveness and safety of corticosteroids in the treatment ofacutetraumatic brain injury.

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

Visit

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)

Visit

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)

Visit

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

Visit

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

Visit

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)

Visit

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

Visit

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)

Visit

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).

Cochrane Systematic Review: Topical analgesia for acute otitis media

Visit

Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C

Objectives: To assess the effectiveness of topical analgesia for AOM.

Review: Ondansetron and probiotics in the management of pediatric acute gastroenteritis in developed countries

Visit

Schnadower D, Finkelstein Y, Freedman SB

The purpose of this review is to present the latest evidence regarding the use of adjunctive therapies, ondansetron and probiotics, in children with acute gastroenteritis.

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

Visit

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.

Review: Caring for the child with an autism spectrum disorder in the acute care setting

Visit

Scarpinato N, Bradley J, Kurbjun K, Bateman X, Holtzer B, Ely B

This article explores the challenges that patients with autism spectrum disorders face when hospitalized and provides assessment strategies and plan-of-care suggestions for nursing caregivers.

Antifibrinolytic drugs for acute traumatic injury

Visit

Ker K, Roberts I, Shakur H, Coats TJ,

Review to assess the effect of antifibrinolytic drugs in patients with acute traumatic injury.

Systematic Review: Management Modalities and Outcomes Following Acute Scaphoid Fractures in Children: A Quantitative Review and Meta-Analysis

Visit

Shaterian A, Santos PJF, Lee CJ, Evans GRD, Leis A

The objective of this study was to compare clinical outcomes following different treatment modalities for pediatric scaphoid fractures.

Cochrane Systematic Review: Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children

Visit

Shaikh N, Borrell JL, Evron J, Leeflang MM

The objectives of this review were to 1) determine whether procalcitonin, C-reactive protein, erythrocyte sedimentation rate can replace the acute DMSA scan in the diagnostic evaluation of children with urinary tract infections; 2) assess the influence of patient and study characteristics on the diagnostic accuracy of these tests, and 3) compare the performance of the three tests to each other.

Cochrane Systematic Review: Antibiotics for acute pyelonephritis in children

Visit

Strohmeier Y, Hodson EM, Willis NS, Webster AC, Craig JC

The objectives of this review were to evaluate the benefits and harms of antibiotics used to treat children with acute pyelonephritis. The aspects of therapy considered were 1) different antibiotics, 2) different dosing regimens of the same antibiotic, 3) different duration of treatment, and 4) different routes of administration.

Cochrane Systematic Review: Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children

Visit

Michael M, Hodson EM, Craig JC, Martin S, Moyer VA

The objective of this review was to assess the benefits and harms of short-course (2-4 days) compared to standard duration (7-14 days) oral antibiotic treatment for acute urinary tract infection in children.

Systematic Review: Comparative effectiveness and safety of interventions for acute diarrhea and gastroenteritis in children: A systematic review and network meta-analysis

Visit

Florez ID, Veroniki AA, Al Khalifah R, Yepes-Nuez JJ, Sierra JM, Vernooij RWM...

Objective: To determine the comparative effectiveness and safety of the pharmacological and nutritional interventions for reducing the duration of acute diarrhea and gastroenteritis in children.

Systematic Review: Rapid intravenous rehydration of children with acute gastroenteritis and dehydration: a systematic review and meta-analysis

Visit

Iro MA, Sell T, Brown N, Maitland K

Objective: To compare rapid and slower intravenous rehydration rates for children with acute gastroenteritis.

Review: Antimicrobial treatment of diarrhea/acute gastroenteritis in children

Visit

Cohen R, Raymond J, Gendrel D

The antimicrobial treatments proposed in this guide follow the latest guidelines of the European Society of Pediatric Infectious Diseases and the European Society of Pediatric Gastroenterology and Nutrition. Azithromycin is the preferred antibiotic for infections due to Shigella and Campylobacter. Ceftriaxone and ciprofloxacin are recommended for salmonellosis when antibiotic treatment is indicated.

Systematic Review: Iatrogenic Dysnatremias in Children with Acute Gastroenteritis in High-Income Countries: A Systematic Review

Visit

Grisaru S, Xie J, Samuel S, Freedman SB

Objectives: To evaluate the association between acquired dysnatremias and intravenous rehydration in children with acute gastroenteritis.

Systematic Review: Diagnosing clinically significant dehydration in children with acute gastroenteritis using noninvasive methods: a meta-analysis

Visit

Freedman SB, Vandermeer B, Milne A, Hartling L; Pediatric Emergency Research ...

Objective: To determine the most accurate, noninvasive method of assessing dehydration.

Cochrane Systematic Review: Fluid therapy for acute bacterial meningitis

Visit

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

Visit

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

Visit

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.

