Poor sleep and psychological symptoms (depressive or anxiety symptoms) are common following concussion. Saliva microRNAs (miRNAs) are promising concussion biomarkers based on associations with the presence of a concussion in prior work. The purpose of this study was to identify saliva miRNAs that differ between participants with and without concussion and show correlations with sleep and/or psychological symptoms. We analyzed salivary miRNAs and concussion symptom data from n = 272 concussion cases (median: 2.5 days postinjury, interquartile range: 2.41-10.65) and n = 153 uninjured controls. Concussion symptoms were quantified with the Post-Concussion Symptom Scale (PCSS). miRNAs were quantified with high-throughput small RNA sequencing. Spearman rank correlations were used to evaluate the association between miRNAs and PCSS sleep ("Drowsiness," "Trouble falling asleep") and PCSS psychological ("Feeling More Emotional," "Irritability," "Sadness," and "Nervousness") symptoms. Wilcoxon rank sum tests evaluated differences in miRNAs between the concussion versus the uninjured controls. All tests were evaluated at the Benjamini-Hochberg adjusted alpha level of 0.05. We identified 14 miRNAs that were correlated with sleep symptoms (n = 5 positively and n = 9 negatively correlated), 28 with psychological symptoms (n = 12 positively and n = 16 negatively correlated), and 4 miRNAs with both (miR-361-5p, miR-4510, miR-193a-3p, miR-3074-5p). Gene targets for miRNAs correlated with both sleep and psychological symptoms were significantly enriched within "spinocerebellar ataxia," "dopaminergic synapse," "axon guidance," and "circadian entrainment" pathways. Of the four miRNAs correlated with both psychological and sleep symptoms, miR-4510 and miR-193a-3p were also differentially expressed between the concussion cases and the uninjured controls. miR-4510 and miR-193a-3p were differentially expressed in individuals with concussion and were correlated with both sleep and psychological symptoms. Additional research is needed to confirm the temporal relationship between alterations in these miRNAs, concussion occurrence, and onset of sleep and/or psychological symptoms.

Because of the widespread availability of urgent care centers (UCCs) and the non-emergent nature of many illnesses and injuries occurring in students who attend school, referrals to UCCs may be an option in the management of students without a primary care provider and with certain health insurance providers. Optimizing the care of these students involves several steps for the school nurse: (a) becoming familiar with the capabilities of the UCC in your community, and (b) establishing a collaborative relationship between the school and UCC through closed-loop communication and quality improvement initiatives.

School-based health interventions have been shown to significantly improve pediatric health outcomes. This study aims to analyze trends in research published on school-based health between 2014 and 2024. A comprehensive literature search was performed on PubMed. Data points abstracted from each article included publication details, study details, and research study topics.  A total of 953 publications were analyzed. A peak in annual publications was apparent in 2018-2019, followed by a decline. Nine- to 13-year-olds were the most studied population (50.9%). The most commonly assigned research topics were physical activity and nutrition (36%), health promotion (25%), mental health (19%), obesity (15%), and substance use (12%). Research in the field of school-based health has evolved, but the overall annual number of publications is declining. Still, published data reveals that most school-based health studies have positive outcomes on the health of our pediatric population. These results underscore the need for continued research, particularly in underrepresented areas such as school-based health centers, telemedicine, minority youth, students with disabilities, and interventions targeting reproductive health, violence prevention, and socioeconomic disparities.

BACKGROUND:School nurses are often tasked with identifying and managing mental and behavioral health concerns. The objective of this study was to better understand school nurse and school preparedness to identify and manage mental health conditions and psychological stressors. METHODS:The authors developed a questionnaire, which was electronically distributed to several National Association of School Nurses members during the 2021-2022 school year. RESULTS:A total of 994 questionnaires were completed and analyzed, a 50% response rate. Of school nurse respondents, 76% felt responsible for identifying depression; 40% reported that their school has naloxone; 22% reported that their school has an emergency preparedness and response plan for opioid overdose; and 18% screened for bullying in the past year. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:School policies and guidelines for the critical areas identified in the present study should be considered. CONCLUSIONS:Based on our national sample of school nurses, we have identified strengths and areas for improvement in school nurse and school preparedness to identify and manage mental health conditions and psychological stressors.

