[This corrects the article DOI: 10.3389/fped.2026.1803886.].

BackgroundIdentifying infectious etiology in pediatric emergency medicine can be challenging, often leading to antibiotic misuse. MeMed BV (MMBV) is a host-protein test that accurately differentiates bacterial from viral infections, but real-world utility data in children are limited.MethodsWe performed a single-center retrospective study of preschool-aged children enrolled in two pragmatic cohort studies, where MMBV was ordered at physician discretion. In the “pre” study, MMBV results were not available (standard of care, SC arm), whereas in the “post” study, MMBV results were available in a timely manner (MMBV arm). The primary endpoint was change in antibiotic prescribing rate among outpatients with viral MMBV results. Secondary endpoints included prescribing rate changes in a lower respiratory tract infection (LRTI) subcohort and changes in hospital length of stay (LOS).ResultsThe study cohort included 1,022 children in the SC arm and 474 in the MMBV arm. Antibiotic prescribing in outpatients with viral MMBV results decreased from 20.3% in the SC arm to 7.5% in the MMBV arm (p = 0.007). Prescribing increased in outpatients with bacterial MMBV results (p = 0.111), resulting in a net decline across outpatients in the SC versus MMBV arms (25.0% vs. 16.8%; p = 0.071). In the LRTI subcohort, there was a prescribing decreased (84.0% to 67.9%; p = 0.002) irrespective of patient disposition. Despite more severe clinical presentation, patients in the MMBV arm had a shorter length of stay (LOS) compared with patients in the SC arm (3.1 ± 1.9 vs. 3.6 ± 1.9 days; p < 0.001).ConclusionsImplementation of MMBV in routine pediatric emergency care was associated with optimized antibiotic use and shorter hospital LOS.

Severe pediatric odontogenic infections may result from caries, periodontal issues, or direct trauma. Untreated, they can cause serious complications. Treatment protocols vary between hospitals. This study compared patient characteristics, treatment outcomes, and hospitalization parameters in two Israeli hospitals. A retrospective (2018–2021) cohort study included patients under 18 suffering from dental infections treated at the Maxillofacial Surgery Department of Rambam Health Care Campus (RHCC) in Haifa, Israel, or the Pediatrics Department of Hillel Yaffe Medical Center (HYMC) in Hadera, Israel. Data included patient demographics, clinical evaluations, treatments, and hospitalization details. Treatment protocols, which differed by hospital policy, served as the predictor variable (HYMC: hospitalization with IV antibiotics; RHCC: tooth extraction with subperiosteal drainage). The primary and secondary outcomes were hospitalization duration and days to clinical improvement, respectively. A total of 156 patients (78 per hospital) were enrolled. The total hospitalization period was twice as long at HYMC compared to RHCC (3.6 ± 1.2 vs. 1.9 ± 0.7; p < 0.001), and the time to clinical improvement was nearly three times higher (3.5 ± 1.3 vs. 1.1 ± 0.3; p < 0.001). The study demonstrates that surgical treatment results in faster clinical improvement and shorter hospitalization, indicating the need for personalized treatment protocols to optimize patient outcomes.

Purpose:To compare dosing error rates between computerized physician order entry (CPOE) and free-text electronic prescribing in hospitalized children during the same time period, given inconsistent evidence regarding the effectiveness of CPOE in pediatric settings. Patients and Methods:We conducted a retrospective multicenter cohort study across four Israeli general hospitals between July 1, 2022, and December 31, 2023. A computerized algorithm analyzed the ten most frequently administered systemic medications and flagged potential dosing errors defined as a ≥20% deviation from weight-based recommendations. All flagged prescriptions underwent blinded independent review by a senior pediatrician with toxicology expertise and a pediatric clinical pharmacist to confirm clinical significance. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs). Results:Of 122,869 medication orders for 63,081 children, the confirmed error rate was 3.6%. In unadjusted analyses, dosing errors were more frequent with CPOE than with manual prescribing (3.8% vs 2.8%; p<0.001). After adjustment, CPOE was not associated with a significant overall difference in error risk (aOR 0.98; 95% confidence interval [CI] 0.88-1.09). In the enteral-only analysis, CPOE was associated with a 33% higher risk of errors in enteral medications (aOR 1.33; 95% CI 1.18-1.51; p<0.001). Error risk also varied by hospital site, patient weight, care setting, and administration route. Conclusion:In real-world pediatric settings, CPOE was not associated with a lower overall incidence of dosing errors, and higher error rates were observed among enteral medications. These results suggest that CPOE may introduce route-specific vulnerabilities, highlighting the need for system-specific optimization rather than assuming electronic ordering is inherently safer.

