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  1. Article ; Online: Pediatric emergency triage systems.

    Simon Junior, Hany / Schvartsman, Claudio / Sukys, Graziela de Almeida / Farhat, Sylvia Costa Lima

    Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo

    2022  Volume 41, Page(s) e2021038

    Abstract: Objective: The aim of this study was to perform a narrative review of the leading pediatric triage systems in emergency departments (EDs).: Data source: Articles published between 1999 and 2019 were identified by searching the MEDLINE, EMBASE, and ... ...

    Abstract Objective: The aim of this study was to perform a narrative review of the leading pediatric triage systems in emergency departments (EDs).
    Data source: Articles published between 1999 and 2019 were identified by searching the MEDLINE, EMBASE, and PubMed databases using the keywords "pediatric triage", "pediatric assessment tools", and "emergency department triage" with an emphasis on studies that evaluated the validation and reliability of triage systems.
    Data synthesis: A total of 105 articles on pediatric emergency triage systems in 12 countries were evaluated. Triage systems were divided into two groups: color-stratified triage systems and alert systems. The color-stratified triage systems included in this review were the Canadian Triage and Acuity Scale (CTAS), Manchester Triage System (MTS), Emergency Severity Index (ESI), and Australasian Triage Scale (ATS), and the alert systems included were the Paediatric Observation Priority Score (POPS), Pediatric Early Warning Score (PEWS), and Pediatric Approach Triangle (PAT). Evidence corroborates the validity and reliability of MTS, PaedCTAS, ESI version 4, PEWS, POPS, and PAT in pediatric emergency services.
    Conclusions: These are fundamental tools for risk classification of patients seeking treatment in EDs. Not all triage systems have been assessed for validity and reliability; nor are they well suited for all regions of the world. Employing triage systems in Brazil requires cultural adaptation and rigorous training of the local health staff, in addition to validation and reliability studies in our country, since the social and cultural context of this country differs from those where these tools were developed.
    MeSH term(s) Brazil ; Canada ; Child ; Emergency Medical Services ; Emergency Service, Hospital ; Humans ; Reproducibility of Results ; Triage
    Language English
    Publishing date 2022-07-15
    Publishing country Brazil
    Document type Journal Article ; Review
    ZDB-ID 2560228-7
    ISSN 1984-0462 ; 1984-0462
    ISSN (online) 1984-0462
    ISSN 1984-0462
    DOI 10.1590/1984-0462/2023/41/2021038
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Clinical management of fever in children in Brazil: practical recommendations from an expert panel.

    Simon Junior, Hany / Pedreira, Marcello Creado / Barbosa, Silvia Maria de Macedo / Fernandes, Tadeu Fernando / Escobar, Ana Maria de Ulhôa

    Einstein (Sao Paulo, Brazil)

    2022  Volume 20, Page(s) eRW6045

    Abstract: The objective of this study was to answer several questions related to the assessment and treatment of fever, as well as other controversies that exist during its management in pediatric patients. First, an advisory board with medical experts was ... ...

    Abstract The objective of this study was to answer several questions related to the assessment and treatment of fever, as well as other controversies that exist during its management in pediatric patients. First, an advisory board with medical experts was conducted to discuss the clinical journey of these patients, considering the main challenges and possible solutions. After this discussion, a non-systematic literature review was performed, between November 2019 and January 2020, to collect the most relevant evidence available in the scientific databases MEDLINE, Lilacs, and SciELO. A narrative review was carried out based on scientific evidence and on extensive experience of experts in clinical practice. The experts developed a set of recommendations and clarifications about the assessment of the severity of fever in pediatrics, the need for treatment and the choice of the most appropriate antipyretic. The most common controversies in the management of fever in pediatric patients were also addressed, such as alternating antipyretics, persistent fever, and dose equivalence. In primary management of pediatric patients, fever should be seen as a relevant symptom that requires treatment with antipyretics in potentially more complex or severe cases, when it causes discomfort to children or is associated with infectious diseases.
    MeSH term(s) Acetaminophen/therapeutic use ; Antipyretics/therapeutic use ; Brazil ; Child ; Fever/diagnosis ; Fever/drug therapy ; Humans ; Ibuprofen/therapeutic use
    Chemical Substances Antipyretics ; Acetaminophen (362O9ITL9D) ; Ibuprofen (WK2XYI10QM)
    Language English
    Publishing date 2022-08-08
    Publishing country Brazil
    Document type Journal Article ; Review
    ZDB-ID 2418293-X
    ISSN 2317-6385 ; 2317-6385
    ISSN (online) 2317-6385
    ISSN 2317-6385
    DOI 10.31744/einstein_journal/2022RW6045
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Clinical management of fever in children in Brazil

    Hany Simon Junior / Marcello Creado Pedreira / Silvia Maria de Macedo Barbosa / Tadeu Fernando Fernandes / Ana Maria de Ulhôa Escobar

    Einstein (São Paulo), Vol

    practical recommendations from an expert panel

    2022  Volume 20

    Abstract: ABSTRACT The objective of this study was to answer several questions related to the assessment and treatment of fever, as well as other controversies that exist during its management in pediatric patients. First, an advisory board with medical experts ... ...