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

Visit

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.

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

Visit

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

Visit

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

Visit

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.

Systematic Review: Screening for Suicide Risk in the Pediatric Emergency and Acute Care Setting

Visit

Wintersteen MB, Diamond GS, Fein JA

Objective: reviews epidemiology, psychiatric comorbidities, risk factors, warning signs, screening measures, and issues related to screening for suicide risk in the pediatric emergency department and acute care settings.

Cochrane Systematic Review: Continuous positive airway pressure (CPAP) for acute bronchiolitis in children

Visit

KR Jat, JL Mathew

Objective: To assess the efficacy and safety of CPAP compared to no or sham CPAP in infants and children under three years of age with acute bronchiolitis.

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

Visit

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

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

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

Visit

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

Visit

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.

Review: Quality indicators for the acute and long-term management of anaphylaxis: a systematic review.

Visit

Dhami S, Sheikh A, Muraro A, et al.

To identify quality indicators to support the acute and long-term management of anaphylaxis.

Systematic Review: Drugs for the acute treatment of migraine in children and adolescents.

Visit

Faber AJ,Lagman-Bartolome AM,Rajapakse T

To assess the effects of pharmacological interventions by any route of administration versus placebo for migraine in children and adolescents 17 years of age or less. For the purposes of this review, children were defined as under 12 years of age and adolescents 1217 years of age.

Systematic review: Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2: a systematic review.

Visit

Abrams JY, Godfred-Cato SE, Oster ME, et al.

Objective: To develop a more comprehensive description of multisystem inflammatory syndrome in children (MIS-C), a novel syndrome linked to severe acute respiratory syndrome coronavirus 2, by conducting a systematic analysis of studies from different settings that used various inclusion criteria.

Key studies

Key Study: Defining No Pain, Mild, Moderate, and Severe Pain Based on the Faces Pain Scale-Revised and Color Analog Scale in Children With Acute Pain.

Visit

Tsze DS, Hirschfeld G, Dayan PS, Bulloch B, von Baeyer CL.

The aims of this study were to define theFacesPainScaleRevised(FPS-R) andColor Analog Scale(CAS) scores associated with nopain, mildpain, moderatepain, and severepainin children with acutepain, and to identify differences based on age, sex, and ethnicity.

Key Study: Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale.

Visit

Le May S, Ballard A, Khadra C, Gouin S, Plint AC, Villeneuve E, Msse B, Tsze ...

The aim of this study was to determine and compare the psychometric properties of 3 self-reported pain scales commonly used in the pediatric emergency department (ED)

Key Study: Comparison of four pain scales in children with acute abdominal pain in a pediatric emergency department

Visit

Bailey B, Bergeron S, Gravel J, Daoust R

Study Objective: In children, the agreement between the many scales used to document the intensity of pain is not well known. Thus, to determine the agreement, we evaluate the visual analog scale, the standardized color analog scale, the Wong-Baker FACES Pain Rating Scale, and a verbal numeric scale in children with acute abdominal pain suggestive of appendicitis in a pediatric emergency department (ED).

Key Study: Changes in Pain Score Associated With Clinically Meaningful Outcomes in Children With Acute Pain.

Visit

Tsze DS, Hirschfeld G, von Baeyer CL, Suarez LE, Dayan PS.

This was a crosssectional study of children 6 to 17 and 4 to 17 years old who were assessed using the Verbal Numerical Rating Scale (VNRS) and Faces Pain ScaleRevised (FPSR), respectively

Key Study: Extremity fracture pain after emergency department reduction and casting: predictors of pain after discharge

Visit

Thompson, RW, Krauss, B, Kim, YJ, Monuteaux, MC, Zerriny, S, & Lee, LK

Objectives: To determine the prevalence of pediatric extremity fracture pain after emergency department (ED) discharge, compare pain severity between fractures requiring simple casting versus sedated reduction and casting, and explore predictors of postdischarge pain.

Key Study: The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement

Visit

Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B

The Faces Pain Scale (FPS; Bieri et al., Pain 41 (1990) 139) is a self-report measure used to assess the intensity of children's pain. Three studies were carried out to revise the original scale and validate the adapted version.

Key Study: Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

Visit

Daoust R, Paquet J, Bailey B, Lavigne G, Piette E, Sanogo K, Chauny JM

Objectives: This study aimed to ascertain the association between self-reported pain intensity and vital signs in both emergency department (ED) patients and a subgroup of patients with diagnosed conditions known to produce significant pain.

Key Study: Reliability of the visual analog scale in children with acute pain in the emergency department

Visit

Bailey B, Gravel J, Daoust R

In children, many psychometric properties of the visual analogue scale (VAS) are known, including the minimum clinically significant difference (10mm on a 100-mm VAS). However, its imprecision or reliability is not well known. Thus, in order to determine the reliability of this scale, a prospective cohort study was performed in patients aged 8-17 years presenting to a pediatric emergency department with acute pain.

