References:
Yamada H, Ohno K, Shiota M, Togawa M, Utsunomiya Y, Akaboshi S, et al. Prevalence and
clinical characteristics of children with medical complexity in Tottori Prefecture, Japan: A
population-based longitudinal study. Brain Dev. 2020;42(10):747-55.
Cohen E, Kuo DZ, Agrawal R, Berry JG, Bhagat SK, Simon TD, et al. Children with medical
complexity: an emerging population for clinical and research initiatives. Pediatrics.
2011;127(3):529-38.
Feudtner C, Christakis DA, Connell FA. Pediatric deaths attributable to complex chronic
conditions: a population-based study of Washington State, 1980-1997. Pediatrics. 2000;106(1 Pt
2):205-9.
Guertin MH, Côté-Brisson L, Major D, Brisson J. Factors associated with death in the
emergency department among children dying of complex chronic conditions: population-based
study. J Palliat Med. 2009;12(9):819-25.
O’Mahony L, O’Mahony DS, Simon TD, Neff J, Klein EJ, Quan L. Medical complexity and
pediatric emergency department and inpatient utilization. Pediatrics. 2013;131(2):e559-65.
Moynihan K, Franca UL, Casavant DW, Graham RJ, McManus ML. Hospital Access Patterns of
Children With Technology Dependence. Pediatrics. 2023;151(4).
Ciurria JA, Lin JR, Pruitt CM, Sisk BA. Functions of communication during emergency care of
children with medical complexity: Caregiver perspectives. Patient Educ Couns.
2025;134:108667.
Cohen E, Lacombe-Duncan A, Spalding K, MacInnis J, Nicholas D, Narayanan UG, et al.
Integrated complex care coordination for children with medical complexity: A mixed-methods
evaluation of tertiary care-community collaboration. BMC Health Services Research 2012;12.
Ghotane S, Hirve R, Forman J, Tan D, Achercouk Z, Wolfe I. Integrated care for children and
young people with special health and care needs: a systematic review. Arch Dis Child.
2024;109(11):924-31.
Cohen E, Quartarone S, Orkin J, Moretti ME, Emdin A, Guttmann A, et al. Effectiveness of
Structured Care Coordination for Children With Medical Complexity: The Complex Care for
Kids Ontario (CCKO) Randomized Clinical Trial. JAMA Pediatr. 2023;177(5):461-71.
Williams DM. Clinical Pharmacology of Corticosteroids. Respir Care. 2018 Jun;63(6):655-670.
doi: 10.4187/respcare.06314. PMID: 29794202.
Lerner EB et Al, Pediatric Emergency Care Applied Research Network (PECARN).
Characteristics of the pediatric patients treated by the Pediatric Emergency Care Applied
Research Network’s affiliated EMS agencies. Prehosp Emerg Care. 2014 Jan-Mar;18(1):52-9.
doi: 10.3109/10903127.2013.836262.
Anriada Nassif, Daniel G. Ostermayer, Kim B. Hoang, Mary K. Claiborne, Elizabeth A. Camp &
Manish I. Shah (2018) Implementation of a Prehospital Protocol Change For Asthmatic
Children, Prehospital Emergency Care, 22:4, 457-465, DOI:10.1080/10903127.2017.1408727
Riney L, Palmer S, Finlay E, Bertrand A, Burcham S, Hendry P, Shah M, Kothari K, Ashby D,
Ostermayer D, Semenova O, Abo BN, Abes B, Shimko N, Myers E, Frank M, Turner T, Kemp
M, Landry K, Roland G, Fishe J. EMS Administration of Systemic Corticosteroids to Pediatric
Asthma Patients: An Analysis by Severity and Transport Interval. Prehosp Emerg Care.
2023;27(7):900-907. doi: 10.1080/10903127.2023.2234996. Epub 2023 Jul 28. PMID:
37428954; PMCID: PMC10592383.
