bims-cliped 2026-05-10 papers

bims-cliped

Biomed News

on Clinical pediatrics

Issue of 2026–05–10
twenty-one papers selected by
Alyssa M. Portwood, Akron’s Children

Assessing unnecessary emergency department visits for poison exposures in pediatric patients less than six years old.
Moving from Challenge to Change: Redesigning Inpatient Care for Children with Complex Care Needs.
Patient Safety Events Among Children Receiving Home Health Care.
Improving Pediatric Bronchiolitis Care: Optimizing Nasal Suctioning in Community Emergency Departments.
Optimizing Sedation to Discharge Time for Orthopedic Patients in a Pediatric Emergency Department.
Promises, Pitfalls, and Paths Forward for the Pediatric Research Equity Act.
Malaria in Children at 9 US Hospitals: 2016-2023.
Recognition and Management of Pediatric Dental Trauma and Infections.
Chest Radiography Use in Hospitalized Children with Acute Respiratory Tract Infections: A Baseline Analysis for Imaging Optimization.
Return-to-Play Protocols for Various Injuries in Skeletally Immature Athletes: A Systematic Review.
Pediatric Skin Disease Frequencies and Dermatology Use by Race and Ethnicity in US Children's Hospitals.
The impact of structured training on the management of agitated pediatric patients in the emergency department: changes in knowledge and self-efficacy perceptions of physicians.
The clinical value of implementing walk-in pediatric dermatology appointments within emergency department services.
Research Letter: Concussion Evaluation by Injury Setting Among US Children.
Missed Contacts: Rethinking the Language of "No-Show" in Pediatric Care.
Understanding how language barriers in the paediatric emergency care setting influences safety of care delivery: a scoping review.
Pediatric lung transplantation in 2026: recent changes and current challenges.
Key performance indicators for acute kidney replacement therapy in critically ill children: a systematic review.
Improving the Delivery of Quality Evidence-Based Inpatient Asthma Care.
School Readiness by Presence of Congenital Heart Condition Among U.S. Preschool-Aged Children Without Diagnosed Developmental Conditions, National Survey of Children's Health 2022-2023.
Respiratory Readmissions in First 3 Years of Life for Children with Bronchopulmonary Dysplasia.

Clin Toxicol (Phila). 2026 May 07. 1-7

Assessing unnecessary emergency department visits for poison exposures in pediatric patients less than six years old.

Liam P McLoughlin, Howard A Greller, Mehruba A Parris, Christopher W Meaden, Christine Ramdin, Trevor Cerbini, Bruce Ruck, Diane P Calello.

   INTRODUCTION: We will investigate the medical necessity of pediatric emergency department presentations, specifically for emergency department poison cases where a poison control center was not contacted prior to presenting.
METHODS: A retrospective analysis of 348 poison control center cases involving patients aged < six, originating from a healthcare facility were evaluated. Toxicologists were presented with case summaries and were asked: "would you send this patient to the emergency department?" Evaluators answered on a 4-point Likert scale from "definitely would not send" to "definitely would send." Reviewers had the opportunity to write in additional information that would be beneficial to deciding their disposition. To simulate the need to make a yes or no decision on whether to send, Likert scores were manipulated into a binomial score of 0/1. Binomial regression analysis and qualitative thematic analysis were completed.
RESULTS: Toxicologists found that 38% of patients definitely did not require emergency department evaluation, and 27% were unlikely to require it. The presence of clinical symptoms were significantly associated with increased concern by toxicologists. Qualitative analysis from reviewer free text case comments, demonstrated that understanding the situation surrounding the exposure (certainty, past medical history, etc. n = 26) and presence of specific symptoms in each case (fever, vomiting, etc. n = 25) were desired to better determine the need for an emergency department.
DISCUSSIONS: About 65% of cases were evaluated as not requiring emergency department evaluation. The presence of clinical symptoms is a key factor related to clinician level of concern. Further work should include finding ways to prevent these emergency department presentations.
CONCLUSIONS: Many emergency department evaluations for poison exposure amongst children less than six years old are not medically required. Further work should focus on improving parental knowledge of poison centers and poison safety, while continuing to promote poison centers as accessible resources to the public.

Keywords:  Emergency department; health care costs; pediatrics; poison center; triage

DOI:  https://doi.org/10.1080/15563650.2026.2654540
Children (Basel). 2026 Apr 02. pii: 502. [Epub ahead of print]13(4):

Moving from Challenge to Change: Redesigning Inpatient Care for Children with Complex Care Needs.

Emma Popejoy, Jane Coad, Eyal Cohen, Aysha Sheikhi, Joseph C Manning.

  Children with complex care needs represent a growing and highly vulnerable population within inpatient hospital settings. They experience disproportionately long lengths of stay, higher rates of safety incidents, and poorer care experiences than other children. Their increasing prevalence in hospitals reflects broader advances in medical care that have improved survival, yet current inpatient systems remain largely designed around episodic, single-condition models of care. As a result, children with complex care needs and their families frequently encounter inpatient services which are fragmented and stretched and environments which are not adequately suited to their needs. The challenges are well recognised, and current drivers exist to move toward meaningful system change. Recent policy drivers, workforce development agendas, and new funding streams provide an opportunity to reimagine how inpatient services are organised and delivered for this population. This opinion piece, situated within the UK healthcare context, offers a structured analysis of the systemic challenges facing inpatient services for children with complex care needs and identifies priority domains of safe care, workforce development, and knowledge generation, where targeted redesign is both feasible and urgently required.

