An interruptive alert as a clinical decision support tool has been implemented to reduce the ordering of unnecessary urine cultures in a tertiary paediatric emergency department. Following its introduction, there was an immediate and sustained reduction in urine culture ordering rates of 25%, with a small increase in cultures with pure growth over a twelve-month period.

We followed up children with Bell’s palsy following completion of a randomised trial on the use of prednisolone. While the vast majority had complete recovery of facial function at 6 months, there were some children without full recovery of facial function at 12 month, regardless of prednisolone use.

AIM:To describe sources of advice and the recommendations given to parents/guardians prior to attending ED with their child. METHODS:This was a prospective observational study of patients presenting to two EDs of a multi-centre Victorian Health service in June 2016. Data collection involved surveying all parents/guardians attending paediatric ED during a 1-week period by trained research assistants. We determined the proportion of eligible respondents who sought advice before attending ED, the source of advice, and the type of advice provided. RESULTS:One thousand sixty-nine patients presented to ED over the 1-week period. There were 730 responses to the survey, of which 65% (477/730) had received a total of 620 recommendations prior to ED attendance. Seventy-six per cent (362/477) had received advice from a single source, 19% (90/477) had received advice from 2 sources, and 5% (25/477) from 3 or more sources. The most common sources of advice were general practice consultations (49%), friends/family (13.5%), and NURSE-ON-CALL (11%). Fifty-four per cent (335/620) of the recommendations were to attend ED immediately and 12% (77/620) were to attend if their child was getting worse. CONCLUSIONS:Most parents and guardians sought advice from a single source prior to attending an ED. The most common source of advice was consultation with a general practitioner and the most common recommendation was to attend ED immediately, or if their child's condition worsened.

OBJECTIVE:The aim of this study was to compare injury circumstances, characteristics, and clinical management of emergency department (ED) presentations for sports-related concussion (SRC) and non-SRC. METHODS:This multicenter prospective observational study identified patients 5-17 years old who presented to EDs within 24 hours of head injury, with one or more signs or symptoms of concussion. Participants had a Glasgow Coma Scale score of 13-15 and no abnormalities on CT (if performed). Data were stratified by age: young children (5-8 years), older children (9-12 years), and adolescents (13-17 years). RESULTS:Of 4709 patients meeting the concussion criteria, non-SRC accounted for 56.3% of overall concussions, including 80.9% of younger child, 51.1% of older child, and 37.0% of adolescent concussions. The most common mechanism of non-SRC was falls for all ages. The most common activity accounting for SRC was bike riding for younger children, and rugby for older children and adolescents. Concussions occurring in sports areas, home, and educational settings accounted for 26.2%, 21.8%, and 19.0% of overall concussions. Concussions occurring in a sports area increased with age, while occurrences in home and educational settings decreased with age. The presence of amnesia significantly differed for SRC and non-SRC for all age groups, while vomiting and disorientation differed for older children and adolescents. Adolescents with non-SRC were admitted to a ward and underwent CT at higher proportions than those with SRC. CONCLUSIONS:Non-SRC more commonly presented to EDs overall, with SRC more common with increasing age. These data provide important information to inform public health policies, guidelines, and prevention efforts.

OBJECTIVE:To describe the prevalence and severity of pain experienced by children with Bell's palsy over the first 6 months of illness and its association with the severity of facial paralysis.METHODS:This was a secondary analysis of data obtained in a phase III, triple-blinded, randomised, placebo-controlled trial of prednisolone for the treatment of Bell's palsy in children aged 6 months to <18 years conducted between 13 October 2015 and 23 August 2020 in Australia and New Zealand. Children were recruited within 72 hours of symptom onset and pain was assessed using a child-rated visual analogue scale (VAS), a child-rated Faces Pain Score-Revised (FPS-R) and/or a parent-rated VAS at baseline, and at 1, 3 and 6 months until recovered, and are reported combined across treatment groups.RESULTS:Data were available for 169 of the 187 children randomised from at least one study time point. Overall, 37% (62/169) of children reported any pain at least at one time point. The frequency of any pain reported using the child-rated VAS, child-rated FPS-R and parent-rated VAS was higher at the baseline assessment (30%, 23% and 27%, respectively) compared with 1-month (4%, 0% and 4%, respectively) and subsequent follow-up assessments. At all time points, the median pain score on all three scales was 0 (no pain).CONCLUSIONS:Pain in children with Bell's palsy was infrequent and primarily occurred early in the disease course and in more severe disease. The intensity of pain, if it occurs, is very low throughout the clinical course of disease.TRIAL REGISTRATION NUMBER:ACTRN12615000563561.

