『Episode 83: Knife Crime, Febrile Infants, and What's Caught My Eye』のカバーアート

Episode 83: Knife Crime, Febrile Infants, and What's Caught My Eye

Episode 83: Knife Crime, Febrile Infants, and What's Caught My Eye

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2 Paeds in a PodShow Notes — Episode 83Knife Crime, Febrile Infants, and What's Caught My EyeReleased: May 2026 | Runtime: ~20 minutesIn this episode, Ian covers what's caught his eye in the paediatric literature this fortnight. The main story looks at a landmark national review of child deaths from knife wounds in England — and what it means for those of us working in paediatric emergency and urgent care. He then turns to new data on febrile infants aged 29 to 60 days and the evolving evidence base around risk stratification in that notoriously tricky age group. The episode closes with three quick picks from this fortnight's journal sweep: point-of-care lung ultrasound for pneumonia, reframing conversations about paediatric palliative care, and a flag for the new Surviving Sepsis Campaign paediatric guidelines — which we'll be coming back to in a dedicated episode soon.Main Story 1 — Knife Crime Deaths in Children in England (2019–2024)Knife-related deaths in children and young people represent one of the most pressing — and most inequitable — public health challenges in England today. This month, Roberts and colleagues published a review using the National Child Mortality Database covering every child under 18 who died of a knife wound between April 2019 and March 2024.The headline findings:145 children died over the five-year period — roughly one every two weeksMean age at death was 14.4 years; 90% were maleBlack or Black British children died at a rate more than 13 times higher than white children when corrected for population sizeChildren in the most deprived areas of England had over 7 times the risk of death compared with those in the least deprived areas60% of children died before reaching hospitalOf those who reached hospital, 57% underwent a thoracotomy — reflecting the severity of injuries sustainedInjuries to the chest and neck were responsible for 76% of fatal wounds75% of children had been known to social services prior to their death58% had experienced domestic violence and abuse51% had documented neurodiversity or mental health concernsWhy this matters for paediatric practice: These were not invisible children. The vast majority were known to statutory services. For clinicians working in paediatric emergency and urgent care, this paper is a reminder that every child who comes through our doors carries a history — and that our role extends beyond the presenting complaint. It also raises important questions about pre-hospital intervention, penetrating trauma training in paediatric settings, and the role of the ED as a potential point of early intervention for children at risk.Knife injuries are not confined to major urban centres — the data show deaths distributed across all regions of England.Reference: Roberts T, Odd D, Coveney J, et al. Emergency Medicine Journal. Published April 2026. https://doi.org/10.1136/emermed-2025-215154Main Story 2 — Bacteraemia and Bacterial Meningitis in Low-Risk Febrile Infants Aged 29–60 DaysThe febrile infant aged 29 to 60 days occupies some of the most uncomfortable clinical territory in paediatric emergency medicine. Too old for the automatic full-septic-screen approach applied under 28 days, but too young to rely on clinical examination alone. This paper from Burstein, Xie, and Kuppermann — published in JAMA Pediatrics — examines how the updated PECARN (Pediatric Emergency Care Applied Research Network) febrile infant rule performs in an international sample.What the PECARN rule involves: The rule uses a combination of clinical and laboratory parameters to stratify infants into low, intermediate, and higher risk for invasive bacterial infection (bacteraemia and bacterial meningitis). Key components include temperature, urinalysis findings, absolute neutrophil count, procalcitonin, and — where indicated — CSF analysis.Why this paper matters: The original PECARN derivation and validation studies were predominantly North American. This international validation is an important step in understanding how the rule performs across different healthcare systems, bacterial epidemiology, and rates of prior antibiotic exposure. The full data are behind a paywall, but the publication itself signals continued maturation of the evidence base.For UK practice: NICE guidance for this age group tends towards more liberal investigation. Whether structured risk stratification tools like PECARN could safely reduce lumbar punctures and admissions in a subset of genuinely low-risk infants is an active and important question for UK paediatric emergency practice.Key learning point: Know the PECARN framework. Know its components. And watch this space — this is a field moving quickly.Reference: Burstein B, Xie J, Kuppermann N. JAMA Pediatrics. Published April 2026. https://doi.org/10.1001/jamapediatrics.2026.0971What's Caught My Eye1. Point-of-Care Lung Ultrasound for Paediatric PneumoniaA review in Pediatric Emergency Care summarising the ...
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