With millions of journal articles published yearly, it is impossible to keep up.
This month, clinicians working in the paediatric emergency department (ED) of University Hospital Galway (UHG), the regional hospital in the West of Ireland are contributing to Bubble Wrap.
In this edition, the UHG team, led by Kene Maduemem, Paediatric Emergency Medicine Consultant, has delved into relevant and topical aspects of paediatric emergency care. Five articles ranging from paediatric ED readiness, acute illnesses, health promotion, and patient safety are reviewed.
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: Paediatric emergency department readiness, inpatient services and child mortality
Newgard CD, Lin A, Goldhaber-Fiebert JD, et al. Changes in Emergency Department Pediatric Readiness, Inpatient Services, and Excess Child Deaths. JAMA Pediatr. Published online17, 2026. doi:10.1001/jamapediatrics.2026.3497.
What’s it about?
Caring for sick children requires specific skills, equipment and systems, but does having a paediatric-ready emergency department (ED) or inpatient services affect survival? This large US cohort study evaluated over 2.4 million children looked after across 759 EDs in 11 states over 10 years. Hospitals were classified based on ED paediatric readiness (using the weighted Paediatric Readiness Score (wPRS)) and availability of paediatric inpatient services.
Compared with hospitals that maintained high readiness, EDs that lost or never had high readiness were associated with 5504 (95%CI, 3244-7657) excess deaths. The lack of inpatient services (lost or never had) was associated with 5403 (95% CI, 4356-6380) excess deaths. When both factors were considered together, the estimated excess mortality was 10,428 (95% CI, 8272-12 521) excess deaths.
Why does it matter?
The hospital where a child receives care is as important as the care delivered. Paediatric emergency experience, appropriate equipment and access to inpatient paediatric care form ED readiness to manage sick or injured children. The findings are observational and hence demonstrate association (not causality) between ED paediatric readiness and survival. Notably, this is a powerful reminder that the right paediatric emergency expertise and services are fundamental to keeping children safe.
Clinically Relevant Bottom Line
Children need child-ready hospitals. Lack or loss of high ED paediatric readiness and inpatient paediatric services can result in excess deaths in children receiving emergency care. Ensuring emergency departments have appropriate paediatric emergency expertise and equipment, while maintaining access to paediatric inpatient care, promotes better care and survival.
Reviewed by Nikita Rodenbach
Article 2: Are Paediatric Asthma Scoring Systems Predictive tools for Hospital Admissions?
Gray C, Armit L, Babl FE, et al; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Diagnostic accuracy study assessing the ability of paediatric asthma scores to predict admission following initial emergency department bronchodilator therapy: a Clinical Asthma Scoring systems in Paediatric Emergency (CASPER) study. Arch Dis Child. 2026 Jul 2:archdischild-2026-330613.
What’s it about?
The CASPER study was a large multicentre prospective observational study involving 1238 children across 4 Emergency Departments in Australia. The study assessed how well 10 asthma severity scores predicted hospital admission, both before and after initial bronchodilator treatment.
Included severity scores were Siriraj Clinical Asthma Score (SiCAS), the Paediatric Asthma Severity Score (PASS), Pediatric Respiratory Assessment Measure (PRAM), Clinical Asthma Score (CAS), Acute Asthma Intensity Research Score (AAIRS), Modified Pulmonary Index Score (MPIS), Pulmonary Index Score (PIS), Pediatric Asthma Score (PAS), Woods and Downs Clinical Asthma Score (WDCAS), and Pulmonary Score (PS).
MPIS performed best, with an AUC ROC of 0.70 before treatment and 0.73 after bronchodilator treatment. After treatment, SiCAS (0.71), PIS (0.72), and PAS (0.72) followed closely. However, none of the 10 scores reached the study’s predefined threshold for good predictive ability (AUC ROC ≥0.80).
All 10 scores performed better after initial treatment than before treatment, suggesting that reassessing the child after initial treatment may provide more useful prognostic information than the initial severity score.
Why does it matter?
Multiple asthma scores have been developed, but their use has been historically controversial. Deciding which child with wheeze or asthma can safely go home vs admission is a frequent challenge for clinicians in any paediatric emergency setting. Developing a reliable early-use asthma score to predict a child’s clinical course and disposition will be golden, particularly on busy winter shifts.
For a hot-off-the-press article on new (ish) asthma management, check out: MART in Childhood Asthma: One Inhaler, Simpler Care? – Don’t Forget the Bubbles
Clinically Relevant Bottom Line
Asthma scores can support structured clinical assessment, but this study suggests no “crystal ball” asthma scoring system yet exists for disposition. Clinicians should be cautious and use good clinical judgement when predicting disposition of paediatric patients with wheeze/asthma.
Reviewed by Conor Martin
Article 3: Nirsevimab reduces LRTI-related ED visits and hospitalisations in infants
Sumsuzzman DM, Shi C, Langley JM, Moghadas SM. Nirsevimab Against Hospitalizations and Emergency Department Visits for Lower Respiratory Tract Infection in Infants: A Meta-Analysis. JAMA Pediatr. 2026 Feb 1;180(2):152-159
What’s it about?