Fishe JN, Garvan G, Bertrand A, Burcham S, Hendry P, Shah M, Kothari K, Ashby DW,
Ostermeyer D, Riney L, Semenova O, Abo B, Abes B, Shimko N, Myers E, Frank M, Turner T,
Kemp M, Landry K, Roland G, Blake KV. Early Administration of Steroids in the Ambulance
Setting: An Observational Design Trial (EASI-AS-ODT). Acad Emerg Med. 2024 Jan;31(1):49-
60. doi: 10.1111/acem.14813. Epub 2023 Oct 19. PMID: 37786991; PMCID: PMC10842452.
Chan, E., Hovenden, M., Ramage, E., Ling, N., Pham, J. H., Rahim, A., Lam, C., Liu, L., Foster,
S., Sambell, R., Jeyachanthiran, K., Crock, C., Stock, A., Hopper, S. M., Cohen, S., Davidson,
A., Plummer, K., Mills, E., Craig, S. S., Deng, G., & Leong, P. (2019). Virtual reality for
pediatric needle procedural pain: Two randomized clinical trials. The Journal of Pediatrics, 209,
160–167.e4. https://doi.org/10.1016/j.jpeds.2019.02.034
Chen, Y.-J., Cheng, S.-F., Lee, P.-C., Lai, C.-H., Hou, I.-C., & Chen, C.-W. (2020). Distraction
using virtual reality for children during intravenous injections in an emergency department: A
randomised trial. Journal of Clinical Nursing, 29(3–4), 503–510.
https://doi.org/10.1542/peds.2008-1055f
Cohen, L. L. (2008). Behavioral approaches to anxiety and pain management for pediatric
venous access. Pediatrics, 122(Suppl 3), S134–S139. https://doi.org/10.1542/peds.2008-1055f
Domene, S. S., Fulginiti, D., Briceno Silva, G. D., Frei, P., Perez Santiago, G. A., Gasbarra, M.,
Peters, I., O’Connell, A., & Calderon Martinez, E. (2025). Virtual reality on perioperative
anxiety in pediatric patients: A narrative review. Digital Health, 11, 20552076251331304.
https://doi.org/10.1177/20552076251331304
Gold, J. I., SooHoo, M., Laikin, A. M., Lane, A. S., & Klein, M. J. (2021). Effect of an
immersive virtual reality intervention on pain and anxiety associated with peripheral intravenous
catheter placement in the pediatric setting: A randomized clinical trial. JAMA Network Open,
4(8), e2122569. https://doi.org/10.1001/jamanetworkopen.2021.22569
Jenabi, E., Bashirian, S., Salehi, A. M., Rafiee, M., & Bashirian, M. (2023). Virtual reality for
pain reduction during intravenous injection in pediatrics: A systematic review and meta-analysis
of controlled clinical trials. Clinical and Experimental Pediatrics, 66(12), 533–537.
https://doi.org/10.3345/cep.2022.01193
Klassen, J. A., Liang, Y., Tjosvold, L., Klassen, T. P., & Hartling, L. (2008). Music for pain and
anxiety in children undergoing medical procedures: A systematic review of randomized
controlled trials. Ambulatory Pediatrics, 8(2), 117–128.
https://doi.org/10.1016/j.ambp.2007.12.005
Nemetski, S. M., Berman, D. I., Khine, H., & Fein, D. M. (2022). Virtual reality as anxiolysis
during laceration repair in the pediatric emergency department. The Journal of Emergency
Medicine, 63(1), 72–82. https://doi.org/10.1016/j.jemermed.2022.01.025
Özalp Gerçeker, G., Bektaş, M., Aydınok, Y., Ören, H., Ellidokuz, H., & Olgun, N. (2021). The
effect of virtual reality on pain, fear, and anxiety during access of a port with huber needle in
pediatric hematology-oncology patients: Randomized controlled trial. European Journal of
Oncology Nursing, 50, 101886. https://doi.org/10.1016/j.ejon.2020.101886
Schreiber, K. M., Cunningham, S. J., Kunkov, S., & Crain, E. F. (2006). The association of
preprocedural anxiety and the success of procedural sedation in children. American Journal of
Emergency Medicine, 24(4), 397–401. https://doi.org/10.1016/j.ajem.2005.10.025
Shetty, V., Suresh, L. R., & Hegde, A. M. (2019). Effect of virtual reality distraction on pain
and anxiety during dental treatment in 5 to 8-year-old children. Journal of Clinical Pediatric
Dentistry, 43(2), 97–102. https://doi.org/10.17796/1053-4625-43.2.5
Tas, F. Q., van Eijk, C. A. M., Staals, L. M., Legerstee, J. S., & Dierckx, B. (2022). Virtual
reality in pediatrics, effects on pain and anxiety: A systematic review and meta-analysis update.
