Pediatric Influenza in the Emergency Department: Diagnosis and Management (Infectious Disease CME) -
Publication Date: January 2021 (Volume 18, Number 01)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 01/01/2024.
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits, subject to your state and institutional approval.
Ran D. Goldman, MD, FRCPC
Professor, University of British Columbia, Pediatric Emergency Physician, BC Children’s Hospital, Vancouver, BC, Canada
Coburn H. Allen, MD, FAAP, FACEP, FPIDS
Distinguished Teaching Professor, Pediatric Emergency Medicine, Fellowship Director, Pediatric Infectious Diseases, UT Austin Dell Medical School, USACS National Director of Pediatric Services, Austin, TX
Sarah C. Cavallaro, MD
Clinical Instructor, Emergency Medicine and Pediatrics, Harvard Medical School Assistant in Pediatrics, Division of Emergency Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, MA
David M. Walker, MD, FAAP, FACEP
Chief, Pediatric Emergency Medicine, Department of Pediatrics, Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center; Associate Professor of Pediatrics, Hackensack Meridian School of Medicine, Hackensack, NJ
Influenza in children is a significant cause of morbidity and mortality. Presenting symptoms of influenza vary greatly among children; clinical presentation should be assessed for severity of illness and potential complications. Available clinical and laboratory findings should be used to guide treatment for young children with fever. Clinicians should be aware of up-to-date recommendations to diagnose and treat children with influenza and to ensure public health engagement to prevent and manage influenza outbreaks and epidemics. This issue reviews common complications of influenza infection, offers guidance for infection control measures, and provides evidence-based recommendations for the management of pediatric patients with influenza in the emergency department.
Excerpt From This Issue
An 18-month-old girl with a runny nose and fever lasting 1 day is brought to the ED by her parents…
The girl is up-to-date on her scheduled vaccinations, but has not received an influenza vaccine yet for the season. Her parents also report that she has had frequent coughing episodes, some resulting in vomiting.
The girl’s vital signs are: rectal temperature, 39.2°C (102.6°F); heart rate, 130 beats/min; respiratory rate, 36 breaths/min; and oxygen saturation, 100% on room air. On examination, the girl is not in apparent distress, she does not seem to be dehydrated, and her mucous membranes are moist. She has minimal nasal congestion. The patient’s tympanic membranes are clear and not bulging. Some coarse crackles are heard, more in the right lung base, although the examination is limited due to crying. There is no respiratory distress when the patient is calm. Her abdomen is soft and neither tender nor distended. Her capillary refill time is 2 seconds.
Is influenza testing appropriate? If so, what type of test should be conducted and how reliable would the result be? Is this patient at increased risk for a more severe disease course? Given the pulmonary findings, could this patient have bacterial or viral pneumonia? Should a chest radiograph be ordered? Is evaluation of the patient’s blood and/or urine necessary?
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