Although Bell's palsy is the most common cause of facial palsy in children, some cases have potentially fatal causes. We report a rare case of isolated facial palsy in a 4-year-old girl whose diagnosis was acute myeloid leukemia with extramedullary infiltration. The findings of laboratory investigations were nonspecific at presentation except that the delta neutrophil index was 34.5% (reference range, 0%–5%). To avoid hasty diagnosis of Bell's palsy in children with isolated facial palsy, vigilant differential diagnosis and workup are recommended.
Bell Palsy ; Child ; Child, Preschool* ; Diagnosis ; Diagnosis, Differential ; Facial Paralysis* ; Female* ; Humans ; Leukemia, Myeloid, Acute* ; Magnetic Resonance Imaging ; Neutrophils*

PURPOSE: We aimed to investigate the triage results and the degree of agreement between prehospital and hospital stages of pediatric patients who visited the emergency department (ED) via emergency medical service providers (EMSP) in comparison with adult patients. METHODS: We retrospectively reviewed 8,152 pediatric patients who visited a regional emergency medical center ED via EMSP from January 2015 to December 2015. Pediatric patients were defined as younger than 15 years according to the Korean Triage and Acuity Scale (KTAS). Given the difference of the triage tools of the prehospital (EMSP) and hospital (KTAS) stages, we performed the re-triage into “critical” and “non-critical” Comparisons of characteristics between pediatric and adult patients were made using chi-square tests. The degree of agreement between the tools was analyzed using κ analysis. RESULTS: Of 8,152 patients, 654 (8.0%) were pediatric patients. Direct medical control was more frequently performed to adult patients (P < 0.001). Critical patients were more common among adults (12.2% by KTAS, 24.8% by EMSP) than children (3.5% by KTAS, 14.1% by EMSP). The κ value of pediatric patients was lower than that of adult patients (0.09 [poor]; 95% confidence interval [CI], 0.01–0.18 vs. 0.38 [fair]; 95% CI, 0.35–0.40). CONCLUSIONS: Pediatric patients transferred by EMSP showed lower severity and degree of agreements of the triage results between prehospital and hospital stages than adult patients. It is necessary to pay particular attention to pediatric triage in a pre-hospital setting.
Adult ; Child* ; Critical Illness ; Emergencies* ; Emergency Medical Services* ; Emergency Service, Hospital* ; Humans ; Observational Study* ; Pediatrics ; Reproducibility of Results ; Retrospective Studies ; Triage*

PURPOSE: To investigate the factors associated with discharge of children from the emergency department (ED) after interfacility transfer. METHODS: We reviewed consecutive children who visited the ED via interfacility transfer from January 2014 to December 2015. The children were divided into two groups according to whether they were discharged from the ED or not (the discharge and admission groups), and their characteristics were compared. Multivariable logistic regression analysis was performed to identify the factors associated with discharge of children from the ED after interfacility transfer. RESULTS: Of the 999 transferred children, 426 (42.6%) were discharged. Compared to the admission group, these children showed older age, more frequent transfers from clinics and arrivals between 16 h and 20 h, shorter stay in the ED, and less frequent surgical abdomen. We found that age (3 to 6 years; adjusted odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3–2.6, compared with 0 to 2 years), diagnosis (trauma; OR, 2.4; 95% CI, 1.5–4.0, compared with gastrointestinal diseases), and referring hospital (primary clinic; OR, 5.4; 95% CI, 3.1–9.4, compared with tertiary hospitals) were the factors. CONCLUSIONS: The children who aged 3 to 6 years, had trauma or underwent transfers from primary clinics were more likely to be discharged at the ED. Considering these factors, we should reduce unnecessary transfers.
Abdomen ; Child* ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Logistic Models ; Odds Ratio ; Patient Discharge ; Patient Transfer ; Pediatrics

