@article {10750, title = {Administering analgesia sublingually is a suitable option for children with acute abdominal pain in the emergency department.}, journal = {Acta Paediatr}, volume = {108}, year = {2019}, month = {2019 Jan}, pages = {143-148}, abstract = {

AIM: Acute abdominal pain is a frequent complaint in children attending emergency departments. The aim of this study was to investigate the pain score reductions when children with acute abdominal pain received medication sublingually.

METHODS: We carried out a multicentre randomised controlled trial in three children{\textquoteright}s hospitals in Italy between March 2015 and June 2017. Children from four to 18~years of age with acute abdominal pain were recruited if their self-reported pain was at least six on a scale from 0-10. The children were randomised to receive ketorolac 0.5~mg/kg (n~=~70) or tramadol 2~mg/kg (n~=~70) sublingually or a melt in the mouth powder of 20~mg/kg paracetamol (n~=~70). The main study outcome was the pain scores for the three drugs after two hours.

RESULTS: The 210 children (58.6\% girls) had a median age of 12~years with an interquartile range of 9-14.3. The median pain scores at two hours were not significantly different between ketorolac 2.0 (interquartile ranges, IQR 0.0-4.3) and tramadol 3.0 (IQR 1.0-5.0) vs paracetamol 3.0 (IQR 0.8-5.0). The median pain reductions were all 5.0 points.

CONCLUSION: Delivering analgesia sublingually was a suitable option for pain relief in children with acute abdominal pain in the emergency department.

}, issn = {1651-2227}, doi = {10.1111/apa.14514}, author = {Cozzi, Giorgio and Zanchi, Chiara and Chiaretti, Antonio and Tipo, Vincenzo and Cernich, Marta and D{\textquoteright}Anna, Carolina and Fantacci, Claudia and Conversano, Ester and Zanon, Davide and Ronfani, Luca and Barbi, Egidio} } @article {10488, title = {Adolescent Admissions to Emergency Departments for Self-Injurious Thoughts and Behaviors.}, journal = {PLoS One}, volume = {12}, year = {2017}, month = {2017}, pages = {e0170979}, abstract = {

The objective of the present study was to describe the incidence and the characteristics of Self-Injurious Thoughts and Behaviors (SITBs), among adolescents aged 11-18 admitted, over a two year period, to all the Emergency Departments of a Region of North-eastern Italy through a comprehensive analysis of medical records. A two-step search was performed in the regional ED electronic database. First, we identified the cases that had been clearly diagnosed as SITBs by an Emergency Department physician. Secondly, suspect cases were detected through a keyword search of the database, and the medical records of these cases were hand screened to identify SITBs. The mean annual incidence rate of SITBs was 90 per 100,000 adolescents aged 11-18 years. Events were more frequent in females. Drug poisoning was the most frequently adopted method (54\%). In 42\% of cases a diagnosis of SITB was not explicitly reported by the physician. In 65\% of cases adolescents were discharged within hours of admission. Only 9\% of patients started a psychiatric assessment and treatment program during hospital stay. This research confirms the high incidence of SITBs among adolescents and highlights the difficulty in their proper diagnosis and management. Such difficulty is confirmed by the fact that only a few patients, even among those with a clear diagnosis, were sent for psychiatric assessment. Correct identification and management of SITB patients needs to be improved, since SITBs are an important public health problem in adolescence and one of the main risk factors for suicide.

}, keywords = {Adolescent, Child, Female, Humans, Incidence, Italy, Male, Medical Records, Patient Admission, Retrospective Studies, Self-Injurious Behavior, Sex Factors, Suicidal Ideation, Suicide, Attempted}, issn = {1932-6203}, doi = {10.1371/journal.pone.0170979}, author = {Zanus, Caterina and Battistutta, Sara and Aliverti, Renata and Montico, Marcella and Cremaschi, Silvana and Ronfani, Luca and Monasta, Lorenzo and Carrozzi, Marco} } @article {10479, title = {Antibiotic Prophylaxis for Urinary Tract Infection-Related Renal Scarring: A Systematic Review.}, journal = {Pediatrics}, volume = {139}, year = {2017}, month = {2017 May}, abstract = {

CONTEXT: Acute pyelonephritis may result in renal scarring. Recent prospective studies have shown a small benefit of antibiotic prophylaxis in preventing symptomatic and febrile urinary tract infections (UTIs), while being underpowered to detect any influence in prevention of renal damage.

OBJECTIVES: Review of the literature and a meta-analysis to evaluate the effect of antibiotic prophylaxis on UTI-related renal scarring.

DATA SOURCES: Medline, Embase, and Cochrane Controlled Trials Register electronic databases were searched for studies published in any language and bibliographies of identified prospective randomized controlled trials (RCTs) performed and published between 1946 and August 2016.

STUDY SELECTION: Subjects 18 years of age or younger with symptomatic or febrile UTIs, enrolled in prospective RCTs of antibiotic prophylaxis where Tc dimercaptosuccinic acid scans were performed at entry into the study and at late follow-up to detect new scar formation.

DATA EXTRACTION: The literature search, study characteristics, inclusion and exclusion criteria, and risk of bias assessment were independently evaluated by 2 authors.

RESULTS: Seven RCTs (1427 subjects) were included in the meta-analysis. Our results show no influence of antibiotic prophylaxis in preventing renal scarring (pooled risk ratio, 0.83; 95\% confidence interval, 0.55-1.26) as did a subanalysis restricted to those subjects with vesicoureteral reflux (pooled risk ratio, 0.79; 95\% confidence interval, 0.51-1.24).

