Richard M. Cantor, MD, of University Hospital of the State University of New York in Syracuse, provided a fast-paced review of pediatric emergency medicine literature published at the end of 2013 and thus far in 2014. He described it as a summary of, “things that you are doing; things that you should be doing; and things that you don’t want to be getting into.”
Explore This IssueACEP14 Daily News Wednesday: Vol 33 - No10C - October 2014
He began with fever, asking, “Is antipyretic response a predictor of bacterial disease?” The answer is no. Dr. Cantor moved swiftly to surveillance data, revealing that urinary tract infections are becoming increasingly common in young children. “Urine is the way to go with children with a fever,” he noted. White blood cell counts, however, are rarely informative. “Basically, stop getting white counts,” he said. “The higher the white count in a child, the more likely they have pneumonia,” he concluded after a swift review of another paper.
Dr. Cantor highlighted a few older papers of value, one of which was the 2011 Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Disease Society of America The pneumonia guidelines state that blood cultures should not be routinely performed. The guidelines do, however, recommend rapid diagnosis of influenza and other respiratory viruses.
“Don’t get blood cultures,” Dr. Cantor summarized. “Spend some money on viral testing.”
Acute phase reactants cannot be used as the sole determinant to distinguish between viral and bacterial causes of community-acquired pneumonia (CAP). Children with suspected CAP do not require routine measurement of the complete blood cell count or routine chest radiographs. Preschool-aged children with CAP typically don’t require antimicrobial therapy. If mild to moderate CAP is suspected to be of bacterial origin, amoxicillin is recommended for infants and preschool children. Macrolide antibiotics might be more appropriate for school-aged children and adolescents.
Moving rapidly from topic to topic, Dr. Cantor made his way to closed head injury (CHI). “How much vomiting is acceptable in CHI?” he asked. Investigators found that it is rare to find traumatic brain injury by CT. Moreover, clinically important traumatic brain injury is uncommon in children with minor blunt head trauma when vomiting is the only sign and symptom.
“This is a big deal,” Dr. Cantor said. He suggested that observation in the emergency department might be appropriate before determining the need for a CT.
Dr. Pullen is a freelance medical writer based in Chicago.