Neonates include both full term and preterm infants up to 28 days of age. The heterogeneity and rapid physiologic change of neonates affect all aspects of pharmacokinetics such as absorption, distribution, metabolism, and elimination. This feature should be considered in determining the dose and regimen of drug therapy in neonates. However, the research on the safety and efficacy of specific drugs is limited due to ethical and technical issues. This review article focuses on the neonatal pharmacokinetics and the rationales of drug therapy in neonates based on findings of previous studies and empirical evidence.
Absorption ; Bronchiolitis ; Drug Administration Routes ; Drug Therapy* ; Humans ; Infant ; Infant, Newborn* ; Infant, Premature ; Metabolism ; Pharmacokinetics* ; Population Characteristics

Interfacility transport of critically ill children (transport) is a challenging component of pediatric critical care. The risk associated with the transport may be reduced by a specialized pediatric transport team, a screening tool for critically ill children, and a standardized handover between referring and referred physicians. Further research is necessary in Korea regarding the above measures for the safe and effective transport.
Checklist ; Child* ; Critical Care ; Critical Illness* ; Humans ; Korea ; Mass Screening ; Pediatrics ; Transportation of Patients

A 3-year-old boy presented to our emergency department with a 3-week history of pain in the bilateral hip and abdomen that had persisted through antibiotic therapy based on diagnosis of acute osteomyelitis. At presentation, he had fever, anemia, and increased concentration of lactate dehydrogenase. After the identification of a left adrenal mass indicating neuroblastoma on computed tomography scan, he was admitted to the hospital by a pediatric oncologist. Subsequently, positron emission tomography and bone scintigraphy showed disseminated metastasis to the bone and bone marrow, and neuroblastoma was pathologically confirmed. This case highlights the importance of differential diagnosis of non-traumatic hip pain in toddlers considering the protean manifestations of neuroblastoma.
Abdomen* ; Anemia ; Bone Marrow ; Child ; Child, Preschool* ; Diagnosis ; Diagnosis, Differential ; Emergencies ; Emergency Service, Hospital ; Fever ; Hip* ; Humans ; L-Lactate Dehydrogenase ; Male* ; Neoplasm Metastasis ; Neuroblastoma* ; Osteomyelitis ; Positron-Emission Tomography ; Radionuclide Imaging

PURPOSE: We aimed to describe the difference in the epidemiologic and clinical characteristics by age groups of the children with hand injuries requiring surgery who visited the emergency department (ED) of a community hospital that runs a hand center. METHODS: We reviewed 388 consecutive children with hand injuries requiring surgery, aged < 16 years, who visited the ED from January 2011 through September 2016. Information was obtained regarding age and gender of the children, seasonal and daily distribution of the visits, location, cause, site, and level of the injury, the diagnosis, and presence of serious injury. The children were classified into 3 age groups; toddlers (0 to 3 years), preschoolers (4 to 6 years), and schoolers (7 to 15 years). Severe injury was defined as amputation or crush injury. RESULTS: Mean age of the children was 7.4 ± 5.0 years and boys accounted for 65.7%. The most frequent visits occurred during the weekend (53.1%) and in spring (30.7%), and most children visited the ED with injuries that occurred at home and indoors (55.2% and 79.9%, respectively). The most common cause, site, and level of the injury were sharp object (34.8%), fingers other than the thumb and index finger (64.7%), and the distal phalanx (46.7%), respectively. In the toddler group, domestic, indoor, door-related, and distal phalanx injuries were more common than in the schooler group (P < 0.001). Physical contact or sharp object-related injuries increased with increasing age (P < 0.001). Severe injuries were more common among the toddlers than the schoolers (P < 0.001). CONCLUSION: In the toddler group, domestic, indoor, door-related, distal phalanx, and severe injuries were more common than in the schooler group. These characteristics by age groups would aid in preventing hand injury in children, especially toddlers.
Amputation ; Child* ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Fingers ; Hand Injuries* ; Hand* ; Hospitals, Community ; Humans ; Pediatrics ; Seasons ; Thumb

