Todd Adam Florin

Background: Predictive analytics using continuously measured vital signs from bedside monitors has improved outcomes in critically ill children. We investigated whether continuous pulse oximetry data collected during emergency department (ED) evaluation can identify infants ≤90 days old with bronchiolitis at low risk of respiratory deterioration. Methods: We conducted a single-center retrospective cohort study of infants ≤90 days old with bronchiolitis who presented to a tertiary-care pediatric ED from November 2021 to November 2025. Infants were identified using the ICD-10 code with manual eligibility confirmation. Heart rate and oxygen saturation features were generated from continuous pulse oximetry during the first 2 hours of ED evaluation. The primary outcome was respiratory deterioration within 24 hours of ED arrival, defined as initiation of high-flow nasal cannula, continuous/bilevel positive airway pressure, or invasive mechanical ventilation. Data were split into derivation and validation cohorts (70/30, stratified by outcome). An L2-regularized logistic regression model estimated the probability of respiratory deterioration, with a classification threshold selected to prioritize sensitivity. Results: Of 290 infants meeting clinical eligibility, 117 had sufficient continuous pulse oximetry data; 57 (49%) had respiratory deterioration. The primary model included 3 features: the median and interquartile range (IQR) of heart rate, and oxygen saturation IQR. In the validation cohort, the model showed moderate sensitivity (0.78, 95% CI: 0.58-0.95) and fair discrimination (AUROC=0.78, 95% CI: 0.62-0.93). Conclusion: We derived and validated a model using data from continuous pulse oximetry to identify low-risk infants with bronchiolitis. With further refinement and integration into monitor design systems, this approach may enhance clinical utility of continuous pulse oximetry.

This paper is part of a larger clinical practice guideline on the diagnosis and management of parapneumonic effusion and empyema in children, developed by the Infectious Diseases Society of America. In this paper, the panel provides recommendations on the appropriate size of thoracostomy tube for drainage. The panel’s recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

This paper is part of a larger clinical practice guideline on the diagnosis and management of parapneumonic effusion and empyema in children, developed by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. In this report, the panel provides recommendations for intrapleural fibrinolysis with tissue plasminogen activator (tPA) alone over tPA and dornase alfa (DNase) in children (3 months to 18 years) with complicated parapneumonic effusion and empyema. The panel’s recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

This paper is part of a larger clinical practice guideline on the diagnosis and management of parapneumonic effusion and empyema in children, developed by the Infectious Diseases Society of America. In this paper, the panel provides recommendations on the choice of pleural fluid drainage by chest tube with fibrinolysis versus mechanical debridement. The panel’s recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

This paper is part of a larger clinical practice guideline on the diagnosis and management of parapneumonic effusion and empyema in children, developed by the Infectious Diseases Society of America. In this paper, the panel provides recommendations for pleural fluid drainage in children (3 months to 18 years) with parapneumonic effusion and empyema. The panel’s recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

This paper is part of a larger clinical practice guideline on the diagnosis and management of parapneumonic effusion and empyema in children, developed by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. In this paper, the panel provides recommendations for the role of chest ultrasound to evaluate parapneumonic effusion and empyema. The panel’s recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

As the first part of an update to the clinical practice guideline on the management of community-acquired pneumonia in infants and children older than 3 months of age, we present six updated recommendations. The updated recommendations span the characterization and management of pneumonia with parapneumonic effusion. The panel’s recommendations are based on evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

Introduction: Community‐acquired pneumonia (CAP) is a frequent and costly cause of pediatric emergency department (ED) visits and hospitalizations. Previous prognostic tools for CAP are limited by small samples, single‐center or retrospective designs, lack of generalizability to ED settings, lack of biomarkers, or limited objective data. To overcome these limitations, we will derive and externally validate a prediction rule for pediatric CAP severity in a large, multicenter prospective cohort. Methods: This is a prospective cohort study of children 3 months to 18 years old with CAP who present to EDs within the Pediatric Emergency Care Applied Research Network. Enrollment began 8/2023 and will end 7/2027. We exclude children with recent hospitalizations and chronic conditions (e.g., immunosuppression). A follow‐up survey and record review is completed 8–15 days after the visit. Blood and nasal specimens are obtained to evaluate the role of C‐reactive protein, procalcitonin, proadrenomedullin, and viral detection in severity prediction. The primary outcome is severity (three‐tiered outcome of mild, moderate, or severe CAP) within 7 days of ED presentation. Model derivation will occur in ~4000 children from 7 EDs over 2 years. External validation will occur in a distinct cohort of at least 2000 children from 7 different EDs. Penalized regression, recursive partitioning, and machine learning will be used in model development. Discussion: At study completion, we will have a validated CAP severity prediction rule well‐positioned for implementation and further evaluation. We will also understand the role of specific biomarkers in predicting outcomes in children with CAP.

Introduction Bronchiolitis, a viral lower respiratory tract infection, is the leading cause of hospitalisation for infants, with healthcare utilisation highest among young infants (aged ≤90 days). Clinical models to predict respiratory deterioration in infants with bronchiolitis have been developed for a broad age group that includes children up to 2 years old, not focusing specifically on young infants. These models have also been limited by exclusion of viral aetiology and by use of vital signs measured at a single time point during clinical evaluation, overlooking the variable and dynamic course of bronchiolitis. This study aims to combine clinical history and examination factors with viral aetiology (primary aim) and continuous physiological data from bedside monitors (secondary aim) to develop accurate prediction models to identify young infants at low risk of respiratory deterioration and enable safe discharge to home. Methods and analysis We are conducting a single-centre, prospective cohort study of young infants with bronchiolitis presenting to the paediatric emergency department (ED) of a tertiary care children’s hospital. Enrolment began in November 2021 and will end in April 2027. Young infants with a clinical diagnosis of bronchiolitis are included. Infants with hospitalisation within 1 week of the index ED visit or baseline (home) use of supplemental oxygen or respiratory support are excluded. We are collecting clinical, laboratory, imaging and treatment data from the ED and hospitalisation, if admitted. All patients have a standardised initial examination as well as a repeat examination at 2–4 hours if still physically located in the ED. We are also obtaining swabs from the anterior nares and the nasopharynx. Continuous physiological data are collected through pulse oximetry and 5-lead ECG. We will contact parents or guardians at 7, 14 and 21 days for follow-up of symptom resolution and unplanned visits to a healthcare provider. The primary outcome is the development of respiratory deterioration within 24 hours of ED presentation. Respiratory deterioration is defined as new use of non-invasive or invasive respiratory support within 24 hours of ED arrival. For the primary aim, regression and recursive partitioning techniques will create the low-risk model. For the secondary aim, we will use machine learning models such as Lasso regression and support vector machines. Ethics and dissemination Ethics approval was obtained through the Columbia University Institutional Review Board (IRB-AAAT8528). Written informed consent will be obtained for all patients. Results will be disseminated through academic conferences, peer-reviewed publications and appropriate free open-access medical education.