Background and Objectives Bell palsy is the third most frequent diagnosis in children with sudden-onset neurologic dysfunction. The cost-effectiveness of treating Bell palsy with prednisolone in children is unknown. We aimed to assess the cost-effectiveness of prednisolone in treating Bell palsy in children compared with placebo. Methods This economic evaluation was a prospectively planned secondary analysis of a double-blinded, randomized, placebo-controlled superiority trial (Bell Palsy in Children [BellPIC]) conducted from 2015 to 2020. The time horizon was 6 months since randomization. Children aged 6 months to <18 years who presented within 72 hours of onset of clinician-diagnosed Bell palsy and who completed the trial were included (N = 180). Interventions were oral prednisolone or taste-matched placebo administered for 10 days. Incremental cost-effectiveness ratio comparing prednisolone with placebo was estimated. Costs were considered from a health care sector perspective and included Bell palsy–related medication cost, doctor visits, and medical tests. Effectiveness was measured using quality-adjusted life-years (QALYs) based on Child Health Utility 9D. Nonparametric bootstrapping was performed to capture uncertainties. Prespecified subgroup analysis by age 12 to <18 years vs <12 years was conducted. Results The mean cost per patient was A$760 in the prednisolone group and A$693 in the placebo group over the 6-month period (difference A$66, 95% CI −A$47 to A$179). QALYs over 6 months were 0.45 in the prednisolone group and 0.44 in the placebo group (difference 0.01, 95% CI −0.01 to 0.03). The incremental cost to achieve 1 additional recovery was estimated to be A$1,577 using prednisolone compared with placebo, and cost per additional QALY gained was A$6,625 using prednisolone compared with placebo. Given a conventional willingness-to-pay threshold of A$50,000 per QALY gained (equivalent to US$35,000 or £28,000), prednisolone is very likely cost-effective (probability is 83%). Subgroup analysis suggests that this was primarily driven by the high probability of prednisolone being cost-effective in children aged 12 to <18 years (probability is 98%) and much less so for those <12 years (probability is 51%). Discussion This provides new evidence to stakeholders and policymakers when considering whether to make prednisolone available in treating Bell palsy in children aged 12 to <18 years. Trial Registration Information Australian New Zealand Clinical Trials Registry ACTRN12615000563561.

OBJECTIVES:Despite significant treatment advances in paediatric diabetes management, ED presentations for potentially preventable (PP) complications such as diabetic ketoacidosis (DKA) remains a major issue. We aimed to examine the characteristics, rates and trends of diabetes-related ED presentations and subsequent admissions in youth aged 0-19 years from 2008 to 2018. METHODS:Data were obtained from the Victorian Emergency Minimum Dataset and the National Diabetes Register. A diabetes-related ED presentation is defined using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification diagnosis codes. 'Non-preventable' presentations were the number of youths with newly diagnosed diabetes, and the remaining are classified as PP diabetes-related presentations. Poisson regression model was used to examine the trends in incidence rate and prevalence. RESULTS:Four thousand eight hundred and seventy-two (59%) of 8220 presentations were PP, 4683 (57%) were for DKA whereas 6200 (82%) required hospital admission. Diabetes-related ED presentations decreased from 38.4 to 27.5 per 100 youth with diabetes per year between 2008 and 2018 (β = -0.04; confidence interval [CI] -0.04 to -0.03; P < 0.001). Females, those aged 0-4 years and rural youth had higher rates of ED presentations than males, older age groups and metropolitan youth. DKA presentations decreased from 20.1 presentations per 100 youth with diabetes in 2008-2009 to 14.9 presentations per 100 youth with diabetes in 2017-2018. The rate of DKA presentations was 68% higher in rural areas compared to metropolitan areas (incidence rate ratio 1.68; CI 1.59-1.78; P < 0.001). CONCLUSIONS:Although the rates of diabetes-related ED presentations declined, PP diabetes-related presentations and subsequent hospitalisation remain high. Patient level research is required to understand the increased DKA presentations in rural youth.

