Emergency Medicine Commons^™

Rural Emergency Department Perspectives On Telemedicine Consultation For Pediatric Emergencies, Caroline Nemechek, Kimberly Randell, Romina Barral, Michelle K. Arzubi-Hughes

Posters

No abstract provided.

Streamlining Pediatric Appendicitis Evaluation In The Emergency Department, Joan C. Bruce, Douglas J. Fox, Owen N. Ferriola, Allen J. Huang, Nicholas A. Long, Erin M. Morris, Krysta M. Sutyak, Jeannette M. Joly, Carleen V. Cuevas, Akemi L. Kawaguchi, Kuojen Tsao

Summer Research Program Abstracts

No abstract provided.

Shopping Cart–Related Injuries In Children: Brief Clinical Review And Public Health Implications, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Shopping cart–related injuries represent a common yet underrecognized mechanism of pediatric trauma. National estimates suggest approximately 24,000 children annually are treated in U.S. emergency departments for shopping cart–related injuries, with falls accounting for the majority of cases. Younger children, particularly those under 5 years of age, are disproportionately affected, and head and facial injuries predominate.

Objective:

To provide a concise clinical and public health review of shopping cart–related pediatric injuries, with emphasis on epidemiology, injury patterns, and opportunities for prevention within emergency department practice.

Methods

Narrative review of national injury surveillance data, prior epidemiologic studies, and consumer safety guidance addressing …

Improving Emergency Department Throughput: Implementation Of A Nurse-Driven Protocol In Pediatric Fast-Track Patients Presenting With Fever, Kerrigan A. Teeple

Evidence-Based Practice Project Reports

Overcrowding in the emergency department presents significant operational challenges and is associated with adverse patient outcomes (Gottlieb et al., 2020). Despite throughput initiatives, increasing patient acuity and rising census levels continue to strain emergency department efficiency. This quality improvement project evaluated whether implementing a fever-reduction standing order protocol could reduce door-to-provider and door-to-disposition times for pediatric fast-track patients presenting to the emergency department. A review of evidence across 6 databases identified nurse-initiated standing orders as a best-practice strategy to expedite care, improve throughput, and reduce delays in disposition. Guided by this evidence, a standing order protocol for acetaminophen administration was …

Navigating The Nicu Without Words: A Case Study Of A Spanish-Speaking Mother’S Healthcare Experience, Emma Norris

Poster Presentations

Research on NICU experiences largely focuses on majority-language families; non-English-speaking families are understudied (Cleveland, 2008). The Family Integrated Care model promotes parent-infant connection and shared decision-making to improve outcomes (Wreesmann et al., 2020). Language barriers impede parent-provider communication, increasing miscommunication and parental anxiety (Kynoe et al., 2020; Ardal et al., 2011). The purpose of this research is to explore communication experiences and barriers between English-speaking and bilingual NICU nurses and a Spanish-speaking NICU mother.

Health Disparities For Pneumonia And Sinusitis Antibiotic Treatment In The Emergency Department, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Rana El Feghaly Md

Posters

Optimal antibiotic selection and duration are pillars of antimicrobial stewardship efforts. In our emergency department (ED), >80% of community acquired pneumonia (CAP) and acute bacterial rhinosinusitis (ABRS) are treated with first-line (FL) guideline-concordant antibiotics. Differences in care based on socioeconomic factors (race, ethnicity, language, and insurance status) have not been characterized. We sought to compare differences in antibiotic choice and duration for different socioeconomic factors, and analyze changes after quality improvement (QI) efforts. Multidisciplinary QI team used multiple Plan- Do-Study-Act cycles and was successful in improving antibiotic duration for CAP and ABRS from a baseline of 13% to 61% (January …

Reducing Waste And Cost By Utilizing Tap Water For Laceration Irrigation In The Emergency Department: A Quality Improvement Approach, Alison L. Fowler, Rohan Akhouri, Josaih Galdean, Isabella Dunt, Christopher Kaberline, Viktoriya Stoycheva Mha, Rn, Cpn, Sarah Nienhaus, Leslie Hueschen

