With millions of journal articles published yearly, it is impossible to keep up. This month, the team from Southampton Children’s PED showcase the latest research on common presentations and use of technology in ED that you really want to know about!
Southampton Children’s Hospital is a tertiary and major trauma centre. The emergency department sees over 35000 children a year and is the single front door for all ill and injured infants, children and young people at the trust.
Bubble Wrap led by Melanie Ranaweera, Paediatric Emergency Medicine Consultant with a passion for POCUS, simulation and major trauma.
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: Comparing Screening Tools for Predicting Phoenix Criteria Sepsis and Septic Shock Among Children
Nathan Georgette, Kenneth Michelson, Michael Monuteaux, Matthew A. Eisenberg; Comparing Screening Tools for Predicting Phoenix Criteria Sepsis and Septic Shock Among Children. Pediatrics April 2025; 155 (5): e2025071155. 10.1542/peds.2025-071155
What’s it about?
This large retrospective cohort of 47,176 children with suspected infection underwent secondary analysis to review the efficacy of the quick Paediatric Septic Shock Screening Score (qPS4). It assessed whether it could predict sepsis and septic shock with greater sensitivity and specificity than other screening tools (LqSOFA, CHOP). The qPS4 score assesses capillary refill time, mental status, respiratory rate, temperature, and age-adjusted mean shock index (TAMSI).
Why does it matter?
qPS4 is a relatively easy-to-perform, non-invasive paediatric sepsis screening tool with no laboratory data required. If effective, this makes it cheap and straightforward to use in the paediatric emergency department setting.
Compared to other paediatric sepsis scoring systems, the qPS4 has improved sensitivity without affecting specificity. The qPS4 identified sepsis in 7 out of 10 children who truly had it, and confirmed 9 out of 10 children without sepsis did not have it. The qPS4 detected 9 out of 10 children with septic shock, and ruled it out in 9 out of 10 unaffected children. This reflects 68% sensitivity and 89.6% specificity for sepsis, and 85.5% sensitivity and 89% specificity for septic shock.
Clinically Relevant Bottom Line
The qPS4 outperformed the other screening tools for sensitivity for predicting Phoenix criteria-defined paediatric sepsis and septic shock while maintaining specificity. Sensitive scores are very important within the PED, where early detection of critical conditions is crucial to improve outcomes.
Reviewed by Dr Pamela Jump (Academic Paediatric Registrar)
Article 2: Predictors of persisting symptoms after concussion in children following a traumatic brain injury
R. Wilson et al. (2025) Predictors of persisting symptoms after concussion in children following a traumatic brain injury: a longitudinal retrospective cohort study: BMJ Paediatrics Open, 9:e, 003036.
What’s it about?
This longitudinal retrospective cohort study of 137873 children aged 1-17 years, over four years, investigated predictors of persistent symptoms after concussion (PSaC) in children secondary to traumatic brain injury (TBI). Patients subsequently presented to a GP, emergency department or were admitted to hospital. The analysis identified key demographic and clinical predictors of PSaC. The strongest predictors were older age (children averaged 8 years vs those without 5.5 years), female sex, Asian or mixed ethnicity, a history of headaches, learning disability, ADHD, anxiety, depression and sleep disorder preceding the TBI. These were associated with symptoms persisting for weeks to months post-injury.
Why does it matter?
PSaC refer to a constellation of cognitive, physical or psychological symptoms that arise following a TBI and result in ongoing distress or disability. Around 3% of children met criteria for PSac or suspected PSaC.
These symptoms may persist, worsen or fail to resolve over time, which may impact a child’s daily functioning and quality of life.
Clinically Relevant Bottom Line
Children with identifiable demographic and clinical risk factors are more likely to experience PSaC following TBI. An awareness of the children at risk of poorer outcomes following a TBI allows clinicians the opportunity to tailor treatment plans, provide guidance on when to seek medical advice and target interventions to prevent or mitigate the burden of PSaC.
Reviewed by Jo House (Trainee Paediatric Advanced Clinical Practitioner)
Article 3: Magnet ingestion in children in the United Kingdom
Reference Neville JJ, Lyttle MD, Messahel S, et al Magnet ingestion in children in the United Kingdom: a national prospective observational surveillance study Archives of Disease in Childhood Published Online First: 18 May 2025. doi: 10.1136/archdischild-2024-328195
What’s it about?