IntroductionTumor Necrosis Factor-Related Apoptosis-Inducing Ligand (TRAIL) has a potential role in the immune response to infections. This study investigated the association between serum TRAIL levels and illness severity in children with suspected infection.MethodsA retrospective post hoc analysis was conducted in children aged 4 months to 18 years who underwent MeMed BV testing during emergency department evaluation for suspected acute infection. Patients were categorized by serum TRAIL levels using a prespecified cutoff of ≤40 pg/mL vs. >40 pg/mL. Clinical and demographic data were compared between groups, with illness severity at presentation as the primary outcome.ResultsThe analysis included 104 children, with 52 children in each TRAIL group. Children with TRAIL levels ≤40 pg/mL had longer hospitalization duration (4.06 ± 3.5 days vs. 2.50 ± 3.5 days, p = 0.026), higher pulse rates (147.9 ± 24.2 bpm vs. 135.5 ± 25.1 bpm, p = 0.012), and more abnormal white blood cell counts (67.3% vs. 36.5%, p = 0.003). They also had higher maximal C-reactive protein levels [128.6 [55.7–180.7] mg/L vs. 22.5 [4.4–56.2] mg/L, p < 0.001] and were more likely to receive antibiotics (85% vs. 42%, p < 0.001) and to require changes in antibiotic therapy (58% vs. 13.5%, p < 0.001). Illness severity differed significantly between groups, with severe illness observed in 44.2% of children with TRAIL ≤40 pg/mL compared with 9.6% in those with TRAIL >40 pg/mL (p < 0.001).A TRAIL cutoff of ≤40 pg/mL showed moderate discriminatory performance for severe illness (AUROC 0.73), with 82.1% sensitivity, 61.8% specificity, PPV 44.2%, and NPV 90.4%.DiscussionLower serum TRAIL levels in children were associated with more severe illness, as evidenced by extended hospital stays, increased antibiotic use, and more severe clinical presentations. These findings suggest an association between low TRAIL levels and illness severity, although differences in infection etiology between groups should be considered.

Abstract Background The gold standard for detecting infections associated with bacteremia is blood cultures. Blood culture yield is low, contamination is frequent and results take 12-48 hours. MeMed BV® is a rapid, FDA-cleared, host-protein test to differentiate bacterial and viral infection, with sensitivity and specificity >90%, and negative predictive value >98%. Here, we assessed its performance in detecting bacteremia in children as early detection of invasive infections is paramount. Methods Multi-cohort analysis of 7 prospective diagnostic accuracy studies of febrile children with suspected infection at the Emergency Department and inpatients. Eligibility required inclusion in the original study, age 3 months to 5 years and blood culture ordered. Reference standard infection etiology was adjudicated by 3 experts based on review of comprehensive patient data including clinical outcomes. Experts were blinded to MeMed BV results. Cases with bacterial reference standard and positive blood cultures adjudicated as having non-contaminant growth were defined as bacteremia. Results 1987 patients were studied. The median age was 1.3 years (interquartile range 0.8-2.4); 54.6% were male and 46.7% were hospitalized. The most common ED discharge diagnoses were viral infection (33.6%), upper respiratory tract infection (20.0%), lower respiratory tract infection (16.1%). The prevalence of bacterial infection was 15.4%. MeMed BV diagnostic performance was evaluated against the reference standard and attained sensitivity of 89.9% (95%CI 85.6-93.0), specificity of 94.3% (95%CI 93.0-95.4), and NPV of 98.1% (95%CI 97.3-98.7) for identifying bacterial infection. 19 (1%) patients had bacteremia; among these, MeMed BV identified 14 with bacterial scores, 2 with equivocal scores, and 3 with viral scores, the latter positive for Kingella kingae (see Table for more details). Conclusion MeMed BV can aid in early detection of bacteremia in children. Disclosures Lior Kellerman, M.D, MeMed: Employee|MeMed: Stocks/Bonds (Private Company) Eran Eden, PhD, MeMed: Employee|MeMed: Stocks/Bonds (Private Company) Tanya Gottlieb, PhD, MeMed: Employee|MeMed: Stocks/Bonds (Private Company) Roy Navon, MSc, MeMed: Employee|MeMed: Stocks/Bonds (Private Company) Richard Bachur, MD, MeMed: Advisor/Consultant|UpToDate - WoltersKluwer: Advisor/Consultant|UpToDate - WoltersKluwer: Royalties - Editor

