@article {10749, title = {Acute small bowel obstruction in a child with a strict raw vegan diet.}, journal = {Arch Dis Child}, year = {2018}, month = {2018 May 14}, issn = {1468-2044}, doi = {10.1136/archdischild-2018-314910}, author = {Amoroso, Stefano and Scarpa, Maria-Grazia and Poropat, Federico and Giorgi, Rita and Murru, Flora Maria and Barbi, Egidio} } @article {10753, title = {Afebrile seizures in infants: Never forget magnesium!}, journal = {J Paediatr Child Health}, volume = {54}, year = {2018}, month = {2018 Apr}, pages = {446-448}, issn = {1440-1754}, doi = {10.1111/jpc.13854}, author = {Minute, Marta and Ventura, Giovanna and Giorgi, Rita and Faletra, Flavio and Costa, Paola and Cozzi, Giorgio} } @article {10829, title = {Pain Intensity and Risk of Bone Fracture in Children With Minor Extremity Injuries.}, journal = {Pediatr Emerg Care}, year = {2018}, month = {2018 Jan 23}, abstract = {

OBJECTIVES: Injuries are one of the most common causes of pediatric emergency department (ED) visit. The aim of this study was to investigate the relationship between the intensity of pain at the ED visit of children presenting with an extremity injury and the risk of fracture.

METHODS: We conducted a retrospective study, considering all patients presenting to the ED of a children{\textquoteright}s hospital in Italy, with an accidental extremity injury, between May and December 2015. We selected all children aged 8 to 17 years who underwent an x-ray. Children with major, multiple, or nonextremity injuries were excluded. Age, sex, spontaneous and palpation pain, local swelling, time between injury, and medical evaluation were recorded. Sensibility and specificity of spontaneous and palpation pain in detecting a fracture were calculated.

RESULTS: We reviewed 994 medical records; of these, 344 (34.6\%) reported a fracture. Children{\textquoteright}s median age was 12 years (interquartile range [IQR], 10-14). Median spontaneous pain at the ED visit was not significantly different between children with and without a fracture: 4.0 (1.0-6.0) and 5 (1.0-6.0), respectively (P = 0.129). Children with mild palpation pain and children without an increase of pain of at least 2 points between spontaneous and palpation pain were fractured in 3.2\% and 0.97\% of cases, respectively.

CONCLUSIONS: In this series, pain intensity in children with a minor extremity injury was not a good marker of fracture. Nevertheless, children with mild palpation pain or with a mild increase of pain between spontaneous and palpation pain had a low risk of fracture.

}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000001418}, author = {Zanchi, Chiara and Giangreco, Manuela and Ronfani, Luca and Germani, Claudio and Giorgi, Rita and Calligaris, Lorenzo and Norbedo, Stefania and Liccari, Giulio and Cozzi, Giorgio and Barbi, Egidio} } @article {10567, title = {Intranasal Dexmedetomidine Sedation as Adjuvant Therapy in Acute Asthma Exacerbation With Marked Anxiety and Agitation.}, journal = {Ann Emerg Med}, volume = {69}, year = {2017}, month = {2017 01}, pages = {125-127}, abstract = {

We describe 2 patients with acute asthma exacerbation who were admitted to the emergency department (ED) with severe~agitation and restlessness as a prominent finding, for which bedside asthma treatment sedation with intranasal dexmedetomidine was performed. In both cases, dexmedetomidine allowed the patients to rest and improved tolerance to treatment. Dexmedetomidine is a unique sedative with an excellent safety profile and minimal effect on respiratory function. These properties render it particularly promising for the management of severe agitation in children admitted to the ED with acute asthma exacerbation.