INTRODUCTION:Pneumonia is the most common cause of pediatric death worldwide. We sought to determine whether the rate of hospital admission of pediatric patients diagnosed with pneumonia at a dedicated pediatric-emergency department (PED) is different than the rate at a community emergency department (CED). This comparison may provide insight into decision-making and factors associated with admission. METHODS:In this retrospective cohort study we reviewed patient records from January 1, 2017-December 31, 2019 for pediatric patients diagnosed with pneumonia. We excluded patients who were not prescribed antibiotics, those who did not receive a chest radiograph or had no radiologic signs of pneumonia. In addition, we excluded patients with comorbid conditions such as tracheostomy, supplemental oxygen requirement at baseline, chronic lung disease other than asthma or reactive airway disease, any cancer diagnosis, cystic fibrosis, or congenital heart disease. The primary outcome was the proportion of pneumonia diagnoses that resulted in admission from the PED vs CED. We used logistic regression analyses to evaluate which clinical factors were associated with hospital admission. Significance levels were determined by chi-square test or the Fisher exact test and Cochran-Mantel-Haenszel statistic. RESULTS:We identified 400 pediatric patients with pneumonia, 182 from the PED and 218 from the CED. There was a significant difference in admission rates between the two hospitals: 53 of 182 patients in the PED were admitted (29.1%) vs 27 of 218 patients in the CED (12.4%, P < .001). Patients in the PED were, therefore, 2.35 times more likely to be admitted than those at the CED (odds ratio 5.1, 95% CI, 2.5-10.4). Patients presenting to the PED were more likely to arrive via ambulance (10.7% vs 3.1%, P = .04) and to be hypoxic upon arrival (13.2% vs 3.2%, P < .001). The median age of patients in the PED was significantly higher than the CED (6.0 years vs 2.0 years, P < .001). A significantly greater proportion of patients in the CED identified as Hispanic or Latino (68.6% vs 20.3%, P < .001). Patients in the CED were more likely to be insured (11.0% vs 19.9%, P = .01). There was no significant difference in immunization status between the two groups. CONCLUSION:Patients presenting to a dedicated pediatric ED had a higher admission rate than did those at a community ED. Patients in the PED were more likely to arrive by ambulance and less likely to have active health insurance coverage. Patients at the PED were more likely to be hypoxic than patients at the CED. These findings highlight important practice differences between PEDs and CEDs that may inform strategies to improve patient outcomes, reduce costs, and promote more effective, evidence-based care. Future studies should further investigate the drivers of these variations and evaluate targeted interventions to optimize care across settings.

The goal of this study is to evaluate pediatric multidisciplinary teams depicted in medical television shows. The first 10 pediatric patient encounters in 8 medical television dramas in 2008 and 2018 were analyzed. Patient demographics, medical team members, and description of team member roles/actions were abstracted from each encounter. Multidisciplinary team members were depicted in each of the 80 encounters as follows: attending physicians (93%), resident physicians (41%), and nurses (51%); no medical students, advanced practice providers, pharmacists, or Child Life specialists were depicted. Attending and resident physicians were commonly depicted communicating with patients and ordering labs/medications. Nurses were often depicted administering medication/treatment. Misrepresentation of roles included physicians conducting criminal investigations, unsupervised resident physician care, and inappropriate patient communication. Based on our sample, critical members of pediatric multidisciplinary teams were not depicted, and several role misrepresentations were discovered, which may lead to unrealistic expectations by viewers of medical television shows.

School nurses are often tasked with identifying and managing mental and behavioral health concerns. The objective of this study was to better understand school nurse and school preparedness to identify and manage mental health conditions and psychological stressors. The authors developed a questionnaire, which was electronically distributed to several National Association of School Nurses members during the 2021–2022 school year. A total of 994 questionnaires were completed and analyzed, a 50% response rate. Of school nurse respondents, 76% felt responsible for identifying depression; 40% reported that their school has naloxone; 22% reported that their school has an emergency preparedness and response plan for opioid overdose; and 18% screened for bullying in the past year. School policies and guidelines for the critical areas identified in the present study should be considered. Based on our national sample of school nurses, we have identified strengths and areas for improvement in school nurse and school preparedness to identify and manage mental health conditions and psychological stressors.