INTRODUCTION:Burns are a common injury in children, and they are treated with various pain management strategies and procedural sedation during dressing changes and debridement. Electrospinning dressing technology is a promising approach for advanced wound care, potentially improving healing outcomes and reducing complications. This retrospective study assessed the safety and feasibility of using electrospinning technology in pediatric burn patients. MATERIALS AND METHODS:This retrospective cohort study included pediatric patients with partial-thickness burns treated between July 2022 and September 2023. Eighteen patients with burns were dressed using electrospinning technology, compared to 38 receiving standard care. The study also compared the number of procedural sedations, doses of opiates, and duration of non-opiate analgesic treatments, as well as the incidence of burn site deepening and burn site infections. RESULTS:The electrospinning dressing yielded patient outcomes comparable to standard care regarding sedation treatments, analgesics, and burn site infections. Additionally, the electrospinning dressing and standard care were similar in cases that required transfer to a specialised burn center or parents refusing treatment. CONCLUSION:Electrospinning dressing technology showed non-inferiority to standard care in this small cohort of pediatric burns. Larger, prospective, randomized controlled trials are needed to confirm these findings and assess their long-term benefits and cost-effectiveness.

BACKGROUND:Exposure to air pollution and meteorological conditions, such as humidity, has been linked to adverse respiratory health outcomes in children. This study aims to develop predictive models for pediatric hospitalizations based on both environmental exposures and clinical features. METHODS:We conducted a retrospective analysis of 2500 children (aged 1-18) who presented with respiratory symptoms at the emergency department, during 2016-2017. Air pollution data, including NOx and NO2 concentrations, and relative humidity (RH) were collected from nine monitoring stations and were cross-referenced with the children's residential locations to assess their specific exposure level. Statistical tests, including Chi-square and Wilcoxon tests, were used to analyze the data. Machine learning models, specifically Random Forest (RF) and eXtreme Gradient Boosting (XGBoost), were developed to predict the children's hospitalizations. RESULTS:Boys were more likely to be hospitalized than girls (60.6% vs. 39.4%, p = 4.31e-06). Hospital visits peaked during winter (p = 3.56e-37). Increased emergency room visits were statistically significantly associated with highly polluted days (p = 0.038). Hospitalized children were exposed to lower RH (median 64.9%) compared to nonhospitalized children (median 69.4%, p = 0.005). The RF and XGBoost models were reliable, with accuracy rates of 0.7-0.98, Precision scores of 0.88-0.99, and AUC scores of 81%-99%. Key features included temperature, NOx levels, RH, and exposure to SO2. CONCLUSION:This study investigates the effects of air pollution and humidity on pediatric respiratory health. The models developed offer valuable tools for predicting hospitalizations and are intended to support public health planning and resource allocation.