AimsTo compare and evaluate the number of paediatric patients classified as ‘suitable for primary care’ using the Australian Institute of Health and Welfare (AIHW) method, the Australasian College for Emergency Medicine (ACEM) method, and parental judgement.MethodsThis was a prospective observational study enrolling parents/carers presenting with their children to two Victorian EDs in Victoria, Australia over a 1‐week period. Trained research assistants were posted within both EDs and surveyed all eligible parents/carers whether they agreed with the statement ‘I think a GP would be able to look after my child's current illness/injury’. Survey responses were linked to clinical outcomes and length of stay. Each presentation was classified as suitable for primary care using the AIHW method, the ACEM method and parental survey. Agreement between definitions was assessed using Cohen's kappa statistic.ResultsDuring the study (June 2016), 1069 patients presented to the two EDs; 677 patients were able to be classified under all three definitions (AIHW: 1069, ACEM: 991, survey: 677 patients). Only 80/677 (12%) patients met all three criteria. Agreement was slight between the parent survey and the ACEM method (K = 0.14, 95% confidence interval (CI) 0.06–0.21), and the parent survey and the AIHW method (K = 0.12, 95% CI 0.05–0.19). There was moderate agreement between the ACEM and AIHW methods (K = 0.45, 95% CI 0.39–0.51).ConclusionsThere is very poor agreement on what defines a ‘primary care‐type’ paediatric patient between the definitions used by government, professional bodies and caregivers.

IntroductionThe cost effectiveness of treating Bell’s palsy with prednisolone in children is unknown. This study aimed to assess the cost effectiveness of prednisolone, compared with placebo, in treating Bell’s Palsy in children from a healthcare sector perspective.MethodsThis economic evaluation was a prospectively planned secondary analysis of a triple-blind randomized superiority trial conducted from 2015 to 2020 that compared prednisolone with placebo. The time horizon was six months after randomization. The 180 participants were aged from six months to 17 years and presented within 72 hours of onset of clinician diagnosed Bell’s palsy. Interventions were oral prednisolone (1 mg per kg daily) or taste-matched placebo administered for ten days. Incremental cost-effectiveness ratios comparing prednisolone with placebo were estimated. Costs included medication costs, doctor visits, and medical tests over the six-month study period. Effectiveness was measured using quality-adjusted life-years (QALYs) derived from the Child Health Utility 9D instrument. Nonparametric bootstrapping was performed to capture uncertainties. Prespecified subgroup analyses by age (12 to 17 years versus <12 years) were performed.ResultsThe mean cost per patient was USD188 in the prednisolone group and USD121 in the placebo group over the six-month period (difference USD66, 95% confidence interval [CI]: 47, 179). The mean QALYs gained over six months were 0.45 in the prednisolone group and 0.44 in the placebo group (difference 0.01, 95%CI: -0.01, 0.03). Prednisolone was very likely cost effective given a conventional willingness-to-pay threshold of USD 50,000 per QALY gained (the cost per additional QALY gained was USD6,625 using prednisolone compared with placebo). Subgroup analysis suggested that this was primarily driven by the high probability of prednisolone being cost effective in children aged 12 to 17 years (98%), compared with those younger than 12 years (51%).ConclusionsThis study provides new evidence to stakeholders and policy makers who are considering whether to make prednisolone available for treating Bell’s palsy in children aged 12 to 17 years.