Key Study: A randomized clinical trial of ibuprofen versus acetaminophen with codeine for acute pediatric arm fracture pain

Visit

Drendel AL, Gorelick MH, Weisman SJ, Lyon R, Brousseau DC, Kim MK

Study Objective: We compare the treatment of pain in children with arm fractures by ibuprofen 10 mg/kg versus acetaminophen with codeine 1 mg/kg/dose (codeine component).

Key Study: Ibuprofen provides analgesia equivalent to acetaminophen-codeine in the treatment of acute pain in children with extremity injuries: a randomized clinical trial

Visit

Friday JH, Kanegaye JT, McCaslin I, Zheng A, Harley JR

Objectives: This study compared the analgesic effectiveness of acetaminophen-codeine with that of ibuprofen for children with acute traumatic extremity pain, with the hypothesis that the two medications would demonstrate equivalent reduction in pain scores in an emergency department (ED) setting.

Key Study: A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department

Visit

Borland M, Jacobs I, King B, O'Brien D

Study Objective: We compare the efficacy of intranasal fentanyl versus intravenous morphine in a pediatric population presenting to an emergency department (ED) with acute long-bone fractures.

Key Study: A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma

Visit

Clark E, Plint AC, Correll R, Gaboury I, Passi B

Objective: Our goal was to determine which of 3 analgesics, acetaminophen, ibuprofen, or codeine, given as a single dose, provides the most efficacious analgesia for children presenting to the emergency department with pain from acute musculoskeletal injuries.

Key Study: Early analgesia for children with acute abdominal pain

Visit

Green R, Bulloch B, Kabani A, Hancock BJ, Tenenbein M

Objectives: The objectives of this study were to determine whether the administration of morphine to children with acute abdominal pain would impede the diagnosis of appendicitis and to determine the efficacy of morphine in relieving the pain.

Key Study: A randomized clinical trial of analgesia in children with acute abdominal pain

Visit

Kim MK, Strait RT, Sato TT, Hennes HM

Objective: To evaluate the effects of intravenous morphine on pain reduction, physical examination, and diagnostic accuracy in children with acute abdominal pain.

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

Visit

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: A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma

Visit

Clark, E, Plint, AC, Correll, R, et al

To determine which of 3 analgesics, acetaminophen, ibuprofen, or codeine, given as a single dose, provides the most efficacious analgesia for children presenting to the emergency department with pain from acute musculoskeletal injuries.

Key Study: Oral administration of morphine versus ibuprofen to manage postfracture pain in children: a randomized trial

Visit

Poonai N, Bhullar G, Lin K, Papini A, Mainprize D, Howard J, Teefy J, Bale M,...

Recent warnings from Health Canada regarding codeine for children have led to increased use of nonsteroidal anti-inflammatory drugs and morphine for common injuries such as fractures. Our objective was to determine whether morphine administered orally has superior efficacy to ibuprofen in fracture-related pain.

Key Study: Pretreatment with intravenous ketamine reduces propofol injection pain

Visit

Barbi E, Marchetti F, Gerarduzzi T, Neri E, Gagliardo A, Sarti A, Ventura A

The aim of the study was to investigate whether pretreatment with ketamine would reduce infusion line pain in propofol sedation in children.

Key Study: A Randomized Clinical Trial of Jet-Injected Lidocaine to Reduce Venipuncture Pain for Young Children

Visit

Lunoe MM, Drendel AL, Levas MN, Weisman SJ, Dasgupta M, Hoffmann RG, Broussea...

Study Objective: The J-Tip (National Medical Products Inc, Irvine, CA) uses air instead of a needle to push lidocaine into the skin. To our knowledge, no studies have investigated its use for venipuncture in young children. We determine whether the J-Tip decreased venipuncture pain in young children compared with vapocoolant spray.

Key Study: Music to reduce pain and distress in the pediatric emergency department: a randomized clinical trial

Visit

Hartling L, Newton AS, Liang Y, Jou H, Hewson K, Klassen TP, Curtis S

Objective: To compare music with standard care to manage pain and distress.

Key Study: A comparison of amethocaine and liposomal lidocaine cream as a pain reliever before venipuncture in children: a randomized control trial

Visit

Poonai N, Alawi K, Rieder M, Lynch T, Lim R

Objective: Although the use of anesthetic creams before intravenous (IV) insertion has been shown to be both safe and effective in decreasing pain during IV cannulation, the use of any single agent based on efficacy is not yet considered the standard of care in children. We sought to compare a commonly used preparation, 4% liposomal lidocaine (Maxilene), with 4% amethocaine (Ametop), a newer agent with reportedly good efficacy and an intrinsic vasodilatory effect.