INTRODUCTION:Athletes in the National Basketball Association (NBA) are subjected to high levels of mechanical stress increasing their risk of injury. The purpose of this study was to see how certain lower extremity injuries affect in-game performance in relation to each NBA athlete's demographics. The hypothesis was that NBA players' post-injury performance would differ depending on their demographics and the type of injury sustained. METHODS:Descriptive epidemiology study of NBA injury list designations from the 2010/2011 season to the 2018/2019 season. About 255 lower leg injuries that met the inclusion criteria were selected from the injury lists spanning from the 2010/2011 season to the 2018/2019 season. These included ligamentous knee injuries, knee sprains, knee strains, knee hyperextensions, patellar injuries, ankle injuries, and Achilles injuries. The change in performance was determined by comparing mean game scores before and after injury with single-tailed, heteroscedastic t-testing and 95% confidence intervals for mean values. RESULTS:An overall statistically significant decrease in mean game score from 9.82 to 8.75 was seen in all included players (p = 0.01). Only athletes taller than the mean height (199.85 cm; p = 0.01) and heavier than the mean weight (101.63 kg; p = 0.02) showed a significant decline in performance. Ankle and knee injuries both resulted in a significant loss in game score (p = 0.04), with ankle injuries resulting in a greater average decline (-1.76 post-injury) than knee injuries (-1.34 post-injury). CONCLUSIONS:These findings suggest that treatment regimens should reflect the type of injury and demographics of the specific NBA player injured. Further research is warranted to determine if treatment may be more efficacious when streamlined based on player size and injury type.

Background With the transition away from traditional numerical grades/scores, residency applicant factors such as service, research, leadership, and extra-curricular activities may become more critical in the application process. Objective To assess the importance of residency application factors reported by program directors (PDs), stratified by director demographics and specialty. Method A questionnaire was electronically distributed to 4241 residency PDs in 23 specialties during spring 2022 and included questions on PD demographics and 22 residency applicant factors, including demographics, academic history, research involvement, and extracurricular activities. Responses were measured using a Likert scale for importance. Descriptive statistics and Chi-square and Fisher exact test analysis were performed. Results 767 questionnaires were completed (19% response rate). Across all specialties, the factor considered most important was the interview (99.5%). When stratified by specialty, surgical PDs were more likely to characterize class rank, letters of recommendation, research, presenting scholarly work, and involvement in collegiate sports as extremely important/very important (all p < 0.0001). In contrast, primary care PDs favored the proximity of the candidate’s hometown ( p = 0.0002) and community service ( p = 0.03). Mean importance of applicant factors also differed by PD age, gender, and ethnicity. Conclusion We have identified several residency application factors considered important by PDs, stratified by their specialty, demographics, and previous experiences. With the transition away from numerical grades/scores, medical students should be aware of the factors PDs consider important based on their chosen specialty. Our analysis may assist medical students in understanding the application and match process across various specialties.

Topically applied compounds containing camphor and menthol have been used to alleviate pain, cold symptoms, and pruritus, historically predominantly in East Asia. Being not studied well, they are less recognized in Western medicine. Given the commonality of pain, pruritus, and cold symptoms in addition to the growing need for non-opioid treatment options, the authors investigated clinical applications of such compounds for their over-counter usage. The purpose was to analyze current clinical research and applications regarding the use of these topical agents. This study involved a bibliometric analysis of peer-reviewed articles, published in English and indexed in PubMed from 2010 to 2022, pertaining to camphor- and menthol-containing compounds. There were 103 results, of which 15 (14.6%) articles were related to the treatment of disorders related to health, such as upper respiratory infection, pain, and pruritus. Excluded were “non-research” articles (e.g., letters to the editor), articles that do not involve human subjects, reports of improper application or misuse (e.g., ingestion), and articles pertaining to intraoral, intranasal, and ophthalmic agents. Of these articles, the originating journals, respective journal impact factor scores, publication years, study designs, and study topics were identified. Underlying trends and themes regarding clinically relevant research on these compounds were subsequently discerned. Based on this analysis, topical agents containing camphor and menthol are potentially effective at treating pain, upper respiratory infection symptoms, and pruritus in addition to potentially functioning as an antimicrobial. However, with a limited number of studies addressing these compounds' uses in each application, no definitive recommendation can be made regarding their use. Given the promising results of earlier studies, the authors recommend that more primary research, particularly randomized, double-blind controlled studies, be done regarding clinical applications of these substances.