    Abstract ABSTRACT The objective of this study was to answer several questions related to the assessment and treatment of fever, as well as other controversies that exist during its management in pediatric patients. First, an advisory board with medical experts was conducted to discuss the clinical journey of these patients, considering the main challenges and possible solutions. After this discussion, a non-systematic literature review was performed, between November 2019 and January 2020, to collect the most relevant evidence available in the scientific databases MEDLINE, Lilacs, and SciELO. A narrative review was carried out based on scientific evidence and on extensive experience of experts in clinical practice. The experts developed a set of recommendations and clarifications about the assessment of the severity of fever in pediatrics, the need for treatment and the choice of the most appropriate antipyretic. The most common controversies in the management of fever in pediatric patients were also addressed, such as alternating antipyretics, persistent fever, and dose equivalence. In primary management of pediatric patients, fever should be seen as a relevant symptom that requires treatment with antipyretics in potentially more complex or severe cases, when it causes discomfort to children or is associated with infectious diseases.
    Keywords Fever ; Health knowledge ; attitudes ; practice ; Ambulatory care ; Child ; Medicine ; R
    Subject code 616
    Language English
    Publishing date 2022-08-01T00:00:00Z
    Publisher Instituto Israelita de Ensino e Pesquisa Albert Einstein
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Fast, cheap and feasible: Implementation of pediatric telemedicine in a public hospital during the Covid-19 pandemic.

    Severini, Rafael da Silva Giannasi / Oliveira, Pedro Carpini de / Couto, Thomaz Bittencourt / Simon Junior, Hany / Andrade, Anarella Penha Meirelles de / Nanbu, Danilo Yamamoto / Farhat, Sylvia C L / Schvartsman, Cláudio

    Jornal de pediatria

    2021  Volume 98, Issue 2, Page(s) 183–189

    Abstract: Objective: In Brazil, telemedicine was allowed as an exception during the coronavirus disease (COVID-19) pandemic. Despite its recognized value and availability, telemedicine is not universally used, suggesting that some barriers prevent its adoption ... ...

    Abstract Objective: In Brazil, telemedicine was allowed as an exception during the coronavirus disease (COVID-19) pandemic. Despite its recognized value and availability, telemedicine is not universally used, suggesting that some barriers prevent its adoption and acceptance within the community. This study aims to describe the implementation of a low-cost telemedicine service in a pediatric hospital in Brazil.
    Method: Retrospective descriptive study reporting the first three months (April to June 2020) of the experience of implementing a low-cost telemedicine emergency care program in a public tertiary hospital. The service was available to patients up to 18 years of age enrolled in this hospital. A tool for assessing the severity of the patient was developed, the aim of standardizing the procedure, while maintaining quality and safety. Guardian's satisfaction was assessed with a questionnaire sent after teleconsultations.
    Results: 255 teleconsultations were carried out with 140 different patients. Of the total consultations, 182 were from 99 patients that had performed the Real-Time Polymerase Chain Reaction (RT-PCR) test for the new coronavirus (SARS-Cov-2) or had direct contact with a person known to be positive for COVID-19. Only 26 (14%) were referred to an in-person consultation. No deaths, adverse events or delayed diagnosis were recorded. 86% of the patients who answered the satisfaction questionnaire were satisfied and 92% would use telemedicine again.
    Conclusion: This study presents an innovative implementation of a telemedicine program in a public and exclusively pediatric tertiary service, serving as a reference for future implementation in other public services in Brazil and developing countries.
    MeSH term(s) COVID-19/epidemiology ; Child ; Hospitals, Public ; Humans ; Pandemics ; Retrospective Studies ; SARS-CoV-2 ; Telemedicine/methods
    Language English
    Publishing date 2021-06-12
    Publishing country Brazil
    Document type Journal Article
    ZDB-ID 731324-x
    ISSN 1678-4782 ; 0021-7557
    ISSN (online) 1678-4782
    ISSN 0021-7557
    DOI 10.1016/j.jped.2021.05.007
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Multisystem inflammatory syndrome associated with COVID-19 from the pediatric emergency physician's point of view.

    Simon Junior, Hany / Sakano, Tania Miyuki Shimoda / Rodrigues, Regina Maria / Eisencraft, Adriana Pasmanik / Carvalho, Vitor Emanoel Lemos de / Schvartsman, Claudio / Reis, Amelia Gorete Afonso da Costa

    Jornal de pediatria

    2020  Volume 97, Issue 2, Page(s) 140–159

    Abstract: Objective: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease (COVID-19) is a rare and challenging diagnosis requiring early treatment. The diagnostic criteria involve clinical, laboratory, and complementary tests. ...