Key Study: Equimolar nitrous oxide/oxygen versus placebo for procedural pain in children: a randomized trial

Visit

Reinoso-Barbero F, Pascual-Pascual SI, de Lucas R, Garca S, Billot C, Dequenn...

Objective: This randomized, single-dose, double-blind, Phase III study was designed to compare the level of procedural pain after use of premixed equimolar mixture of 50% oxygen and nitrous oxide (EMONO) or placebo (premixed 50% nitrogen and oxygen).

Key Study: A randomized, double-blind controlled study of jet lidocaine compared to jet placebo for pain relief in children undergoing needle insertion in the emergency department

Visit

Auerbach M, Tunik M, Mojica M

Objectives: The objectives were to determine whether pretreatment with needleless jet-delivered lidocaine decreases self-reported pain in children undergoing needle insertion in the emergency department (ED) and to explore whether pretreatment with a jet device decreases self-reported pain in children undergoing needle insertion in the ED.

Key Study: Liposomal lidocaine to improve procedural success rates and reduce procedural pain among children: a randomized controlled trial

Visit

Taddio A, Soin HK, Schuh S, Koren G, Scolnik D

Historically, children have been undertreated for their pain, and they continue to undergo painful cutaneous procedures without analgesics. A new topical anesthetic, liposomal lidocaine 4% cream (Maxilene, RGR Pharma, Windsor, Ont.), has become available. It has pharmacologic properties that are superior to other topical anesthetics, including an onset of action of only 30 minutes. We sought to determine the success rate of cannulation, analgesic effectiveness, procedure duration and rate of adverse skin reactions when liposomal lidocaine is used before intravenous cannulation of children.

Key Study: Association of race and ethnicity with management of abdominal pain in the emergency department

Visit

Johnson TJ, Weaver MD, Borrero S, Davis EM, Myaskovsky L, Zuckerbraun NS, Kra...

Objective: To determine if race/ethnicity-based differences exist in the management of pediatric abdominal pain in emergency departments (EDs).

Key Study: Pain assessment for children: overcoming challenges and optimizing care

Visit

Drendel AL, Kelly BT, Ali S

This review will highlight the many complexities of the assessment of pain for the pediatric patient. In addition, a variety of factors that affect the self-report of pain in children will be identified.

Key Study: Pain management of musculoskeletal injuries in children: current state and future directions

Visit

Ali S, Drendel AL, Kircher J, Beno S

Objectives: Upon completion of this CME article, the reader should be better able to (1) distinguish multiple nonpharmacological techniques for minimizing and treating pain and anxiety in children with musculoskeletal injuries, (2) apply recent medical literature in deciding pharmacological strategies for the treatment of children with musculoskeletal injuries, and (3) interpret the basic principles of pharmacogenomics and how they relate to analgesic efficacy.

Key Study: Use of intranasal fentanyl for the relief of pediatric orthopedic trauma pain

Visit

Saunders M, Adelgais K, Nelson D

Objectives: The objective was to evaluate the use of a single 2 g/kg dose of intranasal fentanyl as analgesia for painful orthopedic injuries in children presenting to a pediatric emergency department (ED).

Key Study: Oxycodone versus codeine for triage pain in children with suspected forearm fracture: a randomized controlled trial

Visit

Charney RL, Yan Y, Schootman M, Kennedy RM, Luhmann JD

Objective: To compare the efficacy of pain reduction of triage oxycodone (O) versus codeine (C) to children with suspected forearm fractures.

Key Study: Efficacy and impact of intravenous morphine before surgical consultation in children with right lower quadrant pain suggestive of appendicitis: a randomized controlled trial

Visit

Bailey B, Bergeron S, Gravel J, Bussieres JF, Bensoussan A

Study Objective: The evidence supporting the use of analgesia in children with abdominal pain suggestive of appendicitis is limited. The objectives of the study are to evaluate the efficacy of morphine before surgical consultation in children presenting to the pediatric emergency department (ED) with right lower quadrant pain suggestive of appendicitis and determine whether it has an impact on the time between arrival in the ED and the surgical decision.

Key Study: Effectiveness of oxycodone, ibuprofen, or the combination in the initial management of orthopedic injury-related pain in children

Visit

Koller DM, Myers AB, Lorenz D, Godambe SA

Objective: Orthopedic injuries comprise a majority of the indications for analgesia in the emergency department. Oxycodone and ibuprofen have demonstrated efficacy for this indication, but no studies have compared these drugs in children. Our objective was to investigate the effectiveness of oxycodone, ibuprofen, or their combination for the management of orthopedic injury-related pain in children.