Keywords:  children with complex care needs; inpatient care; policy drivers; workforce development

DOI:  https://doi.org/10.3390/children13040502
JAMA Netw Open. 2026 May 01. 9(5): e2610321

Patient Safety Events Among Children Receiving Home Health Care.

Carolyn C Foster, Peter Walsh, Michelle High, Leo Barrera, Cara L Coleman, Margaret M Storey, Nikki Montgomery, Debbi Simmons Harris, Danny Valdez, Carol Haywood, Tara Lagu, Kathleen E Walsh, Alisa Khan, Nicole E Werner.

Importance: Children with medical complexity often require complicated home care regimens, yet health care safety issues in community settings have been rarely described. Systems-level approaches to addressing patient safety in pediatric home health care (HHC) also remain nascent. Quantifying and categorizing HHC staff incidents is a first step toward preventing the occurrence of safety events in this population.
Objective: To identify the rates and types of patient safety events within a US national pediatric population receiving HHC.
Design, Setting, and Participants: This was a retrospective cohort study (September 1, 2022, to August 31, 2023) that used staff incident reports from a pediatric HHC agency with sites in 11 US states. Participants were patients aged younger than 21 years receiving HHC within the study year, excluding psychiatric HHC.
Exposure: Days of HHC receipt.
Main Outcomes and Measures: Rate and type of staff-reported patient safety events per 1000 HHC-days, reviewed by 3 trained clinician reviewers, and classified using the National Coordinating Council for Medication Error Reporting and Prevention Index.
Results: This study identified 2901 children (males, 1710 [59.0%]) who received a median of 98.0 (IQR, 14.0-312.0) days of HHC. The mean (SD) age was 8.7 (5.3) years. A total of 678 incident reports were filed for 348 children (11.9%). Of these, 307 (45.3%) were patient safety events, including 168 harmful errors (54.7%), 110 nonharmful errors (35.8%), and 22 hazards (7.2%). This equated to a mean (SD) of 0.68 (4.40) patient safety events per 1000 HHC-days. Errors most frequently involved medications (108 [38.8%]) and implanted devices (91 [32.7%]). Harmful errors were most frequently related to non-pressure-related skin injuries (45 [26.8%]) and falls (30 [17.9%]). Approximately half of all errors required additional monitoring (133 [47.8%]) and 45 (16.2%) required emergency care. Patient safety events were more likely in children with invasive home ventilation compared with other types of implanted medical technology.
Conclusions and Relevance: In this cohort study of children receiving HHC, more than 1 in 10 had a reported incident, of which approximately half were patient safety related. This work provides new data about pediatric HHC safety. Further work should explore factors contributing to and preventing health care-related harms to children at home and include parent perspectives.

DOI: https://doi.org/10.1001/jamanetworkopen.2026.10321
Cureus. 2026 Apr;18(4): e106285

Improving Pediatric Bronchiolitis Care: Optimizing Nasal Suctioning in Community Emergency Departments.

Christine E Maloney, Kendra L Powell, Ashley E Keilman, Neil G Uspal.

  Community emergency departments see the majority of children receiving emergency care. However, each of these emergency departments may only see a small volume of pediatric patients per day, often leaving staff uncomfortable when caring for sick infants. By forming partnerships between an academic pediatric emergency department and community emergency departments, we sought to improve the clinical skills of community staff caring for infants with bronchiolitis, a common pediatric presentation. We created a training module that summarizes evidence-based best practices for bronchiolitis management and conducted hands-on suctioning simulations with 31 community emergency department nurses and respiratory therapists. Through education and simulation on bronchiolitis care, the majority of study participants were confident in their ability to improve their care of children with bronchiolitis and intended to change their practice. This multi-center pilot study highlights the power of academic and community emergency department partnerships in enhancing continuing education and promoting pediatric care quality in community emergency departments.

Keywords:  community emergency department; continuing health education; pediatric emergency care; simulation-based learning; viral bronchiolitis

DOI:  https://doi.org/10.7759/cureus.106285
Hosp Pediatr. 2026 May 06. pii: e2025008826. [Epub ahead of print]

Optimizing Sedation to Discharge Time for Orthopedic Patients in a Pediatric Emergency Department.

Jessica Hayes, Tucker Anderson, David Ebenezer, S Barron Frazier.