Posters

Purpose/Objective: Lacerations requiring closure make up 8 million emergency department (ED) visits annually. Irrigating prior to closure with potable tap water decreases cost and waste without increasing rates of infection compared to sterile fluids. Currently, only 3.5% of lacerations closed in our ED are irrigated with tap water. This project aims to increase the percent age of lacerations closed by ED providers irrigated with tap water from 3.5% to 60% by March 2026 in a freestanding pediatric emergency department across two sites (ED 1, ED 2). Design/Methods: A multidisciplinary team (physicians, nurses, QI consultant, parent advisors) formed in November 2024. …

Association Of Higher Body Mass Index With Imaging Escalation And Operative Complexity In Pediatric Appendicitis, Ryan T. Davis, Sahithi Pemmasani, Margaret Menoch

Conference Presentation Abstracts

Background: Obesity may complicate clinical assessment and ultrasound (US) evaluation in children with appendicitis, potentially increasing reliance on computed tomography (CT). At the same time, national pediatric quality-improvement initiatives and ALARA-driven imaging pathways emphasize reducing CT use and promoting US-first approaches. Data examining how body mass index (BMI) influences diagnostic pathways within these modern low-radiation protocols are limited.

Objective: To determine whether higher BMI is associated with greater CT utilization, escalation from US to CT, nondiagnostic US examinations, emergency department (ED) length of stay (ED-LOS), and operative duration in children with appendicitis.

Design/Methods: This retrospective cohort study included patients < 18 years with surgically confirmed appendicitis presenting to a tertiary pediatric ED from January 1, 2010, to December 31, 2023. Consistent with prior dataset methodology, encounters were identified through structured EHR query using ICD-10 and CPT codes and restricted to unique first visits. A total of 2,275 children were included; BMI was available for 2,012 (88%). BMI was analyzed in quartiles. Imaging modality (US-only, CT-only, or CT after US) and operative duration (proxy for case complexity) were evaluated. χ² and Wilcoxon tests and odds ratios (OR) with 95% CI were used. IRB approval was obtained (Corewell Health IRB No. 2024-128).

Results: …

Isolated Clonidine Ingestions In Pediatric Patients, Spencer Greene, Caleb King, Sharan Campleman

Gulf Coast Division GME Research Day 2026

No abstract provided.

Reducing Respiratory Viral Testing In A Pediatric Emergency Department: A Quality Improvement Initiative, Anna Suessman

North Texas GME Research Forum 2026

Background: Respiratory viral testing in pediatric emergency departments (EDs) is frequently performed despite limited impact on clinical management for many low-risk presentations. Unnecessary testing increases cost and operational burden may delay patient throughput and can provide false reassurance to caregivers. Additionally, pediatric emergency department nurses agreed with overburden and impact to throughput based on overuse of viral testing (qualitative nursing survey conducted on September 4, 2024 showed >98% felt testing was unnecessary). We hypothesized that reducing testing through standardized team education and discharge processes would not negatively affect patient experience. This initiative aimed to decrease unnecessary respiratory viral testing during …

Nitrous Oxide Vs. Ketamine: Impacts On Pediatric Emergency Department Length Of Stay, Tabitha Brock, Anna Suessman

North Texas GME Research Forum 2026

Background Nitrous oxide (N₂O) is a well-established analgesic and anxiolytic agent, widely used for procedural sedation in pediatric dentistry. Despite its demonstrated safety and efficacy, its use in Pediatric Emergency Departments (PEDs) remains limited and underexplored. To address this gap, we implemented a comprehensive training program for PED providers and introduced N₂O as an alternative sedation agent.

Objective We hypothesized that using N₂O for procedural sedation would significantly reduce patient length of stay (LOS) without compromising safety or outcomes.

