Purpose: Pott’s puffy tumor (PPT), characterized by frontal bone osteomyelitis and subperiosteal abscess, typically arises as a complication of head trauma or frontal sinusitis and is associated with diverse triggers. Since 2001, PPT, previously considered rare in the pediatric population, has been increasingly reported, underscoring heightened recognition. By outlining specific protocols and guidelines, a clinical pathway (CP) facilitates rapid identification and treatment of PPT. Methods: We reviewed 11 cases of PPT in patients aged 0 to 18 years who were either hospitalized or discharged from 2 large hospitals in South Florida, United States, from January 31, 2016 through February 1, 2019. This multicenter retrospective case review was complemented by a comprehensive literature review. Additionally, the study team proposed a diagnostic CP tailored for the emergency department setting. Variables of interest included demographic data, clinical presentation, imaging studies, medical and surgical management details, laboratory/microbiological data, and clinical outcomes. Results: A total of 11 patients with PPT were identified, of whom 8 and 7 were boys and African Americans, respectively. The common symptoms were fever, headache, and frontal edema. All patients underwent antibiotic therapy for 6-8 weeks, as well as both computed tomography and magnetic resonance imaging. The imaging studies showed intracranial complications in the 10 patients such as epidural abscess, which were caused by Streptococcus pneumoniae, Streptococcus intermedius, Streptococcus pyogenes, Eikenella spp., and methicillin-sensitive Staphylococcus aureus. The 10 patients underwent endoscopic sinus surgeries, with 6 of them also doing craniotomies. No mortality or sequelae was reported. Conclusion This study contributes to the growing body of literature on PPT, shedding light on its evolving epidemiology, clinical manifestations, and management strategies while emphasizing the pivotal role of emergency physicians for optimal outcomes. The proposed CP aims to establish a standard of care that can be adopted across various pediatric emergency departments.

Purpose: Large language models (LLMs) like ChatGPT (OpenAI) are increasingly used in healthcare, raising questions about their accuracy and reliability for medical information. This study compared 2 versions of ChatGPT in answering post-discharge follow-up questions in the area of pediatric emergency medicine (PEM). Methods: Twenty-three common post-discharge questions were posed to ChatGPT-4 and -3.5, with responses generated before and after a simplification request. Two blinded PEM physicians evaluated appropriateness and accuracy as the primary endpoint. Secondary endpoints included word count and readability. Six established reading scales were averaged, including the Automated Readability Index, Gunning Fog Index, Flesch-Kincaid Grade Level, Coleman-Liau Index, Simple Measure of Gobbledygook Grade Level, and Flesch Reading Ease. T-tests and Cohen’s kappa were used to determine differences and inter-rater agreement, respectively. Results: The physician evaluations showed high appropriateness for both defaults (ChatGPT-4, 91.3%-100% vs. ChatGPT-3.5, 91.3%) and simplified responses (both 87.0%-91.3%). The accuracy was also high for default (87.0%-95.7% vs. 87.0%-91.3%) and simplified responses (both 82.6%-91.3%). The inter-rater agreement was fair overall (κ = 0.37; P < 0.001). For default responses, ChatGPT-4 produced longer outputs than ChatGPT-3.5 (233.0 ± 97.1 vs. 199.6 ± 94.7 words; P = 0.043), with a similar readability (13.3 ± 1.9 vs. 13.5 ± 1.8; P = 0.404). After simplification, both LLMs improved word count and readability (P < 0.001), with ChatGPT-4 achieving a readability suitable for the eighth grade students in the United States (7.7 ± 1.3 vs. 8.2 ± 1.5; P = 0.027). Conclusion The responses of ChatGPT-4 and -3.5 to post-discharge questions were deemed appropriate and accurate by the PEM physicians. While ChatGPT-4 showed an edge in simplifying language, neither LLM consistently met the recommended reading level of sixth grade students. These findings suggest a potential for LLMs to communicate with guardians.

Testicular torsion needs prompt detorsion to prevent testicular necrosis. Manual detorsion has recently gained acceptance as an initial treatment. The aim of this study was to assess the recurrence rate of testicular torsion in patients who underwent successful detorsion but did not receive immediate orchiopexy. Among the 27 patients, 3 (11%) experienced the recurrences 35, 80, and 340 days after successful detorsions. In our limited cohort, recurrences did not occur during the acute phase after the detorsions; instead, they occurred months later. Therefore, orchiopexy should be timely performed after manual detorsion.

Bezoars in infants are rare owing to their limited dietary diversity. This report presents a novel case of multiple phytobezoars in the small bowel of a 3-month-old boy following ingestion of a synbiotic, a nutritional supplement combining probiotics (bacteria) and prebiotics (fibers that promote bacterial growth), which required a surgical intervention. Given the increasing use of synbiotics, the possibility of such bezoar formation should be considered, particularly in infants with underlying risk factors, such as congenital aganglionic megacolon.