BACKGROUND: Many fractures are reduced in the pediatric emergency department (PED), followed by discharge. We appreciated inefficiencies after sedation. We aimed to decrease the time from sedation end to discharge by 50%, from 240 to 120 minutes, for patients with simple, isolated fractures who undergo fracture reduction in the PED from May 2023 to May 2025.
METHODS: A multidisciplinary team formed in May 2023. Interventions included the introduction of a portable radiograph order (mini C-arm), a sedation column on the track board, and a policy change to improve flow. The primary outcome was average time from sedation end to discharge. Process measures included percentage of encounters with the mini C-arm ordered and with postreduction films. Secondary outcome measures included average time from sedation end to discharge for patients with and without postreduction films. The balancing measure was the rate of return visits or operating room admissions within 24 hours. Retrospective baseline data were obtained from October 2022 through April 2023. Biweekly data were followed prospectively. Statistical process control charts were used to analyze data.
RESULTS: Of 558 total encounters, baseline centerline data represented 68 encounters with an average time from sedation end to discharge of 240 minutes. Interventions led to 3 centerline shifts with a final average time of 71 minutes.
CONCLUSIONS: This quality-improvement initiative with targeted, interdisciplinary interventions was associated with significantly reduced discharge times after sedation for pediatric fracture reductions. The most impactful was the introduction of mini C-arm imaging for real-time assessment of fracture reductions.

DOI: https://doi.org/10.1542/hpeds.2025-008826
JAMA Health Forum. 2026 May 01. 7(5): e260993

Promises, Pitfalls, and Paths Forward for the Pediatric Research Equity Act.

Alexa Pagano, Danielle J Green, Jennifer L Goldman, Anjali Deshmukh.

Importance: Since its enactment in 2003, the Pediatric Research Equity Act (PREA) has significantly increased the number of pediatric drug studies performed and expanded pediatric drug labeling. Despite these advancements, many drugs used in children still lack pediatric-specific US Food and Drug Administration (FDA) labeling, even when pediatric studies are required by law. Recent legislative changes strengthened the FDA's enforcement authority over PREA. As these changes are implemented, persistent gaps in pediatric drug development warrant examination. Addressing these gaps may help ensure that children are systematically included in clinical research and that medications used in children are supported by rigorous evidence on safety, dosing, and efficacy.
Observations: Legislation to ensure pediatric drug safety and efficacy has a long history, yet pediatric-specific labeling frequently lags behind initial drug approval, with many studies required under PREA remaining incomplete for years after initial FDA approval. Consequently, off-label prescribing can be necessary for pediatric health care, leaving children exposed to medications lacking adequate pediatric evidence. Barriers to the timely completion of clinical trials are often attributed to challenges inherent to smaller, disease-specific pediatric populations; however, the FDA's limited enforcement authority and insufficient resources to address delayed pediatric trial completion play an underappreciated role. In addition, limited ability to track required studies and insufficient public transparency undermine the regulatory goals intended to protect children. With new legislative authority strengthening enforcement of PREA, understanding these barriers is essential to ensure this authority is effectively deployed to improve children's health.
Conclusions and Relevance: To ensure children have access to safe, effective, evidence-based medications, effective policy changes are necessary. The FDA should use its new authority to ensure the timely completion of required pediatric studies and enhance public transparency by improving mechanisms to track PREA-mandated research.

DOI: https://doi.org/10.1001/jamahealthforum.2026.0993
Pediatrics. 2026 May 08. pii: e2025073556. [Epub ahead of print]

Malaria in Children at 9 US Hospitals: 2016-2023.

Sesh Alexander Sundararaman, Brianne Roper, Amy K F Davis, Karen L Hanze Villavicencio, Jonathan A Mayhew, Michelle L Wang, Nina L Tang, Vijaya L Soma, Ziyi Wang, Margaret E Feeney, Indi Trehan, Jill E Weatherhead, Chandy C John, Jeffrey S Gerber, Audrey R Odom John.

OBJECTIVES: This study set out to describe imported pediatric malaria in the United States over an 8-year period, including patient demographics, clinical outcomes, and risk factors for severe disease.
METHODS: A retrospective descriptive study of pediatric patients treated for malaria at 9 hospitals in the United States from 2016 to 2023 was conducted to analyze patient demographics, clinical outcomes, and risk factors for severe malaria.
RESULTS: A total of 171 children were treated across the 9 US hospitals included in this study from 2016 to 2023. Most patients had traveled to West Africa to visit friends and relatives. Fever was the most common symptom recorded (90%), and most reported at least 1 abdominal symptom (66%). Thirty-two percent of patients were diagnosed with severe malaria. No deaths occurred. Delayed diagnoses were common (26%), occurred at similar rates across all hospitals in the study, and were a risk factor for severe malaria.
CONCLUSIONS: Delayed diagnoses of travel-acquired malaria were common for pediatric patients presenting to hospitals in the United States and are associated with higher risk for severe malaria, which is associated with longer hospitalizations and increased morbidity. Chemoprophylaxis against travel-acquired malaria and prompt diagnosis of imported cases are crucial to improving patient outcomes.

DOI: https://doi.org/10.1542/peds.2025-073556
J Pediatr Health Care. 2026 May-Jun;40(3):pii: S0891-5245(25)00312-8. [Epub ahead of print]40(3): 451-463

Recognition and Management of Pediatric Dental Trauma and Infections.

Lisa Schaeg Merritt, Katelyn Glaenzer.