Key Study: Pain assessment for pediatric patients in the emergency department

Visit

Drendel AL, Brousseau DC, Gorelick MH

Objective: To examine the relationship between pediatric patient visit characteristics and pain score documentation in the emergency department (ED) and determine whether documentation of a pain score is associated with increased analgesic use.

Key Study: Oxycodone vs placebo in children with undifferentiated abdominal pain: a randomized, double-blind clinical trial of the effect of analgesia on diagnostic accuracy

Visit

Kokki H, Lintula H, Vanamo K, Heiskanen M, Eskelinen M

Objective: To evaluate the effects of buccal oxycodone on pain relief, physical examination findings, diagnostic accuracy, and final clinical outcomes in children with acute abdominal pain.

Key Study: Emergency department analgesia for fracture pain

Visit

Brown JC, Klein EJ, Lewis CW, Johnston BD, Cummings P

Study Objectives: We analyze records of all emergency department (ED) patients with extremity or clavicular fractures to describe analgesic use, compare analgesia between adults and children, and compare analgesia between the subset of these adults and children with documented moderate or severe pain. Among children, we compare treatment between pediatric and nonpediatric facilities.

Key Study: The FLACC: a behavioral scale for scoring postoperative pain in young children

Visit

Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S

Purpose: To evaluate the reliability and validity of the FLACC Pain Assessment Tool which incorporates five categories of pain behaviors: facial expression; leg movement; activity; cry; and consolability.

Key Study: Reducing Time to Pain Medication Administration for Pediatric Patients with Long Bone Fractures in the Emergency Department

Visit

Schuman, S S, Regen, R B, Stuart, L H, Harrell, C, Jones, T L, Stewart, B M, ...

The purpose of this quality improvement project was to develop a protocol with the goal to administer pain medication to children presenting with suspected long bone fractures 47 minutes of emergency department arrival.

Key Study: Expedited Delivery of Pain Medication for Long-Bone Fractures Using an Intranasal Fentanyl Clinical Pathway

Visit

Schacherer, N M, Erikson Ramirez, D, Frazier, S B and Perkins, A M

This study aims to determine whether a pathway designed to facilitate the use of intranasal (IN) fentanyl for long-bone fractures will expedite the delivery of pain medication, decrease the total length of emergency department (ED) stay, and provide faster analgesia compared with intravenous (IV) morphine.

Key Study: A RCT of a Combination of Analgesics for Pain Management in Children With a Suspected Fracture

Visit

Alam Khan, T, Jamil Khattak, Y, Awais, M, Alam Khan, A, Husen, Y, Nadeem, N a...

To assess the utility of trauma series radiographs in the management of alert pediatric patients with traumatic injury and to ascertain whether it is necessary to acquire the entire trauma series in these children.

Key Study: A comparison of pain assessment by physicians, parents and children in an outpatient setting

Visit

Christina Brudvik,Svein-Denis Moutte, Valborg Baste,andTone Morken

Our objective was to compare pain assessments by patients, parents and physicians in children with different medical conditions, and analyse how this affected the physicians' administration of pain relief.

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

Visit

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.

Key Study: Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury

Visit

Vavilala MS, Kernic MA, Wang J, Kannan N, Mink RB, Wainwright MS, Groner JI, ...

The effect of the 2003 severe pediatric traumatic brain injury (TBI) guidelines on outcomes has not been examined. We aimed to develop a set ofacutecare guideline-influenced clinical indicators of adherence and tested the relationship between these indicators during the first 72 hours after hospital admission and discharge outcomes.

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

Visit

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)

Visit

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.

Key Study: Equivalency of two concentrations of fentanyl administered by the intranasal route for acute analgesia in children in a paediatric emergency department: a randomized controlled trial

Visit

Borland M, Milsom S, Esson A

Objective: Intranasal fentanyl's (INF) effectiveness is established using highly concentrated INF (HINF). Standard concentration INF (SINF) is more widely available. We aimed to illustrate the equivalence of SINF to HINF.

Key Study: Acute EEG findings in children with febrile status epilepticus: results of the FEBSTAT study

Visit

Nordli DR Jr, Mosh SL, Shinnar S, Hesdorffer DC, Sogawa Y, Pellock JM, Lewis ...

Objective: The FEBSTAT (Consequences of Prolonged Febrile Seizures) study prospectively addresses the relationships among serial EEG, MRI, and clinical follow-up in a cohort of children followed from the time of presentation with febrile status epilepticus.

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

Visit

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

Visit

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

Visit

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.

Key Study: Photographing Injuries in the Acute Care Setting: Development and Evaluation of a Standardized Protocol for Research, Forensics, and Clinical Practice

Visit

Bloemen EM, Rosen T, Cline Schiroo JA, Clark S, Mulcare MR, Stern ME, Mysliwi...

