Background and Aims: Data on acute paediatric anaphylaxis presentations to the emergency department (ED) are limited. All allergic presentations to one Australian paediatric ED were studied to determine epidemiological, clinical, and outcome data. Methods: Retrospective, case based study of patients under 16 years attending one metropolitan, paediatric teaching hospital ED in Australia over three years. The medical records of patients presenting with generalised allergic reactions and anaphylaxis satisfying relevant ICD-9-CM diagnostic codes were studied. The incidence, age, sex ratio, co-morbidities, likely aetiology, clinical features, management, and disposal were determined. Results: A total of 526 children with generalised allergic reactions, and 57 with anaphylaxis were included in the study. This represented incidences of 9.3:1000 ED presentations for generalised allergic reactions and 1:1000 for anaphylaxis. There were no fatalities. In anaphylaxis cases, a cause was recognised in 68.4%. Cutaneous features were present in 82.5%. A past history of asthma was reported in 36.8%. Adrenaline was used in 39.3% of severe anaphylaxis cases. The ED alone definitively cared for 97.8% of all patients. Follow up was inadequate in cases of anaphylaxis. Conclusions: This is the first reported incidence figure for paediatric anaphylaxis ED presentations in Australia, and is less than that reported in adults in the same local population. However, the incidence of generalised allergic reactions of 9.3:1000 was greater than in the adults. Virtually all paediatric allergic cases may be managed in the ED alone, provided that the importance of specialist follow up, particularly for severe anaphylaxis, is recognised.

Paediatric emergency research is hampered by a number of barriers that can be overcome by a multicentre approach. In 2004, an Australia and New Zealand-based paediatric emergency research network was formed, the Paediatric Research in Emergency Departments International Collaborative (PREDICT). The founding sites include all major tertiary children's hospital EDs in Australia and New Zealand and a major mixed ED in Australia. PREDICT aims to provide leadership and infrastructure for multicentre research at the highest standard, facilitate collaboration between institutions, health-care providers and researchers and ultimately improve patient outcome. Initial network-wide projects have been determined. The present article describes the development of the network, its structure and future goals.

This is the first description of the epidemiology of patient presentations to major paediatric ED in Australia and New Zealand. It details baseline data important to future collaborative studies and for planning health services for children.

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The present study devised an age-based method for paediatric weight estimation which should more accurately predict weight than the widely used APLS formula.

Convulsive status epilepticus is an important neurological emergency, with many children experiencing prolonged seizures in both the prehospital and hospital phases. Persistent seizure activity beyond 40 minutes contrasts with current published guidelines. There is a need to adopt a widely accepted approach to the management of children who fail to respond to standard anticonvulsant therapy.

The provision of adequate analgesia and anxiolysis is an important role for emergency physicians. Despite increased awareness of this subject in the medical literature, inadequate attention to pain and anxiety in paediatric patients continues. Recent reviews 1-5 have centred on safety issues in the delivery of sedative drugs in the non-operating room setting and highlight the need for controlled trials of diVerent sedative protocols used in children in varied settings. Ketamine and midazolam are two agents commonly used for sedating children during medical procedures but despite their reported suitability for procedural sedation in the emergency department (ED) setting 1 4 5 their use remains erratic. This study aimed to compare intranasal midazolam (INM) with a combination of intravenous ketamine plus intravenous midazolam (IVKM) for sedation of children requiring minor procedures, such as laceration repair or foreign body removal, in the ambulatory setting. A comparison of these methods in this particular setting has not previously been published. The ED in this study had existing protocols for these techniques and although INM was being used more frequently than IVKM, there were concerns regarding its reliability. We hypothesised that IVKM would more reliably produce a suitable level of sedation for minor procedures than INM and that both doctors and parents would be more satisfied with this method of sedation.

The 'classic' picture of intussusception might frequently not be present in children with intussusception. Reliance on 'classic' features alone might delay diagnosis. Delayed diagnosis is associated with poorer patient outcomes. Air enema has a high success rate for reduction of intussusception.