Pediatric Potpourri:PECARN and the less than 60-Day old, Ketamine for induction in the Critical Child and Does ondansetron keep them home?

This month marks another combined virtual JC with our EM colleagues from CHKD EM. Rather than focus on a single topic we generally enjoy having the opportunity to pick their collective brains regarding a broader range of topics. This month we will review a new prediction rule published by the PECARN network that attempts to assist with identifying febrile patients at low risk for serious bacterial infections.  In addition, we will look at a large study on the impact of the use of ondansetron in pediatric patients with acute gastroenteritis. There is always a host of discussion around emergent pediatric intubation as it remains a generally infrequent procedure. The third article being reviewed looks at the use of ketamine for intubation induction in the setting of critically ill pediatric patients. Finally, I included an article from the NEJM Medicine and Society series regarding reopening primary schools during a pandemic. I think there are a host of credible points on both sides of this discussion and look forward to the discussion.  

ARTICLES:

Kupperman et al. A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections  Pediatr 2019 Apr 1;173(4):342-351.  Appraisal

Benary et al. Ondansetron Prescription Is Associated With Reduced Return Visits to the Pediatric Emergency Department for Children With Gastroenteritis. Ann Emerg Med. 2020 May 26:S0196-0644(20)30262-6.  Appraisal

Critical Care Med Ketamine Use for Tracheal Intubation in Critically Ill Children Is Associated With a Lower Occurrence of Adverse Hemodynamic Events Crit Care Med. 2020 Jun;48(6):e489-e497.  Appraisal 

Levinson M et al. Reopening Primary Schools during the Pandemic. N Engl J Med. 2020.Jul 29.