Objective To estimate traumatic brain injuries (TBIs) and acute care costs due to sports activities.Methods A planned secondary analysis of 7799 children from 5 years old to <18 years old with head injuries enrolled in a prospective multicentre study between 2011 and 2014. Sports-related TBIs were identified by the epidemiology codes for activity, place and injury mechanism. The sports cohort was stratified into two age groups (younger: 5–11 and older: 12–17 years). Acute care costs from the publicly funded Australian health system perspective are presented in 2018 pound sterling (£).Results There were 2903 children (37%) with sports-related TBIs. Mean age was 12.0 years (95% CI 11.9 to 12.1 years); 78% were male. Bicycle riding was associated with the most TBIs (14%), with mean per-patient costs of £802 (95% CI £644 to £960) and 17% of acute costs. The highest acute costs (21%) were from motorcycle-related TBIs (3.8% of injuries), with mean per-patient costs of £3795 (95% CI £1850 to £5739). For younger boys and girls, bicycle riding was associated with the highest TBIs and total costs; however, the mean per-patient costs were highest for motorcycle and horse riding, respectively. For older boys, rugby was associated with the most TBIs. However, motorcycle riding had the highest total and mean per-patient acute costs. For older girls, horse riding was associated with the most TBIs and highest total acute costs, and motorcycle riding was associated with the highest mean per-patient costs.Conclusion Injury prevention strategies should focus on age-related and sex-related sports activities to reduce the burden of TBIs in children.Trial registration number ACTRN12614000463673.

OBJECTIVE:Incidence and short-term outcomes of clinically important traumatic brain injury (ciTBI) in head-injured children presenting to ED with post-traumatic seizure (PTS) is not described in current literature. METHODS:Planned secondary analysis of a prospective observational study undertaken in 10 Australasian Paediatric Research in Emergency Departments International Collaborative (PREDICT) network EDs between 2011 and 2014 of head-injured children <18 years with and without PTS. Clinical predictors and outcomes were analysed by attributable risk (AR), risk ratios (RR) and 95% confidence interval (CI), including the association with Glasgow Coma Scale (GCS) scores. RESULTS:Of 20 137 head injuries, 336 (1.7%) had PTS with median age of 4.8 years. Initial GCS was 15 in 268/336 (79.8%, AR -16.1 [95% CI -20.4 to -11.8]), 14 in 24/336 (7.1%, AR 4.4 [95% CI 1.6-7.2]) and ≤13 in 44/336 (13.1%, AR 11.7 [95% CI 8.1-15.3]) in comparison with those without PTS, respectively. The ciTBI rate was 34 (10.1%) with PTS versus 219 (1.1%) without PTS (AR 9.0 [95% CI 5.8-12.2]) with 5/268 (1.9%), 6/24 (25.0%) and 23/44 (52.3%) with GCS 15, 14 and ≤13, respectively. In PTS, rates of admission ≥2 nights (34 [10.1%] AR 9.0 [95% CI 5.8-12.3]), intubation >24 h (9 [2.7%] AR 2.5 [95% CI 0.8-4.2]) and neurosurgery (8 [2.4%] AR 2.0 [95% CI 0.4-3.7]), were higher than those without PTS. Children with PTS and GCS 15 or 14 had no neurosurgery, intubations or death, with two deaths in children with PTS and GCS ≤13. CONCLUSIONS:PTS was uncommon in head-injured children presenting to the ED but associated with an increased risk of ciTBI in those with reduced GCS on arrival.

