Tessa Davis

Paediatric prescribing errors

Prescribing errors are particularly important in paediatrics where dose calculations are complicated and small errors can cause significant harm. Unfortunately, there is no generally agreed definition of what constitutes an error, so studies often use differing criteria. In addition to this, obtaining statistics on rates of error is problematic as staff may be reluctant to report errors or may not include errors that were corrected before any harm occurred. Prescribing errors can be reduced by improving training, using computerised systems and involving pharmacists in checking drug charts.

Head injury: triage, assessment, investigation and early management of head injury in children, young people and adults (NICE guideline CG 176)

Very few children and young people who present with head injury will have significant intracranial pathology. This presents a common diagnostic dilemma for physicians, as these injuries need to be rapidly identified.1 The previous National Institute of Health and Care Excellence (NICE) head injury guidelines published in 2003 and updated in 2007, established CT scan as the primary imaging modality in head injury. CT provides rapid, definite diagnosis of intracranial injuries, and guides subsequent neurosurgical management, but is associated with significant risks and costs.2 ,3 This NICE update is necessary to ensure the best evidence-based practice regarding initial assessment of head injury and ensuring rapid imaging where appropriate. This NICE guideline also updates some terminology regarding safeguarding children, as the injuries of up to 30% of children aged under 2 years admitted with head injury will be the result of non-accidental/abusive injury.4 As well as reviewing indications and timing of CT brain in the emergency department (ED), this update also addresses indications for transporting head-injured patients directly from the scene to the nearest neuroscience centre, and information that should be given on discharge of head-injured patients. Although this guideline includes adults, for the purposes of review, this paper will focus on children and young people.

NICE guideline: feverish illness in children—assessment and initial management in children younger than 5 years

The National Institute for Health and Care Excellence (NICE) guideline for feverish illness in children (assessment and initial management in children younger than 5 years) was partially updated in May 2013.1 Not all sections were reviewed, but the following were: the signs and symptoms of serious illness; the predictive value of tachycardia; the use of inflammatory markers; and the role of paracetamol and ibuprofen. The aim of the guideline is to optimise the management of young children with fever, and in particular to guide health professionals to recognise the signs of serious infection. The update made new recommendations based on current evidence. This guideline was developed by the National Collaborating Centre for Womens and Childrens Health. They worked with the Guideline Development Group to review the evidence and write the recommendations. It is linked to other NICE guidance on Bacterial meningitis and meningococcal septicaemia and Urinary tract infection in children. 2–4 The previous NICE guideline on feverish illness in children was published in May 2007.

Needle in a haystack: how to identify the sick febrile child

Emergency Department, Sydney Children’s Hospital, Sydney, New South Wales, Australia, Emergency Department, Lady Cilento Children’s Hospital, Brisbane, Queensland, Australia, School of Medicine, University of Queensland, Brisbane, Queensland, Australia, Emergency Department, Logan Hospital, Logan City, Queensland, Australia, and Emergency Department, Footscray Hospital, Melbourne, Victoria, Australia

Utility of blood cultures in children admitted to hospital with community-acquired pneumonia.

The aim of the study was to assess the utility of blood cultures in children admitted to hospital with community‐acquired pneumonia. The primary outcome was the number of positive blood culture results, and secondary outcomes included the effect of positive blood culture results on management, and the identification of other clinical/biochemical variables that could predict blood culture results or the course of illness.

Paediatric resuscitation: Always breathe carefully.

Emergency Department, Footscray Hospital, Melbourne, Victoria, Australia, Emergency Department, Sydney Children’s Hospital, Sydney, New South Wales, Australia, Emergency Department, Lady Cilento Children’s Hospital, Brisbane, Queensland, Australia, School of Medicine, University of Queensland, Brisbane, Queensland, Australia, and Emergency Department, Logan Hospital, Logan City, Queensland, Australia

Identifying autism early: The Toddlers at Risk of Autism Clinic model

This paper describes the Toddlers at Risk of Autism Clinic (TRAC), which utilises the Social Attention and Communication Study (SACS) and/or Autism Detection in Early Childhood (ADEC) play‐based assessments to facilitate the early diagnosis of autism.

Spoonful of sugar: Improving the palatability of emergency department visits for children and their families

Emergency Department, Lady Cilento Children’s Hospital, Brisbane, Queensland, Australia, School of Medicine, University of Queensland, Brisbane, Queensland, Australia, Emergency Department, Logan Hospital, Logan City, Queensland, Australia, Emergency Department, Sydney Children’s Hospital, Sydney, New South Wales, Australia, and Emergency Department, Footscray Hospital, Melbourne, Victoria, Australia

Making a difference: pragmatic paediatric pain management

One of the great rewards of paediatric emergency medicine is the opportunity to manage the pain of a suffering child and in doing so provide welcome relief to a family in distress. Although there is no single analgesic recipe that is appropriate for all clinical situations, there is a toolbox of interventions that allows us to reduce the pain in the vast majority of illnesses, injuries and medical procedures to a level that most children and families find acceptable. The present paper aims to open that toolbox, explore its contents and demonstrate that, while many children still suffer from under-analgesia in EDs, the solutions to this disservice are not intimidating.

No need to strain: A practical approach to paediatric constipation

Ben LAWTON, Tessa DAVIS, Henry GOLDSTEIN and Andrew TAGG Emergency Department, Lady Cilento Children’s Hospital, Brisbane, Queensland, Australia, Emergency Department, Logan Hospital, Brisbane, Queensland, Australia, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia, Royal London Hospital, London, UK, Emergency Department, Footscray Hospital, Melbourne, Victoria, Australia, and Adult Retrieval Victoria, Melbourne, Victoria, Australia