LIMITATIONS: Limitations include the small number of studies, short duration of follow-up, and insufficient children with high-grade dilating reflux and/or renal dysplasia enrolled in the studies.

CONCLUSIONS: Antibiotic prophylaxis is not indicated for the prevention of renal scarring after a first or second symptomatic or febrile UTI in otherwise healthy children.

}, keywords = {Acute Disease, Antibiotic Prophylaxis, Child, Cicatrix, Humans, Kidney, Pyelonephritis, Urinary Tract Infections}, issn = {1098-4275}, doi = {10.1542/peds.2016-3145}, author = {Hewitt, Ian K and Pennesi, Marco and Morello, William and Ronfani, Luca and Montini, Giovanni} } @article {8042, title = {Analgesia by cooling vibration during venipuncture in children with cognitive impairment.}, journal = {Acta Paediatr}, year = {2015}, month = {2015 Sep 24}, abstract = {

AIM: Children with cognitive impairment experience pain more frequently than healthy children and are more likely to require venipuncture or intravenous cannulation for various procedures. They are frequently unable to report pain and often receive poor pain assessment and management. This study assessed the effectiveness of physical analgesia during vascular access in children with cognitive impairments.

METHODS: We conducted a prospective randomised controlled study at a tertiary-level children{\textquoteright}s hospital in Italy from April to May 2015 to assess whether a cooling vibration device called Buzzy decreased pain during venipuncture and intravenous cannulation in children with cognitive impairment. None of the children had verbal skills and the main cognitive impairments were cerebral palsy, epileptic encephalopathy and genetic syndromes.

RESULTS: We tested 70 children with a median age of nine years: 34 in the Buzzy group and 36 in the no-intervention group. Parents were trained in the use of the Noncommunicating Children{\textquoteright}s Pain Checklist - postoperative version scale, and they reported no or mild procedural pain in 32 cases (91.4\%) in the Buzzy group and in 22 cases (61.1\%) in the no-intervention group (p = 0.003).

CONCLUSION: Cooling vibration analgesia during vascular access reduced pain in children with cognitive impairment.

}, issn = {1651-2227}, doi = {10.1111/apa.13224}, author = {Schreiber, Silvana and Cozzi, Giorgio and Rutigliano, Rosaria and Assandro, Paola and Tubaro, Martina and Cortellazzo Wiel, Luisa and Ronfani, Luca and Barbi, Egidio} } @article {1857, title = {Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {54}, year = {2012}, month = {2012 Feb}, pages = {229-41}, abstract = {

OBJECTIVE: The aim of this study was to summarise the evidence from 2004 to September 2009 on the performance of laboratory-based serological and point of care (POC) tests for diagnosing coeliac disease (CD) in children using histology as reference standard.

PATIENTS AND METHODS: We searched MEDLINE and EMBASE for studies reporting on children for tests based on IgA and IgG anti-gliadin (AGA), endomysial (EmA), anti-transglutaminase-2 (TG2), and anti-deamidated gliadin peptides (DGP) antibodies or POC tests. For inclusion, histological analysis of duodenal biopsies and sensitivity and specificity for index tests had to be reported. Data were pooled and summary measures calculated for sensitivity, specificity, positive and negative likelihood ratios ("LR+", "LR-"), and diagnostic odds ratios (DOR). In case of elevated statistical heterogeneity, studies reaching 90\% sensitivity or specificity were reported.

RESULTS: A total of 2510 articles were reviewed; 16 entered meta-analysis, reporting on 3110 patients (1876 with CD, 1234 without CD). For IgA-EmA, sensitivity was >=90\% in 7/11 studies and pooled specificity 98.2\%. For IgA-anti-TG2, 11/15 studies yielded sensitivities >=90\% and 13/15 specificities >=90\%. For IgA-DGP, sensitivity ranged between 80.7\% and 95.1\% (specificity 86.3\%-93.1\%); for IgG-DGP between 80.1\% and 98.6\% (specificity 86.0-96.9\%). IgA-EmA had the highest pooled DOR (554) and LR+ (31.8) for a laboratory test, followed by IgA-anti-TG2, IgG-DGP, IgA-DGP and IgA-AGA. POC tests showed a pooled sensitivity of 96.4\% for IgA-TG2 (specificity 97.7\%).

CONCLUSIONS: IgA-EmA and IgA-anti-TG2 tests appear highly accurate to diagnose CD. IgG-anti-DGP tests may help in excluding CD. IgA-AGA and IgA-DGP tests show inferior accuracy. POC tests may achieve high accuracy in the hands of experienced readers, but IgA-anti-TG2/EmA were superior.

}, keywords = {Autoantibodies, Biological Markers, Celiac Disease, Child, Gliadin, GTP-Binding Proteins, Humans, Immunoglobulin A, Immunoglobulin G, Point-of-Care Systems, Sensitivity and Specificity, Transglutaminases}, issn = {1536-4801}, doi = {10.1097/MPG.0b013e318216f2e5}, author = {Giersiepen, Klaus and Lelgemann, Monika and Stuhldreher, Nina and Ronfani, Luca and Husby, Steffen and Koletzko, Sibylle and Korponay-Szab{\'o}, Ilma R} }