There is substantial variation in the medical care provided to pediatric patients across diverse clinical settings. This variation raises concerns about whether every patient is receiving optimal care and whether more standardized approaches around clinical decisions are needed.

We observed wide variation in admission rates for common pediatric conditions across US children’s hospitals. Our findings highlight the need for greater focus on the standardization of decisions regarding hospitalization of patients presenting to the emergency department. (Read the full article)

Urinary tract infection is the most common serious bacterial illness among febrile infants and young children. Automated urine cytometry may supplant traditional urinalysis, but diagnostic performance at unique pediatric cutpoints has not been described for this labor-saving technique.

We describe new, clinically useful cutpoints for automated leukocyte and bacterial counts. The sensitivity and specificity of bacterial counts ≥250 cells/μL exceed those of other methods. However, point-of-care dipstick tests for leukocyte esterase or nitrite have acceptable performance. (Read the full article)

Although frequent utilizers of emergency departments (EDs) are targeted for quality improvement initiatives across the United States, little is known about the health services these patients receive in the ED.

Eight percent of children account for 24% of ED visits and 31% of all costs. Frequent utilizers of pediatric EDs, especially infants without a chronic condition, are least likely to need medications, testing, and hospital admission during their ED visits. (Read the full article)

Despite child-resistant packaging requirements for most medications and safe storage education for all medicines, tens of thousands of young children are brought to emergency departments and thousands are hospitalized annually after ingesting prescription medications. Targeted prevention efforts may be needed.

Twelve medications were implicated in nearly half of hospitalizations for prescription medication ingestions. Buprenorphine and clonidine were most commonly implicated and had the highest hospitalization rates when accounting for outpatient use. Prevention efforts should focus on most commonly implicated medications. (Read the full article)

Various low-risk criteria have been developed to guide management of the febrile young infant (<90 days), but they differ in age criteria, recommendations, and implementation. Therefore, variation in care is likely but has not been previously studied.

There is wide variation in testing, treatment, and overall resource utilization in management of the febrile young infant across all 3 age groups: ≤28, 29 to 56, and 57 to 89 days. There may be opportunities to improve care variation without compromising outcomes. (Read the full article)

Migraine headaches are a common presenting complaint in emergency departments. Abortive treatment in this setting is not well studied, leading to considerable variation in treatment. The relationship between acute medications and emergency department revisits has not been studied.

Eighty-five percent of children with migraine are successfully discharged from the emergency department; only 1 in 18 children require a return visit. Prochlorperazine is associated with less revisits than metoclopramide, and diphenhydramine use is associated with increased risk of return visits. (Read the full article)

In adults, adverse drug events account for 5% to 25% of all hospital admissions and 12% of emergency department (ED) visits of which 50% to 70% are preventable. There remains a significant gap in our understanding of the magnitude and impact of medication-related ED visits in pediatrics.

This study is the largest and most rigorous study performed evaluating the impact of medication-related visits to the ED in pediatrics and provides important information regarding the magnitude of this problem in our health care system. (Read the full article)

Childhood bacteremia caused by vaccine-preventable organisms has substantially declined over the last decade. Recognition of bacteremia in children is difficult, and delayed administration of antibiotics is associated with poor outcomes. Adults with health care–associated Gram-negative bacteremia experience delays in receiving appropriate antibiotics.

Bacteremia in children presenting to the emergency department is increasingly health care associated and resistant to empirical antibiotics. These infections are associated with increased length of stay. Rates of Gram-negative bacteremia have increased, and children with Gram-negative bacteremia experience delayed antibiotic administration. (Read the full article)

Firearm violence is a leading cause of death among US youth aged 14 to 24. The emergency department is a key setting for interacting with high-risk assault-injured youth and remains an underused but important setting for violence prevention programs.

High-risk youth seeking emergency department care for assault have high rates of firearm violence over the subsequent 2 years. Higher severity substance use, combined with negative retaliatory attitudes and access to firearms, increases this risk for involvement with firearm violence. (Read the full article)

Simulation-based education is increasing but its use in pediatric emergency medicine (PEM) fellowships has not been recently documented. Previous studies identified barriers including equipment and space, but growth of simulation centers and equipment has been widespread.

Simulation is widely used in PEM fellowships, and current barriers include faculty and learner time, implementation of best practices in simulation; equipment is less significant. Future work should focus on curriculum and evaluation development, aligning with the milestones. (Read the full article)

Self-harm behavior is a major public health problem and a leading cause of death in adolescents. The majority of patients who self-injure do not die, but they are at increased risk for a successful future suicide attempt.

Emergency department visits for self-inflicted injuries in adolescents increased from 2009 to 2012, whereas visits for self-inflicted firearm injuries decreased. The presence of any comorbid condition increased risk for self-harm, indicating that increased attempts at prevention may be warranted in these young people. (Read the full article)

Unsupervised medication exposures increased during the previous decade, despite child-resistant packaging and caregiver education. To achieve the Healthy People 2020 objective of reducing emergency department visits for unintentional pediatric medication overdoses, targeted interventions including improved safety packaging may be needed.