Abstract Background Infectious etiology is often unclear in children hospitalized with symptoms of lower respiratory tract infection (LRTI), driving antibiotic misuse. A host-protein test (MMBV) exhibits high diagnostic accuracy for differentiating bacterial from viral etiology. Best practices for test implementation should be established. We evaluate the effectiveness of implementing MMBV into routine care without specific antimicrobial stewardship (AMS) education by assessing impact on antibiotic administration to children hospitalized with LRTI symptoms. Patient flow Eligibility required age 3 months to 5 years old and hospitalized with 1 or more of the following signs or symptoms that concern for lower respiratory tract infection (LRTI): accessory muscle use, chest pain, cough, crepitation or rales, decreased breath sound, dyspnea, prolonged expiration, wheezing. MMBV, MeMed BV. Methods Retrospective pragmatic study of MMBV implementation at a single medical center without specific AMS education. Children 3 months to 5 years old hospitalized with LRTI symptoms were included. In the non-interventional arm (2014-2017) MMBV results were not available in time to impact antibiotic decisions. In the interventional arm (2021-2022) MMBV results were rapidly available. Patients were assigned into discharge diagnosis classes: bronchiolitis, community acquired pneumonia (CAP), viral diagnosis and other diagnosis. Antibiotic administration was compared between arms per diagnosis class. The relative reduction in antibiotic administration in the interventional arm versus the non-interventional arm according to discharge diagnosis class There was a relative reduction in antibiotic administration in the interventional arm relative to the non-interventional arm from 60.0% (12/20) to 22.5% (9/40) for bronchiolitis; from 98.7% (74/75) to 97.3% (71/73) for CAP; from 15.0% (12/80) to 13.3% (6/45) for viral diagnosis; and from 60.7% (51/84) to 51.8% (43/83) for other diagnosis. P-values were calculated using Richardson’s method. CAP, community-acquired pneumonia. Results Age, sex and MMBV results were similar across arms. Viral MMBV rates were high (39%-90%) across all diagnosis classes in the non-interventional (n=259) and interventional (n=241) arms. A significant relative reduction in antibiotic administration of 62.5% (p=0.004) was attained in patients discharged with bronchiolitis without impacting length of stay (p=0.530). Non-significant reductions in antibiotic administration were observed for CAP, viral diagnosis and other diagnosis. Conclusion MMBV availability is associated with judicious antibiotic administration to children hospitalized with bronchiolitis without AMS education. Combining MMBV introduction with AMS education is required to reduce potentially unwarranted antibiotics in children hospitalized with CAP. Disclosures All Authors: No reported disclosures

BACKGROUND:Community-acquired pneumonia (CAP) is a prevalent bacterial infection in children. Lung ultrasound (LUS) is gaining popularity as a diagnostic tool for pneumonia, with the added potential for monitoring disease progression. However, research on the benefits of this modality for monitoring disease progression remains limited. OBJECTIVES:To categorize the follow-up sonographic findings of lung inflammation in pediatric patients performed 10-14 days after being diagnosed with CAP. METHODS:We conducted a prospective observational study of children aged 0-18 years, diagnosed with CAP between 2020 and 2022. LUS findings at the time of diagnosis and 10-14 days later were recorded and documented. RESULTS:In total, 47 children were recruited, and 22 were included in the analysis. At the time of diagnosis, 20 patients (90%) had B-lines. Air bronchograms were found in all patients, and consolidation findings were observed in seven of the examined patients (32%). At the follow-up LUS 10-14 days later, B-lines were observed in six patients (27%). Air bronchograms were observed in eight patients, and consolidation findings were observed in six (27%). In 13 patients (59%), the follow-up LUS was completely normal. These patients were younger and had lower body weights. Pathological findings persisted in 41% of the patients. CONCLUSIONS:For most patients, LUS demonstrated a resolution. Further large-scale studies are needed to validate the findings and determine the role of LUS in pediatric CAP.

BACKGROUND:A host-protein test's diagnostic accuracy for discriminating bacterial from viral infections [MeMed BV (MMBV)] was established at emergency departments and urgent care settings. We determined its performance in children postadmission and in subcohorts stratified according to timing of the blood draw. METHODS:We analyzed postadmission MMBV data from children (3 months to 17 years) with suspected acute infections recruited across 5 previous studies. MMBV results were interpreted as bacterial/viral/equivocal according to the manufacturer's instructions. Reference standard infection etiology was as assigned in the original studies, where adjudicators were provided comprehensive patient data but blinded to MMBV. We calculated diagnostic performance by comparing MMBV to the reference standard. RESULTS:The study population comprised 1059 children, encompassing 659 patients sampled on admission day (day = 0), 69 patients sampled on day ≥1 of hospital stay and 331 with blood drawn postadmission without recorded timing. Median age was 1.9 years (interquartile range 1.0, 4.0), with 51.5% males. The most prevalent discharge diagnoses were systemic viral infections (29.7%), upper respiratory tract infection (17.6%) and lower respiratory tract infection (14.4%). MMBV attained comparable area under the receiver operating characteristic curves ( P > 0.9) of 0.92 (95% confidence interval: 0.90-0.94) for the study population, 0.92 (0.89-0.94) for those sampled on day = 0, 0.92 (0.82-1.0) for those sampled on day ≥1 of hospital stay and 0.92 (0.88-0.96) for those with sampling time unknown. CONCLUSIONS:These data support MMBV's performance in hospitalized children. Real-world studies are warranted to establish MMBV's utility postadmission.