}, keywords = {Acute Disease, Administration, Intranasal, Anxiety, Asthma, Child, Preschool, Dexmedetomidine, Emergency Service, Hospital, Female, Humans, Hypnotics and Sedatives, Infant, Psychomotor Agitation}, issn = {1097-6760}, doi = {10.1016/j.annemergmed.2016.08.005}, author = {Cozzi, Giorgio and Lega, Sara and Giorgi, Rita and Barbi, Egidio} } @article {8290, title = {A quasi randomized-controlled trial to evaluate the effectiveness of clowntherapy on children{\textquoteright}s anxiety and pain levels in emergency department.}, journal = {Eur J Pediatr}, volume = {175}, year = {2016}, month = {2016 May}, pages = {645-50}, abstract = {

UNLABELLED: The aim of the study is to investigate if the presence of medical clowns during painful procedures in the emergency department (ED) affects children{\textquoteright}s anxiety and pain. Forty children (4-11 years) admitted to the ED with the need of painful procedures were prospectively enrolled. They were randomly assigned to the clown group, where children interacted with clowns or to the control group in which they were entertained by parents and ED nurses. The children{\textquoteright}s anxiety was assessed by the Children{\textquoteright}s Anxiety and Pain Scales; pain was evaluated with the Numerical Rating Scale and Wong-Backer Scale, according to the children{\textquoteright}s age. Staff and clown{\textquoteright}s opinions were evaluated by means of dedicated questionnaires. Children{\textquoteright}s anxiety levels in the clown group were significantly lower than those compared with the control group, while children{\textquoteright}s pain levels did not change between the two groups.

CONCLUSION: The presence of clowns in the ED before and during painful procedures was effective in reducing children{\textquoteright}s anxiety.

WHAT IS KNOWN: {\textbullet} Anxiety and fear caused by medical procedures exacerbate children{\textquoteright}s pain and may interfere with the procedure. {\textbullet} To reduce anxiety, fear, and pain and to facilitate patient{\textquoteright}s evaluation, different non-pharmacological approaches have been proposed and positive effects of laughter and humor have been reported. What is New: {\textbullet} The presence of clowns in the waiting room and in the ED during medical evaluation and painful procedures helps to reduce children{\textquoteright}s anxiety.

}, issn = {1432-1076}, doi = {10.1007/s00431-015-2688-0}, author = {Felluga, Margherita and Rabach, Ingrid and Minute, Marta and Montico, Marcella and Giorgi, Rita and Lonciari, Isabella and Taddio, Andrea and Barbi, Egidio} } @article {3572, title = {A comparison of three scales for measuring pain in children with cognitive impairment.}, journal = {Acta Paediatr}, volume = {103}, year = {2014}, month = {2014 Nov}, pages = {e495-500}, abstract = {

AIM: Pain is a neglected problem in children with cognitive impairments, and few studies compare the clinical use of specific pain scales. We compared the Non-Communicating Children{\textquoteright}s Pain Checklist Postoperative Version (NCCPC-PV), the Echelle Douleur Enfant San Salvador (DESS) and the Children{\textquoteright}s Hospital of Eastern Ontario Pain Scale (CHEOPS). The first two were developed for children with cognitive impairment, and the third is a more general pain scale.

METHODS: Two external observers and the child{\textquoteright}s caregiver assessed 40 children with cognitive impairment for pain levels. We assessed inter-rater agreement, correlation, dependence on knowledge of the child{\textquoteright}s behaviour, simplicity and adequacy in pain rating according to the caregiver for all three scales.

RESULTS: The correlation between the NCCPC-PV and the DESS was strong (Spearman correlation coefficient = 0.76) and better than between each scale and the CHEOPS. Although the DESS showed better inter-rater agreement, it was more dependent on familiarity with the child and was judged more difficult to use by all observers. The NCCPC-PV was the easiest use and the most appropriate for rating the child{\textquoteright}s pain.

CONCLUSION: The NCCPC-PV was the easiest to use for pain assessment in cognitively impaired children and should be adopted in clinical settings.

}, issn = {1651-2227}, doi = {10.1111/apa.12748}, author = {Massaro, Marta and Ronfani, Luca and Ferrara, Giovanna and Badina, Laura and Giorgi, Rita and D{\textquoteright}Osualdo, Flavio and Taddio, Andrea and Barbi, Egidio} }