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Many CPRs have been derived for children, but few have been validated. Relative to adult CPRs, several quality indicators demonstrated weaknesses. Existing performance standards may prove elusive for CPRs that involve children. CPRs for children that are more assistive and less directive and include patients' values and preferences in decision-making may be helpful.

An HSV infection was uncommon in young infants evaluated for CNS infection, particularly in the second month of life. Evidence-based approaches to the evaluation for HSV in young infants are needed.

Homelessness has reached epidemic proportions in Canada. Canadian children and adolescents are the most vulnerable because youth comprise the fastest growing segment of the homeless population. A systematic literature review was undertaken using MEDLINE, Web of Science and the Homeless Hub (www.homelesshub.ca) to encompass the time frame from January 1990 to June 2009. The following terms were used as key words: 'homelessness', 'homeless youth', 'poverty', 'street youth' and 'runaway'. The present review identified an intersection among education deficits, social service insufficiencies, and poor mental and physical health in homeless youth. Health care delivery to homeless youth was often nonanticipatory, inconsistent and perceived as discriminatory. However, street youth were identified as requiring health care for pregnancy, mental health concerns, sexually transmitted illnesses, respiratory conditions, substance abuse and a myriad of other illnesses. Plenty of work is still required to reduce health inequalities and improve the daily living conditions of Canadian youth living in poverty.

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The age-specific CSF WBC count, protein concentration, and glucose concentration reference values identified in this large, multicenter cohort of infants can be used to interpret the results of lumbar puncture in infants ≤60 days of age.

Study Objective To determine the optimal correction factor for cerebrospinal fluid (CSF) white blood cell (WBC) counts in infants with traumatic lumbar punctures (LPs). Methods We performed a secondary analysis of a retrospective cohort of infants ≤ 60–days-old with a traumatic LP [CSF red blood cell (RBC) count ≥ 10,000 cells/mm3] at 20 participating centers. CSF pleocytosis was defined as a CSF WBC count ≥ 20 cells/mm3 for infants ≤ 28 days, ≥ 10 cells/mm3 for infants 29–60 day and bacterial meningitis as growth of pathogenic bacteria from CSF culture. Using linear regression, we derived a CSF WBC correction factor and compared the uncorrected to the corrected CSF WBC count for the detection of bacterial meningitis. Results Of the eligible 20,319 LPs, 2,880 (14%) were traumatic of whom 33 (1.1%) had bacterial meningitis. The derived CSF RBCs:WBCs ratio was 877:1 [95% confidence interval (CI) 805–961:1]. Compared with the uncorrected CSF WBC count, the corrected CSF WBC count had lower sensitivity for bacterial meningitis [88% uncorrected vs. 67% corrected; difference 21%, 95% CI 10–37%] but resulted in fewer infants with CSF pleocytosis [78% uncorrected vs. 33% corrected; difference 45%, 95% CI 43–47%]. CSF WBC count correction resulted in 7 additional infants with bacterial meningitis being misclassified as not having CSF pleocytosis; only one of these infants was > 28-days-old. Conclusion Correction of the CSF WBC count substantially reduced the number of infants with CSF pleocytosis while misclassifying only one infant with bacterial meningitis 29 to 60 days of age.

Objectives: The primary objective was to determine the diagnostic accuracy of a serial ultrasound (US) clinical diagnostic pathway to detect appendicitis in children presenting to the emergency department (ED). The secondary objective was to examine the diagnostic performance of the initial and interval US and to compare the accuracy of the pathway to that of the initial US.Methods: This was a prospective cohort study of 294 previously healthy children 4 to 17 years old with suspected appendicitis and baseline pediatric appendicitis scores of ≥2, who were managed with the serial US clinical diagnostic pathway. This pathway consisted of an initial US followed by a clinical reassessment in each patient and an interval US and surgical consultation in patients with equivocal initial US and persistent concern about appendicitis. The USs were interpreted by published criteria as positive, negative, or equivocal for appendicitis. Children in whom this pathway did not rule in or rule out appendicitis underwent computed tomography (CT). Cases with missed appendicitis, negative operations, and CTs after the pathway were considered inaccurate. The primary outcome was the diagnostic accuracy of the serial US clinical diagnostic pathway. The secondary outcomes included the test performance of the initial and interval US imaging studies.Results: Of the 294 study children, 111 (38%) had appendicitis. Using the serial US clinical diagnostic pathway, 274 of 294 children (93%, 95% confidence interval [CI] = 90% to 96%) had diagnostically accurate results: 108 of the 111 (97%) appendicitis cases were successfully identified by the pathway without CT scans (two missed and one CT), and 166 of the 183 (91%) negative cases were ruled out without CT scans (14 negative operations and three CTs). The sensitivity of this pathway was 108 of 111 (97%, 95% CI = 94% to 100%), specificity 166 of 183 (91%, 95% CI = 87% to 95%), positive predictive value 108 of 125 (86%; 95% CI = 79% to 92%), and negative predictive value 166 of 169 (98%, 95% CI = 96% to 100%). The diagnostic accuracy of the pathway was higher than that of the initial US alone (274 of 294 vs. 160 of 294; p < 0.0001). Of 123 patients with equivocal initial US, concern about appendicitis subsided on clinical reassessment in 73 (no surgery and no missed appendicitis). Of 50 children with persistent symptoms, 40 underwent interval US and 10 had surgical consultation alone. The interval US confirmed or ruled out appendicitis in 22 of 40 children (55.0%) with equivocal initial US, with one false-positive interval US. Conclusions:The serial US clinical diagnostic pathway in suspected appendicitis has an acceptable diagnostic accuracy that is significantly higher than that of the initial US and results in few CT scans.