Since 2010, emergency department visits for unsupervised medication exposures started to decrease. Most visits involved solid dose medications, typically for adult use. Most liquid medication exposure visits involved 4 over-the-counter pediatric products and may be more readily amenable for interventions. (Read the full article)

Tricycle riding is a common activity in children. In calendar year 2012, tricycle accidents were the most common cause of reported toy-related deaths in children. Little research has been conducted regarding tricycle-related injuries and how to counsel parents appropriately.

This study uses nationally representative data to investigate various characteristics of tricycle-related injuries in children to better counsel parents. This study highlights the importance of helmet and elbow pad use and parental supervision. (Read the full article)

Deferral of consent avoids delaying emergency interventions while ensuring consent to ongoing participation and use of data. Deferred consent is particularly important for enabling trials in pediatric settings, where many medicines and devices are unlicensed and untested for use.

Approaches for seeking deferred consent should balance the potential burden of obtaining consent against risk of bias due to outcome-related attrition. Ethics committees could consider approving data use when best efforts to obtain deferred consent are met with no response. (Read the full article)

National guidelines recommend testing and prophylaxis for chlamydia, gonorrhea, and pregnancy for adolescent sexual assault victims. Little is known about rates of testing and prophylaxis in adolescent victims of sexual assault evaluated in pediatric emergency departments.

There is significant variation in testing and prophylaxis practices in the pediatric emergency department evaluation of adolescent victims of sexual assault. Adolescents cared for in emergency departments with clinical pathways are more likely to receive recommended prophylaxis. (Read the full article)

BACKGROUND AND OBJECTIVES:

Antibiotic therapy is often prescribed for suspected community-acquired pneumonia (CAP) in children despite a lack of knowledge of causative pathogen. Our objective in this study was to investigate the association between antibiotic prescription and treatment failure in children with suspected CAP who are discharged from the hospital emergency department (ED).

BACKGROUND:

For children who cannot be discharged from the emergency department, definitive care has become less frequent at most hospitals. It is uncertain whether this is true for common conditions that do not require specialty care. We sought to determine how the likelihood of definitive care has changed for 3 common pediatric conditions: asthma, croup, and gastroenteritis.

Two of Penn State’s most generous supporters and prominent alumni leaders have made a new commitment to support students impacted by the COVID-19 crisis. Helen S. Hintz, 1960, and Edward “Ed” R. Hintz, 1959, have directed $100,000 to the Student Care and Advocacy Emergency Fund.

Matthew J. Lipshaw
Apr 1, 2020; 145:e20193138-e20193138
ARTICLES

The two national teachers' unions and other prominent groups are seeking $175 billion for state K-12 budgets, $13 billion in dedicated aid for special education, and more to help schools deal with the coronavirus.

Paul L. Aronson
Oct 1, 2014; 134:667-677
ARTICLES

On Tuesday (24 March), MSPs from across the Scottish Parliament will scrutinise the proposed UK-wide Emergency Coronavirus Bill

Statewide Emergency Repair Program launches from Delaware State Housing Authority MILFORD – Qualified homeowners in need of assistance to keep their homes livable can apply for assistance from the new Statewide Emergency Repair Program announced today by Governor John Carney and the Delaware State Housing Authority. “No one should live in a home with broken […]

DOVER, Del. — Too much rain at the wrong time, like Delaware experienced in April and May, has destroyed several high dollar crops and threatens the yield of many others, leaving farmers to wonder what the future holds. In surveying the state and listening to farmers, Secretary of Agriculture Michael T. Scuse made a request […]

Photos are available for media use on Flickr. Dover, Del. – The Delaware Department of Agriculture (DDA) announced today that they are quarantining eleven zip codes in New Castle County to eradicate, control, and prevent the spread of spotted lanternfly in Delaware and to surrounding states. The spotted lanternfly is a destructive invasive plant hopper […]

Agency: DOT Closing Date: 5/12/2020

Agency: HSS Closing Date: 5/27/2020

The Division of Public Health (DPH) is looking for volunteers to participate in an emergency preparedness exercise on Saturday, September 28, 2019, at two Delaware Technical Community College (Delaware Tech) campuses. The purpose of the exercise is to evaluate the state’s ability to set up Points of Dispensing and simulate the dispersal of life-saving medication in an emergency situation.

DEPARTMENT OF HEALTH AND SOCIAL SERVICES: Division of Health Care Quality

DNREC reduces the striped bass fishing quota for commercial fishing and limits the number and size of fish that recreational anglers can keep.

