Tuesday, February 9, 2016

Decreasing Venipuncture Pain: Should You Insist on This New Device for Blood Draws in Young Children?

I'm not ready to jump on the bandwagon to recommend all pediatric providers use this device for blood draws, but the authors of this article provided one of the best descriptions of study limitations I've seen in a long time.

Source: Lunoe MM, Drendel AL, Levas MN, et al. A randomized clinical trial of jet-injected lidocaine to reduce venipuncture pain for young children. Ann Emerg Med. 2015;66(5):466-473; doi.org/10.1016/j.annemergmed.2015.04.003. See AAP Grand Rounds commentary by Dr. Pamela Okada (subscription required).

PICO Question: Among young children undergoing venipuncture, does jet-injected lidocaine reduce pain more effectively than vapocoolant spray or sham?
Question type: Intervention
Study Design: Randomized controlled

Tuesday, February 2, 2016

Bariatric Surgery for Adolescents: Benefits, Risks, and Future Needs

It might not be a stretch to say that childhood obesity is the leading health threat for US children in our time. But when are drastic measures, like bariatric surgery, indicated, and what are the long-term outcomes of such procedures? We now have a bit more detail on this, but as usual more questions than answers.

Source: Inge TH, Courcoulas AP, Todd MJ, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2016;374:113-123. doi:10.1056/NEJMoa1506699. See AAP Grand Rounds commentary by Dr. Ronald Holmes (subscription required). 

PICO Question: Among severely obese adolescents undergoing bariatric surgery in the United States, what are the benefits and adverse events that occur during the following three years?
Question type: Treatment
Study design: Observational

Monday, February 1, 2016

29 Days, Must Be Leap Year!

Welcome to February's Evidence eMended. As usual, I'll be commenting on the February issue of AAP Grand Rounds, which includes discussion of pertussis and epilepsy association, possible connection between medical opioid use and future adult opioid misuse, and growth and development of international adoptees.

In this month's blog, I'll feature discussions of jet-injected lidocaine for reducing venipuncture pain, adolescent bariatric surgery outcomes, management of traumatic stress in children, and, finally, an answer to what your mother always told you about breakfast being the most important meal of the day!

Tuesday, January 26, 2016

Good News for Premature Infant Outcomes, But Have We Reached a Plateau?

Source: Stoll BJ, Hansen NI, Bell EF, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA. 2015;314(10):1039-1051; doi:10.1001/jama.2015.10244. See AAP Grand Rounds commentary by Dr. Jonathan Mintzer (subscription required). 

PICO Question: Among extremely premature newborns, how have maternal and neonatal care practices, neonatal morbidity, and neonatal mortality changed between 1993 and 2012?
Question type: Descriptive
Study design: Prospective cohort

Tuesday, January 19, 2016

Children Are Not Small Adults: The Case of Steroids for Acute Respiratory Distress Syndrome

This study came up with a very different conclusion on the use of steroid therapy for children with acute respiratory distress syndrome (ARDS), compared to studies performed in adult populations. Should we believe it? 

Source: Yehya N, Servae S, Thomas NJ, et al. Corticosteroid exposure in pediatric acute respiratory distress syndrome. Intensive Care Med. 2015;41(9):1658-1666; doi:10.1007/s00134-015-3953-4. See AAP Grand Rounds commentary by Dr. Susan Bratton (subscription required).

PICO Question: Among children with acute lung injury, do corticosteroids affect survival or duration of mechanical ventilation?
Question type: Treatment
Study design: Prospective cohort

Tuesday, January 12, 2016

Can Probiotic Therapy Prevent Asthma?

This study is one of the highest quality I've ever reviewed in Evidence eMended (now approaching its 6th anniversary). Paradoxically, it has no immediate value to clinicians. It's still worthy of attention from pediatric healthcare providers, however, so keep reading.

Source: Arrieta M-C, Stiemsma LT, Dinitriu, et al. Early infancy microbial and metabolic alterations affect risk of childhood asthma.Sci Transl Med. 2015;7(307):307ra152; doi:10.1126/scitranslmed.aab2271. See AAP Grand Rounds commentary by Dr. Daniel Lesser (subscription required). 

PICO Question: Among healthy infants, do those at risk of developing asthma have altered gut microbiota? 
Question type: Descriptive
Study design: Case-control

Tuesday, January 5, 2016

How Valuable is Patient History in Syncope Evaluation?

Sometimes I feel like the old geezer at case conferences at my institution. I perceive increasing focus on expensive technology (MRIs and PCRs, among many other acronyms) at the expense of simple history and physical examination. Likely because I was hoping this article supported my old geezer approach, I chose it for review this month. Unfortunately, all I gained from a close look is yet another example of how not to design and report a research study.

Source: Hurst D, Hirsch D, Oster M, et al. Syncope in the pediatric emergency department-can we predict cardiac disease based on history alone? J Emerg Med.2015;49(1):1-7; doi:10.1016/j.jemermed.2014.12.068. See AAP Grand Rounds commentary by Dr. Jeffrey Anderson (subscription required).
PICO Question: Among pediatric patients presenting to the emergency department with syncope, what historical features predict an underlying cardiac etiology?
Question type: Descriptive
Study design: Retrospective review

Saturday, January 2, 2016

Happy New Year from Evidence eMended

Happy New Year to everyone, and welcome to January's lineup of commentary. This month's AAP Grand Rounds is chock full of interesting articles, including a look at whether psychostimulant medications are associated with tic disorders, whether maternal socioeconomic status is associated with oral clefts in their offspring, predictors of pertussis mortality in California, and association of strokes with infection and vaccination.

For the blog this month, I'll be commenting on use of detailed history to predict cardiac-related causes of syncope, relationship of infant gut microbiota to asthma development, use of steroids in pediatric acute respiratory distress syndrome, and trends in premature infant outcomes. Stay tuned!

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