  Dental emergencies are common during childhood and typically occur due to trauma or infection. The current evidence on managing dental injuries is from a dental perspective, with limited information on treating pediatric dental injuries in medical settings. Proper treatment of infection, correct storage, prompt repositioning, and replantation are essential for successful outcomes, as supported by the latest evidence-based guidelines. Pediatric patients have a better prognosis when proper treatment is provided without delay. Understanding potential issues enables providers to assess the severity of the condition, offer initial guidance and management, and recommend appropriate follow-up dental care. This continuing education activity aims to educate providers on how to care for children with low-acuity dental injuries and infections using an evidence-based approach.

Keywords:  Pediatric; dental infections; dental injuries; periapical abscess; tooth avulsion

DOI:  https://doi.org/10.1016/j.pedhc.2025.09.025
Children (Basel). 2026 Apr 03. pii: 505. [Epub ahead of print]13(4):

Chest Radiography Use in Hospitalized Children with Acute Respiratory Tract Infections: A Baseline Analysis for Imaging Optimization.

Roxana Axinte, Sorin Axinte, Elena Tătăranu, Laura Ion, Adina Mihaela Frenți, Florin Filip, Gabriela Burțilă, Liliana Anchidin-Norocel, Smaranda Diaconescu.

  Background: Pediatric respiratory infections represent a leading cause of emergency department (ED) visits and hospitalizations. Chest X-rays are frequently used in their diagnostic evaluation, despite guideline recommendations advocating restrictive imaging strategies, particularly in young children with uncomplicated disease. Excessive imaging raises concerns regarding cumulative radiation exposure and inefficient resource utilization. Objectives: To quantify potentially unnecessary chest radiography use in hospitalized pediatric patients with respiratory infections and to identify age-related and diagnostic patterns suitable for targeted imaging optimization interventions. Methods: We conducted a retrospective observational study analyzing pediatric patients presented to the ED of a tertiary county hospital in Romania over a period of 12 months. Data regarding respiratory diagnoses, hospitalization status, patient age, and chest radiography utilization were extracted from electronic medical records. Results: Among more than 26,000 pediatric emergency presentations, 4139 children required hospitalization, of whom 1212 were diagnosed with respiratory infections. A total of 3414 chest radiographs were performed, with the highest imaging burden observed in children aged 0-4 years. Repeated imaging was common in interstitial pneumonia, bronchiolitis, and bronchial hyperreactivity. A strong negative correlation was identified between patient age and imaging frequency (r = -0.70, p < 0.001). Conclusions: Thoracic radiographs are disproportionately used in young children with respiratory infections, particularly in conditions with limited imaging indications. These findings provide an essential baseline for the development of targeted quality improvement interventions aimed at reducing unnecessary pediatric imaging.

Keywords:  chest radiography; diagnostic stewardship; imaging optimization; pediatric emergency care; pediatric respiratory infections; quality improvement; radiation exposure

DOI:  https://doi.org/10.3390/children13040505
Cureus. 2026 Mar;18(3): e106148

Return-to-Play Protocols for Various Injuries in Skeletally Immature Athletes: A Systematic Review.

Delaney Tyl, Anastasia Laurenzo-Wrigley, Christopher Rennie, Katerina N Futch, Elena Arcaroli, Alessandra Ottley, Melissa K Rodriguez, Mackenzie Elting, Leighann C Krasney.

  Sports-related injuries are a commonly encountered orthopedic complaint in the United States. Return-to-play (RTP) protocols are in place to guide safe progression through injury recovery and offer a stepwise timeline for resuming athletic activity. In pediatric athletes, this is increasingly important in the context of disrupted growth, muscular and skeletal imbalances, and heightened social importance of team-based activities. Despite this, there is limited literature defining a concise RTP protocol for pediatric athletes suffering from various common sports-related injuries. The primary aim of this investigation was to systematically review and synthesize existing RTP protocols for the most commonly encountered pediatric athletic injuries based on the currently available literature at this time. The literature search for this analysis was performed in the Biomedical Reference Collection, Cochrane Library, CINAHL, and MEDLINE. After inclusion criteria were met and article screening was performed, a total of 36 articles were selected for further qualitative analysis. This review reaffirmed the lack of standardized RTP protocols for pediatric sports injuries. A total of 51% of the protocols analyzed involved anterior cruciate ligament (ACL) tears and concussions, both of which hold highly variable RTP guidelines. For ACL injuries, this review determined an average of 9-12 months of recovery is the most commonly utilized timeframe; however, younger athletes may require upwards of 14-16 months depending on physeal maturation. While concussion protocols are relatively accepted across athletic disciplines, there are possible improvements available, including sport-specific testing such as the Gapski-Goodman Test, provocation tests, or ImPACT scoring. RTP protocols are highly variable depending on a variety of factors such as the type of provider performing the assessment, age of the patient, and the sport involved. Further research is necessary to further delineate the nuanced differences in safe RTP guidelines for injuries seen in each sport.

Keywords:  pediatric trauma; return to play; sports injury; sports medicine; youth sports

DOI:  https://doi.org/10.7759/cureus.106148
JAMA Dermatol. 2026 May 06.

