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Patients and Family Resources

all patients and families resources





Resources in Evidence Repository and Individual Compendia

Bottom Line Recommendations

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

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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

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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

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Ali, S, Drendel A & TREKK Network

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

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

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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 Recommendations: Pain Treatment

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Ali, S, Drendel A and TREKK Network

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

Bottom Line: Psychological Interventions

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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

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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

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World Health Organization

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

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.

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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.

UNDER REVIEW: Recommandations de Base: Douleur procdurale

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

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

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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.

Clinical Pathway: ED Pathway for Evaluation/Treatment of Febrile Young Infant (0-56 Days Old)

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Scarfone R, Gala R, Murray A, Funari MK, Lavelle J, Bell L

The clinical pathway for treating and evaluating febrile infants is built upon publicly available medical evidence and/or a consensus of medical practitioners at The Childrens Hospital of Philadelphia.

Dosing Chart: Analgesic starting dosages for children

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World Health Organization

Analgesic starting doses for children.

Recommandations de Base: Prise en charge de la douleur

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Ali, S, Drendel A and TREKK Network

Recommandations de base pour la prise en charge de la douleur aigüe chez l’enfant. Publiée en ligne juillet 2018.

 

Clinical guidelines

Clinical Practice Guideline: AboutKidsHealth: Tools for measuring pain

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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

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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

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

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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.

Clinical Practice Guideline: Good practice in postoperative and procedural pain management

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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

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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

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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: The recognition and assessment of acute pain in children

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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.

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

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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.

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

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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

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

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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

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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: Management of acute pediatric pain in the emergency department.

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

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Young VB

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

Clinical Practice Guideline: AAOS clinical practice guideline: the treatment of pediatric diaphyseal femur fractures

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Kocher, MS, Sink, EL, Blasier, RD, Luhmann, SJ, Mehlman, CT, Scher, DM, Mathe...

This is a summary of the recommendations in the AAOS clinical practice guideline, The Treatment of Pediatric Diaphyseal Femur Fractures.

Guidelines: Agitation Treatment for Pediatric Emergency Patients

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Hilt RJ, Woodward TA, Henderson SW, Jellinek MS

Guideline based on a review of the existing literature & review of expert opinions for the management of agitated children in an emergency department setting.

Clinical Practice Guideline: Treatment of Pediatric Diaphyseal Femur Fractures

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Jevsevar DS & Shea K

This is an AAOS clinical guideline on the treatment of pediatric diaphyseal femur fractures (PDFF).

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

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

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

Clinical Practice Guidelines: The treatment of pediatric supracondylar humerus fractures

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Howard A, Mulpuri K, Abel MF, Braun S, Bueche M, Epps H, Hosalkar H, Mehlman ...

Based on the best current evidence and a systematic review of published studies, 14 recommendations have been created to guide clinical practice and management of supracondylar fractures of the humerus in children.

Clinical Practice Guidelines: The treatment of pediatric supracondylar humerus fractures: Evidence-Based Guideline and Evidence Report

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Howard A, Mulpuri K, Abel MF, Braun S, Bueche M, Epps H, Hosalkar H, Mehlman ...

This clinical practice guideline is based on a systematic review of published studies on the treatment of supracondylar fractures of the humerus in children. In addition to providing practice recommendations, this guideline highlights gaps in the literature and areas that require future research.

Clinical Practice Guidelines: Treatment of Distal Radius Fractures: Guideline and Evidence Report

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Lichtman DM, Randipsingh RR, Boyer MI, Putnam MD, Ring D, Slutsky DJ, Taras JS

This an an AAOS clinical guideline for pediatric distal radial fractures.

Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology

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Halperin JJ, Shapiro ED, Logigian E, Belman AL, Dotevall L, Wormser GP, Krupp...

Provides evidence-based recommendations on the treatment of nervous system Lyme disease and post-Lyme syndrome. Three questions were addressed: 1) Which antimicrobial agents are effective? 2) Are different regimens preferred for different manifestations of nervous system Lyme disease? 3) What duration of therapy is needed?

The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America

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Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, Kr...

Evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis.

Consensus statement: Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts consensus statement.

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Shen K, Yang Y, Wang T, et al.

This statement is based on the Novel Coronavirus Infection Pneumonia Diagnosis and Treatment Standards (the fourth edition) (National Health Committee) and other previous diagnosis and treatment strategies for pediatric virus infections. The present consensus statement summarizes current strategies on diagnosis, treatment, and prevention of 2019-nCoV infection in children.

Clinical Practice Guideline: CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria.

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Fein MN, Fischer DA, OKeefe AW, Sussman GL

The objective of this was to overview the effects of new and old h1 antihistamines.

Guidelines: Evaluation and Treatment of Functional Constipation in Infants and Children: Evidence-based Recommendations from ESPGHAN and NASPGHAN

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

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

Clinical Practice Guideline: Codeine:Time to Say "No".

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American Academy of Pediatrics

Suggests not using codeine for pediatric patients for pain management

Summaries of systematic reviews

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

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

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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

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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

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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

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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

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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

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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

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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

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

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

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

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

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Griffiths, B, Ducharme, FM,

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

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

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

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

Cochrane Summary: Short courses of antibiotics (2-4 days) are as effective as longer treatment for bladder infections in children

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

Bladder and kidney infections (urinary tract infections - UTI) are common in children. Bladder infections cause pain on passing urine and frequency of urination. Some children keep getting repeat bouts. Standard courses of antibiotics (7-10 days) are used to clear the infection. Shorter courses may reduce adverse effects and costs, but there has been concern that they might reduce the chances of clearing the infection and increase the risk of recurrence. A review of studies found that short courses of antibiotics (2-4 days) used for bladder infections are as effective as standard courses at clearing UTI, with no increase in recurrence.

Cochrane Summary: Helium-oxygen (heliox) treatment for children with croup

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Moraa I, Sturman N, McGuire TM, van Driel ML,

Objective: To examine the effect of heliox compared to oxygen or other active interventions, placebo, or no treatment, on relieving signs and symptoms in children with croup as determined by a croup score and rates of admission and intubation.

