@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 {10864, title = {Red Flags in Torticollis: A Historical Cohort Study.}, journal = {Pediatr Emerg Care}, volume = {34}, year = {2018}, month = {2018 Jul}, pages = {463-466}, abstract = {

OBJECTIVE: This study aimed to assess the spectrum of pathologies responsible for torticollis in children presenting to the emergency department and to evaluate the associated symptoms to determine clinical red flags for hospitalization.

METHODS: This was a historical retrospective cohort study. Medical records of children evaluated in our emergency department for torticollis from 2008 to 2013 were reviewed.

RESULTS: Among 392 identified patients, 61\% had postural torticollis,19.4\% infection related, 16.3\% traumatic, and 3.5\% other. Twenty-five patients (6.4\%) were hospitalized. Four variables were strongly and independently related to the severe outcome: fever, sore throat, headache, and age.

CONCLUSIONS: The association of 2 or 3 of these 4 features carried a risk of 32\% and 58\%, respectively, of having a severe illness.

}, keywords = {Adolescent, Child, Child, Preschool, Cohort Studies, Emergency Service, Hospital, Female, Hospitalization, Humans, Male, Retrospective Studies, Torticollis}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000001377}, author = {Starc, Meta and Norbedo, Stefania and Tubaro, Martina and Ronfani, Luca and Bassanese, Giulia and Barbi, Egidio} } @article {10559, title = {Acute Abdominal Pain: Recognition and Management of Constipation in the Emergency Department.}, journal = {Pediatr Emerg Care}, volume = {33}, year = {2017}, month = {2017 Oct}, pages = {e75-e78}, abstract = {

OBJECTIVE: The main aim of the study was to investigate the incidence and the clinically relevant features of functional constipation in patients evaluated for acute abdominal pain in a tertiary care pediatric emergency department.

METHODS: This is a retrospective study. We analyzed 4394 medical records and recorded the information (demographics, triage code, symptoms, medical history, physical evaluation, laboratory tests, radiological studies, procedures, and treatments) of all patients admitted for acute abdominal pain to the emergency department of the IRCCS Burlo Garofolo, Trieste, during 2010 to 2013.

RESULTS: In this study, a quarter of patients (1020) presenting in the emergency department with acute abdominal pain were affected by functional constipation. Acute pain associated with functional constipation is generally rated from moderate to severe, and the location of the pain on physical evaluation was not a sufficient criterion to guide diagnosis. Isolated vomiting may be present in a minority of cases. Digital rectal exploration was never performed; the majority of patients were treated by means of an enema with prompt relief. Six percent of patients with constipation underwent radiological studies.

CONCLUSIONS: This study confirms that the medical history provides a pivotal role in the diagnosis of functional constipation. Digital rectal exploration and x-rays should be avoided in this setting, whereas an enema plays a useful diagnostic and therapeutic role in our study patients.

}, keywords = {Abdominal Pain, Acute Pain, Adolescent, Child, Child, Preschool, Constipation, Emergency Service, Hospital, Enema, Female, Humans, Incidence, Infant, Male, Retrospective Studies}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000001039}, author = {Norbedo, Stefania and Bassanese, Giulia and Barbieri, Francesca and Barbi, Egidio} } @article {10531, title = {Authors{\textquoteright} Reply to M.S. Raghuraman: "Intranasal Dexmedetomidine for Procedural Sedation in Children, a Suitable Alternative to Chloral Hydrate".}, journal = {Paediatr Drugs}, volume = {19}, year = {2017}, month = {2017 08}, pages = {377}, keywords = {Administration, Intranasal, Child, Chloral Hydrate, Dexmedetomidine, Humans, Hypnotics and Sedatives, Infant}, issn = {1179-2019}, doi = {10.1007/s40272-017-0246-0}, author = {Cozzi, Giorgio and Norbedo, Stefania and Barbi, Egidio} } @article {10508, title = {Intranasal Dexmedetomidine for Procedural Sedation in Children, a Suitable Alternative to Chloral Hydrate.}, journal = {Paediatr Drugs}, volume = {19}, year = {2017}, month = {2017 Apr}, pages = {107-111}, abstract = {

Sedation is often required for children undergoing diagnostic procedures. Chloral hydrate has been one of the sedative drugs most used in children over the last 3 decades, with supporting evidence for its efficacy and safety. Recently, chloral hydrate was banned in Italy and France, in consideration of evidence of its carcinogenicity and genotoxicity. Dexmedetomidine is a sedative with unique properties that has been increasingly used for procedural sedation in children. Several studies demonstrated its efficacy and safety for sedation in non-painful diagnostic procedures. Dexmedetomidine{\textquoteright}s impact on respiratory drive and airway patency and tone is much less when compared to the majority of other sedative agents. Administration via the intranasal route allows satisfactory procedural success rates. Studies that specifically compared intranasal dexmedetomidine and chloral hydrate for children undergoing non-painful procedures showed that dexmedetomidine was as effective as and safer than chloral hydrate. For these reasons, we suggest that intranasal dexmedetomidine could be a suitable alternative to chloral hydrate.