PURPOSE: Recently, the use of end-tidal carbon dioxide (ETCO₂) monitoring has been suggested for early detection of hypoventilation over oxygen saturation (S(P)O₂) monitoring. We aimed to determine the usefulness of capnography in monitoring patients sedated using intramuscular (IM) ketamine in the pediatric emergency department (ED). METHODS: This study retrospectively reviewed medical records of patients younger than 16 years who were sedated using IM ketamine and whose ETCO₂ values were documented in the ED. Age, sex, American Society of Anesthesiologists physical status classification (ASA classification), and purpose of sedation were investigated. Vital signs were recorded at pre-sedation, 5 and 10 minutes after sedation, and after recovery. Hypoventilation was defined as S(P)O₂< 95%, ETCO₂≥ 50 mmHg or ≤ 30 mmHg, or increase in ETCO₂≥ 10 mmHg from the baseline without tachypnea. RESULTS: A total of 49 patients were investigated; 42 of them belonged to ASA classification I, and 7 to II. There was no patient with S(P)O₂< 95%, or ETCO₂≥ 50 mmHg, or increase in ETCO₂≥ 10 mmHg from the pre-sedation value. However, 5 patients had an ETCO₂≤ 30 mmHg, and 4 of them (8.2%) had normal respiratory rate and were suitable for hypopneic hypoventilation. Ten patients showed abnormal range of ETCO₂ (normal range, 35-45 mmHg), but did not meet the definition of hypoventilation. No one had clinically serious respiratory events. CONCLUSIONS: During sedation using IM ketamine, 8.2% of the patients had hypopneic hypoventilation without hypoxemia, and they were all younger than 36 months. Capnography for patients sedated using IM ketamine in the ED is useful in detecting hypopneic hypoventilation, and has the potential for preventing clinically serious respiratory events in patients, especially toddlers.
Anoxia ; Capnography ; Carbon Dioxide* ; Carbon* ; Classification ; Conscious Sedation ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Hypoventilation ; Ketamine* ; Medical Records ; Oxygen ; Pediatrics ; Respiratory Rate ; Retrospective Studies ; Tachypnea ; Vital Signs

This review discusses an underestimated risk of rare-earthmagnet (henceforth, magnet) ingestion in children and its surgical indication. Due to the ubiquity of magnets, the incidence of magnet ingestion has rapidly increased. While most foreign body ingestions show spontaneous passage, multiple magnet ingestion requires surgery in 30%-70% of the cases. Multiple magnets can attract each other across the bowel wall, leading to pressure necrosis, and subsequently, fistula, perforation, obstruction or volvulus. After recognizing magnet ingestion, the number of magnets should be checked using radiographs. In case of multiple magnet ingestion, surgery should be promptly considered.
Child* ; Eating* ; Fistula ; Foreign Bodies ; Gastrointestinal Tract ; Humans ; Incidence ; Intestinal Volvulus ; Necrosis ; Neodymium

Tumor lysis syndrome (TLS) is an oncologic emergency due to the rapid lysis of tumor cells and subsequent release of large amounts of intracellular potassium, phosphate, and uric acid into the bloodstream. Precipitation of uric acid and/or calcium phosphate crystals in the renal tubules can result in acute kidney injury. TLS is frequently observed in children with malignancy, which has high tumor burden, rapid cell turnover or high chemosensitivity (particularly, Burkitt's lymphoma and acute lymphoblastic leukemia), following the initiation of cytotoxic therapy. The current recommendations for prophylaxis and management are based on the TLS risk stratification. It is essential to administer adequate fluid and hypouricemic agents (allopurinol and/or rasburicase) to prevent acute kidney injury. In children susceptible to TLS, prompt diagnosis and aggressive treatment, such as renal replacement therapy, should be performed through close monitoring.
Acute Kidney Injury ; Burkitt Lymphoma ; Calcium ; Child ; Diagnosis ; Emergencies ; Humans ; Hyperkalemia ; Hyperphosphatemia ; Hyperuricemia ; Hypocalcemia ; Monitoring, Physiologic ; Potassium ; Primary Prevention ; Renal Replacement Therapy ; Tumor Burden ; Tumor Lysis Syndrome* ; Uric Acid