Cochrane Summary: Glucocorticoids for the treatment of anaphylaxis

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Choo K, Simons FR, Sheikh A

To overview literature of emergency treatment of anaphylaxis

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

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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: Pain relievers for children with acute middle ear infection

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

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

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

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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

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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.

Cochrane Summary: Treatment for the neurological complications of Lyme disease

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Cadavid D, Auwaerter PG, Rumbaugh J, Gelderblom H

Objective: To assess the effects of antibiotics for the treatment of Lyme neuroborreliosis (LNB).

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

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Fox JL

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

Cochrane Summary: Topical analgesia for acute otitis media

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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.

Overviews of systematic reviews

Cochrane Summary: Surgical treatment for forearm fractures in children (fractures involving the shafts of the radius and ulna)

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Abraham A, Kumar S, Chaudhry S, Ibrahim T

Fractures of the shafts of the forearm bones in children are common injuries and occur after a fall on an outstretched hand. There are two bones in the forearm: the radius and the ulna. After a fall either one or both bones may fracture. The shape of forearm bones are important for the twisting motion of the hand, such as in receiving change from a shop keeper with an open palm (supination) or turning a key in a door (turning the palm facing down - pronation). Treatment of the forearm fracture aims to restore the shape of the bones such that supination and pronation ability is restored. The first stage of treatment involves manipulating (setting) the bones to the correct shape. This is usually done under anaesthesia. The second stage involves stabilising the fractured bones either with a plaster cast (conservative treatment) or metal implants (surgical treatment). This review aimed to examine the evidence from randomised controlled trials comparing conservative versus surgical methods and trials comparing different surgical methods for treatment of these fractures. We hoped to find which are the best methods in terms of function and complications. In spite of a thorough search we found no evidence from properly conducted studies to help inform decisions on treatment of these fractures.

Cochrane Overview: The Cochrane Library and the treatment of croup in children: an overview of reviews

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Bjornson, C, Russell, K, Foisy, M, Johnson, D,

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

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

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Bialy L, Foisy M, Smith M, Fernandes RM

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

Treatment of severe blunt pancreatic lesions in children

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Haugaard MV, Wettergren A, Hillings JG, Gluud C, Penninga L,

This review shows that strategies regarding non-operative versus operative treatment of severe blunt pancreatic trauma in children are not based on randomised clinical trials.

Synthesis of Systematic Reviews: Treatment of Childhood Constipation: a synthesis of systematic reviews and meta-analyses

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Southwell BR

In 2016, treatment of childhood constipation was extensively reviewed by Rome IV. This review covers meta-analyses and evidence for treatment of paediatric constipation since 2016 and new emerging treatments.

Systematic reviews

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

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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.

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

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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.

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

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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

Review: Analgesics for the treatment of pain in children

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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: Use Of Fibers in Childhood Constipation Treatment: systematic review with meta-analysis

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Piccoli de Mello P,Eifer DA,Daniel de Mello E

To gather current evidence on the use of fiber for constipation treatment in pediatric patients.

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

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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

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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

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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

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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

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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: Oxcarbazepine for neuropathic pain

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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

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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: Hydromorphone for acute and chronic pain

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Quigley C

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

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

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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

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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

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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

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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

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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

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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: Diclofenac for acute pain in children

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

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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.

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

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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.

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

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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

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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

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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

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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

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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

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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

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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

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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

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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: Intranasal fentanyl for the management of acute pain in children

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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

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

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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

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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

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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

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

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

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

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

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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.

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

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

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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.

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

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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

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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

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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

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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

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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.

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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.

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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?

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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

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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.

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

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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).

Cochrane Systematic Review: Corticosteroids as standalone or add-on treatment for sore throat

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Hayward G, Thompson MJ, Perera R, Glasziou PP, Del Mar CB, Heneghan CJ.

Objectives: To assess the clinical benefit and safety of corticosteroids for symptoms of sore throat 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

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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: Symptomatic treatment of the cough in whooping cough

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Bettiol S, Wang K, Thompson MJ, Roberts NW, Perera R, Heneghan CJ, Harnden A.

Objectives: To assess the effectiveness and safety of interventions to reduce the severity of paroxysmal cough in whooping cough in children and adults.

Cochrane Systematic Review: Zinc supplementation as an adjunct to antibiotics in the treatment of pneumonia in children 2 to 59 months of age

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Haider BA, Lassi ZS, Ahmed A, Bhutta ZA.

Objectives: To evaluate zinc supplementation, as an adjunct to antibiotics, in the treatment (clinical recovery) of pneumonia in children aged two to 59 months.

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

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Griffiths B, Ducharme FM.

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

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

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

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

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

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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: gastroesophageal reflux treatment for asthma in adults and children

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Gibson PG, Henry RL, Coughlan JL.

Objectives: The objective of this review was to evaluate the effectiveness of treatments for gastroesophageal reflux in terms of their benefit on asthma.

Cochrane Systematic Review: gastroesophageal reflux treatment for prolonged non-specific cough in children and adults

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Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA.

Objectives: To evaluate the efficacy of GORD treatment on chronic cough in children and adults with GORD and prolonged cough that is not related to an underlying respiratory disease, i.e. non-specific chronic cough.

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

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Cates CJ, Welsh EJ, Rowe BH.

Objectives: To assess the effects of holding chambers (spacers) compared to nebulisers for the delivery of beta(2)-agonists for acute asthma.

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

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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: Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock

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Sheikh A, Shehata YA, Brown SG, Simons FE

OBJECTIVES: To assess the benefits and harms of adrenaline (epinephrine) in the treatment of anaphylaxis.

