Just Finished the Sick Kids Emergency Medicine Conference

The conference at the Old Mill in Toronto was a success. Aside from the usual updates in hot topics in pediatric medicine we were entertained by many of the keynote speakers. There were some impressive stats presented by Dr Marianne Gausche-Hill from UCLA. Her talk was about pre-hospital care.

First she spoke about ALTEs (Apparent Life Threatening Events). These events are characterized by some combination of apnea, colour change, marked change in muscle tone, choking or gagging. Her data showed that 48% of these kids had a serious / life threatening illness at ED evaluation!

Another issue she brought up was about whether kids undergoing severe trauma should be sent to the nearest center vs the nearest trauma center. Although the care could be better at the trauma center - most of these kids will do better just getting to the closest ER. Another stat she brough to us was the abysmal survival of kids undergoing cardiac arrest after trauma - out of 601 cardiac arrests, 29% had return of spontaneous circulation and only 5% survived (all with poor neurologic outcomes).

There were lots of other cool presenters. Kevin Chan from Sick Kids spoke about the evaluation of febrile infants in the post Prevnar era. The bottom line is that the old approach with the Rochester criteria etc is likely not needed. The number of positive cultures have fallen off the map in the past few years. In one study, the number of positive strep cultures dropped 84% since 1998 to 2003. All 27 patients with positive cultures had UTIs. A WBC greater than 15000 had a NPV of 99.5%! However - all of these studies are in kids > 3 months. The jury is still out on the kids from 1 to 3 months.

Otitis media is practically all viral now - there really is no HIB or Pneumococcus in the inner ear anymore in Prevnar vaccinated kids.

The last pearl was the new consensus statement on clearing C-spines in kids. The main point is the vast majority with injuries will have a C1 to C3 injury. If you need to CT - CTing these is all you need with a normal xray.