BACKGROUND:Prior to the coronavirus disease 2019 (COVID-19) pandemic, bronchiolitis caused by respiratory syncytial virus (RSV) was primarily observed during the winter months. Recently, however, an increase in incidence during the warmer months has been noted. This trend suggests an interaction between RSV and coronavirus, as well as the impact of public health measures, such as hand hygiene, mask-wearing, and social distancing. OBJECTIVES:To characterize bronchiolitis cases in children under 2 years old caused by RSV during the COVID-19 pandemic in Israel from 2018 to 2022. METHODS:We conducted retrospective study by analyzing medical records of children hospitalized with bronchiolitis from January 2018 to December 2022. A comparison was made between cases before and after the first COVID-19 lockdown. RESULTS:A total of 922 children with bronchiolitis were studied: 276 cases occurred before the lockdown and 646 cases afterward. We found an increase in bronchiolitis frequency during the summer following the lockdown and a decrease during the winter (P < 0.0001). In addition, there was a shift in the pathogenic profile, with a notable rise in mixed infections after the lockdown (P < 0.0001). No significant differences in clinical presentation were observed between pre- and post-lockdown periods. CONCLUSIONS:There was a change in bronchiolitis seasonality after the lockdown, with a significant increase in cases during the summer and a rise in mixed infections. Further studies are needed to assess whether this shift is a lasting consequence of the pandemic or a temporary change.

STUDY OBJECTIVE:To cover pediatric emergency physicians' off-hours, third-year pediatric residents in Israel are trained for unsupervised administration of emergency department (ED) dissociative and deep sedation. We assessed the frequency of critical sedation events associated with resident-performed sedations. METHODS:We conducted a retrospective chart review on all patients receiving intravenous sedation across 10 pediatric EDs between January 2018 and September 2022. We defined a critical sedation event as one or more of the following: chest compressions, tracheal intubation, neuromuscular blockers, vasopressors, atropine for bradycardia, aspiration syndrome, death, or unplanned hospital admission due to sedation. We liaised with the Ministry of Health's reporting department and ED directors to verify complete identification of all sentinel events. RESULTS:Pediatric residents and pediatric emergency physicians performed 12,733 and 10,845 sedations, respectively, most frequently for fracture reduction (44.4%) and laceration repair (25.6%). Patients' mean (SD) age was 6.9 (4.4) years. Residents and emergency physicians administered ketamine or propofol alone in 6,473 and 3,465 cases, respectively, with drug combinations for the remainder. We identified 6 critical sedation events, of which 3 were resident-performed sedations. The frequency of critical sedation events among pediatric residents and emergency physicians was 0.024% (95% CI, 0.005% to 0.069%) and 0.028% (95% CI, 0.006% to 0.080%), respectively. CONCLUSION:We observed a low frequency of critical sedation events in this large sample of dissociative and deep sedations performed by pediatric residents and pediatric emergency physicians. Our findings suggest that ED sedation by unsupervised, trained pediatric residents is a safe practice in Israel.