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

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Sheikh A, Simons FE, Barbour V, Worth A

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

Cochrane Systematic Review: Glucocorticoids for the treatment of anaphylaxis

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Choo KJ, Simons FE, Sheikh A

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

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

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

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

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

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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: Antibiotic treatment for Burkholderia cepacia complex in people with cystic fibrosis experiencing a pulmonary exacerbation

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Horsley A, Jones AM

OBJECTIVES: To assess the effectiveness and safety of different antibiotic regimens in people with cystic fibrosis experiencing an exacerbation, who are chronically infected with organisms of the Burkholderia cepacia complex.

Cochrane Systematic Review: Neuraminidase inhibitors for the treatment of influenza infection in people with cystic fibrosis

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Jagannath VA, Asokan GV, Fedorowicz Z, Lee TW

OBJECTIVES: To assess the effects of neuraminidase inhibitors for the treatment of influenza infection in people with cystic fibrosis.

Cochrane Systematic Review: Pharmacological treatment for Attention Deficit Hyperactivity Disorder (ADHD) in children with comorbid tic disorders

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Pringsheim T, Steeves T

OBJECTIVES: To assess the effects of pharmacological treatments for ADHD on ADHD symptoms and tic severity in children with ADHD and comorbid tic disorders.

Cochrane Systematic Review: Identification of children in the first four years of life for early treatment for otitis media with effusion

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Simpson SA, Thomas CL, van der Linden MK, Macmillan H, van der Wouden JC, Bu...

OBJECTIVES: The aim of this review was to assess evidence from randomised controlled trials about the effect, on language and behavioural outcomes, of screening and treating children with clinically important OME in the first four years of their life. The focus was on the first four years of life because this is the time of most rapid language development. The consequences of hearing loss are likely to be most serious during this time. In addition, children of this age are least likely to be able to report or seek help for impaired hearing, particularly if these problems have a slow onset and are subtle.

Cochrane Systematic Review: Propofol versus thiopental sodium for the treatment of refractory status epilepticus

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Prabhakar H, Bindra A, Singh GP, Kalaivani M. Propofol versus thiopental sod...

OBJECTIVES: To compare the efficacy, adverse effects, and short- and long-term outcomes of RSE treated with one of the two anaesthetic agents, thiopental sodium or propofol.

Cochrane Systematic Review: Treatment of Lennox-Gastaut syndrome

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Hancock EC, Cross JH

OBJECTIVES: To compare the effects of pharmaceutical therapies used to treat LGS in terms of control of seizures and adverse effects. Many people who suffer from this syndrome will already be receiving other antiepileptic medications at the time of their entry into a trial. However, for the purpose of this review we will only consider the effect of the single therapeutic agent being trialled (often as add-on therapy).

Cochrane Systematic Review: Adenosine versus intravenous calcium channel antagonists for the treatment of supraventricular tachycardia in adults

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Holdgate A, Foo A

OBJECTIVES: To examine the relative effects of adenosine and calcium channel antagonists and, if possible, to determine which is most appropriate for the management of supraventricular tachycardia.

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

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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: Antibiotic treatment for travellers' diarrhoea

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De Bruyn G, Hahn S, Borwick A. Antibiotic treatment for travellers' diarrhoe...

OBJECTIVES: The aims of this review were to assess the effects of antibiotics on traveller's diarrhoea in relation to duration of illness, severity of illness, and adverse effects of medications.

Cochrane Systematic Review: Physical methods versus drug placebo or no treatment for managing fever in children

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Meremikwu M, Oyo-Ita A

OBJECTIVES: To evaluate the benefits and harms of physical cooling methods used for managing fever in children.

Cochrane Systematic Review: Treatment of infantile spasms

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Hancock EC, Osborne JP, Edwards SW

OBJECTIVES: To compare the effects of single pharmaceutical therapies used to treat infantile spasms in terms of control of the spasms, resolution of the EEG, relapse rates, psychomotor development, subsequent epilepsy, side effects, and mortality.

Cochrane Systematic Review: Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury

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Sahuquillo J, Arikan F

OBJECTIVES: To assess the effects of secondary decompressive craniectomy (DC) on outcome and quality of life in patients with severe TBI in whom conventional medical therapeutic measures have failed to control raised ICP.

Cochrane Systematic Review: Recombinant factor VIIa for the prevention and treatment of bleeding in patients without haemophilia

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Simpson E, Lin Y, Stanworth S, Birchall J, Doree C, Hyde C

OBJECTIVES: To assess the effectiveness of rFVIIa when used therapeutically to control active bleeding or prophylactically to prevent (excessive) bleeding in patients without haemophilia.

Cochrane Systematic Review: Treatment of seizures in multiple sclerosis

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Koch MW, Polman SK, Uyttenboogaart M, De Keyser J

OBJECTIVES: To evaluate the efficacy and safety of antiepileptic treatments in patients with MS.

Cochrane Systematic Review: Medical treatment for botulism

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Chalk CH, Benstead TJ, Keezer M

OBJECTIVES: To assess the effects of medical treatments on mortality, duration of hospitalization, mechanical ventilation, tube or parenteral feeding and risk of adverse events in botulism.

Cochrane Systematic Review: Salicylate for the treatment of Kawasaki disease in children

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Baumer JH, Love SJ, Gupta A, Haines LC, Maconochie I, Dua JS

OBJECTIVES: The objective of this review was to evaluate the effectiveness of salicylate in treating and preventing cardiac consequences of Kawasaki disease in children.

Cochrane Systematic Review: Non-corticosteroid treatment for nephrotic syndrome in children

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Pravitsitthikul N, Willis NS, Hodson EM, Craig JC

OBJECTIVES: To evaluate the benefits and harms of non-corticosteroid immunosuppressive medications in relapsing SSNS in children.

Cochrane Systematic Review: Treatment for lupus nephritis

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Henderson L, Masson P, Craig JC, Flanc RS, Roberts MA, Strippoli GF, Webster AC

OBJECTIVES: To assess the benefits and harms of different immunosuppressive treatments in biopsy-proven proliferative lupus nephritis.

Cochrane Systematic Review: Cisapride treatment for gastroesophageal reflux in children

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Maclennan S, Augood C, Cash-Gibson L, Logan S, Gilbert RE. Cisapride treatme...