Pediatric Skin Disease Frequencies and Dermatology Use by Race and Ethnicity in US Children's Hospitals.

Nicolas G Quan, Elizabeth Garcia-Creighton, Molly Thapar, Briana Kille, Josh Tucker, Sarah J Schmiege, Markus D Boos, Esteban Fernández Faith, Amy S Paller, Dawn H Siegel, Liza H Siegel, Roslyn T Varki, Albert C Yan, Lucinda L Kohn.

Importance: Understanding which children present with skin disease and reach specialty care is essential for characterizing patterns of disease frequency and care use.
Objective: To describe the frequencies of common pediatric skin diseases and patterns of dermatology use, stratified by race and ethnicity, across 8 US children's hospitals participating in the PEDSnet system.
Design, Setting, and Participants: This was a multicenter cross-sectional study of 8 US children's hospitals in PEDSnet from January 2009 to July 2022. Data were analyzed from January 3 to March 26, 2024. The study cohort included children with 1 or more dermatology clinic visit or 2 or more non-dermatology clinic visits coded for atopic dermatitis (AD), acne, infantile hemangioma, psoriasis, or hidradenitis suppurativa (HS).
Main Outcomes and Measures: Disease frequency per 100 000 children and proportion of children using dermatology care for each condition, stratified by race and ethnicity.
Results: Of 536 776 patients, the mean (SD) age was 6.4 (6.3) years, 51.5% were female, and 0.2% were American Indian or Alaska Native, 6.4% Asian, 27.9% Black, 14.1% Hispanic, 0.3% Native Hawaiian or Other Pacific Islander, 8.4% non-Hispanic, 44.3% White, 4.3% multiple races, 5.5% unknown ethnicity, and 16.6% unknown race. Case counts were 377 970 for AD, 139 632 for acne, 54 305 for infantile hemangioma, 11 339 for psoriasis, and 5722 for HS. Electronic health record-derived frequencies varied across race and ethnicity groups. There were 10 469 (95% CI, 10 414-10 524) cases of AD per 100 000 Black children compared with 3099 (95% CI, 3083-3114) per 100 000 White children. There were 290 (95% CI, 280-300) cases of infantile hemangioma per 100 000 Black children compared with 764 (95% CI, 756-772) per 100 000 White children. Black children had a low proportion of dermatology use across all 5 conditions, yet high frequencies of AD, acne, and HS.
Conclusions and Relevance: In this study, across all studied conditions, Black children had a low proportion of dermatology use at participating PEDSnet US children's hospitals, despite having high frequencies of AD, acne, and HS. Further research is required to determine whether these patterns represent appropriate specialty care use or reflect gaps in care.

DOI: https://doi.org/10.1001/jamadermatol.2026.0916
BMC Pediatr. 2026 May 09.

The impact of structured training on the management of agitated pediatric patients in the emergency department: changes in knowledge and self-efficacy perceptions of physicians.

Tugce Nalbant, Yüksel Bıcılıoglu, Gamze Gokalp, Gonca Özyurt, Yeşim Ece Ünsal, Gizem Buket Yayla Coşgun, Esin Ergonul.

   BACKGROUND: Children and adolescents presenting with acute behavioral agitation are increasingly admitted to pediatric emergency departments. Agitation management requires a structured and multidisciplinary approach that integrates effective communication strategies with pharmacological and non-pharmacological interventions. However, evidence-based guidance in this field remains limited, and healthcare professionals' knowledge and training levels are heterogeneous.
OBJECTIVE: This study aimed to evaluate the impact of a structured training program on pediatric and child psychiatry residents' knowledge and perceived self-efficacy in the management of agitation.
METHODS: This quasi-experimental educational study was conducted in a tertiary pediatric emergency department between January and August 2025. A total of 39 physicians, including pediatric residents, pediatric emergency medicine fellows, and child psychiatry residents, participated in a training program developed using the ADDIE instructional design model. The program combined theoretical instruction with case-based workshops focusing on verbal de-escalation, pharmacological management, and ethical application of physical restraint. Knowledge and self-efficacy were assessed before and after the intervention using structured questionnaires.
RESULTS: Thirty-nine physicians completed the study. Post-test knowledge scores were significantly higher than pre-test scores (Z = - 3.56; p < 0.001; r = 0.56), and score improvement was observed in 64.1% of participants. No significant association was found between professional experience and pre-test or post-test scores; however, a significant negative correlation was identified between professional experience and score difference (post-test - pre-test) (r = - 0.480; p = 0.002). This finding indicates that participants with lower baseline knowledge levels achieved greater gains from the training.
CONCLUSIONS: Structured, case-based, and multidisciplinary training significantly enhances physicians' knowledge and self-efficacy in managing agitated pediatric patients in emergency settings. These findings demonstrate that systematically designed, institution-specific training programs can support physician competency in pediatric emergency departments.

Keywords:  Behavioral crisis; Multidisciplinary training; Pediatric agitation; Pediatric emergency department; Physician education; Self-efficacy

DOI:  https://doi.org/10.1186/s12887-026-06972-7
J Am Acad Dermatol. 2026 Apr 30. pii: S0190-9622(26)02583-1. [Epub ahead of print]

The clinical value of implementing walk-in pediatric dermatology appointments within emergency department services.