Methods We conducted a retrospective chart review of pediatric patients who underwent painful procedures in a tertiary children’s hospital emergency department. …

Improving Timely Asthma Treatment In A Pediatric Emergency Department Through A Standardized Evidence-Based Pathway, Olivia Everard Harris

Covenant Nurses Week 2026

No abstract provided.

Ed Presentation Of Pediatric Suprasellar Mass Presenting As Headache With New-Onset Seizure, Pranav Bommineni, Arjavon Talebzadeh, Michael Beck

South Atlantic Division GME Research Days 2026

No abstract provided.

Staphylococcal Scalded Skin Syndrome In Melanated Skin: A Pediatric Case Report, Aleah Lafrancis-Ream, Scott Gutovitz, Hannah Chotiner

HCA Healthcare Journal of Medicine

Background

Staphylococcal scalded skin syndrome (SSSS) is a dermatologic emergency that most commonly affects young children, requiring prompt recognition and treatment to avoid severe symptoms and fatal sequelae. It is characterized by a desquamation of the skin caused by exotoxins produced by the Staphylococcus aureus species and may present differently in melanated skin.

Case Presentation

Our case describes a 6-month-old Black infant girl who presented to the emergency department with SSSS that was unrecognized on 2 prior encounters. This delay in diagnosis and the misapplication of topical antibacterial agents and steroids may have contributed to the worsening of her symptoms …

Unexpected Companions: Appendicitis And Bilateral Testicular Torsion, Jc Alvarenga, Melissa Kirk, Michelle Osorio-Rodriguez

Florida Journal of Emergency Medicine (FJEM)

Abdominal pain is a frequent chief complaint in the emergency department (ED), responsible for 5% of all visits yearly. Despite emergency room work ups, 25% of these cases go undiagnosed. In the pediatric population, abdominal pain can be even harder to differentiate with causes ranging from low acuity constipation to emergent surgical emergencies like torsion or appendicitis. During these visits, the likelihood of two emergent surgical diagnoses occurring concurrently is a rare and often overlooked occurrence.

This case describes a 15-year-old male with a chief complaint of nausea and vomiting starting several hours prior to arrival. In the ED, history, …

Can The Combination Of White Blood Cell Count And C-Reactive Protein Rule Out Pediatric Appendicitis, A Retrospective Analysis?, Scott Gutovitz, Samantha Stoner, Jarrett Koper, Sarah Kleist

HCA Healthcare Journal of Medicine

Background

Pediatric appendicitis (PA) is the most frequent cause of pediatric emergency surgery. Standard PA scoring systems incorporate inflammatory biomarkers (white blood cell count [WBC] or C-reactive protein [CRP]); however, the individual biomarker sensitivities have not been reported beyond single-center sites. We aimed to measure the individual and combined sensitivities of WBC and CRP to rule out PA in a large multicenter hospital system.

Methods

We did a retrospective study of pediatric emergency department patients (age <18) with abdominal pain, using a deidentified electronic health database from a 175-hospital system in the United States, comparing PA versus non-PA patients. Pediatric appendicitis patients were identified by ICD-10 diagnosis codes and had advanced imaging, whereas non-PA patients had advanced imaging and were discharged home with the ICD-10 code for abdominal pain. Using matched propensity matching, we calculated receiver operator characteristics and Youden’s index to find the optimal cutpoints. Sensitivity was calculated at the optimal and traditional cutpoints for each biomarker, also combined in parallel fashion.

Results

We identified 7414 subjects (3707 PA matched to 3707 controls). The WBC in PA patients was 14.99 ± 5.00 k/mm³ versus 9.63 …

Evolving Management In Pediatric Appendicitis: A 14-Year Review Of Ketorolac, Opioid Use, And Imaging Trends, Sahithi Pemmasani, Ryan T. Davis, Margaret Menoch, Nathan M. Novotny

Conference Presentation Abstracts

Background: Acute appendicitis is a common pediatric emergency requiring timely diagnosis and effective pain management. This study evaluates trends in ketorolac use, opioid prescribing, and imaging modalities in pediatric appendicitis cases, addressing concerns about ketorolac’s role in diagnostic accuracy and opioid reduction.