OBJECTIVES: To determine the effectiveness of cisapride versus placebo or non-surgical treatments for symptoms of GOR.

Cochrane Systematic Review: Honey as a topical treatment for wounds

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Jull AB, Walker N, Deshpande S

OBJECTIVES: The objective was to determine whether honey increases the rate of healing in acute wounds (e.g. burns, lacerations) and chronic wounds (e.g. skin ulcers, infected surgical wounds).

Cochrane Systematic Review: Topical treatment for facial burns

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Hoogewerf CJ, Van Baar ME, Hop MJ, Nieuwenhuis MK, Oen IM, Middelkoop E

OBJECTIVES: To assess the effects of topical interventions on wound healing in people with facial burns of any depth.

Cochrane Systematic Review: Pharmacological treatment other than corticosteroids, intravenous immunoglobulin and plasma exchange for Guillain-Barr syndrome

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Hughes RA, Pritchard J, Hadden RD

OBJECTIVES: To review systematically the evidence from randomised controlled trials (RCTs) for pharmacological agents other than plasma exchange, intravenous immunoglobulin and corticosteroids.

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

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

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

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

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Griffiths, B, Ducharme, FM,

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

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

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

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

Systematic Review: Treatment of children with migraine in the emergency department: a qualitative systematic review

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Bailey B, McManus BC

Objective: To evaluate which treatment could be effective in the emergency department (ED) for children with migraine and status migrainosus, we carried out a qualitative systematic review of randomized controlled trials (RCTs) that evaluated treatment that could be used for those conditions.

Sytematic Review: Symptomatic treatment of migraine in children: a systematic review of medication trials

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Damen L, Bruijn JK, Verhagen AP, Berger MY, Passchier J, Koes BW

Objective: Treatment of pediatric migraine includes an individually tailored regimen of both nonpharmacologic and pharmacologic measures. The mainstay of symptomatic treatment in children with migraine is intermittent oral or suppository analgesics, but there is no coherent body of evidence on symptomatic treatment of childhood migraine available. The objective of this review is to describe and assess the evidence from randomized and clinical controlled trials concerning the efficacy and tolerability of symptomatic treatment of migraine in children.

Systematic Review: Is There A Role for Pre-, Pro- and Synbiotics in the Treatment of Functional Constipation in Children?

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Koppen IJ, Benninga MA, Tabbers MM

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

Systematic Review: Currently recommended treatments of childhood constipation are not evidence based: a systematic literature review on the effect of laxative treatment and dietary measures

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Pijpers MA, Tabbers MM, Benninga MA, Berger MY

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

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

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

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

Non-operative versus operative treatment for blunt pancreatic trauma in children

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Haugaard MV, Wettergren,A, Hillings JG, Gluud C, Penninga L,

Review to assess the benefits and harms of operative versus non-operative treatment of blunt pancreatic trauma in children.

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

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Nurmatov UB, Rhatigan E, Simons FE, Sheikh A

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

Systematic Review: Age- and severity-adjusted treatment of proximal humerus fractures in children and adolescents-A systematical review and meta-analysis

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Hohloch L, Eberbach H, Wagner FC, Strohm PC, Reising K, Sdkamp NP, Zwingmann J

The aim of this systematic review was to gather the best evidence of different treatment methods and their associated functional outcome, complication rates, rates of limb length discrepancies and radiological outcome for proximal humerus fractures in children and adolescents.

Systematic Review: Plate Fixation Versus Nonoperative Treatment for Displaced Midshaft Clavicular Fractures: A Meta-Analysis of Randomized Controlled Trials

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Woltz S, Krijnen P, Schipper IB

The aim was to analyze whether patients with a displaced midshaft clavicular fracture are best managed with plate fization or nonoperative treatment with respect to nonunion, secondary operations, and functional outcome, by evaluating all available randomized controlled trials on this subject.

Systematic Review: Outcomes of Nonoperative Treatment of Salter-Harris II Distal Radius Fractures: A Systematic Review

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Larsen MC, Bohm KC, Rizkala AR, Ward CM

This systematic review was conducted of studies examining the radiographic and clinical outcomes of nonoperatively managed SH II distal radius fractures.

Review: Pediatric and Adolescent Forearm Fractures: Current Controversies and Treatment Recommendations

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Pace JL

Pediatric and adolescent forearm fractures continue to present treatment challenges. Despite high-level evidence to the contrary, traditional guidelines for nonsurgical treatment have been challenged in favor of surgical intervention, but it is unclear if this results in improved outcomes. Recent evidence suggests that certain open fractures in children may be successfully treated nonsurgically. Good results have been achieved with closed reduction and appropriate casting and clinical follow-up. Further research investigating functional outcomes into adulthood is needed

Systematic Review: The treatment of displaced supracondylar humerus fractures: evidence-based guideline

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Mulpuri K, Wilkins K

The purpose of this paper is to summarize and highlight the major findings from the systematic review that developed a clinical practice guideline from the American Academy of Orthopaedic Surgeons regarding treatment for type III supracondylar fractures.

Systematic Review: Comparative Effectiveness of Imaging Modalities for the Diagnosis and Treatment of Intussusception: A Critically Appraised Topic

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Carroll AG, Kavanagh RG, Ni Leidhin C, Cullinan NM, Lavelle LP, Malone DE

The purpose of this study was to critically appraise and compare the diagnostic performance of imaging modalities that are used for the diagnosis of intussusception and methods used in the treatment of ileocolic intussusception.

Review: Antimicrobial treatment of diarrhea/acute gastroenteritis in children

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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.

Review: Lyme disease: clinical diagnosis and treatment

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Hatchette TF, Davis I, Johnston BL

Objective: To review the clinical diagnosis and treatment of Lyme disease for front-line clinicians.

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

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Dorsett M, Liang SY

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

Review: Treatment of herpes simplex virus infections in pediatric patients: current status and future needs

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James SH, Whitley RJ

Objective: To present an overview of the major clinical manifestations of HSV infections in the pediatric population.

