Objectives-Parents of children who visit the pediatric emergency department (PED) for asthma exacerbations may not receive adequate instruction in preventive asthma care. Our primary objective was to assess knowledge and use of preventive asthma care measures among parents of children with asthma who present to the PED with asthma exacerbations. Our secondary objective was to identify variables that predict adherence to four key preventive care measures.Methods-We administered a 38-item questionnaire to 229 parents of children ages 2 to 18 years with asthma exacerbations who presented to two, urban PEDs, one in the southeast and one in the northwest U.S. Descriptive statistics were calculated to assess parental knowledge of preventive care. Multivariable logistic regression was used to identify variables associated with the use of four key preventive care measures.Results-Thirty-two percent of the children had an action plan, 29% of children ≥ 5 years of age had a peak flow meter, and 52% received the influenza vaccine within the preceding year. Sixtysix percent of the children had persistent asthma by NIH criteria. Of these, 51% received daily inhaled corticosteroids (ICS). When parents were asked how an ICS medicine worked, 29% (64/221) responded "immediately opens the airway", and 24% (53/221) responded "I do not know." Daily use of ICS in these children was significantly associated with parent education level beyond high school (OR=2.81; 95% CI: 1.26, 6.24; P=0.01). Non-African Americans were more likely to have received an action plan than African Americans (OR=2.18; 95% CI:1.17, 4.06; P=0.01). A secondary analysis of the parent's perception of his/her ability to provide care during an asthma exacerbation was significantly associated with receipt of an action plan in a multivariable proportional odds model (OR=3.63; 95% CI: 1.99, 6.62; P<0.001).Corresponding author: Jamie N. Deis, MD, 1100 Sweetflag Lane, Hillsborough, NC 27278, Phone: 615-476-4197, jdeis@wfubmc.edu. Conclusions-Parents of children with persistent asthma presenting to urban tertiary care PEDs with asthma exacerbations frequently have inadequate understanding of appropriate ICS use. Parents with less than a high school education, in particular, may benefit from focused educational interventions which address the importance of daily ICS use in asthma control. Parents who receive a written action plan are more confident in their ability to provide care for their child during an asthma exacerbation. NIH Public AccessAuthor Manuscript J Asthma. Author manuscript; available in PMC 2013 November 19.

Procalcitonin, the prohormone of calcitonin, is a relatively new and innovative marker of bacterial infection that has multiple potential applications in the pediatric emergency department. In healthy individuals, circulating levels of procalcitonin are generally very low (<0.05 ng/mL), but in the setting of severe bacterial infection and sepsis, levels can increase by hundreds to thousands of fold within 4 to 6 hours. Although the exact physiologic function of procalcitonin has not been determined, the consistent response and rapid rise of this protein in the setting of severe bacterial infection make procalcitonin a very useful biomarker for invasive bacterial disease. In Europe, serum procalcitonin measurements are frequently used in the diagnosis and the management of patients in a variety of clinical settings. To date, the use of procalcitonin has been limited in the United States, but this valuable biomarker has many potential applications in both the pediatric emergency department and the intensive care unit. The intent of this article is to review the history of procalcitonin, describe the kinetics of the molecule in response to bacterial infection, describe the laboratory methods available for measuring procalcitonin, examine the main causes of procalcitonin elevation, and evaluate the potential applications of procalcitonin measurements in pediatric patients.

This study examined the characteristics of culture-negative osteoarticular infections (OAIs) during the emergence of methicillin-resistant Staphylococcus aureus. Culture-negative OAIs were mild compared with culture-positive infections, especially those caused by methicillin-resistant Staphylococcus aureus. Despite no increase in severity during the study period, the duration of parenteral antibiotics for children with culture-negative OAIs more than tripled in 2004-2008 compared with 2002-2003.

Noninvasive ventilation (NIV) refers to the delivery of ventilatory support using techniques that do not require an endotracheal airway. Noninvasive ventilation is being used with increased frequency in a variety of clinical situations in the emergency department, intensive care unit, and prehospital environment. This article reviews the history of NIV, the rationale for its use, and the evidence of efficacy in both the adult and pediatric literature. This article also describes equipment and techniques currently available for administration of NIV as well as new trends in noninvasive respiratory support.