Paediatric Anaesthesia, 32(12), 1292–1304. https://doi.org/10.1111/pan.14546
Vagnoli, L., Bettini, A., Amore, E., De Masi, S., & Messeri, A. (2019). Relaxation-guided
imagery reduces perioperative anxiety and pain in children: A randomized study. European
Journal of Pediatrics, 178(6), 913–921. https://doi.org/10.1007/s00431-019-03376-x
Xiang, H., Shen, J., Wheeler, K. K., Patterson, J., Lever, K., Armstrong, M., Shi, J., Thakkar, R.
K., Groner, J. I., Noffsinger, D., Giles, S. A., & Fabia, R. B. (2021). Efficacy of smartphone
active and passive virtual reality distraction vs standard care on burn pain among pediatric
patients: A randomized clinical trial. JAMA Network Open, 4(6), e2112082.
https://doi.org/10.1001/jamanetworkopen.2021.12082
Yan, X., Yan, Y., Cao, M., Xie, W., O’Connor, S., Lee, J. J., & Ho, M.-H. (2023). Effectiveness
of virtual reality distraction interventions to reduce dental anxiety in paediatric patients: A
systematic review and meta-analysis. Journal of Dentistry, 132, 104455.
https://doi.org/10.1016/j.jdent.2023.104455
Young, K. D. (2005). Pediatric procedural pain. Annals of Emergency Medicine, 45(2), 160–171.
https://doi.org/10.1016/j.annemergmed.2004.09.019
Knight K., 2018, retrieved from: https://www.paediatricfoam.com/2017/06/kawasaki-disease-
pearls-and-pitfalls.
Brian W. et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease A
Scientific Statement for Health Professionals From the American Heart Association. Circulation.
2017;135:e927–e999. DOI:10.1161/CIR.0000000000000484
Levin M. Steroids for Kawasaki disease: the devil is in the detail. Heart. 2013 Jan;99(2):69-70.
doi: 10.1136/heartjnl-2012-302407. Epub 2012 Oct 19. PMID: 23086972.
Newburger JW, Sleeper LA, McCrindle BW, Minich LL, Gersony W, Vetter VL, Atz AM, Li
JS, Takahashi M, Baker AL, Colan SD, Mitchell PD, Klein GL, Sundel RP; Pediatric Heart
Network Investigators. Randomized trial of pulsed corticosteroid therapy for primary treatment
of Kawasaki disease. N Engl J Med. 2007 Feb 15;356(7):663-75. doi: 10.1056/NEJMoa061235.
PMID: 17301297.
Kobayashi T, Saji T, Otani T, Takeuchi K, Nakamura T, Arakawa H, Kato T, Hara T, Hamaoka
K, Ogawa S, Miura M, Nomura Y, Fuse S, Ichida F, Seki M, Fukazawa R, Ogawa C, Furuno K,
Tokunaga H, Takatsuki S, Hara S, Morikawa A; RAISE study group investigators. Efficacy of
immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe
Kawasaki disease (RAISE study): a randomised, open-label, blinded-endpoints trial. Lancet.
2012 Apr 28;379(9826):1613-20. doi: 10.1016/S0140-6736(11)61930-2. Epub 2012 Mar 8.
PMID: 22405251.