Introduction: High-sensitivity cardiac troponin T (hs-cTnT) is not used routinely as a diagnostic biomarker in newborns. The high precision of hs-cTnT assays increases the ability to determine small differences in cTnT over time and to detect troponin T elevation; thus, we believe that hs-cTnT assays might improve clinical care. We explored the plausible association between hs-cTnT levels (ng/L) in healthy newborns and prolonged second stage of labor, neonatal, and maternal factors. Methods: A prospective study was performed among healthy newborns in the Obstetrics and Gynecology Department at Hillel Yaffe Medical Center in Israel in January-June 2021. The sociodemographic characteristics of the participants, maternal age, gravidity, parity, Pitocin use, epidural analgesia, and neonatal anemia were obtained from the electronic medical records. Gestational age was determined by ultrasound biometric measurements. We classified second-stage labor as normal or prolonged using the WHO guidelines. Samples from umbilical cord blood were drawn using syringes rinsed with anticoagulant by a specialist in pediatrics. The remaining blood was used to determine hs-cTnT levels (ng/L), which was defined as a continuous quantitative variable with the median value and the 25th-75th percentiles. Results: Overall, 184 cord blood samples were performed from healthy newborns (60.6% males) with a median hs-cTnT of 39.03 (25th-75th percentiles = 30.53-54.09) ng/L. A multivariable linear regression model showed no significant association between neonatal anemia and hs-cTnT levels (ng/L) (p = 0.8). Gestational age (B coefficient -4.24, p < 0.001) and gravidity (B coefficient -2.41, p = 0.03) were negatively associated with hs-cTnT levels (ng/L), while Pitocin use (B coefficient 6.91, p = 0.04) and prolonged second stage of labor (B coefficient 18.07, p = 0.02) were positively associated with hs-cTnT levels (ng/L). Conclusions: High hs-cTnT levels (ng/L) were documented in the cord blood of healthy newborns. Hs-cTnT levels were positively correlated with a prolonged second stage of labor and Pitocin use and negatively correlated with longer gestational age and higher gravidity. Hs-cTnT may signify labor-related fetal distress. A larger surveillance study is mandatory to establish this correlation and assess for possible prognostic significance of elevated hs-cTnT in this context. (c) 2023 S. Karger AG, Basel

ImportanceHealthcare organizations operate in a data-rich environment and depend on digital computerized systems; thus, they may be exposed to cyber threats. Indeed, one of the most vulnerable sectors to hacks and malware is healthcare. However, the impact of cyberattacks on healthcare organizations remains under-investigated.ObjectiveThis study aims to describe a major attack on an entire medical center that resulted in a complete shutdown of all computer systems and to identify the critical actions required to resume regular operations.SettingThis study was conducted on a public, general, and acute care referral university teaching hospital.MethodsWe report the different recovery measures on various hospital clinical activities and their impact on clinical work.ResultsThe system malfunction of hospital computers did not reduce the number of heart catheterizations, births, or outpatient clinic visits. However, a sharp drop in surgical activities, emergency room visits, and total hospital occupancy was observed immediately and during the first postattack week. A gradual increase in all clinical activities was detected starting in the second week after the attack, with a significant increase of 30% associated with the restoration of the electronic medical records (EMR) and laboratory module and a 50% increase associated with the return of the imaging module archiving. One limitation of the present study is that, due to its retrospective design, there were no data regarding the number of elective internal care hospitalizations that were considered crucial.Conclusions and relevanceThe risk of ransomware cyberattacks is growing. Healthcare systems at all levels of the hospital should be aware of this threat and implement protocols should this catastrophic event occur. Careful evaluation of steady computer system recovery weekly enables vital hospital function, even under a major cyberattack. The restoration of EMR, laboratory systems, and imaging archiving modules was found to be the most significant factor that allowed the return to normal clinical hospital work.

Objectives To determine the diagnostic accuracy of a rapid host-protein test for differentiating bacterial from viral infections in patients who presented to the emergency department (ED) or urgent care center (UCC). Methods This was a prospective multicenter, blinded study. MeMed BV (MMBV), a test based on tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), interferon gamma-inducible protein-10 (IP-10), and C-reactive protein (CRP), was measured using a rapid measurement platform. Patients were enrolled from 9 EDs and 3 UCCs in the United States and Israel. Patients >3 months of age presenting with fever and clinical suspicion of acute infection were considered eligible. MMBV results were not provided to the treating clinician. MMBV results (bacterial/viral/equivocal) were compared against a reference standard method for classification of infection etiology determined by expert panel adjudication. Experts were blinded to MMBV results. They were provided with comprehensive patient data, including laboratory, microbiological, radiological and follow-up. Results Of 563 adults and children enrolled, 476 comprised the study population (314 adults, 162 children). The predominant clinical syndrome was respiratory tract infection (60.5% upper, 11.3% lower). MMBV demonstrated sensitivity of 90.0% (95% confidence interval [CI]: 80.3-99.7), specificity of 92.8% (90.0%-95.5%), and negative predictive value of 98.8% (96.8%-99.6%) for bacterial infections. Only 7.2% of cases yielded equivocal MMBV scores. Area under the curve for MMBV was 0.95 (0.90-0.99). Conclusions MMBV had a high sensitivity and specificity relative to reference standard for differentiating bacterial from viral infections. Future implementation of MMBV for patients with suspected acute infections could potentially aid with appropriate antibiotic decision-making.

