Q1 2024 Urgent Caring – Urgent Updates in Pediatrics


Urgent Care Physician and Medical Lead Kings College Hospital Urgent Treatment Centre, London
Abstracts Section Editor, Journal of Urgent Care Medicine  
Convenor Ireland and UK Faculty of the Royal New Zealand College of Urgent Care
Independent Assessor European Reference Network, Andalusian Agency for Healthcare Quality

Fatigue Recovery Following Concussion

Fabiano F, Takagi M, Anderson N, et. al. . Br J Sports Med 2024;58:59–65. doi:10.1136/bjsports-2023-106894

This was a single site, prospective, longitudinal study of children and adolescents presenting to the emergency department (ED) of a tertiary pediatric hospital with a diagnosis of concussion. Participants completed assessments in the form of questionnaires over five time points: T0: during the initial ED admission; T1: 2–4 days post injury; T2: 2 weeks; T3: 1 month and T4: 3 months post injury. 

The authors found that in the 240 children reviewed, fatigue decreased between the acute post-injury stage to 3 months following concussion. There was a linear decrease in fatigue symptoms over the course of time with most children gaining energy levels up to pre-injury states at the 3-month mark. Child behavior issues were the most significant factor when related to fatigue when incorporated in a regression with other covariates.

The setting of the study may limit its generalizability as most patients with head injuries do not present to the ED. It does highlight the need for us as UC clinicians to consider mental health history and issues when assessing children presenting with head injuries. 

Full Access: BMJ

Shorter Courses of Antibiotic Treatment

Vernacchio L, Hatoun J, Patane LB, et al.  Improving Short Course Treatment of Pediatric Infections: A Randomized Quality Improvement Trial.  Pediatrics. 2024;153(2):e2023063691

Antibiotic stewardship is one of the important areas of prescribing within Urgent Care Centers. This was a site-randomized quality improvement trial to test the effectiveness of education with performance feedback and clinical decision support (CDS) delivered at the point of care or a combination of both in improving prescribing habits. The study was set within an independent practice association of 76 privately-owned pediatric practices with 500 pediatric primary care clinicians (PCC; generally, physicians and pediatric nurse practitioners) affiliated with Boston Children’s Hospital. The practices were randomly assigned in blocks of 4 to 1 of 4 intervention groups using a random number generator: education and feedback; CDS; both education and feedback plus CDS (combined group); and control (no intervention). Prescribing of antibiotics for soft tissue skin infection and pneumonia were studied.

The authors found the combination of the 2 techniques was substantially more effective than either approach alone. There was a 23% to 26% absolute improvement in the groups assigned to education with performance feedback alone or to CDS alone, and with 42% absolute improvement in the group assigned to the combination of the 2 intervention strategies. 

This study was limited by its setting, which was in a large practice group whose clinicians were accustomed with QI projects. However, there it does highlight the benefits of ongoing education and support for clinicians, to improve prescribing practices. 

Full Access: AAP

Trends of RSV Infection Severity in Children Pre- and Post- Covid

Garcia-Maurino C, Brenes-Chacón H, Halabi K, et. al.        Trends in Age and Disease Severity in Children Hospitalized with RSV Infection Before and During the COVID-19 Pandemic JAMA Pediatric. 2024 Feb 1;178(2):195-197. doi: 10.1001/jamapediatrics.2023.5431

The authors of this cohort study analyzed hospitalization trends and disease severity in children younger than 5 years with RSV infection at Nationwide Children’s Hospital, Ohio, during 8 RSV seasons. These included 6 pre-pandemic years, 1 pandemic year and 1 post-pandemic year. 

They found the proportion of hospitalized children younger than 5 years with RSV infection increased significantly after 2020, the first year of the COVID-19 pandemic. Disease severity parameters were increased in infants younger than 12 months during pandemic and post-pandemic seasons vs pre-pandemic years. Analyses stratified by age showed that disease severity gradually increased from pre-pandemic to 2021 and 2022 to 2023 and was significant among the groups aged younger than 6months and 6months to younger than 12 months. 

This study highlights the severity of RSV infections in younger children that are presenting, and, therefore, vigilance is needed during consultations in the Urgent Care to ensure appropriate referrals and discharge safety-netting are given. 

Full Access: JAMA