Methods: A retrospective analysis of 2,294 pediatric emergency department (ED) visits for suspected appendicitis from 2010 to 2023 was conducted. Data included administration of ketorolac, opioids, and non-opioid analgesics, as well as imaging use (ultrasound [US] vs. computed tomography [CT]). Statistical analyses included Pearson correlation and chi-square tests.

Results: Ketorolac use increased significantly from 1.5% in 2010 to …

Nurse-Initiated Improvement For Documentation Of Penicillin Adverse Drug Reactions In Pediatric Urgent Care Clinics., Elizabeth Monsees, Diane Petrie, Rana El Feghaly, Sarah Suppes, Brian R. Lee, Megan Whitt, Amanda Nedved

Manuscripts, Articles, Book Chapters and Other Papers

Background/Objective: Penicillin allergy labels (PALs) contribute to broad-spectrum antibiotic use. Thorough documentation can help prescribers identify and remove unnecessary PALs. We aimed to improve documentation of PALs in three pediatric urgent care (PUC) clinics, using a nurse-initiated quality improvement (QI) approach. Methods: QI interventions included a survey to assess prescriber and nurse confidence, an online educational module, and an algorithm to aid in clarifying PALs. We measured the percentage of PALs with a clarified reaction severity as our primary outcome using annotated control charts. Descriptive and inferential statistics evaluated survey responses between nurses and prescribers. Results: Clarified PAL reaction severity …

Resonant Disruptions: Understanding Canadian Nurses’ Practice With Youth Survivors Of Sexual Exploitation, Danielle E. Giebelhaus, Andrew Estefan Phd, Rpn

Dignity: A Journal of Analysis of Exploitation and Violence

The sexual exploitation of youth is a global concern. Youth survivors of sexual exploitation present to and require healthcare services, but most nurses do not feel effectively equipped to care for this population. There is currently little nursing literature to guide nurses in their practice with youth survivors. In this article, we report on a qualitative, hermeneutic study undertaken to explore nursing practice with youth survivors of sexual exploitation. Hermeneutics is concerned with understanding, and is a helpful way to conduct research when little is known about a topic. In this study, we asked the research question, “How might we …

Urgent Implementation Of Point-Of-Care Testing For Group A Streptococcal Infection In A Uk Children’S Emergency Department, Ruth Shorrocks, Philip J. Turner, Thomas Fanshawe, Umasha Ukwatte, Jim Gray, James Taylor, Liliana Graveto, Gail Hayward, Chris Bird

Journal of Pediatric Infectious Diseases

Objective: In late 2022, Western Europe and the United States experienced increased incidences of scarlet fever and life-threatening invasive group A strepto- coccal (iGAS) infections, especially among children. The outbreak was widely reported in the media in the United Kingdom, leading to increased emergency department (ED) attendances and threatened supplies of antibiotics. Our ED rapidly introduced point-of-care testing for GAS pharyngitis with the aim of rationalizing antibiotic prescribing.

Methods: We rapidly implemented the use of a molecular-based (polymerase chain reaction) point-of-care test for all children scoring 3 or higher on the McIsaac clinical prediction rule for GAS pharyngitis in children …

Reducing Antibiotic Duration For Pneumonia And Sinusitis In The Emergency Department: A Quality Improvement Approach, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Marsha Dannenburg, Patricia Phillips, Jennifer Floyd, Alaina N. Burns, Rana El Feghaly

Research Days

Background: Our aim is to increase the percentage of children discharged home from the ED with a diagnosis of CAP or ABRS treated with an optimal antibiotic duration (3-5 days for CAP, 5-7 days for ABRS) from 13% to 70% by July 25.