DOVER (March 18, 2020) – Maintaining the supply of food and fiber for our citizens, especially during times of an emergency, is of paramount importance. Our poultry industry plays a critical role in feeding our citizens and supplying an abundant, healthy source of protein. “It is extremely important that the entire vertically integrated chain of […]

Second update provides support to restaurant industry WILMINGTON, Del. –  Governor John Carney on Wednesday issued a second modification to his emergency declaration that allows any restaurant, brewpub, tavern or taproom with a valid on-premise license to sell alcoholic beverages as part of transactions for take-out food or drive through food service. Alcohol sales cannot […]

Delaware beaches closed to help slow spread of coronavirus REHOBOTH, Del. – Governor John Carney on Saturday issued a third modification to his emergency declaration. The new orders close Delaware beaches to help slow the spread of the coronavirus (COVID-19). The public is prohibited from accessing the beach except to exercise or walk their dogs […]

WILMINGTON, Del. – Governor John Carney on Monday declared a Public Health Emergency and released a more robust Order to assist with Delaware’s response to the coronavirus (COVID-19). The Delaware Emergency Management Agency (DEMA) and the Delaware Division of Public Health (DPH) issued a companion order focused on strengthening Delaware’s health care workforce in response […]

In consultation with the Delaware Department of Insurance, Governor John Carney today issued a sixth modification to the state of emergency that requires that insurers cease cancellations or nonrenewals of insurance policies due to nonpayment throughout the duration of the declared Delaware State of Emergency for those residents and business owners who are experiencing a […]

H.E.L.P. to include more industries and additional small businesses WILMINGTON, Del. –  Governor John Carney on Thursday announced the expansion of the Hospitality Emergency Loan Program (H.E.L.P.) to provide financial relief for additional industries impacted because of coronavirus (COVID-19). The expansion makes personal care services businesses – such as barber shops, hair salons, nail salons, and beauty shops […]

Existing clients may receive additional benefits for March 2020 and April 2020 NEW CASTLE (March 30, 2020) – Emergency benefits will be made available to Delaware Supplemental Nutrition Assistance Program (SNAP) participants for the months of March and April as part of a provision set forth by the federal Families First Coronavirus Responses Act of […]

State buildings, essential businesses to screen workers, visitors WILMINGTON, Del. – Governor John Carney on Monday signed the eighth modification to his State of Emergency declaration, which allows child care programs in Delaware to be designated as emergency child care sites in an effort to assist essential personnel during the coronavirus crisis. Read the full […]

Out-of-state visitors must self-quarantine for 14 days before engaging in fishing, hunting, golf, visiting state parks and wildlife areas.

Enforcement actions have been initiated throughout state to handle noncompliance Attorney General Kathy Jennings urges Delawareans to heed Gov. John Carney’s Declarations of a State of Emergency.  The Declaration of a State of Emergency and all its modifications carry criminal punishment and have been enforced throughout Delaware. “This is a tremendously difficult time for everyone, […]

Tenth update to emergency order also closes additional businesses to fight COVID-19 WILMINGTON, Del. – Governor John Carney on Monday issued the tenth modification to his State of Emergency declaration, banning all short-term rental units – including vacation home rentals, hotels, motels, and condo rentals – to help fight the spread of COVID-19. Commercial lodging […]

Governor teams up with popular social network to keep Delawareans informed of the latest on the neighborhood level   WILMINGTON, Del. – Governor John Carney on Friday formally extended the State of Emergency declaration in place to limit the spread of COVID-19, and announced a partnership with the social network Nextdoor to keep Delawareans informed on […]

Modification provides additional protections for Delaware renters WILMINGTON, Del. – Governor John Carney on Thursday issued the fourteenth modification to his State of Emergency declaration, providing additional protections for Delaware renters during the COVID-19 pandemic, and extending the application deadline for Delaware’s Senior School Property Tax Credit Program until June 1.  Click here to read the full text […]

NEW CASTLE (May 5, 2020) – On May 1, the Division of Social Services was approved by the United States Department of Agriculture (USDA) to operate Pandemic Electronic Benefit Transfer (P-EBT), a new program authorized by the Families First Coronavirus Response Act that provides assistance to families with children who are eligible for free or reduced-price school meals. The […]

A fleet of 15 Jaguar F-Pace has been provided to support the UK’s ‘Help NHS Heroes’ initiative delivering food and essentials to NHS frontline staff, carers and their families.

The Delaware Emergency Management Agency (DEMA) and Delaware State Police will conduct a quarterly test of the Salem/Hope Creek Nuclear Generating Stations Alert and Notification system on Tuesday, July 9, 2019.  The sirens will sound at around 7:30 p.m. The 37 sirens located within ten miles of the Salem/Hope Creek (New Jersey) plants will be […]

The Delaware Emergency Management Agency (DEMA) and Delaware State Police will conduct a quarterly test

January 7, 2020: Sirens to be tested are the same sirens used to alert the public in the event of an actual emergency at either the Salem or Hope Creek Nuclear Generating Stations.

(Smyrna, Delaware) – On December 13, 2019, the Delaware Emergency Management Agency (DEMA) officially earned accreditation by the Emergency Management Accreditation Program (EMAP). Only nine programs nationwide completed the rigorous assessment process in 2019 to achieve either initial accreditation or reaccreditation. This is the initial accreditation for DEMA and the State’s emergency management program. “Congratulations […]

Governor John Carney on Thursday issued a State of Emergency declaration to prepare for the spread of Coronavirus (COVID-19). The State of Emergency directs the Delaware Emergency Management Agency (DEMA) and the Delaware Department of Health & Social Services’ Division of Public Health to mobilize state agency resources to assist with Delaware’s response to the virus.