Our goal was to develop and evaluate a protocol for standardized photography of injuries that may be broadly applied.

Key Study: Adherence behavior in an acute pediatric hand trauma population: A pilot study of parental report of adherence levels and influencing factors

Visit

Cole T, Underhill A, Kennedy S

The hand is a common site of injury in children; however, little is known regarding adherence to hand trauma management in this population.

Key Study: Acute ischemia and pink pulseless hand in 68 of 404 gartland type III supracondylar humeral fractures in children: Urgent management and therapeutic consensus

Visit

Louahem D, Cottalorda J

The purpose of this retrospective study was to describe our strategy and to determine the guidelines of therapeutic consensus.

Key Study: A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam Pediatric Wrist Rules

Visit

Slaar A, Walenkamp MM, Bentohami A, Maas M, van Rijn RR, Steyerberg EW, Jager...

The objective of this study was to develop and validate a clinica decision rule to decide whether radiography in children with wrist trauma is required.

Key Study: The role of dexamethasone in decreasing early recurrence of acute intussusception in children: A retrospective study

Visit

Efrati Y, Klin B, Kozer E, Abu-Kishk I

The purpose of this study was to examine the role of dexamethasone in decreasing early RI.

Key Study: Prevalence and Impact of Admission Acute Traumatic Coagulopathy on Treatment Intensity, Resource Use, and Mortality: An Evaluation of 956 Severely Injured Children and Adolescents

Visit

Liras IN, Caplan HW, Stensballe J, Wade CE, Cox CS, Cotton BA

The purpose of this study was to assess the prevalence and impact of arrival coagulopathy, determined by viscoelastic hemostatic testing, in severely injured children.

Key Study: Prevalence of Concomitant Acute Bacterial Meningitis in Neonates with Febrile Urinary Tract Infection: A Retrospective Cross-Sectional Study

Visit

Wallace SS, Brown DN, Cruz AT

The objective of this study was to describe the frequency of concomitant acute bacterial meningitis in neonates with febrile urinary tract infection.

Key Study: Efficacy of an Oral Rehydration Solution Enriched with Lactobacillus reuteri DSM 17938 and Zinc in the Management of Acute Diarrhoea in Infants: A Randomized, Double-Blind, Placebo-Controlled Trial

Visit

Maragkoudaki M, Chouliaras G, Moutafi A, Thomas A, Orfanakou A, Papadopoulou A

Objective: to assess the efficacy of an oral rehydration solution enriched with Lactobacillus reuteri DSM 17938 and zinc in well-nourished, non-hospitalized infants with acute diarrhoea.

Key Study: Lactobacillus rhamnosus GG versus Placebo for Acute Gastroenteritis in Children

Visit

Schnadower D, Tarr PI, Casper TC, Gorelick MH, Dean JM, O'Connell KJ, Mahajan...

This study evaluated outcomes for children with acute gastroenteritis who received Lactobacillus rhamnosus GG versus placebo.

Key Study: Performance of Stool Testing Recommendations for Acute Gastroenteritis when Used to Identify Children with Nine Potential Bacterial Enteropathogens

Visit

Tarr GAM, Chui L, Lee BE, Pang XL, Ali S, Nettel-Aguirre A, Vanderkooi OG, Be...

This study evaluated six leading gastroenteritis guidelines for stool testing recommendations.

Key Study: Identification of Enteric Viruses in Oral Swabs from Children with Acute Gastroenteritis

Visit

Zhuo R, Parsons BD, Lee BE, Drews SJ, Chui L, Louie M, Crago B, Freedman SB, ...

This study evaluated if oral swabs are a suitable alternative specimen to stools for identifying enteric viruses from children with acute gastroenteritis.

Key Study: Implementation of clinical decision support in young children with acute gastroenteritis: a randomized controlled trial at the emergency department

Visit

Geurts D, de Vos-Kerkhof E, Polinder S, Steyerberg E, van der Lei J, Moll H, ...

Objectives: To evaluate feasibility of a nurse-guided clinical decision support system for rehydration treatment in children with AGE, and the impact on diagnostics, treatment, and costs compared with usual care by attending physician.

Key Study: A randomized trial of Plasma-Lyte A and 0.9 % sodium chloride in acute pediatric gastroenteritis

Visit

Allen CH, Goldman RD, Bhatt S, Simon HK, Gorelick MH, Spandorfer PR, Spiro DM...

Objective: To compare the efficacy and safety of Plasma-Lyte A (PLA) versus 0.9 % sodium chloride (NaCl) intravenous (IV) fluid replacement in children with moderate to severe dehydration secondary to acute gastroenteritis.