Jordan K Bui, Cyrelle Finan, Ashley Smith-Fraser, Kaiane Habeshian, Colleen H Cotton, James Chamberlain, Xian Sam Zhao, A Yasmine Kirkorian.



Keywords:  dermatologic emergency; emergency room visit; pediatric dermatology; urgent clinic

DOI:  https://doi.org/10.1016/j.jaad.2026.04.1978
J Head Trauma Rehabil. 2026 May 01.

Research Letter: Concussion Evaluation by Injury Setting Among US Children.

Todd Burus, Jennifer D Burus, Svetla Slavova, Celysse M van Zyl.

   OBJECTIVE: To examine differences in medical evaluation for concussion after sports-related head trauma (SRHT) versus non-SRHT among school-aged children in the United States.
SETTING: National Health Interview Survey.
PARTICIPANTS: Children aged 5-17 years living in the United States.
DESIGN: Caregiver-reported responses to questions on health topics among a nationally-representative sample of US children.
MAIN MEASURES: Experience of concussion-like symptoms after head trauma in the prior year, injury setting, and receipt of medical evaluation for concussion from health professional.
RESULTS: The study included 11,768 children aged 5-17 years in 2023-2024. An estimated 2.6% (95% confidence interval [CI], 2.3-2.9) reported concussion-like symptoms after head trauma in the prior year, with a higher prevalence among those aged 13-17 years (3.5%; 95% CI, 3.0-4.1). Most injuries occurred outside of sports settings (60.8%; 95% CI, 54.4-66.8). Overall, 67.7% (95% CI, 61.5-73.5) of injured children received a medical evaluation for concussion. Evaluations were more common among males than females (adjusted prevalence ratio [aPR], 1.249; 95% CI, 1.043-1.495) and those aged 13-17 years than aged 5-12 years (aPR, 1.366; 95% CI, 1.104-1.689). Concussion evaluations were administered to 90.4% of children with SRHT compared with only 53.1% with non-SRHT. Adjusting for relevant characteristics, we estimated medical evaluation occurred 39.2% less often for non-SRHT (aPR, 0.608; 95% CI, 0.505-0.733). Based on the 2023-2024 population estimates, this indicates approximately 388,905 (95% CI, 292,880-484,929) missed concussion evaluations for children with non-SRHT each year.
CONCLUSION: These findings suggest substantially more missed concussion evaluations among children with concussion-like symptoms after non-SRHT compared with those with SRHT. Increasing awareness about concussion care among school personnel and health professionals that work with pediatric populations, and embedding clear guidance for referral and treatment into non-sports-related settings, may serve to reduce differences in evaluation and improve long-term recovery.

Keywords:  adolescence; concussion; head injuries; primary health care; school health services

DOI:  https://doi.org/10.1097/HTR.0000000000001173
J Pediatr. 2026 May 05. pii: S0022-3476(26)00166-6. [Epub ahead of print] 115138

Missed Contacts: Rethinking the Language of "No-Show" in Pediatric Care.

Brittany L Willer, Helen H Lee.

DOI: https://doi.org/10.1016/j.jpeds.2026.115138
Emerg Med J. 2026 May 04. pii: emermed-2025-215617. [Epub ahead of print]

Understanding how language barriers in the paediatric emergency care setting influences safety of care delivery: a scoping review.

Ricky Odedra, Phoebe Averill, Ruud Gerard Nijman, Veronika Wiemker, Bhairavi Hariharan, Erik Mayer.

   BACKGROUND: Communication in a family's primary language can support safe care. Vital steps within the care delivery process are contingent on successful communication, including reporting symptoms, clinical decision-making, informed consent, discharge communication and follow-up coordination. The importance of effective information exchange is particularly pronounced in paediatric emergency care, and complex interactions may arise as parents or carers advocate on behalf of children. This scoping review aimed to identify and map existing research indicating where along the care journey communication-related risks for safety lie during paediatric emergency care and what strategies exist to mitigate them.
METHODS: We searched MEDLINE, Embase, CINAHL, Scopus, Web of Science and Cochrane Library for studies which examined the influence of language barriers on patient safety in paediatric emergency care as well as studies that evaluated interventions. Bibliographic database searches were executed on 18 December 2024; retrieved records were independently screened by two authors at title and abstract level followed by full text level. Data on study objectives, population characteristics, study design and their key findings were extracted.
RESULTS: 1578 articles were identified, of which 33 were included and mapped according to (i) studies reporting safety risks linked to language barriers in paediatric emergency care (n=24) and (ii) existing interventions designed to mitigate these risks (n=9). Studies highlighted that language barriers can influence safety at multiple stages of the emergency care pathway, with discharge most frequently reported as a point of risk for paediatric patient safety. Interventions focused primarily on usage, uptake and documentation of professional interpreter services.
CONCLUSION: Addressing misunderstandings around follow-up and home-care advice during medical safety netting are priority areas for intervention. Future research should involve carer and clinical perspectives in exploring whether technology-enabled tools, including artificial intelligence, can safely mitigate language barriers in these situations.