Systematic Review: Suicide in the pediatric population: screening, risk assessment and treatment

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Cwik MF, O'Keefe VM, Haroz EE

Objective: to synthesise the literature on paediatric suicide screening, risk assessment and treatment to inform clinical practice and suicide prevention efforts.

Meta-analysis: Efficacy of salbutamol in the treatment of infants with bronchiolitis: a meta-analysis of 13 studies

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Cai Z, Lin Y, Liang J

Objective: To systematically evaluate the clinical efficacy of salbutamol treatment in infants with bronchiolitis.

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

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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: The Role of Fiber in the Treatment of Functional Gastrointestinal Disorders in Children

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Cara Hannah Axelrod,Miguel Saps

We reviewed the available evidence on the role of fiber in the treatment of Functional Constipation (FC) and Irritable Bowel Syndrome (IBS) in children.

Systematic Review: When Poorly Conducted Systematic Reviews and Meta-analyses can Mislead: a critical appraisal and update of systematic reviews and meta-analyses examining the effects of probiotics in the treatment of functional constipation in children

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Harris RG,Neale EP,Ferreira I

The aim of this study was to critically review and update the evidence in this field by mapping all the steps involved against those reported in previous reviews, in an attempt to understand the nature of their conflicting results.

Review: Irritable Bowel Syndrome in Children: Pathogenesis, Diagnosis and Evidence-Based Treatment

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Sandhu BK, Paul SP

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

Review: Does analgesia mask diagnosis of appendicitis among children?

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Bromberg R, Goldman RD

Question: Can analgesia be given safely to patients with suspected appendicitis prior to surgical evaluation without masking physical signs and symptoms?

Cochrane Systematic Review: Topical analgesia for acute otitis media

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

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

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.

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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.

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

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

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

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

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

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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: Polyethylene Glycol Maintenance Treatment for Childhood Functional Constipation: A Randomized,Placebo-controlled Trial

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Modin L,Walsted AM,Dalby K,Jakobsen MS

The aim of this study was to investigate the long-term efficacy of polyethylene glycol (PEG) during maintenance treatment of childhood functional constipation (FC) in a randomized, double-blinded, placebo-controlled trial.

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

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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

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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

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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

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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

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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

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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

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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

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

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

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

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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: Pain assessment for children: overcoming challenges and optimizing care

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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

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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

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

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

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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

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

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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

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

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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

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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: Early analgesia for children with acute abdominal pain

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

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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

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

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

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

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

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

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

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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

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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

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

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

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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: Outpatient treatment of moderate croup with dexamethasone: intramuscular versus oral dosing

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Rittichier, KK, Ledwith, CA,

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

Key Study: Nebulized budesonide and oral dexamethasone for treatment of croup: a randomized controlled trial

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Klassen, TP, Craig, WR, Moher, D, Osmond, MH, Pasterkamp, H, Sutcliffe, T, Wa...

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

Key Study: Early goal-directed therapy in the treatment of severe sepsis and septic shock (2001)

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Rivers EN, B.; Havstad, S.; Ressler, J.; Muzzin, A.; Knoblich, B.; Peterson, ...

Background: Goal-directed therapy has been used for severe sepsis and septic shock in the intensive care unit. This approach involves adjustments of cardiac preload, afterload, and contractility to balance oxygen delivery with oxygen demand. The purpose of this study was to evaluate the efficacy of early goal-directed therapy before admission to the intensive care unit. Published: 2001.

Key Study: Application of topical local anesthetic at triage reduces treatment time for children with lacerations: a randomized controlled trial

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Priestley S, Kelly AM, Chow L, Powell C, Williams A

Study Objectives: We determine whether application of topical local anesthetic at triage reduces total treatment time for children with simple lacerations.

Key Study: Treatment of pediatric migraine headaches: a randomized, double-blind trial of prochlorperazine versus ketorolac

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Brousseau DC, Duffy SJ, Anderson AC, Linakis JG

Study Objective: We compare the effectiveness of intravenous ketorolac and intravenous prochlorperazine in the treatment of pediatric migraine headaches.

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

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Kramer HH, Sommer M, Rammos S, Krogmann O

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

Key Study: How can cerebral edema during treatment of diabetic ketoacidosis be avoided?

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Watts W, and Edge JA

This article discusses how DKA might be prevented from occurring in the first instance, known risk factors for cerebral edema, fluid and insulin management, the importance of careful monitoring during DKA treatment, and the importance of recognizing and acting on the earliest symptoms to prevent long-term harm.

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

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

Objective: We undertook this clinical trial to determine the extent to which antimicrobial treatment affects the course of both symptoms and signs of acute otitis media, irrespective of the apparent severity of the disease, among children 6 to 23 months of age in whom the diagnosis of acute otitis media is quite certain.

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

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

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

Key Study: Injury treatment among children with autism or pervasive developmental disorder

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McDermott S, Zhou L, Mann J

This study examined the difference in the frequency and type of injury for children with autism and pervasive developmental disorder compared with typically developing peers.

Key Study: Comparison of Polyethylene Glycol-Electrolyte Solution vs Polyethylene Glycol-3350 for the Treatment of Fecal Impaction in Pediatric Patients

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Boles EE, Gaines CL, Tillman EM

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

Key Study: Polyethylene glycol 4000 for treatment of functional constipation in children

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Dziechciarz P, Horvath A, Szajewska H

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

Key Study: Pediatric constipation in the emergency department: evaluation, treatment, and outcomes

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Freedman SB, Thull-Freedman J, Rumantir M, Eltorki M, Schuh S

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

Key Study: Safety and efficacy of milk and molasses enemas compared with sodium phosphate enemas for the treatment of constipation in a pediatric emergency department

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Hansen SE, Whitehill JL, Goto CS, Quintero CA, Darling BE, Davis J

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

Key Study: Rectal fecal impaction treatment in childhood constipation: enemas versus high doses oral PEG

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Bekkali NL, van den Berg MM, Dijkgraaf MG, van Wijk MP, Bongers ME, Liem O, B...