Key Study: Evaluating the Impact of Clinical Decision Tools in Pediatric Acute Gastroenteritis: A Population-based Cohort Study

Visit

Bahm A, Freedman SB, Guan J, Guttmann A

This study sought to determine if the following tools - 1) pathways/order sets, 2) medical directives for oral rehydration therapy (ORT) or ondansetron, and 3) printed discharge instructions - are associated with acute gastroenteritis admission and emergency department revisits.

Key Study: Oral Ondansetron versus Domperidone for Acute Gastroenteritis in Pediatric Emergency Departments: Multicenter Double Blind Randomized Controlled Trial

Visit

Marchetti F, Bonati M, Maestro A, Zanon D, Rovere F, Arrighini A, Barbi E, Be...

Objective: To evaluate whether a single oral dose of ondansetron vs domperidone or placebo improves outcomes in children with gastroenteritis.

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

Visit

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

Visit

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

Visit

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: Shortened Antimicrobial Treatment for Acute Otitis Media in Young Children

Visit

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

Visit

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: [Does heliox administered by low-flow nasal cannula improve respiratory distress in infants with respiratory syncytial virus acute bronchiolitis? A randomized controlled trial]

Visit

Seliem, W and Sultan, AM

Objective: To evaluate whether the use of heliox (79:21) delivered through a low flow nasal cannula would improve respiratory distress in infants with acute bronchiolitis caused by respiratory syncytial virus.

Key Study: Heliox delivered by high flow nasal cannula improves oxygenation in infants with respiratory syncytial virus acute bronchiolitis

Visit

Seliem, W. S., A. M.

Objective: to evaluate the hypothesis that use of heliox would result in improvement of gas exchange when used with high flow nasal cannula in infants with RSV acute bronchiolitis.

Key Study: Lung ultrasound for the diagnosis of pneumonia in children with acute bronchiolitis

Visit

Biagi C, Pierantoni L, Baldazzi M, Greco L, Dormi A, Dondi A, Faldella G, Lan...

Objective: to assess the diagnostic accuracy and reliability of LUS for the detection of pneumonia in hospitalized children with bronchiolitis and to evaluate the agreement between LUS and CXR in diagnosing pneumonia in these patients.

Key Study: Effect of nebulized hypertonic saline treatment in emergenc departments on hospitalization rate for acute bronchiolitis: a randomized clinical trial

Visit

Angoulvant F, Belletre X, Milcent K, et al

Objective: To examine whether HS nebulization treatment would decrease the hospital admission rate among infants with a first episode of acute bronchiolitis.

Key Study: High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study)

Visit

Milsi C, Essouri S, Pouyau R, Liet JM, Afanetti M, Portefaix A, Baleine J,Dur...

Objective: To assess oxygen delivery via high flow nasal cannula (HFNC).

Key Study: A cost-effectiveness analysis of omitting radiography in diagnosis of acute bronchiolitis

Visit

Yong JHE, Schuh S, Rashidi R, Vanderby S, Lau R, Laporte A, Nauenberg E, Unga...

Objective:To carry out a cost-effectiveness analysis of omitting chest radiography in the diagnosis of infant bronchiolitis.

Key Study: Acute cannabis toxicity

Visit

Noble MJH, K.; Hendrickson, R. G.

We describe the clinical effects of, and products associated with, acute exposures to cannabis during the early legalization period of recreational cannabis in Oregon and Alaska.

Key Study: Acute intoxication caused by synthetic cannabinoids 5F-ADB and MMB-2201: A case series

Visit

Barcelo BP, S.; Lopez-Corominas, V.; Gomila, I.; Yates, C.; Busardo, F. P.; P...

Here, we report five cases of acute intoxication by synthetic cannabinoids 5F-ADB and MMB-2201 with analytical confirmation

Key Study: Acute intoxication caused by a synthetic cannabinoid in two adolescents

Visit

Heath TSB, Z.; Thompson, A. J.; Tecklenburg, F. W.

In this report, we describe two adolescent patients admitted after they inhaled K2, resulting in loss of consciousness, tachycardia, and diffuse pain.

Key Study: Ataxia and shaking in a 2-year-old girl: acute marijuana intoxication presenting as seizure.

Visit

Bonkowsky, J. L., Sarco, D., & Pomeroy, S. L

This is a case study of a young girl experiencing cannabis usage.

Key Study: Drugs for the acute treatment of migraine in children and adolescents.

Visit

Richer L, Billinghurst L, Linsdell MA, Russell K, Vandermeer B, Crumley ET, D...

To assess the effects of pharmacological interventions by any route of administration versus placebo for migraine in children and adolescents 17 years of age or less. For the purposes of this review, children were defined as under 12 years of age and adolescents 12 to 17 years of age.

Key Study: Pediatric Abdominal X-rays in the Acute Care Setting Are We Overdiagnosing Constipation?