Yang TJ, Lin MT, Lu CY, Chen JM, Lee PI, Huang LM, Wu MH, Chang LY. The prevention of
coronary arterial abnormalities in Kawasaki disease: A meta-analysis of the corticosteroid
effectiveness. J Microbiol Immunol Infect. 2018 Jun;51(3):321-331. doi:
10.1016/j.jmii.2017.08.012. Epub 2017 Sep 6. PMID: 28927685.
Davies S, Sutton N, Blackstock S, Gormley S, Hoggart CJ, Levin M, Herberg JA. Predicting
IVIG resistance in UK Kawasaki disease. Arch Dis Child. 2015 Apr;100(4):366-8. doi:
10.1136/archdischild-2014-307397. Epub 2015 Feb 10. PMID: 25670405.
Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O’Leary ST, Okechukwu K,
Woods CR Jr; SUBCOMMITTEE ON FEBRILE INFANTS. Evaluation and Management of
Well-Appearing Febrile
Infants 8 to 60 Days Old. Pediatrics. 2021 Aug;148(2):e2021052228. doi: 10.1542/peds.2021-
052228. Epub 2021 Jul 19. Erratum in: Pediatrics. 2021 Nov;148(5):e2021054063. doi:
10.1542/peds.2021-054063. PMID: 34281996.
Perry MC, Yaeger SK, Noorbakhsh K, Cruz AT, Hickey RW. Hypothermia in Young Infants:
Frequency and Yield of Sepsis Workup. Pediatr Emerg Care. 2021 Aug 1;37(8):e449-e455. doi:
10.1097/PEC.0000000000001674. PMID: 30422948; PMCID: PMC6511495.
Ramgopal S, Graves C, Aronson PL, Cruz AT, Rogers A; RIsk Stratification for Hypothermic
Infants (RISHI) study group. Clinician Management Practices for Infants With Hypothermia in
the Emergency Department. Pediatrics. 2023 Dec 1;152(6):e2023063000. doi:
10.1542/peds.2023-063000. PMID: 38009075.
Ramgopal S, Horvat CM, Adler MD. Association of triage hypothermia with in-hospital
mortality among patients in the emergency department with suspected sepsis. J Crit Care. 2020
Dec;60:27-31. doi: 10.1016/j.jcrc.2020.07.011. Epub 2020 Jul 16. PMID: 32731103; PMCID:
PMC7872398.
Ramgopal S, Noorbakhsh KA, Pruitt CM, Aronson PL, Alpern ER, Hickey RW. Outcomes of
Young Infants with Hypothermia Evaluated in the Emergency Department. J Pediatr. 2020
Jun;221:132-137.e2. doi: 10.1016/j.jpeds.2020.03.002. PMID: 32446472.
Westphal K, Adib H, Doraiswamy V, Basiago K, Lee J, Banker SL, Morrison J, McCartor S,
Berger S, Schmit EO, Van Meurs A, Mitchell M, Lee C, Wood JK, Tapp LG, Kunkel D,
Halvorson EE, Potisek NM;
Hypothermic Young Infant Research Collaborative. Performance of Febrile Infant Decision
Tools on Hypothermic Infants Evaluated for Infection. Hosp Pediatr. 2024 Mar 1;14(3):163-171.
doi: 10.1542/hpeds.2023-007525. PMID: 38312006.
Wood JK, Halvorson EE, Auriemma JR, Ervin SE, Thurtle DP, Keskinyan VS, DeWeese DM,
Marsh MC, Theroux LA, Rushing J, Haberman C. Clinical Characteristics and Health Outcomes
of Neonates Reporting to the Emergency Department With Hypothermia. Hosp Pediatr. 2018
Aug;8(8):458-464. doi: 10.1542/hpeds.2017-0176. Epub 2018 Jul 3. PMID: 29970399.
Yankova LC, Aronson PL. Infants With Hypothermia: Are They Just Like Febrile Infants? Hosp
Pediatr. 2024 Mar 1;14(3):e161-e163. doi: 10.1542/hpeds.2023-007641. PMID: 38312018.