Methods: Outcome metric is the percentage of patients receiving recommended antibiotic duration for CAP and ABRS. Process metrics include use of order set, "Quick Discharge” order set, and clinical pathway QR codes. Balancing metric is the number of return visits with the same diagnosis < 14 days. Plan-Do-Study-Act methodology was used. In Aug 23, our ASP disseminated a handbook that emphasized shorter durations. A new multidisciplinary team (infectious diseases, ED, and urgent care physicians, advanced practice providers, nurses, and pharmacy) formed in Dec 23. We utilized cause-and-effect analysis, driver diagram, and prioritization matrix, which helped identify other impactful interventions, including implementation of new internal CAP clinical pathway order set (April 24) and “Quick Discharge” order sets (May 24). Next, we surveyed prescriber comfort (June 24) with shorter duration identifying barriers and providing education, leading to posted evidence for lower duration treatment in practitioner workrooms and developing a new ABRS clinical pathway (Sept 24). Top prescribers providing optimal duration received email acknowledgement (Oct 24) and resident rotators received antibiotic handbook and CAP clinical pathway QR codes (Nov 24). New best treatment practices for ABRS were elucidated and disseminated through clinical pathway and internal article publishing to our hospital and associated clinics (Dec 24).

Results: We saw shifts in the outcome metric’s center line in Sept 23 …

Decreasing Time To Narcotic Pain Medication In Patients With Sickle Cell Disease Presenting With Acute Pain Crises In A Pediatric Emergency Department: A Quality Improvement Initiative., Allison Adam, Leslie Hueschen, Lina Patel, Christopher Kaberline, Ibad Siddiqi

Research Days

Background: Guidelines published by the National Heart, Lung and Blood Institute recommend that patients with sickle cell disease who present in acute pain crisis receive narcotic medication < 60 minutes from arrival. Multi-center studies indicate approximately 50% of institutions are adherent to this level 1a recommendation. From October 2022-October 2023, our institutional median time to narcotic was 61 minutes.

Objective: Our aim was to decrease the time to narcotic administration by 10% (61 min to 55 min) in patients with Sickle Cell Disease presenting to the emergency department for acute pain crisis while simultaneously decreasing disparities in our patient population by Oct 2024. Additionally, we sought to increase the percentage of patients within this population to receive their first narcotic in 60 min from 49% to 70%, by Oct 2024.

Methods: We …

Case: Pituitary Mass In A Pediatric Patient, Alyssa Baldini, Carla Calvo

Rowan-Virtua Research Day

We report a case of a 16-year-old female presented to the pediatric emergency department for intermittent visual disturbance and was diagnosed with a pituitary mass resulting in episodic complete bilateral vision loss. Pediatric neurologic complaints can be challenging for a number of reasons. It is important as much as possible to obtain a detailed history from the patient and parent, conduct a relevant chart review, and identify if there have been any recent medication changes. Seeking expert consultation may also be helpful in establishing a diagnosis.

Reducing Antibiotic Duration For Pneumonia And Sinusitis In The Emergency Department: A Quality Improvement Approach, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Marsha Dannenburg, Patricia Phillips, Jennifer Floyd, Alaina N. Burns, Rana El Feghaly

Presentations

Background: Limiting antibiotic duration is one of the pillars of antimicrobial stewardship programs (ASP) as it reduces unnecessary antibiotic exposure. In our emergency department (ED), >90% of respiratory infections are treated with first-line guideline-recommended antibiotics; however, duration continues to be prolonged especially for community acquired pneumonia (CAP) and acute bacterial rhinosinusitis (ABRS). Institutional guidance recommends shortening antibiotic durations to 3-5 days for CAP and 5-7 days for ABRS, however only 13% of discharged ED patients receive the recommended duration. Objective: Our aim is to increase the percentage of children discharged home from the ED with a diagnosis of CAP or …

Reducing Antibiotic Duration For Pneumonia And Sinusitis In The Emergency Department: A Quality Improvement Approach, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Marsha Dannenberg, Patricia Phillips, Jennifer Floyd, Alaina N. Burns, Rana El Feghaly