    Abstract Objective: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease (COVID-19) is a rare and challenging diagnosis requiring early treatment. The diagnostic criteria involve clinical, laboratory, and complementary tests. This review aims to draw pediatrician attention to this diagnosis, suggesting early treatment strategies, and proposing a pediatric emergency care flowchart.
    Sources: The PubMed/MEDLINE/WHO COVID-19 databases were reviewed for original and review articles, systematic reviews, meta-analyses, case series, and recommendations from medical societies and health organizations published through July 3, 2020. The reference lists of the selected articles were manually searched to identify any additional articles.
    Summary of the findings: COVID-19 infection is less severe in children than in adults, but can present as MIS-C, even in patients without comorbidities. There is evidence of an exacerbated inflammatory response with potential systemic injury, and it may present with aspects similar to those of Kawasaki disease, toxic shock syndrome, and macrophage activation syndrome. MIS-C can develop weeks after COVID-19 infection, suggesting an immunomediated cause. The most frequent clinical manifestations include fever, gastrointestinal symptoms, rash, mucous membrane changes, and cardiac dysfunction. Elevated inflammatory markers, lymphopenia, and coagulopathy are common laboratory findings. Supportive treatment and early immunomodulation can control the intense inflammatory response and reduce complications and mortality.
    Conclusions: MIS-C associated with COVID-19 is serious, rare, and potentially fatal. The emergency department pediatrician must recognize and treat it early using immunomodulatory strategies to reduce systemic injury. Further studies are needed to identify the disease pathogenesis and establish the most appropriate treatment.
    MeSH term(s) Adult ; COVID-19 ; Child ; Coronavirus ; Emergency Service, Hospital ; Humans ; Physicians ; SARS-CoV-2 ; Systemic Inflammatory Response Syndrome
    Keywords covid19
    Language English
    Publishing date 2020-09-11
    Publishing country Brazil
    Document type Journal Article ; Review
    ZDB-ID 731324-x
    ISSN 1678-4782 ; 0021-7557
    ISSN (online) 1678-4782
    ISSN 0021-7557
    DOI 10.1016/j.jped.2020.08.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.B 1265: Show issues Location:
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  6. Article ; Online: Multisystem inflammatory syndrome associated with COVID-19 from the pediatric emergency physician's point of view

    Simon Junior, Hany / Sakano, Tania Miyuki Shimoda / Rodrigues, Regina Maria / Eisencraft, Adriana Pasmanik / Carvalho, Vitor Emanoel Lemos de / Schvartsman, Claudio / Reis, Amelia Gorete Afonso da Costa

    Jornal de Pediatria ; ISSN 0021-7557

    2020  

    Keywords Pediatrics, Perinatology, and Child Health ; covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    DOI 10.1016/j.jped.2020.08.004
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article: Multisystem inflammatory syndrome associated with COVID-19 from the pediatric emergency physician's point of view

    Simon Junior, Hany / Sakano, Tania Miyuki Shimoda / Rodrigues, Regina Maria / Eisencraft, Adriana Pasmanik / Carvalho, Vitor Emanoel Lemos de / Schvartsman, Claudio / Reis, Amelia Gorete Afonso da Costa

    Abstract: OBJECTIVE: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease (COVID-19) is a rare and challenging diagnosis requiring early treatment. The diagnostic criteria involve clinical, laboratory, and complementary tests. ... ...

    Abstract OBJECTIVE: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease (COVID-19) is a rare and challenging diagnosis requiring early treatment. The diagnostic criteria involve clinical, laboratory, and complementary tests. This review aims to draw pediatrician attention to this diagnosis, suggesting early treatment strategies, and proposing a pediatric emergency care flowchart. SOURCES: The PubMed/MEDLINE/WHO COVID-19 databases were reviewed for original and review articles, systematic reviews, meta-analyses, case series, and recommendations from medical societies and health organizations published through July 3, 2020. The reference lists of the selected articles were manually searched to identify any additional articles. SUMMARY OF THE FINDINGS: COVID-19 infection is less severe in children than in adults, but can present as MIS-C, even in patients without comorbidities. There is evidence of an exacerbated inflammatory response with potential systemic injury, and it may present with aspects similar to those of Kawasaki disease, toxic shock syndrome, and macrophage activation syndrome. MIS-C can develop weeks after COVID-19 infection, suggesting an immunomediated cause. The most frequent clinical manifestations include fever, gastrointestinal symptoms, rash, mucous membrane changes, and cardiac dysfunction. Elevated inflammatory markers, lymphopenia, and coagulopathy are common laboratory findings. Supportive treatment and early immunomodulation can control the intense inflammatory response and reduce complications and mortality. CONCLUSIONS: MIS-C associated with COVID-19 is serious, rare, and potentially fatal. The emergency department pediatrician must recognize and treat it early using immunomodulatory strategies to reduce systemic injury. Further studies are needed to identify the disease pathogenesis and establish the most appropriate treatment.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #753227
    Database COVID19

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