Drowning is the third most common cause of accidental death in children. Various predictors for survival and neurological dysfunction include the age of victim, submersion time, salt versus fresh water, temperature of water, cardiopulmonary resuscitation at the scene, and time required to hospital arrival. Autonomic dysfunction, in particular heart rate variability in a critically ill patient, has been attributed to good neurological outcomes. We hereby describe a 10-year-old boy who accidentally drowned and developed a substantial heart rate variability with autonomic dysfunction. He was in the need for prolonged vasopressor support but eventually had a good neurological outcome.

Erector spinae plane nerve block (ESPB) has become a frequently used tool of analgesia among anesthesiologists or emergency physicians. The ESPB utilizes a guidance of point-of-care ultrasound and has a favorable safety profile. It had historically been used primarily in operative settings, but has become increasingly used for refractory pain in emergency settings. Here, we present a case of an adolescent with refractory renal colic pain who received an ESPB, performed by an emergency physician, with an improvement in the pain. To our knowledge, this is the first case report of ESPB use for renal colic in a pediatric patient.

Rapunzel syndrome is a rare condition that typically occurs in young females with trichotillomania or trichophagia. The name “Rapunzel” was given due to the presence of trichobezoars extending from the stomach down to various parts of the gastrointestinal tract. In this case, we discuss a 6-year-old female patient with a large trichobezoar that was further complicated by the occurrence of gastric perforation. This case emphasizes not only the presentation of a rare pathology with a rare complication but also the importance of meticulous history taking and physical examination for the approach to an acute abdominal emergency in the pediatric emergency setting.

Children often engage in a habit of carrying items in their mouths and are prone to falling. We report a novel case involving a 5-year-old boy who experienced an oral injury characterized by the penetration of “miswak,” a wooden stick used for dental hygiene, into the floor of the mouth and was discharged without complications. Penetrating injuries require a comprehensive evaluation and management. Close monitoring and follow-up are crucial to ensure proper wound healing and resolution of any associated issues.

Purpose: It is important for emergency physicians to be able to evaluate and manage pediatric respiratory distress, which is rare in general emergency departments. Despite this importance, the emergency departments show inconsistency in pediatric readiness, while emergency medicine (EM) residents express discomfort in caring for critically ill children due to limited exposure during their residency training. The purpose of this study was to meet this educational need by developing and implementing a curriculum to prepare EM residents to provide safe care for pediatric respiratory distress. Methods: We prospectively assessed 20 senior EM residents after undergoing a 3-hour simulation-based curriculum at Indiana University School of Medicine. The curriculum was developed using the Kern’s methodology by content experts. Pre- and post-curriculum confidence, knowledge, competency, and situational awareness were assessed using the 5-point Likert scale, multiple-choice questions, checklists of a pediatric acute respiratory distress scenario, and a novel modified video version of the situational awareness global assessment technique, respectively. Results: From the pre- to post-intervention phases, the confidence improved from 3.2 ± 0.4 to 3.9 ± 0.2 on the Likert scale (P < 0.001). The knowledge improved from 50.3% ± 12.9% to 75.3% ± 10.6% on the multiple-choice questions (P < 0.001). The competency improved from 46.8% ± 16.0% to 73.6% ± 10.6% (P < 0.001) with significant improvements in 7 of the 14 checklist items. The situational awareness raised both data perception (P < 0.001) and comprehension (P = 0.004) with no significant improvements in data extrapolation (P = 0.120). Conclusion Preliminary findings suggest that a 3-hour simulation-based curriculum for EM residents, including implementation of a novel situational awareness assessment tool, can improve learner’s confidence, knowledge, competency, and situational awareness of pediatric respiratory distress.

Purpose: This study investigated the rate and factors of spontaneous reduction (SR) during plain radiography in pediatric patients with radial head subluxation (RHS). Methods: We retrospectively reviewed patients aged 5 years or younger with RHS who visited a tertiary hospital emergency department (ED) from March 2015 through February 2022. They were classified into the SR during X-ray, manual reduction (MR) after X-ray, and MR-first groups. We compared the clinical variables, such as ED length of stay, among the 3 groups, and investigated factors associated with SR during radiography. Results: Among a total of 550 enrolled patients, 153 (27.8 %), 177 (32.2%), and 220 (40.0%) belonged to the SR during X-ray, MR after X-ray, and MR-first groups, respectively. Among the groups, no difference was found in the proportions of indoor injury (SR during X-ray, 92.6% vs. MR after X-ray, 79.0% vs. MR-first, 89.0%; P = 0.066). The mean ED length of stay was shorter in the MR-first group than in the equivalent values of the other groups (23.1 minutes vs. 49.0-53.0 minutes; P < 0.001), without differences in the other time intervals. The sole factor associated with SR during radiography was the indoor injury (odds ratio, 3.32; 95% confidence interval, 1.01-10.88; P = 0.048). Conclusion Based on the results of this study, emergency physicians or pediatricians might consider obtaining radiographs first in patients with RHS injured indoors, which can cause SR and exclusion of complications such as iatrogenic injury.