Aronson PL, Shabanova V, Shapiro ED, Wang ME, Nigrovic LE, Pruitt CM, DePorre AG,
Leazer RC, Desai S, Sartori LF, Marble RD, Rooholamini SN, McCulloh RJ, Woll C,
Balamuth F, Alpern ER, Shah SS, Williams DJ, Browning WL, Shah N, Neuman MI; Febrile
Young Infant Research Collaborative. A Prediction Model to Identify Febrile
Infants ≤60 Days at Low Risk of Invasive Bacterial Infection. Pediatrics. 2019
Jul;144(1):e20183604. doi: 10.1542/peds.2018-3604. Epub 2019 Jun 5. PMID: 31167938;
PMCID: PMC6615531.
Baker MD, Bell LM, Avner JR. The efficacy of routine outpatient management without
antibiotics of fever in selected infants. Pediatrics. 1999 Mar;103(3):627-31. doi:
10.1542/peds.103.3.627. PMID: 10049967.
Baskin MN, O’Rourke EJ, Fleisher GR. Outpatient treatment of febrile infants 28 to 89 days of
age with intramuscular administ ration of ceftriaxone. J Pediatr. 1992 Jan;120(1):22-7. doi:
10.1016/s0022-3476(05)80591-8. PMID: 1731019.
Dagan R, Powell KR, Hall CB, Menegus MA. Identification of infants unlikely to have serious
bacterial infection although hospitalized for suspected sepsis. J Pediatr. 1985 Dec;107(6):855-60.
doi: 10.1016/s0022-3476(85)80175-x. PMID: 4067741.
Kuppermann N, Dayan PS, Levine DA, Vitale M, Tzimenatos L, Tunik MG, Saunders M, Ruddy
RM, Roosevelt G, Rogers AJ, Powell EC, Nigrovic LE, Muenzer J, Linakis JG, Grisanti K, Jaffe
DM, Hoyle JD Jr, Greenberg R, Gattu R, Cruz AT, Crain EF, Cohen DM, Brayer A, Borgialli D,
Bonsu B, Browne L, Blumberg S, Bennett JE, Atabaki SM, Anders J, Alpern ER, Miller B,
Casper TC, Dean JM, Ramilo O, Mahajan P; Febrile Infant Working Group of the Pediatric
Emergency Care Applied Research Network (PECARN). A Clinical Prediction Rule to Identify
Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA
Pediatr. 2019 Apr 1;173(4):342-351. doi: 10.1001/jamapediatrics.2018.5501. PMID: 30776077;
PMCID: PMC6450281.
Money NM, Lo YHJ, King H, Graves C, Holland JL, Rogers A, Hashikawa AN, Cruz AT,
Lorenz DJ, Ramgopal S. Predicting Serious Bacterial Infections Among Hypothermic Infants in
the Emergency Department. Hosp Pediatr. 2024 Mar 1;14(3):153-162. doi: 10.1542/hpeds.2023-
007356. PMID: 38312010; PMCID: PMC10896741.
A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis. (2020). New
England Journal of Medicine, 383(20), 1907–1919. https://doi.org/10.1056/nejmoa2014320
St Peter, S. D., Noel-MacDonnell, J. R., Hall, N. J., Eaton, S., Suominen, J. S., Wester, T.,
Svensson, J. F., Almström, M., Muenks, E. P., Beaudin, M., Piché, N., Brindle, M., MacRobie,
A., Keijzer, R., Lilja, H. E., Kassa, A., Jancelewicz, T., Butter, A., Davidson, J., . . . Pierro, A.
(2025). Appendicectomy versus antibiotics for acute uncomplicated appendicitis in children: an
open-label, international, multicentre, randomised, non-inferiority trial. The Lancet, 405(10474),
233–240. https://doi.org/10.1016/s0140-6736(24)02420-6
Jian-Sheng Wei, Min-Yan Zhang, Shen Liu, Kang Li, Jun-Jie Fu, Peng Lin. Oophoropexy to
prevent adnexal torsion recurrence in children. Clin. Exp. Obstet. Gynecol. 2021, 48(5), 1089–
1093.