Keywords:  communication; pediatric emergency medicine; safety

DOI:  https://doi.org/10.1136/emermed-2025-215617
Curr Opin Organ Transplant. 2026 May 08.

Pediatric lung transplantation in 2026: recent changes and current challenges.

Saba Sheikh, Christian Benden, Gary A Visner.

   PURPOSE OF REVIEW: Lung transplantation has evolved as an accepted therapy in carefully selected children with end-stage lung disease, offering prolonged survival and improved health-related quality of life (HRQoL). Pediatric lung transplantation is complex and multilayered and differs from adult transplant. Specific aspects of pediatric lung transplantation will be reviewed, updates on recent developments in the field will be shared, and current challenges will be discussed.
RECENT FINDINGS: The underlying diagnoses leading to lung transplantation vary considerably by age group and have shifted in the last decade. With children requiring special consideration due to their size and immune status, early referral, careful patient selection, and appropriate timing of listing are crucial. Surgical techniques, donor organ utilization, bridging sick patients to transplant and management of posttransplant complications are continually evolving to improve long term survival.
SUMMARY: Despite its challenges, lung transplant in pediatrics is successful and can improve HRQoL. Developments and further research in expanding the donor pool, peri-transplant management and prevention and treatment of infectious complications and transplant rejection are needed.

Keywords:  chronic lung allograft dysfunction; donor; lung transplant recipient; pediatric lung transplant

DOI:  https://doi.org/10.1097/MOT.0000000000001290
Pediatr Nephrol. 2026 May 07.

Key performance indicators for acute kidney replacement therapy in critically ill children: a systematic review.

Prit Kusirisin, Kristin J Dolan, Rashid Alobaidi, Dana Y Fuhrman, Aadil K Kakajiwala, Tara M Neumayr, Ahmed S Said, Janice Y Kung, Ayse Akcan Arikan, Oleksa G Rewa.

   BACKGROUND: Acute kidney injury is common among critically ill children and independently associated with morbidity and mortality, particularly in those receiving kidney replacement therapy (KRT). As KRT is not innocuous, standardizing its delivery is critical for accurate outcome tracking. Establishing key performance indicators (KPIs) is essential to guide quality improvement and support decision-making through ongoing monitoring of KRT processes.
OBJECTIVES: This systematic review evaluated existing evidence on KPIs related to KRT delivery in critically ill pediatric populations.
DATA SOURCES: A comprehensive search of Ovid MEDLINE, Ovid Embase, CINAHL, and the Cochrane Library was conducted for studies published from inception to February 2025.
STUDY ELIGIBILITY CRITERIA: Eligible studies reported KPIs related to dialysis processes in critically ill children receiving KRT.
PARTICIPANTS AND INTERVENTIONS: Critically ill children receiving all KRT modalities were assessed for KPIs according to the Donabedian framework, with each KPI stratified based on whether it measured a process related to KRT care.
STUDY APPRAISAL AND SYNTHESIS METHODS: Six reviewers independently screened, selected, and appraised studies using the risk-of-bias tool appropriate for each study design. Data were summarized narratively.
RESULTS: Of 7,111 citations screened, 107 studies met inclusion criteria, comprising 57 retrospective cohorts, 27 case series, 16 prospective cohorts, 4 case reports, 2 randomized controlled trials, and 1 audit. Most studies (66.7%) were of moderate quality. Six KPIs were identified across 240 instances: solute clearance (n = 59), filter life (n = 52), downtime (n = 43), fluid management (n = 36), hypotension (n = 25), and prescription (n = 24). KPI definitions were heterogeneous. KPIs were categorized as important (n = 242, 52.1%), scientifically acceptable (n = 107, 23.1%), and feasible (n = 115, 24.8%).
LIMITATIONS: This systematic review is limited by heterogeneity in study quality, with most evidence derived from observational or clinical studies rather than structured quality improvement initiatives. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS : Multiple potential KPIs for pediatric KRT were identified; however, definitions and validation were inconsistent. Standardizing and prioritizing a set of concise KPIs are needed to measure, benchmark, and improve KRT quality in critically ill children.
SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42023474374 (October 30, 2023).

Keywords:  Acute kidney injury; Critical care; Dialysis; Key performance indicator; Kidney replacement therapy; Pediatric

DOI:  https://doi.org/10.1007/s00467-026-07332-4
Pediatrics. 2026 May 08. pii: e2025073834. [Epub ahead of print]

Improving the Delivery of Quality Evidence-Based Inpatient Asthma Care.

Eleanor E Young, Daniela Bullard-Elias, Skylar Faul, Jessica Luong, Abbey Scott, Andrew F Beck, Laura Brower, Jennifer D Treasure.