Nirsevimab, a single-dose long-acting monoclonal antibody, has strong RCT evidence of protection against RSV. Trials have shown Nirsevimab works against RSV under controlled conditions. This meta-analysis asks: does this hold up in everyday practice? Does it reduce infant presentations to the ED and hospital admissions in unselected, real-world populations?
This meta-analysis reviewed 263,755 children aged ≤24 months from 11 studies across five countries. Compared with controls, recipients of Nirsevimab had 62% lower odds of all-cause LRTI-related hospitalisation and 48% lower odds of all-cause related ED visits. Against RSV-specific LRTI visits, protection was even stronger at 76%.
Why does it matter?
RSV is the leading cause of LRTIs in infancy, with enormous burden on the healthcare system. The benefits of Nirsevimab translate to real-world paediatric practice, which is excellent. Clarifying RSV immunisation status appears to be a useful risk stratification element. RSV-unimmunised young infants could be at greater risk of severe disease and hence, impacts on clinical decisions regarding disposition. Current evidence supports clinicians to engage families in health promotion (vaccination) conversations.
Check out Protection from RSV – Don’t Forget the Bubbles
Clinically Relevant Bottom Line
Real-world data now backs up the previously published trials, demonstrating that an infant immunised with Nirsevimab is less likely to need ED care or admission for LRTI from any cause. Clinicians can confidently tell parents/families that RSV immunisation reduces the risk of severe disease that requires intensive care.
Reviewed by Fiona Newsome
Article 4: Vapour pen: the emerging menace to children and young people
Oyella P, Gilchrist FJ, Talawila Da Camara N, et al. Impacts of vaping on children and young people: a systematic review. Archives of Disease in Childhood Published Online First: 19 August 2026. doi: 10.1136/archdischild-2025-330125
What’s it about?
This study is about the impact on health and social factors in children and young people (CYP) who vape. The authors conducted a systematic review of 81 articles, including over 200,000 CYP people aged 12 to 19 years. The studies spanned 2014 to 2025 and covered North America (n=56), Asia (n=18), and Europe (n=7).
Harm from vaping was described in 8 ways – respiratory diseases, mental health difficulties, cigarette smoking initiation, oral health problems, allergies, sleep difficulties, ocular symptoms and perinatal outcomes for in utero exposure. Although the systematic review was limited by heterogeneity of studies, the negative health outcomes associated with vaping and e-cigarettes are evident.
Why does it matter?
Vaping has become a worrying trend amongst CYP, with a tenfold increase in use in the past 10 years. Previous short-term data had been used to promote vaping as a smoking cessation tool, with widespread underestimation of its risks. Flavoured vape products (appealing to teenagers) are associated with more frequent use, higher levels of dependence and more respiratory symptoms. Clinicians need heightened awareness of the medium- to long-term consequences.
Check out Vaping: A 30 Second-High – Don’t Forget the Bubbles
Clinically Relevant Bottom Line
There is strong evidence that vaping increases risk of cigarette smoking initiation in CYP who have never smoked. High-quality studies reveal that young people who vape have more troublesome respiratory symptoms than those who don’t. There are higher rates of depression, panic disorder and suicidal ideation in CYP who vape.
These findings support the need for health professionals to routinely enquire about vaping, to offer cessation support.
Reviewed by Andrew Dore
Article 5: Lost in Translation: Language Barriers and Patient Safety in Paediatric Emergency Care
Odedra R, Averill P, Nijman RG, et al. Understanding how language barriers in the paediatric emergency care setting influences safety of care delivery: a scoping review. Emerg Med J. 2026 Jul 21;43(8):472-478. doi: 10.1136/emermed-2025-215617.
What’s it about?
Effective communication with children and parents/carers is critical in paediatric emergency care, but what happens when their primary language differs from that of the healthcare provider?
This scoping review analysed 33 studies: 24 examined safety risks related to language barriers, and 9 examined mitigation strategies. Discharge was frequently identified as a critical phase where risks may occur. Intervention studies lacked co-design with families and/or frontline healthcare professionals. The most common interventions centred on interpreter services, with some potentially significant errors; therefore, additional research is needed to evaluate how well these strategies work.
Why does it matter?
In a busy emergency department, it might seem easier to have family members, multilingual staff, or even children act as interpreters. Crucial details can be missed, changed, or misunderstood, especially when families leave with medication instructions or safety advice. A consultation might seem successful because we’ve explained everything, but true success is whether the family understands what to do once they are home.
Clinically Relevant Bottom Line
Language barriers constitute a core patient safety issue. Identifying language needs early may help, but the key opportunity to prevent harm is at discharge: ensuring parents/carers understand follow-up and safety-netting advice. The most effective method remains unclear.
No study investigated AI-enabled translation tools, especially as these are becoming popular in clinical practice. Notably, the authors recommend extreme care when using such tools at present.
Reviewed by Niamh Vaughan and Mairead Reidy
If you or your team want to submit a review, please get in touch with Dr Vicki Currie at @DrVickiCurrie1 or vickijanecurrie@gmail.com.
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.