Visit

Malik Muhammad Anwar ul Haq, Hernando Lyons, Madiha Halim

To determine 1) the sensitivity and specificity of plain AXR in the diagnosis of constipation and 2) the effect of age, race, gender, comorbid conditions, and practice setting on the diagnosis of constipation.

Key study: Severe acute respiratory syndrome coronavirus 2 clinical syndromes and predictors of disease severity in hospitalized children and youth.

Visit

Fernandes DM, Oliveira CR, Guerguis S, et al.

Objective: To characterize the demographic and clinical features of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) syndromes and identify admission variables predictive of disease severity.

Key Study: Clinical risk score for persistent postconcussion symptoms among children with acute concussion in the ED

Visit

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: Association between early participation in physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents

Visit

Grool AM, Aglipay M, Momoli F, et al.

To investigate the association between participation in physical activity within 7 days postinjury and incidence of persistent postconcussive symptoms (PPCS).

undefined

Resource - Acute Procedural Pain Toolkits

Visit

Canadian Association of Paediatric Health Centres Pain Community of Practice

These Toolkits are a resource for clinicians who work with children that may experience acute procedural pain and support moving best practice recommendations into practice. Based on the best research evidence and clinical practice, these Toolkits bring together a collection of evidence-based recommendations, clinical and family resources, policy examples, pre-populated power point templates, videos, and background articles with the purpose of making these recommendations easier to move into practice. 

There are eight toolkits to choose from: 

  • Assessment
  • Distraction
  • Intranasal fentanyl
  • Breast feeding, non-nutritive sucking, and positioning
  • Oral sucrose
  • Pain with suturing
  • Topical anesthetics (venipuncture)
  • Implementation strategies

Emergency Medicine Cases Podcast: Pediatric abdominal pain & appendicitis

Visit

Dr. Anna Jarvis & Dr. Stephen Freedman

Episode 19 Part 1:In Part 1 of this Episode on Pediatric Abdominal Pain, Dr. Anna Jarvis & Dr. Stephen Freedman discuss the nuances of the history, physical and work up of Pediatric Abdominal Pain & Appendicitis and key pearls on how to distinguish serious surgical causes from the very common diagnosis of gastroenteritis. An in-depth discussion on the pearls of the history, physical exam, lab tests, imaging including serial ultrasounds vs CT abdomen, clinical decision rules such as the Alvarado Score, best analgesics and antibiotics in pediatric appendicitis follows. Published online: December 2011.  

Emergency Medicine Cases Podcast: Pediatric Pain Management

Visit

Dr. Samina Ali & Dr. Anthony Crocco

Episode 67: Pain is the most common reason for seeking health care. It accounts for 80% of ED visits. The WHO has declared that “optimal pain treatment is a human right”. As has been shown in multiple ED-based Pediatric pain management studies, Pediatric pain is all too often under-estimated and under-treated. Why does this matter? Under-estimating and under-treating pediatric pain may have not only short term detrimental effects but life-long detrimental effects as well; not to mention, screaming miserable children disturbing other patients in your ED and complaints to the hospital from parents. Whether it’s venipuncture, laceration repair, belly pain or reduction of a fracture we need to have the skills and knowledge to optimize efficient and effective pain management in all the kids we see in the ED. What are the indications for intranasal fentanyl? intranasal ketamine? Why should codeine be contra-indicated in children? How do triage-initaited pain protocols improve pediatric pain management? Which are most effective skin analgesics for venipuncture? To help you make these important pediatric pain management decisions, in this podcast we have one of the most prominent North American researchers and experts in Emergency Pediatric pain management, Dr. Samina Ali and not only the chief of McMaster Children’s ED but also the head of the division of Pediatric EM at McMaster University, Dr. Anthony Crocco.

Website: Pain Assessment and Management Initiative (PAMI)

Visit

Pain Assessment and Management Initiative (PAMI) is an e-Learning and patient safety educational project funded through a grant by the Florida Medical Malpractice Joint Underwriting Association. The overall goal of PAMI is to improve the safety of patients of all ages by developing tools and learning modules for health care providers to recognize, assess, and manage acute and chronic pain in acute care settings such as the Emergency Department. The tools and resources developed are designed to be used, adapted and implemented by any health care facility or agency based on their specific needs. The PAMI site also includes pain related resourcesapps/podcasts and learning modules. PAMI learning modules and materials are developed by a state and national expert panel and are multidisciplinary, targeting physicians, nurses, PAs, pharmacists, paramedics, hospital patient safety officers, risk managers and other providers.

Emergency Medicine Cases Podcast: Pediatric gastroenteritis, constipation & bowel obstruction

Visit

Dr. Anna Jarvis & Dr. Stephen Freedman