Posters

Background: Antibiotic duration is one of the pillars of antimicrobial stewardship programs (ASP) as it helps to limit unnecessary antibiotic exposure while continuing to provide appropriate care for infections. In our emergency department (ED), clinicians are using first-line guideline-recommended antibiotics as an appropriate choice for most patients (per our ASP report tracking), however, duration continues to be prolonged especially for community acquired pneumonia (CAP) and acute bacterial rhinosinusitis (ABRS). National guidelines recommend shortening antibiotic durations to 3-5 days for CAP and 5-7 days for ABRS, however currently only 22% of patients discharged from our ED receive the recommended duration. Objective: …

More Of Less: Optimizing Opioid Prescriptions For Acute Fractures In The Emergency Department At A Children’S Hospital, Mitch Kinkor, Spencer Young, Colton Schwarz, Nicholas Clark, Michelle Dephillips, Elizabeth Edmundson, Ryan Mcdonough, Warren Teachout

Presentations

Introduction: Deaths related to drug overdose are at record highs, with over 110,000 recorded from May 2022-2023.1 75% of drug overdose deaths can be attributed to opioids.1 Pediatric opioid exposure is significant, with 406,000 American teens reporting illicit opioid use in 2022.2 Increased prescription opioids in circulation leads to increased opportunity for ingestion by children and adolescents. Current literature suggests most pediatric patients may only use one-two days’ worth of opioid doses prescribed for acute pain control, with the rest of prescribed doses going unused.3 From 2022-2023 in the Children’s Mercy Emergency Department (ED), 48% of children prescribed opioids for …

Decreasing Time To Narcotic Pain Medication In Patients With Sickle Cell Disease Presenting With Acute Pain Crises In A Pediatric Emergency Department: A Quality Improvement Initiative, Allison Adam, Lina Patel, Christopher Kaberline, Ibad Siddiqi, Leslie Hueschen

Posters

No abstract provided.

Navigating Nonlinear Pathways: Challenges And Opportunities For Diversity, Equity, And Inclusion Leaders In Academic Emergency Medicine, Melanie F Molina, Annika Bhananker, Beatrice Torres, Dalia Owda, Edgardo Ordoñez, Anita N Chary

Faculty, Staff and Students Publications

OBJECTIVES: Diversity, equity, and inclusion (DEI) leadership roles have grown in academic emergency medicine (EM). We sought to elucidate specific pathways to DEI leadership roles among current DEI leaders in academic EM.

METHODS: From March to May 2023, we conducted semistructured, qualitative interviews with DEI leaders in academic EM across 5 US regions to investigate their pathways to leadership. Participants were recruited via email using Accreditation Council for Graduate Medical Education-accredited EM residency websites and the Academy for Diversity and Inclusion in EM. After recording and transcribing the interviews, we used an inductive approach to identify major themes.

RESULTS: Of …

Unlocking Prognostic Potential: Biomarker Predictors Of Admission And Length Of Stay In Pediatric Sickle Cell Vaso-Occlusive Pain Crisis, Jeffrey Hernandez, Abhishek Dutta, Jacob Lowry, Bruce Bernstein, Luis Gamboa, Nataly Apollonsky

Tower Health Research Day

No abstract provided.

Stop The Bleed! Acute Epistaxis Management, Christopher R. Cannell

Lynchburg Journal of Medical Science

Epistaxis, the most common Otolaryngology-related emergency, is responsible for one in 200 emergency department (ED) visits in the United States (US) and one-third of otolaryngology visits.^1,11 Up to 60% of the population will experience epistaxis during their lifetime, and 6% -10 % will require medical intervention.^2,3 Epistaxis occurs in children and adults and has a seasonal variation. Although 85% of nosebleeds are idiopathic, they are more frequent in those on supplemental oxygen, anticoagulation, antiplatelet therapy, and in those with other conditions that may predispose them to bleeding. Most clinicians will encounter patients with acute epistaxis; therefore, it is …