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

Key Study: PEG3350 in the treatment of childhood constipation: a multicenter, double-blinded, placebo-controlled trial

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Nurko S, Youssef NN, Sabri M, Langseder A, McGowan J, Cleveland M, Di Lorenzo C

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

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

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

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

Key Study: Reducing resource utilization during non-operative treatment of pediatric proximal humerus fractures

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Gladstein AZ, Schade AT, Howard AW, Camp MW

The primary outcome of the study was the proportion of proximal humerus fractures, initially treated non-operatively, for which displacement or angulation on follow-up radiographs led to a change to operative treatment.

Key Study: Functional outcomes following non-operative versus operative treatment of clavicle fractures in adolescents

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Herzog MM, Whitesell RC, Mac LM, Jackson ML, Culotta BA, Axelrod JR, Busch MT...

This study aimed to assess shoulder function in adolescents following shortened clavicle fracture and compare operative versus non-operative treatment.

Key Study: Emerging U.S. National Trends in the Treatment of Pediatric Supracondylar Humeral Fractures

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Holt JB, Glass NA, Bedard NA, Weinstein SL, Shah AS

Understanding national treatment trends will provide important insight into variations in regional treatment standards and help identify areas for improvement in value in care delivery.

Key Study: Capitellar Fractures in Children and Adolescents: Classification and Early Results of Treatment

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Murthy PG, Vuillermin C, Naqvi MN, Waters PM, Bae DS

The purpose of this investigation was to characterize capitellar fracture patterns in children and adolescents and to assess early clinical and radiographic treatment outcomes.

Key Study: Childhood Obesity Increases the Risk of Failure in the Treatment of Distal Forearm Fractures

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Auer RT, Mazzone P, Robinson L, Nyland J, Chan G

A retrospective case-controlled study was conducted to determine whether obesity is an independent risk factor for the failure of closed reduction and casting.

Key Study: Functional Outcomes After Treatment of Scaphoid Fractures in Children and Adolescents

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Bae DS, Gholson JJ, Zurakowski D, Waters PM

The purpose of this investigation was to characterize the functional outcomes of children and adolescents treated for scaphoid fractures.

Key Study: Radiographic Evaluation During Treatment of Pediatric Forearm Fractures: Implications on Clinical Care and Cost

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Luther G, Miller P, Waters PM, Bae DS

The purpose of this study was to analyze the clinical utility and cost of the week 4 radiograph following closed treatment of pediatric forearm fractures.

Key Study: Reducing Cost and Radiation Exposure During the Treatment of Pediatric Greenstick Fractures of the Forearm

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Ting BL, Kalish LA, Waters PM, Bae DS

The purpose of this investigtion was to evaluate the LOR rate requiring intervention - including either repeat closed reduction or surgical reduction and fixation- following closed reduction and cast immobilization of pediatric greenstick forearm fractures.

Key Study: Synthetic versus plaster of Paris casts in the treatment of fractures of the forearm in children: a randomised trial of clinical outcomes and patient satisfaction

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Inglis M, McClelland B, Sutherland LM, Cundy PJ

The aim of this study was to investigate which cast material is superior for the management of fractures of the forearm.

Key Study: Simple treatment for torus fractures of the distal radius

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Davidson JS, Brown DJ, Barnes SN, Bruce CE

Based on the results of a postal questionnaire and a prospective randomised trial, this study descibes a simple treatement for a torus fracture of the distal radius, which saves both time and money.

Key Study: Examining Emergency Department Treatment Processes in Severe Pediatric Traumatic Brain Injury

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Ajdari A, Boyle LN, Kannan N, Rowhani-Rahbar A, Wang J, Mink R, Ries B, Wainw...

Our objectives were to examine the treatment process of acute pediatric TBI and the impact of non-value-added time (NVAT) on patient outcomes.

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

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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: Delayed treatment of the first febrile urinary tract infection in early childhood increased the risk of renal scarring

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Karavanaki KA, Soldatou A, Koufadaki AM, Tsentidis C, Haliotis FA, Stefanidis CJ

This study evaluated the controversial relationship between the duration of fever before treatment initiation for a febrile urinary tract infection, with renal scarring based on dimercaptosuccinic acid scintigraphy (DMSA) findings.

Key Study: Improving the Diagnosis and Treatment of Urinary Tract Infection in Young Children in Primary Care: Results from the DUTY Prospective Diagnostic Cohort Stud

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Hay AD, Sterne JA, Hood K, Little P, Delaney B, Hollingworth W, Wootton M, Ho...

Up to 50% of urinary tract infections (UTIs) in young children are missed in primary care. Urine culture is essential for diagnosis, but urine collection is often difficult. The aim of this study was to derive and internally validate a 2-step clinical rule using (1) symptoms and signs to select children for urine collection; and (2) symptoms, signs, and dipstick testing to guide antibiotic treatment.

Key Study: Early Antibiotic Treatment for Pediatric Febrile Urinary Tract Infection and Renal Scarring

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Shaikh N, Mattoo TK, Keren R, Ivanova A, Cui G, Moxey-Mims M, Majd M, Ziessma...

The objective of this study was to determine whether delay in the initiation of antimicrobial therapy for febrile urinary tract infections is associated with the occurrence and severity of renal scarring.

Key Study: Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits

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Coulthard MG, Lambert HJ, Vernon SJ, Hunter EW, Keir MJ, Matthews JN

The objective of this study was to test whether active management of urinary tract infections in young children by general practitioners can reduce kidney scarring rates.

Key Study: Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial

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Freedman SB, Willan AR, Boutis K, Schuh S

Objective: To determine if oral hydration with dilute apple juice/preferred fluids is noninferior to electrolyte maintenance solution in children with mild gastroenteritis.

