Aim To evaluate the frequency and predictors of poor outcome in febrile children presenting to the Emergency Department. Methods Retrospective observational study from the Emergency Department of The Royal Children's Hospital, Melbourne, Australia. All children with presenting complaint of fever or triage temperature >38°C over a 6‐month period were included. Poor outcome was defined as: new organ dysfunction or the requirement for organ support therapy (inotrope infusion, mechanical ventilation, renal replacement therapy and extra‐corporeal life support). Predictors evaluated were as follows: initial vital signs, blood tests and clinical scores. Odds ratio, sensitivity, specificity and area under the receiver‐operating characteristics curve were calculated for each predictor variable. Results Between Jan‐June 2019, 6217 children met inclusion criteria. Twenty‐seven (0.4%) developed new organ dysfunction, 10 (0.2%) required organ support therapy (inotrope infusion in 5, mechanical ventilation in 6, renal replacement therapy in 1, extra‐corporeal life support in 1). Odds of new organ dysfunction, requirement for inotropic support and mechanical ventilation were higher with abnormal initial vital signs, blood tests and clinical scores, though overall test characteristics were poor due to infrequency. Conclusion Poor outcomes were uncommon among febrile children presenting to the Emergency Department. Vital signs, blood tests and clinical scores were poor predictors.

Objective: Fluid bolus therapy (FBT) is recommended as the initial form of acute circulatory support for many disease processes. The epidemiology of its use in the ED is unknown. The aim of this study was to assess indications, use patterns and short-term effects of FBT in a paediatric ED. Methods: Retrospective observational study in the ED of the Royal Children's Hospital, Melbourne, Australia (annual census >90 000) using hospital electronic medical record data for all patients who received an i.v. fluid bolus in the ED over the calendar year 2018 were included in the study. We extracted demographics, indications, volume, content of FBT as well as subsequent vital sign and biochemical changes. Results: One thousand five hundred and thirty-nine fluid boluses were administered to 1343/90 000 children (1.5%), 1185 received 1, 123 received 2, 32 received 3, and 3 received 4 boluses. Fluid bolus volume of 10 mL/kg was used in 45.3%, 20 mL/ kg in 35.7%, 500 mL in 6.4% and 1000 mL in 7.1%. The fluid content was 0.9% saline in 99.9% of cases. The most common indications for FBT were: vomiting/diarrhoea (23%), acute febrile illness (11%) and pneumonia or sepsis (10% each). FBT was associated with a reduction in median heart rate by 6 beats per minute (P < 0.01), reduction in mean blood pressure by 3 mmHg (P < 0.01), and reduction in venous lactate by 0.2 mmol/L (P < 0.01). Conclusions: Fluid bolus therapy is a commonly used intervention in the paediatric ED, most often for dehydration. Variability in indications, dose and effects of FBT warrant further exploration.

ObjectivesEmergency intubation in children is an infrequent procedure both in the pre‐hospital and hospital setting. The anatomical, physiological and situational challenges together with limited clinician exposure can make this a difficult procedure with high risk of adverse events. The aim of this collaborative study between a state‐wide ambulance service and a tertiary children's hospital was to describe the characteristics of pre‐hospital paediatric intubations by Intensive Care Paramedics.MethodsWe conducted a retrospective review of state‐wide ambulance service electronic patient care records (ePCRs) in Victoria, Australia, population: 6.5 million. Children aged 0–18 years who were attended by paramedics over a 12‐month period that required advanced airway management were analysed for demographics and first‐pass success rate.ResultsParamedics attended 2674 cases aged 0–18 years over the 12‐month study period who received basic or advanced airway management. A total of 78 cases required advanced airway management. The median age of patients was 12 years (interquartile range 3–16) and most were male (60.2%). Sixty‐eight patients (87.5%) were intubated successfully on the first attempt, first‐pass success was lowest in children <1 year of age. The most common indications for pre‐hospital intubation were closed head injury and cardiac arrest. It was not possible to report complication rates because of incomplete documentation.ConclusionPre‐hospital intubation in children is performed infrequently in an extremely unwell patient group. Continued high‐level paramedic training is required to prevent adverse events and ensure patient safety.

No abstract