BACKGROUND AND OBJECTIVES:Corticosteroids are used to treat the early stages of idiopathic facial paralysis (Bell palsy) in children, but their effectiveness is uncertain. We set out to determine whether prednisolone improves the proportion of children with Bell palsy with complete recovery at 1 month. METHODS:We conducted a double-blind, placebo-controlled, randomized trial of prednisolone in children presenting to emergency departments with Bell palsy. Patients aged 6 months to younger than 18 years were recruited within 72 hours after the symptom onset and were randomly assigned to receive 10 days of treatment with oral prednisolone (approximately 1 mg/kg) or placebo. The primary outcome was complete recovery of facial function at 1 month rated on the House-Brackmann scale. Secondary outcomes included facial function, adverse events, and pain up to 6 months. Target recruitment was n = 540 (270 per group). RESULTS:Between October 13, 2015, and August 23, 2020, 187 children were randomized (94 to prednisolone and 93 to placebo) and included in the intention-to-treat analysis. At 1 month, the proportions of patients who had recovered facial function were 49% (n = 43/87) in the prednisolone group compared with 57% (n = 50/87) in the placebo group (risk difference -8.1%, 95% CI -22.8 to 6.7; adjusted odds ratio [aOR] 0.7, 95% CI 0.4 to 1.3). At 3 months, these proportions were 90% (n = 71/79) for the prednisolone group vs 85% (n = 72/85) for the placebo group (risk difference 5.2%, 95% CI -5.0 to 15.3; aOR 1.2, 95% CI 0.4 to 3.0) and, at 6 months, 99% (n = 77/78) and 93% (n = 76/82), respectively (risk difference 6.0%, 95% CI -0.1 to 12.2; aOR 3.0, 95% CI 0.5 to 17.7). There were no serious adverse events and little evidence for group differences in secondary outcomes. DISCUSSION:In children with Bell palsy, the vast majority recover without treatment. This study, although underpowered, does not provide evidence that early treatment with prednisolone improves complete recovery. TRIAL REGISTRATION INFORMATION:Registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000563561, registered June 1, 2015. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368505&isReview=true. CLASSIFICATION OF EVIDENCE:This study provides Class I evidence that for children with Bell palsy, prednisolone does not significantly change recovery of complete facial function at 1 month. However, this study lacked the precision to exclude an important harm or benefit from prednisolone.

Background and Objectives Corticosteroids are used to treat the early stages of idiopathic facial paralysis (Bell palsy) in children, but their effectiveness is uncertain. We set out to determine whether prednisolone improves the proportion of children with Bell palsy with complete recovery at 1 month. Methods We conducted a double-blind, placebo-controlled, randomized trial of prednisolone in children presenting to emergency departments with Bell palsy. Patients aged 6 months to younger than 18 years were recruited within 72 hours after the symptom onset and were randomly assigned to receive 10 days of treatment with oral prednisolone (approximately 1 mg/kg) or placebo. The primary outcome was complete recovery of facial function at 1 month rated on the House-Brackmann scale. Secondary outcomes included facial function, adverse events, and pain up to 6 months. Target recruitment was n = 540 (270 per group). Results Between October 13, 2015, and August 23, 2020, 187 children were randomized (94 to prednisolone and 93 to placebo) and included in the intention-to-treat analysis. At 1 month, the proportions of patients who had recovered facial function were 49% (n = 43/87) in the prednisolone group compared with 57% (n = 50/87) in the placebo group (risk difference −8.1%, 95% CI −22.8 to 6.7; adjusted odds ratio [aOR] 0.7, 95% CI 0.4 to 1.3). At 3 months, these proportions were 90% (n = 71/79) for the prednisolone group vs 85% (n = 72/85) for the placebo group (risk difference 5.2%, 95% CI −5.0 to 15.3; aOR 1.2, 95% CI 0.4 to 3.0) and, at 6 months, 99% (n = 77/78) and 93% (n = 76/82), respectively (risk difference 6.0%, 95% CI −0.1 to 12.2; aOR 3.0, 95% CI 0.5 to 17.7). There were no serious adverse events and little evidence for group differences in secondary outcomes. Discussion In children with Bell palsy, the vast majority recover without treatment. This study, although underpowered, does not provide evidence that early treatment with prednisolone improves complete recovery. Trial Registration Information Registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000563561, registered June 1, 2015. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368505&isReview=true. Classification of Evidence This study provides Class I evidence that for children with Bell palsy, prednisolone does not significantly change recovery of complete facial function at 1 month. However, this study lacked the precision to exclude an important harm or benefit from prednisolone.

Paediatric head injuries (PHI) are the most common cause of trauma‐related emergency department (ED) presentations. This study sought to report the incidence of PHI in Australia, examine the temporal trends from 2014 to 2018 and estimate the patient and population‐level acute care costs.