Key Study: Emergency Department Treatment of Children With Diarrhea Who Attend Day Care: A Randomized Multidose Trial of a Lactobacillus helveticus and Lactobacillus rhamnosus Combination Probiotic

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Freedman SB, Sherman PM, Willan A, Johnson D, Gouin S, Schuh S; Pediatric Eme...

This study evaluated the rates of day care absenteeism of children with gastroenteritis treated with probiotics.

Key study: Efficacy of nebulized L-epinephrine for treatment of croup: a randomized, double-blind study

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Eghbali A, Sabbagh A, Bagheri B, Taherahmadi H, Kahbazi M

Objective: The objective of this study was to compare the effect of L-epinephrine plus dexamethasone vs. dexamethasone for treatment of croup in children.

Key study: The comparison of oral and IM dexamethasone efficacy in croup treatment

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Soleimani G, Daryadel A, Ansari Moghadam A, Sharif MR

Objective: In this study, the efficacies of intramuscular and oral dexamethasone administration are compared for treatment of croup.

Key study: A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup

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Chub-Uppakarn S, Sangsupawanich P

Objective: The aim of this study was to investigate the effectiveness of dexamethasone 0.15 mg/kg single dose compared with the recommended dose of 0.6 mg/kg for treatment of hospitalized children with moderate to severe croup.

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

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

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

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

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

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

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

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

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

Key Study: Effect of potassium infusion on serum levels in children during treatment of diabetic ketoacidosis

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Musaitif R and Basnet S

Objectives: to determine the effect of 40 mEq/L and 60 mEq/L infusions on potassium levels in children during treatment of DKA.

Key Study: Emergency room closed reduction versus in situ splinting in the treatment of paediatric supracondylar humerus fractures

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Sylvia, SM, Maguire, KJ, Molho, DA, Levens, BJ, Stone, MEJ, Hanstein, R, Schu...

The purpose of this study was to investigate if outcomes or complications differ between two management methods.

Key Study: A comparison of intervention and conservative treatment for angulated fractures of the distal forearm in children (AFIC): study protocol for a randomized controlled trial

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Adrian, M, Wachtlin, D, Kronfeld, K, Sommerfeldt, D and Wessel, LM

The primary objective of this trial is to assess whether or not the long-term functional outcome in remodeling patients is inferior to patients receiving closed reduction and K-wire pinning.

Key Study: Multiple interventions improve analgesic treatment of supracondylar humerus fractures in a pediatric emergency department

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Porter, RN, Chafe, RE, Newhook, LA and Murnaghan, KD

To measure the effectiveness of a set of interventions in improving the rate and timeliness of analgesic medication administration, as well as appropriate backslab immobilization (application of a moldable plaster or fiberglass splint), in a pediatric ED.

Key Study: Comparison of two analgesia protocols for the treatment of pediatric orthopedic emergencies

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Barcelos, A, Garcia, P C, Portela, J L, Piva, J P, Garcia, J P and Santana, J C

To compare the efficacy of two analgesia protocols (ketamine versus morphine) associated with midazolam for the reduction of dislocations or closed fractures in children.

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

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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: Efficacy and tolerability of zolmitriptan nasal spray for the treatment ofacutemigraine in adolescents: Results of a randomized, double-blind, multi-center, parallel-group study (TEENZ).

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Winner P,Farkas V,tillov H,Woodruff B,Liss C,Lillieborg S,Raines S;TEENZ Stud...

The primary objective of the TEENZ Study (NCT01211145) was to assess the efficacy of zolmitriptan nasal spray in the acute treatment of adolescent migraine patients (ages 12 to 17 years), as measured by the primary outcome variable of pain-free status at 2 hours post-treatment.

Key Study: Ultrasound-guided forearm nerve blocks in kids: a novel method forpaincontrol in the treatment of hand-injuredpediatricpatients in the emergency department.

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Frenkel O,Liebmann O,Fischer JW.

Ultrasound-guided forearm nerve blocks have been shown to safely reduce pain for emergency procedures in the adult emergency department (ED). Although ultrasonography is widely used for forearm nerve blocks in the adult ED and in the pediatric operating room, no study to date has examined its use in the pediatric emergency setting.

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

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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: Lubiprostone for the treatment of functional constipation in children.

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Hyman PE,Di Lorenzo C,Prestridge LL,Youssef NN,Ueno R.

We evaluated the safety and effectiveness of lubiprostone in children and adolescents with functional constipation.

Key study: No association between metoclopramide treatment in ED and reduced risk of post-concussion headache

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Bresee N, Aglipay M, Dubrovsky AS, et al.

There is a lack of definitive pediatric literature on effective pharmacotherapy for persistent post-concussion headache symptoms. This study assessed whether acute metoclopramide treatment in the Emergency Department (ED) was associated with a reduction in persistent headache in children at 1- and 4-weeks post-concussion.

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

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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: Clinical outcomes of children treated with intravenous prochlorperazine for migraine in a pediatric emergency department

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Trottier ED, Bailey B, Dauphin-Pierre S, Gravel J

Objective: To evaluate the rate of treatment failure associated with prochlorperazine used in children with severe migraine in a pediatric ED.

Key Study: Comparative review of the clinical use of intranasal fentanyl versus morphine in a paediatric emergency department

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Borland ML, Clark LJ, Esson A

Objectives: Comparison of intranasal fentanyl (INF) and parenteral morphine in children in an ED. Primary objective was to compare time to analgesia from presentation, with secondary objectives to assess patient profiles, specifics of opiate analgesics used plus rate of i.v. access for analgesia alone.

Key Study: Oral Analgesics Utilization for Children With Musculoskeletal Injury (OUCH Trial): An RCT

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Le May S, Ali S, Plint AC, Msse B, Neto G, Auclair MC, Drendel AL, Ballard A,...

We aimed to test the efficacy of a combination of an anti-inflammatory drug with an opioid for pain management of MSK-I in children presenting to the ED.

Key Study: FactorsAssociatedWithDischargeAfterInitialEmergency TreatmentofPediatricMigraine.

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Aravamuthan BR,Mar SS,Williams KG.