Introduction: Interruptions that occur during sign-out in the emergency department (ED) may affect workflow, quality of care, patient safety, errors in documentation, and resident education. Our objective this study was to determine the frequency and classification (emergent vs non-emergent, in-person phone call) of interruptions that occur during emergency medicine (EM) resident sign-out before and after the institution of a group sign-out process involving residents and attending physicians. Methods: A convenience sample of sign-out observations between EM residents were observed and coded between April-December 2021. We excluded sign-out observations of pediatric patients (<18 years of age) and observations not conducted in the main ED. Collected data included number patients signed out during each observation; total duration in minutes for each observation; total number of interruptions during each observation; and type of interruption (emergent vs non-emergent, in-person vs phone call). We further stratified data before and after the institution of a group sign-out process (July 2021). Results: We performed data analysis on 58 individual and 65 group sign-out observations, respectively. Although the total number of patients signed out, the total duration of sign-outs observed, mean number of patients signed out per minute, and mean duration of sign-out per observation were more for the group sign-out aggregate compared with the individual sign-out aggregate, the total number of interruptions (44 vs 73, P = 0.007), number of interruptions per minute (0.05 vs 0.16, P < 0.001), total number of non-emergent interruptions (38 vs. 67, P = 0.005), and total number of in-person interruptions (14 vs 44, P < 0.001) was less in the group sign-out compared with the individual sign-out totals. Conclusion: Based on our sample, although the total duration of group sign-out with both residents and an attending was longer than individual resident-to-resident sign-out, the total number of interruptions, number of interruptions per minute, total number of non-emergent interruptions, and total number of person interruptions was less in the group sign-out. Group sign-out may be an option to limit the negative effects of interruptions in the ED. [West J Emerg Med. 2024;25(1)17-21.]

The American Academy of Pediatrics has previously expressed concerns about the thematic content of television (TV) and the amount of time children spend viewing TV. The objective of this study was to determine the positive and negative themes depicted in a select number of TV shows targeted toward adolescents. We analyzed the thematic content depicted in the first season of 26 Netflix TV shows. The mean occurrences/h for positive and negative themes were 39.53 and 47.20, respectively. The most common positive themes were "encouragement from a friend/peer," "demonstrating honesty," and "staying true to oneself" (5.98, 5.38, and 3.72 mean occurrences/h, respectively). The most common negative themes were "dishonesty," "cursing," and "selfishness," (5.30, 4.96, and 4.85 mean occurrences/h, respectively). We suggest that health care providers become aware of TV thematic content and promote media education, and we encourage co-viewing and active mediation by parents/guardians with their children.

OBJECTIVE:This study aimed to determine athletic trainer compliance with emergency medicine and athletic training evidence-based guidelines for the on-the-field management of common pediatric sports-related injury and illness. METHODS:A questionnaire was distributed electronically to selected members of the National Athletic Trainer Association. The questionnaire included 10 clinical scenarios describing common sports-related injury/illness (closed head injury, cervical spine injury, blunt chest injury, blunt abdominal injury, ankle injury, knee injury with laceration, heat-related illness). On-the-field management decisions for each scenario were compared with selected emergency medicine and athletic training guidelines. RESULTS:Analysis was performed on 564 completed questionnaires (9% response rate). Responders were compliant with practice guidelines for both emergency medicine and athletic training except for blunt chest trauma with tachycardia, closed head injury with loss of consciousness, closed head injury with repetitive speech, closed head injury with a fall higher than 5 feet, cervical spine injury with paresthesias, and heat-related illness with persistent symptoms. Discrepancies between emergency medicine and athletic training guidelines included closed head injury with repetitive speech, closed head injury and height of fall, closed head injury and unequal pupils, and cervical spine injury with neck pain and paresthesias. CONCLUSIONS:Based on our sample, athletic trainers were compliant with many guidelines supported by both emergency medicine and athletic training. We identified several deficiencies in the availability of evidence-based guidelines and discrepancies between these guidelines and athletic trainer responses. To provide optimal care to pediatric athletes who sustain injury or illness, emergency medicine and athletic training organizations should collaborate to improve these discrepancies.

