With millions of journal articles published yearly, it is impossible to keep up.
The team at Derby Royal Hospital have scoured the literature this month- picking out some key articles of interest.
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: Corrected QT Intervals in the Paediatric Emergency Department: Don’t be Misled
Wilson JA, Dasgupta S, Johnsrude C. Corrected QT Intervals in the Pediatric Emergency Department: Don’t Be Misled. Pediatr Emerg Care. 2026 Jan 1;42(1):e8-e12. doi: 10.1097/PEC.0000000000003496. Epub 2025 Oct 27. PMID: 41140108.
What’s it about?
In this single centre retrospective cohort study of 200 children, Wilson et al. sought to assess variance in the calculation of corrected QT interval (QTc), the potential impact on practice and reinforcement of the correct approach to determine accurate QTc intervals.
This study measured the difference in msecs recorded between the automated ECG machine and electrophysiologist manual calculations in both the length of QT and QTc.
The average automated QT was longer by 24msecs compared to the manually measured QT. This led to the average automated QTc being 29msecs longer than the manually measured values. This difference led to 15 (7.5%) patients having borderline prolonged QTc and 4 having abnormally prolonged (2%) in the automated ECG machine calculations. By contrast, only one patient (0.5%) had a manually calculated borderline prolonged QTc. Therefore, automated QTc may have led to under 10% of patients being referred/investigated/managed for prolonged QTc when it was not present on manual calculation.
Why does it matter?
Most significantly to rule out congenital long QT syndrome, which is associated with arrhythmic events and death, but also to assess for prolonged QT caused by other pathologies such as electrolyte abnormalities, drug side effects/overdoses, and post cardiac pathology/arrest. Therefore, it is often important in the undifferentiated patient with possible cardiac symptoms, or in common presentations such as seizures or drug overdoses, eating disorder patients (and for refeeding syndrome), amongst others. Abnormal values often require escalation to senior colleagues, rechecking of the ECG and interpretation, and sometimes discussion with tertiary cardiology services, further investigations and observation/admission.
Check out Cardiac Rhythms/ECG Module – Don’t Forget the Bubbles for a deep dive into ECG’s.
Clinically Relevant Bottom Line
The most important learning from this study is reinforcing the merit of manually calculating QTc, understanding how to do this accurately, and interpreting the results correctly. This can be done calculating using the exact formulae or via accredited medical apps such as Mdcalc. This will shorten the amount of time spent discussing these patients and possibly reduce over investigation/management, optimising patient management and saving healthcare resources.
Reviewed by Dr David White
Article 2: Outdoor play and risk in kids: A Cross-Sectional Study.
Armstrong F, Barrett M, D’Arcy L, Gaul D. Outdoor play and risk in kids: a cross-sectional study. Arch Dis Child. 2026 Feb 19;111(3):205-210. doi: 10.1136/archdischild-2024-328315. PMID: 41125300; PMCID: PMC13018846
What’s it about?
This Dublin cross-sectional study reviewed two years of paediatric ED attendances (6470 cases) to explore outdoor play injuries in children. 3.5% of total ED attendances were due to outdoor play. Most injuries occurred in 4-12-year-olds, with scooters and bikes accounting for over half, while trampolines and climbing frames also featured prominently. But rather than simply counting fractures, the authors asked a more useful question: were these injuries the cost of healthy risk-taking, or the result of preventable hazards?
Why does it matter?
Paediatricians often default to “be careful”, but this paper gives us a better language: risk versus hazard. Risk is the challenge children can recognise, test, and learn from. Hazard is the danger they cannot reasonably predict of control. Risky play builds confidence and resilience. Preventable hazards however, seemed to underlie the more serious injuries. Particularly in wheeled activities, where helmet use remained a key modifiable factor.
Clinically Relevant Bottom Line
Let children climb, jump, and scoot- but manage the hazards around them. Helmets for wheels, safer trampoline setups, and supervision where is matters are easy wins. As with all ED data, this captures the sharper end of play-related injury, not every scraped knee. The message for parents? Encourage the thrill, control the danger. The fun shouldn’t stop; the preventable injuries should. Message for paediatricians? Use every opportunity to a health promotion moment, particularly with helmet use.
Reviewed by Dr James Manley
Article 3: What’s the (McBurney’s) point? Point of care ultrasound for paediatric appendicitis.
McCreary D, Chan N, Miller B, Rees J, Sarvesh B, Mullen N. Evaluating the diagnostic accuracy of point-of-care ultrasound for paediatric appendicitis: a UK multicentre observational study. Arch Dis Child. 2026 Feb 19;111(3):199-204. doi: 10.1136/archdischild-2025-329440. PMID: 41192956.
What’s it about?
This observational study used a convenience method, (scanning appropriate children presenting when a POCUS capable clinician was available), to look at whether POCUS is effective for detecting or excluding appendicitis, and whether it reliably agreed with formal radiologist performed scans. The study looked at 226 children presenting with abdominal pain and tenderness where appendicitis was a differential. Sensitivity (0.89) and specificity (0.96) were high, and consistent with previous pooled study results. POCUS diagnosis was based on either visualised inflamed appendix or secondary signs such as free fluid or fat stranding and compared against operative and histological findings.
Why does it matter?
Appendicitis is a challenging diagnosis and has a high rate of negative appendicectomy (10%). Getting it right first time (GIRFT) recommends paediatric ultrasound as first line to reduce this uncertainty, but access to ultrasonography is limited, so improving this is key to reducing unnecessary surgeries.