Introduction:Acute lobar nephronia (ALN) is a focal renal infection without liquefaction, historically regarded as rare in the pediatric population, yet recent literature suggests it may be under-diagnosed, which may result in the formation of renal abscess and future renal scarring. Methods:The clinical presentation, investigations, treatment and long-term outcomes of 5 patients diagnosed with ALN was described and literature review was conducted by reviewing publications in PubMed using the keywords "acute lobar nephronia" and "pediatric". Results:Three patients were males, aged 1 to 11 years. The primary complaint in all cases was fever, accompanied by significantly elevated inflammatory markers. Upon presentation, none of the patients exhibited pyuria on urinalysis, and all had sterile blood and urine cultures. Diagnosis was based on CT scans for three patients and renal sonography for two. Main findings included hyperechogenic renal parenchyma, and hypodense localized parenchyma. Treatment consisted of broad-spectrum intravenous antibiotics, administered for 7 to 12 days and additional 1 week course with amoxicillin-clavulanate, resulting in similar defervescence times across all patients. None of the patients demonstrated recurrence and none had renal pathology upon repeated renal sonography and upon DMSA scintigraphy. Discussion:Clinical suspicion for ALN should arise in cases of abdominal pain and markedly increased inflammatory markers. It"s crucial to note that the absence of pyuria and negative culture results should not exclude ALN diagnosis, underscoring the need for a high index of suspicion in the pediatric population.

BACKGROUND: This study aimed to investigate the outcomes of pediatric patients with acute mastoiditis while examining the role of intravenous steroid therapy, patient demographics, and serum inflammatory values as prognostic factors. METHODS: This study is a single-center retrospective observational study including 73 consecutive patients treated for acute mastoiditis in the course of the 10-year study period (January 2010 to December 2019). RESULTS: Data analysis showed that patients requiring surgical treatment (14%) had a 3-fold higher C-reactive protein value at admission compared to those treated conservatively (P <.001). Receiver operating characteristic analysis revealed that a C-reactive protein cut-off of >= 98.7 had a sensitivity and specificity of 100% and 74.6%, respectively, for predicting the need for surgery (area under the curve = 0.927, P <.001). The duration of symptoms before hospitalization was nearly 2 days shorter in male patients (P =.031), and the use of intravenous steroid therapy significantly shortened the length of hospitalization (P =.023), by 1.4 days on average. CONCLUSION: Intravenous steroid therapy may be useful in decreasing the length of hospital stay. Mastoiditis tends to present more severely in male patients, and monitoring C-reactive protein values during treatment correlated well with the need for surgery.

COVID-19 patients are oftentimes over-or under-treated due to a deficit in predictive management tools. This study reports derivation of an algorithm that integrates the host levels of TRAIL, IP-10, and CRP into a single numeric score that is an early indicator of severe outcome for COVID-19 patients and can identify patients at-risk to deteriorate. 394 COVID-19 patients were eligible; 29% meeting a severe outcome (intensive care unit admission/non-invasive or invasive ventilation/death). The score's area under the receiver operating characteristic curve (AUC) was 0.86, superior to IL-6 (AUC 0.77; p = 0.033) and CRP (AUC 0.78; p < 0.001). Likelihood of severe outcome increased significantly (p < 0.001) with higher scores. The score differentiated severe patients who further deteriorated from those who improved (p = 0.004) and projected 14-day survival probabilities (p < 0.001). The score accurately predicted COVID-19 patients at-risk for severe outcome, and therefore has potential to facilitate timely care escalation and de-escalation and appropriate resource allocation.