Objective To evaluate the cost-effectiveness of planned observation on cranial CT use in children with minor head trauma. Design Planned secondary analysis of a multicentre prospective observation study. Setting Australia and New Zealand. Patients An analytic cohort of 18 471 children aged <18 years with Glasgow Coma Scale scores 14-15 presenting <24 hours after blunt head trauma stratified by the Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) risk categories. Intervention A plan for observation and immediate CT scan were documented after the initial assessment. The planned observation group included those with planned observation and no immediate plan for CT. Main outcome measures Taking an Australian public-funded healthcare perspective, we estimated the cost-effectiveness of planned observation on the adjusted mean costs per child and CT use reduction by net benefit regression analysis using ordinary least squares with robust SEs and bootstrapping. All costs presented in 2018 euros. Results Planned observation in 4945 (27%) children was cost-saving of (sic)85 (95% CI -120 to -51) with 10.4% lower CT use (95% CI 9.6 to 11.2). This strategy was cost-saving for the PECARN high-risk (-(sic)757 (95% CI -961 to -554)) and intermediate-risk (-(sic)52 (95% CI -99 to -4.3)) categories, with 43% (95% CI 39 to 47) and 11% (95% CI 9.6 to 12.4) lower CT use, respectively. The very low-risk category incurred more cost of (sic)86 (95% CI 67 to 104) with planned observation and 0.05% lower CT use (95% CI -0.61 to 0.71). Conclusion Planned ED observation in selected children with minor head trauma is cost-effective for reducing CT use for the PECARN intermediate-risk and high-risk categories.

BACKGROUND:The Pediatric Emergency Care Applied Research Network (PECARN) head trauma clinical decision rules informed the development of algorithms that risk stratify the management of children based on their risk of clinically important traumatic brain injury (ciTBI). We aimed to determine the rate of ciTBI for each PECARN algorithm risk group in an external cohort of patients and that of ciTBI associated with different combinations of high- or intermediate-risk predictors.METHODS:This study was a secondary analysis of a large multicenter prospective data set, including patients with Glasgow Coma Scale scores of 14 or 15 conducted in Australia and New Zealand. We calculated ciTBI rates with 95% confidence intervals (CIs) for each PECARN risk category and combinations of related predictor variables.RESULTS:Of the 15,163 included children, 4,011 (25.5%) were aged <2 years. The frequency of ciTBI was 8.5% (95% CI = 6.0%-11.6%), 0.2% (95% CI = 0.0%-0.6%), and 0.0% (95% CI = 0.0%-0.2%) in the high-, intermediate-, and very-low-risk groups, respectively, for children <2 years and 5.7% (95% CI = 4.4%-7.2%), 0.7% (95% CI = 0.5%-1.0%), and 0.0% (95% CI = 0.0%-0.1%) in older children. The isolated high-risk predictor with the highest risk of ciTBI was "signs of palpable skull fracture" for younger children (11.4%, 95% CI = 5.3%-20.5%) and "signs of basilar skull fracture" in children ≥2 years (11.1%, 95% CI = 3.7%-24.1%). For older children in the intermediate-risk category, the presence of all four predictors had the highest risk of ciTBI (25.0%, 95% CI = 0.6%-80.6%) followed by the combination of "severe mechanism of injury" and "severe headache" (7.7%, 95% CI = 0.2%-36.0%). The very few children <2 years at intermediate risk with ciTBI precluded further analysis.CONCLUSIONS:The risk estimates of ciTBI for each of the PECARN algorithms risk group were consistent with the original PECARN study. The risk estimates of ciTBI within the high- and intermediate-risk predictors will help further refine clinical judgment and decision making on neuroimaging.