This large UK prospective multicentre observational study aimed to describe the incidence, circumstances and outcomes of paediatric magnet ingestion. From May 2022 to April 2023, 314 eligible magnet ingestion cases occurred in children ≤16 years, estimating an incidence of 2.4 per 100,000 per year. Median age was 8.7 years; magnets were primarily sourced from toys, and 6% of cases were linked to social media trends.
Although 75% were asymptomatic, 7% sustained magnet-related injuries, and 10% required surgery; risk increased with the number of magnets (OR 1.1 per magnet) and presence of symptoms (OR 3.8). Single magnet ingestions caused no injuries. Authors recommend heightened awareness, targeted public health measures, and evidence-based guidelines distinguishing single vs multiple magnet management.
Why does it matter?
Multiple magnet ingestion can cause severe bowel damage if not identified and treated, whereas single magnet ingestion causes no injuries. Most ingestions are unwitnessed, with patients initially asymptomatic. Caregivers typically purchase magnets. There was a suggested positive association of magnet ingestion in areas of higher socioeconomic deprivation.
Clinically Relevant Bottom Line
Risk of magnet-related injury was almost 4x higher in symptomatic patients and higher still in those who had ingested more than two magnets. If there is a suggestion of magnetic ingestion, follow local guidelines. There is an ongoing need to promote the dangers of magnet ingestion.
Reviewed by Dr George Hunter (Paediatric Registrar)
Article 4: Smartphone use for paediatric calculations in emergencies (SPaCE)
Evans, J., Morrison, Z., Thomas-Turner, R., Bouamra, O., Mullen, S., and Morgan, J., 2024. Smartphone use for Paediatric Calculations in Emergencies (SPaCE). Arch Dis Child; 109, pp282-286. https://doi.org/10.1136/archdischild-2023-326180
What’s it about?
This study looked at the accuracy of three different methods for calculating emergency drug doses and fluid volumes using the WETFLAG mnemonic. Precision of calculations, as well as time and stress burden to clinicians, were compared.
A convenience sample of 96 multi-disciplinary healthcare professionals from four UK hospitals was used. Participants were asked to calculate the drugs and fluids for fictional patients using three specified methods: traditional calculation methods (mental arithmetic or calculator use), a reference chart, and a specifically developed smartphone application. Ninety-six participants calculated values for six fictional patients, resulting in 576 calculations.
Traditional calculation methods had the highest mean number of errors. Using the app showed a significantly shorter mean time compared to other methods. Mean stress levels on a Likert scale were significantly lower for the app.
Why does it matter?
Time is often limited when preparing for the arrival of emergency patients. Reducing the errors in these calculations is crucial, and decreasing the time to complete them, whilst also minimising the stress involved, is hugely beneficial to performance.
Clinically Relevant Bottom Line
The use of smartphone applications can minimise errors, time and stress involved in calculating drug and fluid doses when preparing for a critically unwell or injured patient.
Reviewed by Lizzi Grieve (Paediatric RCEM credentialed ACP)
Article 5: Genital bleeding in prepubertal girls
Moore Y, Hopkinshaw B, Arrowsmith B, et al Genital bleeding in prepubertal girls: a systematic review Archives of Disease in Childhood 2025; 110:358-362.
What’s it about?
A systematic review of 99 studies (80 case reports, 13 retrospective cohort studies, 5 case series and 1 prospective cohort study) described 672 prepubertal girls (Tanner stage 1 and/ or under 12) with genital bleeding, excluding CSA (child sexual abuse) and accidental injury.
Why does it matter?
It is a stressful and often distressing presentation for girls, families and medical staff. CSA is more common than perceived and should be high in the differential list.
However, in the absence of a disclosure or clinical suspicion, hormonal causes, lichen sclerosis, infections and infestations (leeches and pinworms), urethral prolapse, vaginal foreign bodies, tumours and ano-genital bleeding were all reported in this study.
Most papers were not from the UK; however, the findings were considered applicable to the UK and other countries, despite the different healthcare and safeguarding systems.
There is a great flow chart that synthesises this evidence, which is also in the RCPCH Physical Signs of Child Sexual Abuse (The Purple Book)
Clinically Relevant Bottom Line
If there is a disclosure or a high suspicion of CSA, follow local protocols.
Otherwise: detailed history (including travel and open water swimming history), external examination and consideration of investigations which may include urine culture, swabs, bloods, abdominal ultrasound and EUA.
Reviewed by Zoe Groves (Paediatric Clinical Fellow)
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.
