With millions of journal articles published yearly, it is impossible to keep up.
This month the team from PEM STAT have scoured the literature so you don’t have to! With hundreds of articles published monthly it can be hard to keep up…
PEMSTAT is an educational platform dedicated to Paediatric Emergency Medicine, focused on delivering high-yield, practical, and accessible learning resources. It provides concise teaching tools, courses, and “rescue cards” designed to support clinicians in real-time decision-making and improve patient care in acute paediatric settings.
Happy reading 🙂
If you or your team want to submit a review, please get in touch with Dr Vicki Currie at @DrVickiCurrie1 or vickijanecurrie@gmail.com.
Article 1: Not All Sepsis Screens Are Equal — Especially Now That the Goalposts Have Moved
Comparing Screening Tools for Predicting Phoenix Criteria Sepsis and Septic Shock Among Children Pediatrics. 2025;155(5):e2025071155. doi: 10.1542/peds.2025-071155
What’s it about?
The Phoenix criteria arrived in 2024 and rewrote how we define paediatric sepsis — out with SIRS, in with organ dysfunction scoring. But here’s the problem: all our existing bedside screening tools were validated against the old definitions.
This study ran three of them head-to-head — the qPS4, the LqSOFA, and the CHOP 2-stage screen — against Phoenix outcomes in over 47,000 paediatric ED encounters with suspected infection. The question was simple: which one actually detects sick kids under the new rules?
An interesting article on predicting sepsis can be found here Using machine learning to predict sepsis in kids – Don’t Forget the Bubbles
Why does it matter?
For sepsis, the qPS4. had 67.8% sensitivity versus 47% for LqSOFA and 49.7% for CHOP. For septic shock, 85.5% sensitivity — significantly better than either comparator.
Crucially, it also sounded the alarm earliest, flagging sepsis a median of 1.9 hours before Phoenix criteria were formally met. In a condition where every hour of delayed recognition worsens outcomes, which lead time may be clinically meaningful. For those of us running SPOT Sepsis-type studies calibrated to Phoenix, this paper is directly relevant: your screening tool choice isn’t just a methods decision — it may be a patient safety decision.
.
Clinically Relevant Bottom Line
If your ED is still using an LqSOFA or CHOP-style screen and calling it your Phoenix-era sepsis safety net, it may be time to re-evaluate. The qPS4 offers meaningfully higher sensitivity with comparable specificity — and it gives you a head start.
Reviewed by PEM STAT Team
Article 2: The Strip That’s Smarter Than the Lab
Urine Dipstick for the Diagnosis of Urinary Tract Infection in Febrile Infants Aged 2 to 6 Months Hunt KM et al. Pediatrics. 2025;155(4):e2024068671. doi: 10.1542/peds.2024-068671
What’s it about?
You’ve catheterised a 3-month-old with a fever. Now what? You can dip the urine at the bedside in under a minute, or you can send it to the lab for a full urinalysis and wait. Most of us have been taught that the microscopic white cell count is the gold standard for guiding early antibiotic decisions.
This multicentre cross-sectional study drawing on over 9,000 febrile infants aged 2 to 6 months across five paediatric EDs asks whether the humble urine dipstick can hold its own. Using urine culture as the reference standard, they compared dipstick performance (leukocyte esterase ≥1+ or positive nitrite) against laboratory urinalysis with an optimised white blood cell cut-point of ≥7 cells per high-power field.
Why does it matter?
The dipstick detected UTI with 90.2% sensitivity and 92.6% specificity — both statistically better than the microscopic WBC count at the chosen threshold. And crucially, a negative dipstick ruled out UTI in 99% of cases. For those of us working in EDs without rapid lab access, or in contexts where turnaround time matters for flow and decision-making, this is meaningful. It also matters for the 2-to-6-month-old age group specifically, a window where clinicians have historically been less confident using the dipstick, given historically lower nitrite positivity rates in young infants with shorter bacterial dwell times.
Clinically Relevant Bottom Line
You don’t need to wait for the full urinalysis to start thinking. A positive dipstick with leukocyte esterase ≥1+ or any nitrite in a febrile 2-to-6-month-old is sufficient to initiate antibiotic treatment while the culture is pending. A negative dipstick makes UTI very unlikely. The strip is fast, cheap, bedside-available, and now formally validated in this age group.
Reviewed by The PEM STAT team
Article 3: Can You Still Trust the Broselow?
A Descriptive Analysis of the Reliability of the Broselow Tape for Use in the US Pediatric Trauma Population: A Trauma Quality Improvement Program Study McCullough IS et al. Pediatr Emerg Care. 2025;41(8):587–591. doi: 10.1097/PEC.0000000000003362
What’s it about?
The Broselow tape is one of paediatric emergency medicine’s most trusted tools — a length-based, colour-coded system for estimating weight when you can’t put a child on a scale.
In trauma, this matters immediately: drug doses, fluid volumes, defibrillation energy, and equipment sizing all depend on it. This retrospective study interrogated over 200,000 paediatric trauma patients from the US Trauma Quality Improvement Program (TQIP) registry between 2017 and 2022 — children under 15 whose height fell within the Broselow tape’s measurement range — and simply asked: how often does the tape get it wrong by more than 20%?
Why does it matter?