BACKGROUND:Children rarely experience critical illness, resulting in low exposure of emergency physicians (EPs) to critical procedures. Our primary objective was to describe senior EP confidence, most recent performance, and/or supervision of critical nonairway procedures. Secondary objectives were to compare responses between those who work exclusively in PEM and those who do not and to determine whether confidence changed for selected procedures according to increasing patient age.METHODS:Survey of senior EPs working in 96 emergency departments (EDs) affiliated with the Pediatric Emergency Research Networks. Questions assessed training, performance, supervision, and confidence in 11 nonairway critical procedures, including cardiopulmonary resuscitation (CPR), vascular access, chest decompression, and cardiac procedures.RESULTS:Of 2446 physicians, 1503 (61%) responded to the survey. Within the previous year, only CPR and insertion of an intraosseous needle had been performed by at least 50% of respondents: over 20% had performed defibrillation/direct current cardioversion. More than 50% of respondents had never performed or supervised ED thoracotomy, pericardiocentesis, venous cutdown, or transcutaneous pacing. Self-reported confidence was high for all patient age groups for CPR, needle thoracocentesis, tube thoracostomy, intraosseous needle insertion, and defibrillation/DC cardioversion. Confidence levels increased with increasing patient age for central venous and arterial line insertion. Respondents working exclusively in PEM were more likely to report being at least somewhat confident in defibrillation/DC cardioversion, intraosseous needle insertion, and central venous line insertion in particular age groups; however, they were less likely to be at least somewhat confident in ED thoracotomy and transcutaneous pacing.CONCLUSIONS:Cardiopulmonary resuscitation and intraosseous needle insertion were the only critical nonairway procedures performed by at least half of EPs within the previous year. Confidence was higher for these procedures, and needle and tube thoracostomy. These data may inform the development of continuing medical education activities to maintain pediatric procedural skills for emergency physicians.