Migraine treatment varies widely in the pediatric emergency department (ED). Factors associated with discharge after only initial emergency treatment were examined.

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Resource - Acute Procedural Pain Toolkits

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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

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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

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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)

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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.

Clincal Practice Guideline: Practice Guideline for the Assessment and Treatment of Patients With Suicidal Behaviors

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American Psychology Association

Non peds specific practise guidline for assessment treatment suicidal behavors

Clincal Practice Guideline: Practice Parameter for the Assessment and Treatment of Children and Adolescents With Suicidal Behavior. American Academy of Child and Adolescent Psychiatry

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American Academy of Child and Adolescent Psychiatry

These guidelines review what is known about the epidemiology, causes, management, and prevention of suicide and attempted suicide in young people. Detailed guidelines are provided concerning the assessment and emergency management of the children and adolescents who present with suicidal behavior.

TREKK.ca Info Pages

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Canadian Paediatric Society Position Statement: Pain Management

Posted: Nov 05, 2019  | Announcement  | Team: News and Events 



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New Bottom Line Recommendation: Pain Treatment

Posted: Jul 16, 2018  | Announcement  | Team: News and Events 



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News Story: Guidelines for managing child pain in the ED

Posted: Jul 15, 2016  | Announcement  | Team: News and Events 



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New Bottom Line Recommendation: Procedural Pain

Posted: Nov 07, 2016  | Announcement  | Team: News and Events 



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Learning to Live With Chronic Pain

Posted: Apr 11, 2017  | Announcement  | Team: News and Events 



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Podcast: Pediatric Procedural Sedation

Posted: Feb 09, 2016  | Announcement  | Team: News and Events 
Tags: Procedural Sedation, Procedural Pain



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Pediatric Pain Letter

Posted: Nov 21, 2017  | Announcement  | Team: News and Events 



view 47 more matching info pages

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Profiling pediatric pain expert: Dr. Samina Ali

Posted: Mar 18, 2016  | Announcement  | Team: News and Events 



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Constipation Resources in French

Posted: Oct 03, 2019  | Announcement  | Team: News and Events 



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DKA Podcast on Emergency Medicine Cases

Posted: May 01, 2015  | Resource  | Team: News and Events 
Tags: Diabetic ketoacidosis



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NEW Parent Tools!

Posted: May 30, 2019  | Announcement  | Team: News and Events 



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Updated fact sheet on COVID-19 and kids

Posted: Mar 29, 2021  | Announcement  | Team: News and Events 



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Manitoba Pediatric Health Conference 2017

Posted: Mar 30, 2017  | Announcement  | Team: News and Events 



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Parent tools - UTI and Bronchiolitis

Posted: Jan 09, 2020  | Announcement  | Team: News and Events 



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TREKK croup story book

Posted: Feb 09, 2016  | Resource  | Team: News and Events 



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Treating Gastroenteritis: Evidence for Clinicians

Posted: Apr 10, 2015  | Announcement  | Team: News and Events 
Tags: Gastroenteritis



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Parent tools - CTV Winnipeg

Posted: Jun 18, 2019  | Announcement  | Team: News and Events 



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Pediatric Anaphylaxis Pediatric Pack Now Available!

Posted: Oct 16, 2018  | Announcement  | Team: News and Events 



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Status Epilepticus Pediatric Pack Now Available!

Posted: Oct 02, 2018  | Announcement  | Team: News and Events 



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Brain Awareness Week

Posted: Mar 11, 2019  | Announcement  | Team: News and Events 



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New Bottom Line Recommendation: Anaphylaxis

Posted: Sep 10, 2018  | Announcement  | Team: News and Events 



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Brain Injury Awareness Month 2019

Posted: Jun 13, 2019  | Announcement  | Team: News and Events 



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New Bottom Line Recommendations: Urinary Tract Information

Posted: Aug 20, 2019  | Announcement  | Team: News and Events 



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New resources available on trekk.ca!

Posted: Jul 10, 2015  | Resource  | Team: News and Events 



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Sick All Night - A storybook on gastroenteritis

Posted: Oct 17, 2017  | Announcement  | Team: News and Events 



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Does a child's cough sound like a barking seal? Could be croup

Posted: May 01, 2015  | Announcement  | Team: News and Events 
Tags: Croup, Infection



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Congratulations Dr. Samina Ali!

Posted: Nov 19, 2018  | Announcement  | Team: News and Events 



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Pediatric Respiratory Assessment Measure (PRAM) App

Posted: Dec 08, 2015  | Announcement  | Team: News and Events 



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Updated Resources for Bronchiolitis

Posted: Feb 09, 2021  | Announcement  | Team: News and Events 



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Croup in children - a Canadian Medical Association Review

Posted: Oct 21, 2013  | Journal Club  | Team: News and Events 



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Updated resource - Croup Bottom Line Recommendations

Posted: Mar 21, 2019  | Announcement  | Team: News and Events 



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I Love to Read Month

Posted: Feb 18, 2020  | Announcement  | Team: News and Events 



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Canadian Anaphylaxis Action Plan for Kids

Posted: Feb 25, 2019  | Announcement  | Team: News and Events 



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Updated resource - Gastroenteritis Bottom Line Recommendations

Posted: Apr 09, 2019  | Announcement  | Team: News and Events 



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New Resources on trekk.ca!

Posted: Nov 13, 2015  | Announcement  | Team: News and Events 



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Asthma Pathway

Posted: Oct 21, 2013  | Module  | Team: ED Clinical Pathways Implementation  > Pathways



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Information on COVID-19

Posted: Jun 26, 2020  | Announcement  | Team: News and Events 



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Gastroenteritis Pathway

Posted: Oct 21, 2013  | Module  | Team: ED Clinical Pathways Implementation  > Pathways



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New Chair for the Pediatric Emergency Research Networks

Posted: Jun 02, 2014  | Announcement  | Team: News and Events 



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TREKK at CAEP 2018

Posted: Feb 06, 2018  | Announcement  | Team: News and Events 




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