The low initial SpO and SF ratio, respiratory acidosis, and SF ratio less than 195 at the first hours of treatment were related to unresponsiveness to HFNC therapy in our pediatric emergency department.

Amaç: Zehirlenmeler çocuk yaş grubunda sık görülen, hızlı tanı ve tedavi gerektiren, önlenebilir çevresel acillerdendir. Bu çalışmada zehirlenme nedeniyle başvuran hastaların epidemiyolojik ve klinik özellikleri incelenmiştir. Yöntemler: Haziran 2010-Ocak 2015 yılları arasında çocuk acil servisine zehirlenme nedeniyle başvuran hastaların hastane kayıtları geriye dönük olarak değerlendirilmiştir. Bulgular: Çalışmaya alınan 997 zehirlenme olgusunun, %55'inin kız olduğu görülmüştür. Hastaların ortanca yaşının 43 ay [çeyrekler arası aralık: 24-166], %58,1'inin 5 yaş altında, %30,7'sinin 12 yaş üstünde olduğu bulunmuştur. Zehirlenmelerin, beş yaş altında çoğunlukla erkeklerde (%57,5) ve tamamının kaza sonucu, 12 yaş üstünde ise kızlarda (%81) ve özkıyım amaçlı (%76,1) olduğu saptanmıştır. Olguların %84,7'si tek etkenle, %15,3'ü ise birden fazla etkenle zehirlenmiştir. En sık ilaçlarla (%56,7), ikinci sırada ise kostik/korozif maddelerle (%27,8) olan zehirlenmeler saptanmıştır. İlaçlar ile olan zehirlenmelerin en sık analjezikler (%26,9) ve santral sinir sistemi ilaçları (%24) ile olduğu görülmüştür. Hastaların %71,3'ünün asemptomatik olduğu, semptomatik hastalarda ise en sık gastrointestinal sistem bulguları olduğu bulunmuştur. İlaçlarla zehirlenen olguların %21'ine mide lavajı; %28'ine aktif kömür uygulanmış, %2'sine antidot tedavisi verilmiştir. Hastaların %92'si çocuk acil servisinden taburcu edilirken, 14 olgu (%1,4) yoğun bakımda tedavi edilmiştir. Beş yıl süresince zehirlenmeye bağlı mortalite gözlenmemiştir. Sonuç: Zehirlenmeler çocuk yaş grubunda morbiditenin önemli ve önlenebilir bir nedenidir. Beş yaş altı grupta kaza sonucu, adölesan yaş grubunda özkıyım amaçlı zehirlenmelerin sık olduğu, ilaçlar ve kostik/korozif maddelerle olan zehirlenmelerin en önemli neden olduğu bulunmuştur. Yaş gruplarına göre bu epidemiyolojik ve klinik özelliklerin bilinmesi, nedene yönelik hızlı tanı ve tedavi yapılmasını sağlayacak; gerekli önlemler alınarak zehirlenmelerin azaltılmasına katkı sağlayacaktır.

Objective:The objective of this study was to evaluate physical examinations, imaging, and laboratory analyses individually and combined using innovative statistical analysis methods for the accurate diagnosis of pediatric appendicitis.Methods: Patients admitted to hospital with symptoms of abdominal pain whose pediatric appendicitis scores greater than 3 were included in the study. Clinical, radiologic, and laboratory findings and as a new biomarker calprotectin (CPT) concentrations were evaluated individually and combined using artificial neural networks (ANNs), which revealed latent relationships for a definitive diagnosis.Results: Three hundred twenty patients were evaluated (190 appendicitis [43 perforated] vs 130 no appendicitis). The mean ± SD age was 11.3 ± 3.6 years and 63% were male. Pediatric appendicitis scores, white blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP) level, procalcitonin (PCT) and CPT concentrations were higher in the appendicitis group; however, only WBC and ANC were higher in first 24 hours of pain. White blood cells and CRP were diagnostic markers in patients whose appendix could not be visualized using ultrasonography (US). On classic receiver operating characteristic (ROC) analysis, the areas under the curve (AUCs) were not strong enough for differential diagnosis (WBC, 0.73; ANC, 0.72; CRP, 0.65; PCT and CPT, 0.61). However, when the physical examination, US, and laboratory findings were analyzed in a multivariate model and the ROC analysis obtained from the variables with ANN, an ROC curve could be obtained with 0.91 AUC, 89.8% sensitivity, and 81.2% specificity. C-reactive protein and PCT were diagnostic for perforated appendicitis with 0.83 and 0.75 AUC on ROC.Conclusions: Although none of the biomarkers were sufficient for an accurate diagnosis of appendicitis individually, a combination of physical examination and laboratory and US was a good diagnostic tool for pediatric appendicitis.

Drowning is still one of the most important causes of the preventable mortality worldwide. Some patients should be treated with noninvasive ventilation immediately in the emergency department (ED). The practice of noninvasive ventilation has been increased recently in the paediatric ED. We present here three nonfatal drowning patients with pulmonary oedema and hypoxia who were successfully treated with noninvasive ventilation in the paediatric emergency department. All of the patients had aspirated sea water during swimming. In addition, two of the patients had aspirated water during snorkeling. Noninvasive ventilation was applied to the patients immediately in paediatric emergency service. All of the patient's clinical and radiological findings recovered rapidly. There are limited reports about use of noninvasive ventilation in nonfatal drowning cases in the paediatric emergency department. We emphasize that the early application of noninvasive ventilation should be a preventive method for reducing the morbidity of nonfatal drowning cases. (Hong Kong j.emerg.med. 2016;23:42-46)

Background: Lower respiratory tract infections (LTRIs) are the most common cause of pediatric emergency department visits and are associated with significant morbidity and mortality. The aim of this study was to evaluate the soluble urokinase plasminogen activator receptor (suPAR) levels in pediatric patients with LRTIs and to investigate the correlation of suPAR with disease severity. Methods: This is a prospective case-control study of children with LTRIs. Demographic data, diagnoses, vital signs, disease severity scores, length of hospital stay, laboratory findings, and viral polymerase chain reaction results for nasopharyngeal aspirates were recorded. Blood samples for suPAR were collected and assessed by enzyme-linked immunosorbent assay. Results: There were 94 patients with LTRIs and 32 children in the control group. Patients were further subdivided into 2 groups based on diagnosis of acute bronchiolitis (n: 31, 33%) or pneumonia (n: 63, 67%). The median levels of suPAR were significantly higher in patients with LTRIs than in healthy controls (4.3 and 3.5 ng/mL, respectively; P = 0.003). There was an association between suPAR levels and disease severity in pneumonia patients. suPAR values were higher in patients with severe pneumonia than mild pneumonia (5.5 and 3.6 ng/mL, respectively; P < 0.001). Conclusion:We have shown that suPAR levels increased in patients with LTRIs and suPAR values were higher in patients with severe pneumonia than mild pneumonia. Further studies with large case series are needed to clarify the role of suPAR levels in children with LTRIs.