Overestimation was rare — only 2% of patients. But underestimation was a different story entirely. Nearly 1 in 7 children had a measured body weight that exceeded the Broselow tape’s estimate by more than 20%. In practical terms, that means for those patients, every weight-based drug dose calculated from the tape was potentially underdosed by a clinically significant margin.
In trauma resuscitation, where getting the analgesia, the ketamine dose, or the tranexamic acid right can matter enormously, a systematic 20%-plus underestimate is not a rounding error — it’s a patient safety signal. This finding reflects a well-documented and growing problem: the Broselow tape was originally calibrated on historical US growth data, and children today — particularly in populations with higher rates of overweight may have outgrown it.
More on weight estimation here I can guess your weight – Don’t Forget the Bubbles
Clinically Relevant Bottom Line
Use the Broselow tape as a starting point, not a definitive answer. When a child looks larger than their colour zone suggests, trust your eyes and adjust upward. If actual weight is obtainable — even a parental estimate, use it. Institutions serving populations where childhood overweight is prevalent should be actively reviewing whether their length-based dosing tools remain fit for purpose, and considering supplementary habitus-adjusted approaches as part of their paediatric trauma protocols.
Reviewed by The PEM STAT Team
Article 4: Ten Seconds You Don’t Have: The Unreliable Pulse Check in Pediatric Resuscitation
Katzenschlager, S., Acworth, J., Tiwari, L. K., Kleinmann, M., Myburgh, M., del Castillo, J., Nadkarni, V., Couto, B. T., Tijssen, J. A., Morrison, L. J., DeCaen, A., & Scholefield, B. R. (2025). Pulse check accuracy in pediatrics during resuscitation: A systematic review. Resuscitation Plus, 23, 100959. https://doi.org/10.1016/j.resplu.2025.100959
What’s it about?
The article examines the accuracy of manual pulse checks in children during cardiac arrest. Best practices stipulate that clinicians should assess pulse within 10 seconds prior to commencing CPR. However, use of pulse palpation to inform whether to use CPR intervention is not the best practice, particularly when the resuscitation is performed in high-stress conditions. In the studies evaluated, the average time of determining the presence of pulse was approximately 20 seconds when compared to the recommended 10 seconds. The review concluded that manual pulse checks for children have moderate accuracy and often take more time than recommended.
Why does it matter?
The clinical decision on whether a child is in a state of cardiac arrest is a high-stakes one. False negative (inability to diagnose arrest) delays CPR intervention and reduces the likelihood of survival. False positive (identifying an arrest falsely) would lead to unnecessary compressions, which can lead to injury.
This review demonstrates that manual pulse palpitation is not a reliable procedure that can be used to inform the decision whether to start CPR. The clinically significant mean pulse check duration of 20 seconds correlates with longer pauses in chest compressions, which can potentially lead to suboptimal outcomes.
Check out What’s new Resus Council Guidance 2025- Paediatric Life Support – Don’t Forget the Bubbles
Clinically Relevant Bottom Line
Clinicians, when faced with a situation where a child who is unresponsive and does not breathe normally, should perform CPR immediately and reduce interruptions. They are also supposed to take into account other adjuncts, including etCO2 monitoring and ultrasound. Delaying compressions to locate a pulse might result in adverse care outcomes.
Reviewed by The PEM STAT Team
Article 5: The Appendix Wins. For Now.
Appendicectomy versus antibiotics for acute uncomplicated appendicitis in children: an open-label, international, multicentre, randomised, non-inferiority trial (The APPY Trial) St Peter SD et al. Lancet. 2025;405(10474):233–240. doi: 10.1016/S0140-6736(24)02420-6
What’s it about?
This study evaluated whether children with acute uncomplicated appendicitis can be safely treated with antibiotics instead of undergoing appendicectomy. In a large international randomized trial, 936 children aged 5–16 years with suspected non-perforated appendicitis were randomly assigned to receive either antibiotic therapy or laparoscopic appendicectomy and followed for 12 months. The study assessed whether the initial treatment was successful or resulted in treatment failure, defined in the antibiotic group as the need for surgery during follow-up.
For all things appendicitis check out Paediatric Appendicitis – Don’t Forget the Bubbles
Why does it matter?
Appendicitis is the most common surgical emergency in children, and appendicectomy has traditionally been the standard treatment. However, there has been increasing interest in non-operative management using antibiotics to avoid surgery, anesthesia, and postoperative recovery. Determining whether antibiotics alone provide comparable outcomes is important because it could change clinical practice and offer families a less invasive treatment option.
Clinically Relevant Bottom Line
Antibiotic therapy alone was associated with a significantly higher failure rate compared with appendicectomy. Within one year, treatment failure occurred in 34% of children treated with antibiotics compared with 7% of those who underwent surgery, demonstrating that antibiotics were inferior as the initial treatment strategy. Appendicectomy therefore remains the most reliable and definitive treatment for uncomplicated appendicitis in children, although antibiotics may still be considered in selected cases if families understand the risk of recurrence or later surgery.
Reviewed by The PEM STAT Team
If we missed something useful or you think other articles are worth sharing, please add them in the comments!
That’s it for this month—many thanks to our reviewers for scouring the literature so you don’t have to.
Vicki Currie, DFTB Bubble Wrap Lead, reviewed all articles.