Objectives This study aimed to analyze pediatric referrals for definite or possible appendicitis, to compare clinical predictors and laboratory values between patients with and without a final diagnosis of appendicitis, and to determine the accuracy of prereferral diagnostic interpretations of computed tomography scans, ultrasound, and magnetic resonance imaging modalities. Methods We conducted a retrospective analysis of pediatric patients referred from 2015 to 2019 to a tertiary care children's emergency department with definitive or possible appendicitis. Data abstracted included patient demographics, clinical symptoms, physical examination findings, laboratory results, and diagnostic imaging findings (by the referring center and the pediatric radiologist at the accepting center). An Alvarado and Appendicitis Inflammatory Response (AIR) score was calculated for each patient. Results Analysis was performed on 381 patients; 226 (59%) had a final diagnosis of appendicitis. Patients with appendicitis were more likely to have symptoms of nausea (P < 0.0001) and vomiting (P < 0.0001), have a higher mean temperature (P = 0.025), right lower quadrant abdominal pain to palpation (P = <0.0001), rebound tenderness (P < 0.0001), a higher mean Alvarado score [5.35 vs 3.45 (P < 0.0001)], and a higher mean AIR score [4.02 vs 2.17 (P < 0.0001)]. Of the 97 diagnostic images initially interpreted as appendicitis by the referring center, 10 (10.3%) were read as no evidence of appendicitis. Of the 62 diagnostic images initially interpreted as “possible appendicitis” by the referring center, 34 (54.8%) were read as no evidence of appendicitis. Of those diagnostic images initially interpreted as “appendicitis” or “possible appendicitis” by the referring center, 24/89 (27.0%) of computed tomography scans, 17/62 (27.4%) of ultrasounds, and 3/8 (37.5%) of magnetic resonance imaging results were read as no evidence of appendicitis. Conclusions Usage of established scoring algorithms, such as Alvarado and AIR, may decrease the unnecessary cost of diagnostic imaging and transfer to tertiary care. Virtual radiology consultations may be 1 potential solution to improve the referral process for pediatric appendicitis if initial interpretation is uncertain.

Purpose Marijuana use has been increasing in the adolescent population. Our objective was to examine the prevalence of marijuana use among a sample of adolescents and young adults, determine an association with risk-taking behaviors, identify reported medical symptoms, and delineate common beliefs about marijuana use. Methods A questionnaire was administered to a sample of patients aged between 12 and 23 years old presenting to the emergency department of Penn State Hershey Medical Center, Hershey, Pennsylvania. Data were stratified by marijuana users and non-users, and further stratified by traditional (vape, pipe, edibles) and non-traditional (oils/concentrates, topical creams) use. Results The analysis was based on 200 questionnaires. Thirty-nine percent (n=78) reported marijuana use. Marijuana users were more likely to report previous sexual intercourse (79.5% vs. 32.8%; p=<0.0001), as well as the use of alcohol (50.0% vs. 10.7%; p=<0.0001), cigarettes (41% vs. 8.2%; p=<0.0001), prescription pain medications (20.5% vs. 4.1%; p=0.002), and cocaine (14.1% vs. 0.8%; p=0.0017). Users more likely reported texting while driving (41.0% vs. 13.1%; p=0.005) and experienced physical or electronic victimization due to bullying (43.6% vs. 19.7%; p=0.002). Users were more likely to report gastroesophageal reflux disease (GERD), attention deficit disorder (ADD), anxiety, and depression. The most common symptoms associated with marijuana use were anxiety (65.4%), headache (61.6%), nausea/vomiting (53.8%), cough (51.3%), and abdominal pain (47.4%). Sixty-nine percent of respondents believed marijuana was "safer than other drugs". Conclusion Based on our sample, we identified risk-taking behaviors, medical symptoms, and beliefs associated with marijuana use. Healthcare professionals may use these data to provide screening and anticipatory guidance to adolescents who use marijuana and consider marijuana use in their differential diagnosis.

Sport participation is an important part of the development, both physically and mentally, of children and adolescents in the United States. Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life-threatening illnesses or injuries may occur. It is important for the school nurse to recognize potential life-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow-up at their primary healthcare provider’s office, or directly to the closest emergency department [ED] via Emergency Medical Services [EMS]). This article specifically describes the initial assessment and management of shortness of breath in an adolescent athlete during a track event.