OBJECTIVE: Evidence-based care guidelines and clinical pathways are central to quality, equitable, and standardized pediatric asthma care. We sought to improve delivery of optimal guideline-concordant asthma care, defined as documentation of (1) medical and social-environmental risk assessment, (2) a maintenance medication plan, and (3) accurate asthma action plan at discharge. Specifically, we sought to increase the proportion of hospital medicine patients receiving all 3 components from 15% to 80% over 12 months.
METHODS: Our multidisciplinary team defined and operationalized optimal inpatient asthma care using the chronic care model, published literature, and local expert input. Interventions focused on guideline-concordant clinical decision support and educational tools aligned to recently updated Global Initiative for Asthma guidelines, enhanced interdisciplinary communication, and redefined inpatient care processes. Process measures included bundled all-or-none completion of the 3 optimal care components. Outcome measures included 30- and 90-day asthma-related readmissions, length of stay, and rates of inhaled corticosteroid-containing prescription regimens at hospital discharge.
RESULTS: Over 12 months of interventions, receipt of optimal asthma care improved from 15% to 69%. Independently, there were notable increases in completion of all 3 components of optimal care. For example, medication maintenance plans, as defined by rates of inhaled corticosteroid prescriptions at hospital discharge, notably increased in alignment with asthma guidelines, from 71% to 80% (P = .002). We also noted a reduction in length of stay and 90-day readmission rates.
CONCLUSIONS: Multidisciplinary interventions targeting clinical decision support and interdisciplinary communication were associated with improved receipt of guideline-concordant care and reduced readmissions.

DOI: https://doi.org/10.1542/peds.2025-073834
Pediatr Cardiol. 2026 May 05.

School Readiness by Presence of Congenital Heart Condition Among U.S. Preschool-Aged Children Without Diagnosed Developmental Conditions, National Survey of Children's Health 2022-2023.

Justina A Omari, Emily O Olsen, Helena J Hutchins, Matthew E Oster, Karrie F Downing.

  Given the heart-brain relationship, children with congenital heart conditions (CHC) may experience poor academic outcomes, even if not diagnosed with developmental conditions. Among children without diagnosed developmental conditions, this study evaluates the "healthy and ready to learn" (HRL) metric by CHC status and identifies associated factors. Using 2022-2023 National Survey of Children's Health (NSCH) data, we compared HRL among 3-5-year-olds with no known genetic, intellectual, or developmental disabilities by CHC status using adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). HRL was defined using an established algorithm with 5 domains (Early Learning skills, Social-Emotional Development, Self-Regulation, Motor Development, Health) and scored as "needs support," "emerging," or "on track," aligning with developmental expectations. Among children with CHC, we further identified associated characteristics. Of 19,094 included children, 408 (1.9%) had CHC. Compared to children without heart conditions, fewer children with CHC were "on track" for HRL overall (CHC = 62.4%; no HC = 70.4%) and for each HRL domain (CHC range: 64.3%-83.9%; no HC range: 71.9%-92.5%), though most aPR 95% CIs included 1. Among children with CHC, characteristics associated with not being "on track" in some domains were: ≥3 h of screen time on most weekdays, having special healthcare needs, access to fewer neighborhood amenities, experiencing ≥ 1 adverse childhood event, or caregivers with less than a high school education (aPRs range: 0.58-0.79). Less than two-thirds of children with CHC were HRL. Families of preschoolers with CHC may benefit from intervention efforts and resources to improve school readiness.

Keywords:  Congenital heart defects; Healthy and ready to learn; Heart conditions; National Survey of Children’s Health; Pediatric cardiology; Preschool

DOI:  https://doi.org/10.1007/s00246-026-04251-x
J Pediatr. 2026 May 06. pii: S0022-3476(26)00168-X. [Epub ahead of print] 115140

Respiratory Readmissions in First 3 Years of Life for Children with Bronchopulmonary Dysplasia.

BPD collaborative outpatient subgroup

   OBJECTIVE: To examine the demographic, clinical, and environmental characteristics of children with bronchopulmonary dysplasia (BPD) associated with respiratory readmissions.
STUDY DESIGN: Demographic and clinical data were obtained from children with BPD recruited from 15 centers participating in the BPD Collaborative between 2018 and 2025. Subjects with any hospital readmission for respiratory reasons were compared with children not readmitted as assessed by questionnaires obtained at clinic visits during the first 3 years of life. Clustered regression models were used to identify variables associated with readmission. Secondary analyses were performed to identify factors associated with a higher number (≥2) of readmissions.
RESULTS: There were 1615 participants who met inclusion criteria with a mean age of 9.4+ 7.5 months at recruitment. During the study period, 352 (21.8%) had at least 1 readmission and 1263 had no reported readmission. In multivariable models, an increased likelihood of readmission was associated with a shorter initial NICU hospitalization, use of a home ventilator, prescription of reflux medications, daycare attendance, and lower BPD control score.
CONCLUSIONS: In young children with BPD, markers of medical complexity, such as home ventilator use for chronic respiratory failure and gastroesophageal reflux, were associated with a high likelihood of respiratory readmissions. Other potentially modifiable factors associated with readmissions include daycare attendance and respiratory symptom control. BPD severity was not associated with readmission risk. Identifying risk factors for respiratory readmission in the outpatient setting will help healthcare providers to provide targeted anticipatory guidance.

Keywords:  Readmissions; bronchopulmonary dysplasia; tracheostomy

DOI:  https://doi.org/10.1016/j.jpeds.2026.115140