Clinically Relevant Bottom Line
If an appropriately qualified POCUS competent clinician is available, POCUS can reduce diagnostic uncertainty and findings correlate very well with formal radiology scans, suggesting that this may reduce reliance on radiologist services. Best results are likely to come from combining POCUS with Paediatric Appendicitis Scores calculated following examination by an experienced clinician. Currently, appropriately POCUS trained clinicians are rare, and training and supervision may be the rate limiting step for utilising this tool.
Reviewed by Dr Niall Durrant
Article 4: Infant Outcomes, Risk Factors, and Diagnostic Yield After a Brief Resolved Unexplained Event: A Systematic Review and Meta-Analysis
Nama N, Liebert S, Abaji M, DeLaroche A, Carlin K, Jewell T, D’Arienzo D, Fung A, Gremse D, Bonkowsky JL, Chen M, Sagiv E, Herman B, Lu E, Gill PJ, Tieder JS, Coon ER. Infant Outcomes, Risk Factors, and Diagnostic Yield After a Brief Resolved Unexplained Event: A Systematic Review and Meta-Analysis. JAMA Pediatr. 2026 Mar 1;180(3):250-262. doi: 10.1001/jamapediatrics.2025.5858. PMID: 41587068; PMCID: PMC12836278.
What’s it about?
This large systematic review and meta-analysis (comprising 24 studies and 6603 infants) examines the outcomes, risk factors and diagnostic test yield after Brief Resolved Unexplained Event (BRUE).
The study mainly focuses on quantifying how often serious diagnoses and death occur after BRUE, clinical characteristics that predict risk and usefulness investigations as part of management.
The authors pooled data from these studies to resolve uncertainty and wide clinical variation in practice. None of the studies had data from the UK.
This study has demonstrated that mortality is extremely rare with 1/1851 death at 3 months, most routine/screening investigations have very low diagnostic yield (<1%) with risk of false positives that may cause further stress for parents and serious underlying diagnoses are uncommon (6%).
Traditional indicators used to define high risk, particularly young chronological age, do not reliably predict serious outcomes. They should not be used in isolation to guide management decisions. Instead, clinicians should focus on a small number of clinically meaningful risk factors, including multiple events, prematurity, abnormal medical or family history, and significant color change during the episode.
Why does it matter?
BRUE presentations in the Children Emergency Department can induce high anxiety for parents and occasionally, diagnostic uncertainty for clinicians. Risk factors for BRUE are based on data from outdated ALTE (Apparent Life-Threatening Event) literature.
As clinicians, investigations are done to reassure families and explore possible causes of the event. This often leads to admission, inpatient stay, and extensive investigations. This may not be cost effective or beneficial to the child or families.
Check out BRUE – Brief Resolved Unexplained Events – Don’t Forget the Bubbles
Clinically Relevant Bottom Line
This systematic review highlights a shift away from ‘routine’ screening and toward more precise, risk-informed diagnostic testing.
For everyday clinical practice, management should involve a targeted, risk informed approach centered on careful history‑taking, physical examination, selective investigation when clinically indicated and high‑quality communication/safety netting with families.
Reviewed by : Dr Aayaatullah Mohammad and Dr Amelia Amaechi
Article 5: The impact of tracheal intubation attempts on chest compression fraction during pediatric CPR: a report from Videography in Pediatric Resuscitation (VIPER) collaborative.
Jariyasakoolroj T, O’Connell K, MacDonald T, Breslin J, Murphy J, MacDonald C, Neubrand T, Rochford L, Myers S, Kerrey B, Donoghue A. The impact of tracheal intubation attempts on chest compression fraction during pediatric CPR: a report from the Videography in Pediatric Resuscitation (VIPER) collaborative. Resuscitation. 2026 Feb 16:111018. doi: 10.1016/j.resuscitation.2026.111018. Epub ahead of print. PMID: 41707976.
What’s it about?
Advanced resuscitation guidelines suggest that no intubation attempt should interrupt chest compressions during CPR for more than 10 seconds. This was a US-based multicentre prospective observational study where video recordings of 183 paediatric CPR events were reviewed, comparing events where chest compressions were held and those where compressions were ongoing during intubation.
The primary outcome measured was the chest compression fraction in both groups i.e. the percentage of time spent actually doing compressions. At least one intubation attempt was made in 40% of cases (73/183). Compressions were held for intubation attempts in 29 out of 73 events with a median pause of 20 seconds.
There was no significant difference in the chest compression fraction in each group. The median duration of one intubation attempt was 34 seconds. Successful first attempt intubations happened in 58%; overall successful intubations at any point during CPR occurred in 88%.
There was no statistically significant difference in the percentage of successful intubations between groups, irrespective of chest compressions.
Why does it matter?
Airway interventions during CPR have been associated with poorer outcomes in terms of both survival and neurological outcomes. The reasons for this aren’t completely clear but one possible reason is the interruptions to chest compressions during intubation attempts. This study suggests that this might not actually be the case.
However, this study did show where compressions were held for intubation, the pauses were longer than the recommended standard of 10 seconds. In addition to this, the success rate of first intubation attempts is actually pretty low, irrespective of whether compressions are ongoing or not.
Check out What’s new Resus Council Guidance 2025- Paediatric Life Support – Don’t Forget the Bubbles
Clinically Relevant Bottom Line
Multiple, prolonged intubation attempts can disrupt the quality and duration of chest compressions during CPR, potentially contributing to poorer outcomes overall so it’s all about the right timing, right place and right people.
It’s easy to lose track and underestimate the time an intubation attempt (or any intervention, for that matter) can take so it’s important to maintain situational awareness and keep track of the time. If intubation is needed during CPR, ensure you have a skilled airway person who is comfortable with paediatric airways.
Reviewed by Dr Jennifer Tsang
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.
