In the emergency setting, sepsis is the primary or differential diagnosis for a substantial proportion of febrile or unwell children. In this Grand Round, we will discuss challenges with early recognition and initial management of sepsis in children. We will discuss RCH efforts to improve the care of children with sepsis, including local, national, and international collaborations.
Wheezing in childhood is extremely common, nearly 50% of children experience at least one episode of wheezing before the age of 6 years and wheeze is one of the commonest health problems requiring medical care. Children aged between 1-5 years account for 75% of these admissions with the median age of admission for acute attacks of wheeze being 3 years.
Pediatric emergency medicine (PEM) is a newer subspecialty in child health starting in Canada in the 1980’s. To build the evidence base for clinical care, single center randomized controlled trials (RCTs) with small sample sizes were conducted. However, this led to potential of poorly designed and conducted trials with inadequate statistical power, which often were not published (if they gave negative answers). Systematic reviews of RCTs started to improve the situation, along with the establishment of research networks performing large RCTs provided more definitive guidance for the clinician.
The Emergency Department is the entrance point for children with first presentations and acute exacerbations of illnesses and injuries ultimately cared for by all hospital clinical departments. For many conditions the evidence base for acute diagnosis and management is limited, and research in this area can be challenging because of service priorities.
Blunt head trauma is a common presentation in the pediatric ED. Although some children have overt signs of traumatic brain injuries (TBIs), many have minor head trauma with no or subtle signs of TBI. Among children with apparently minor blunt head trauma, identifying those who indeed have TBI is challenging. Over the past decade there has been increasing use of computed tomography (CT) to avoid missing children with TBI.