Emergency Medicine AustralasiaVolume 33, Issue 4 p. 769-771 Letter to the Editor Seizure- and syncope-related head injuries in children: A prospective PREDICT cohort study Nitaa Eapen, Nitaa Eapen Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia Murdoch Children's Research Institute, Melbourne, Victoria, AustraliaSearch for more papers by this authorAmit Kochar, Amit Kochar Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, AustraliaSearch for more papers by this authorMark D Lyttle, Mark D Lyttle Emergency Department, Bristol Royal Hospital for Children, Bristol, UK Faculty of Health and Life Sciences, University of the West of England, Bristol, UKSearch for more papers by this authorNatalie Phillips, Natalie Phillips orcid.org/0000-0002-7616-5712 Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, AustraliaSearch for more papers by this authorJohn A Cheek, John A Cheek orcid.org/0000-0002-3615-3821 Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia Murdoch Children's Research Institute, Melbourne, Victoria, Australia Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, AustraliaSearch for more papers by this authorJeremy Furyk, Jeremy Furyk Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, AustraliaSearch for more papers by this authorJocelyn Neutze, Jocelyn Neutze Emergency Department, Kidz First Middlemore Hospital, Auckland, New ZealandSearch for more papers by this authorSilvia Bressan, Silvia Bressan Murdoch Children's Research Institute, Melbourne, Victoria, Australia Department of Women's and Children's Health, University of Padova, Padova, ItalySearch for more papers by this authorAmanda Williams, Amanda Williams Murdoch Children's Research Institute, Melbourne, Victoria, AustraliaSearch for more papers by this authorStephen Hearps, Stephen Hearps Murdoch Children's Research Institute, Melbourne, Victoria, AustraliaSearch for more papers by this authorEd Oakley, Ed Oakley orcid.org/0000-0002-3712-6200 Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia Murdoch Children's Research Institute, Melbourne, Victoria, Australia Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, AustraliaSearch for more papers by this authorStuart R Dalziel, Stuart R Dalziel Emergency Department, Starship Children's Health, Auckland, New Zealand Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New ZealandSearch for more papers by this authorMeredith L Borland, Meredith L Borland Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia School of Medicine, Divisions of Emergency Medicine and Paediatrics, The University of Western Australia, Perth, Western Australia, AustraliaSearch for more papers by this authorFranz E Babl, Franz E Babl orcid.org/0000-0002-1107-2187 Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia Murdoch Children's Research Institute, Melbourne, Victoria, Australia Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, AustraliaSearch for more papers by this authorPaediatric Research in Emergency Departments International Collaborative (PREDICT), Paediatric Research in Emergency Departments International Collaborative (PREDICT)Search for more papers by this author Nitaa Eapen, Nitaa Eapen Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia Murdoch Children's Research Institute, Melbourne, Victoria, AustraliaSearch for more papers by this authorAmit Kochar, Amit Kochar Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, AustraliaSearch for more papers by this authorMark D Lyttle, Mark D Lyttle Emergency Department, Bristol Royal Hospital for Children, Bristol, UK Faculty of Health and Life Sciences, University of the West of England, Bristol, UKSearch for more papers by this authorNatalie Phillips, Natalie Phillips orcid.org/0000-0002-7616-5712 Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, AustraliaSearch for more papers by this authorJohn A Cheek, John A Cheek orcid.org/0000-0002-3615-3821 Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia Murdoch Children's Research Institute, Melbourne, Victoria, Australia Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, AustraliaSearch for more papers by this authorJeremy Furyk, Jeremy Furyk Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, AustraliaSearch for more papers by this authorJocelyn Neutze, Jocelyn Neutze Emergency Department, Kidz First Middlemore Hospital, Auckland, New ZealandSearch for more papers by this authorSilvia Bressan, Silvia Bressan Murdoch Children's Research Institute, Melbourne, Victoria, Australia Department of Women's and Children's Health, University of Padova, Padova, ItalySearch for more papers by this authorAmanda Williams, Amanda Williams Murdoch Children's Research Institute, Melbourne, Victoria, AustraliaSearch for more papers by this authorStephen Hearps, Stephen Hearps Murdoch Children's Research Institute, Melbourne, Victoria, AustraliaSearch for more papers by this authorEd Oakley, Ed Oakley orcid.org/0000-0002-3712-6200 Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia Murdoch Children's Research Institute, Melbourne, Victoria, Australia Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, AustraliaSearch for more papers by this authorStuart R Dalziel, Stuart R Dalziel Emergency Department, Starship Children's Health, Auckland, New Zealand Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New ZealandSearch for more papers by this authorMeredith L Borland, Meredith L Borland Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia School of Medicine, Divisions of Emergency Medicine and Paediatrics, The University of Western Australia, Perth, Western Australia, AustraliaSearch for more papers by this authorFranz E Babl, Franz E Babl orcid.org/0000-0002-1107-2187 Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia Murdoch Children's Research Institute, Melbourne, Victoria, Australia Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, AustraliaSearch for more papers by this authorPaediatric Research in Emergency Departments International Collaborative (PREDICT), Paediatric Research in Emergency Departments International Collaborative (PREDICT)Search for more papers by this author First published: 08 June 2021 https://doi.org/10.1111/1742-6723.13812Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume33, Issue4August 2021Pages 769-771 RelatedInformation

Objective To establish, in children aged from 3 months to less than 13 years with a febrile illness, caregiver medication usage patterns and drivers. Secondary objectives assessed caregiver knowledge and concern about fever. Methodology This was a prospective, observational study of a convenience sample of 147 children presenting to a tertiary Paediatric Emergency Department, where the caregivers reported a concern of fever within the preceding 48 h. A paper-based survey was completed by the caregivers, and the results analysed both qualitatively and quantitatively. Results Caregivers of 92.4% had administered medication for fever in the 48 h prior to presentation. Dual therapy of paracetamol and ibuprofen was used by 45.8%, with paracetamol used more frequently as monotherapy (35.4%). Almost one-third of caregivers woke their child to administer medication. Just over one-third of respondents stated that a temperature of less than 38.0 degrees C is a fever. The majority of caregivers (67.6%) said that fever is bad for their child, with 97.9% being concerned by fever. Almost half the children (46.8%) were given medication purely to treat the degree of the temperature. General practitioners were reported as the strongest influence on medication decision (60%). Conclusions This study provides insight into current knowledge and practices of parents regarding fever and its treatment. The results of this study may be used to direct future interventions to educate caregivers on this topic.