}, keywords = {Administration, Intranasal, Child, Chloral Hydrate, Dexmedetomidine, Humans, Hypnotics and Sedatives}, issn = {1179-2019}, doi = {10.1007/s40272-017-0217-5}, author = {Cozzi, Giorgio and Norbedo, Stefania and Barbi, Egidio} } @article {3501, title = {A boy with sudden headache.}, journal = {Pediatr Emerg Care}, volume = {30}, year = {2014}, month = {2014 Mar}, pages = {182-4}, abstract = {

Headache is a common presenting complaint in pediatric emergency departments. The goal of emergent evaluation is to identify those children with potentially life-threatening conditions. We present the case of an adolescent boy presenting with headache and hypertension who was diagnosed with a catecholamine-secreting abdominal paraganglioma. Genetic testing eventually led to the diagnosis of SDHB-related hereditary paraganglioma-pheochromocytoma syndrome. Alarm features ("red flags") in children presenting with headache are reviewed, as well as the main features of paragangliomas and the indications for genetic testing.

}, keywords = {Abdominal Neoplasms, Adolescent, Emergencies, Headache, Humans, Male, Paraganglioma}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000000090}, author = {Norbedo, Stefania and Naviglio, Samuele and Murru, Flora Maria and Cavallin, Roberta and Giurici, Nagua and Rabusin, Marco and Barbi, Egidio} } @article {3564, title = {Diagnostic accuracy of ultrasonography for hand bony fractures in paediatric patients.}, journal = {Arch Dis Child}, volume = {99}, year = {2014}, month = {2014 Dec}, pages = {1087-90}, abstract = {

OBJECTIVE: Hand fractures are common in childhood, and radiography is the standard diagnostic procedure. US has been used to evaluate bone injuries, mainly in adults for long-bone trauma; there are only a few studies about hand fractures in children. The purpose of this study was to evaluate and confirm the safety and applicability of the US diagnostic procedure in comparison to X-ray diagnosis.

STUDY DESIGN: This cross-sectional study involved a convenience sample of young patients (between 2 and 17 years old) who were taken to the emergency department due to hand trauma. After clinical assessment, patients with a suspected hand fracture first underwent X-ray, and subsequently US examination by two different operators; a radiologist experienced in US and a trained emergency physician in "double-blind" fashion. US and radiographic findings were then compared, and sensitivity as well as specificity was calculated.

RESULTS: A total of 204 patients were enrolled in the study. Seventy-nine fractures of phalanges or metacarpals were detected by standard radiography. When US imaging was performed by an expert radiologist, 72 fractures were detected with sensitivity and a specificity of 91.1\% and 97.6\%, respectively. Sensitivity and specificity were found to be (respectively) 91.5\% and 96.8\% when US was performed by the ED physicians.

CONCLUSIONS: US imaging showed excellent sensitivity and specificity results in the diagnosis of hand fractures in children. The study also showed a great agreement between the results of the US carried out by the senior radiologist and those carried out by the paediatric emergency physician, suggesting that US can be performed by an ED physician, allowing a rapid and accurate evaluation in ED and could become the first diagnostic approach whenever a hand fracture is suspected.

}, keywords = {Adolescent, Child, Child, Preschool, Cross-Sectional Studies, Double-Blind Method, Emergency Service, Hospital, Female, Fractures, Bone, Hand Bones, Humans, Italy, Male, Sensitivity and Specificity}, issn = {1468-2044}, doi = {10.1136/archdischild-2013-305678}, author = {Neri, Elena and Barbi, Egidio and Rabach, Ingrid and Zanchi, Chiara and Norbedo, Stefania and Ronfani, Luca and Guastalla, Veronica and Ventura, Alessandro and Guastalla, Pierpaolo} } @article {1768, title = {A coughing spine.}, journal = {Emerg Med J}, volume = {29}, year = {2012}, month = {2012 Jan}, pages = {14}, keywords = {Cervical Vertebrae, Child, Dyspnea, Humans, Male, Mediastinal Emphysema, Spinal Diseases, Subcutaneous Emphysema, Tomography, X-Ray Computed}, issn = {1472-0213}, doi = {10.1136/emermed-2011-200108}, author = {Norbedo, Stefania and Perini, Roberto and Amaddeo, Alessandro} } @article {1737, title = {Acute respiratory failure in a child after talc inhalation.}, journal = {Respiration}, volume = {79}, year = {2010}, month = {2010}, pages = {340}, keywords = {Female, Humans, Infant, Inhalation Exposure, Respiratory Insufficiency, Talc}, issn = {1423-0356}, doi = {10.1159/000181013}, author = {Patarino, Federica and Norbedo, Stefania and Barbi, Egidio and Poli, Furio and Furlan, Stefano and Savron, Fabio} }