Shelby L. Guile, Josephin K. Mathai. Ovarian Torsion. (2020)
Adnexal torsion in adolescents. American College of Obstetricians and Gynecologists
Committee opinion no 783. Obstet Gynecol. 2019; 134(2):e56–e63.
Doi:10.1097/aog.0000000000003373
Dasgupta R, et al. Ovarian torsion in pediatric and adolescent patients: a systematic review. J
Pediatr Surg. 2018; 53(7):1387–1391. Doi:10.1016/j.jpedsurg.2017.10.053
Kives S. No. 341-diagnosis and management of adnexal torsion in children, adolescents, and
adults. J Obstet Gynaecol Can. 2017; 39(2): 82–90.
Lawrence AE, Fallat ME, Hewitt G, et al. Factors associated with torsion in pediatric patients
with ovarian masses. J Surg Res. 2021 Jul; 263:110–115.
Murphy DNC, et al. Post-operative ovarian morphology on ultrasound after ovarian torsion-
Effect of immediate surgery: A retrospective cohort study. J Pediatr Adolesc Gynecol. 2021
Nov; 4:S1083-3188(21)00332-6. Doi: 10.1016/j.jpag.2021.10.013
Schwartz B, et al. Creation of a compositive score to predict adnexal torsion in children and
adolescents. J Pediatr Adolesc Gynecol. 2018; 31(2):132–137. Doi:10.1016/j.jpag.2017.08.007
Tasset J, et al. Ovarian torsion in premenarchal girls. J Pediatr Adolesc Gynecol. 2019;
32(3):254–258. Doi:10.1016/j.jpag.2018.10.003
Sanfilippo, J.S., Lara-Torre, E., & Gomez-Lobo, V. (Eds.). (2019). Sanfilippo’s Textbook of
Pediatric and Adolescent Gynecology (2nd ed.). CRC Press.
Bergus K et. Al. Characterization of Pediatric Female Genital Trauma Using a Novel Grading
System and Recommendations for Management. J Pediatr Surg. 2024 Oct;59(10):161599.
Pinto, A., et al. (2023). Artificial intelligence in medical education: a scoping review. JMIR Med
Educ, 9(1), e43061.
Topol, E. J. (2019). High-performance medicine: the convergence of human and artificial
intelligence. *Nature Medicine*, *25*(1), 44-56
Attia, Z. I., et al. (2019). Screening for cardiac contractile dysfunction using an artificial
intelligence–enabled electrocardiogram. *Nature Medicine*, *25*(1), 70-74.
Jiang, F., et al. (2017). Artificial intelligence in healthcare: past, present and future. *Stroke and
Vascular Neurology*, *2*(4), 230-243.
WHO. (2021). *Ethics and governance of artificial intelligence for health*. World Health
Organization.
Choi, A., Choi, S.Y., Chung, K. et al. Development of a machine learning-based clinical decision
support system to predict clinical deterioration in patients visiting the emergency department. Sci
Rep 13, 8561 (2023). https://doi.org/10.1038/s41598-023-35617-3
Muralitharan, S. et al. Machine learning-based early warning systems for clinical deterioration:
Systematic scoping review. J. Med. Internet Res. 23, e25187. https://doi.org/10.2196/25187
(2021).
Sun, J. T. et al. External validation of a triage tool for predicting cardiac arrest in the emergency
department. Sci. Rep. 12, 8779. https://doi.org/10.1038/s41598-022-12781-6 (2022).
Robert J. Petrella, The AI Future of Emergency Medicine, Annals of Emergency Medicine,
Volume 84, Issue 2, 2024, Pages 139-153, ISSN 0196-0644,
https://doi.org/10.1016/j.annemergmed.2024.01.031
(https://www.sciencedirect.com/science/article/pii/S019606442400043X)
Krockow, E.M.; Patel, S.; Roland, D. Decision Challenges for Managing Acute Paediatric
Infections: Implications for Antimicrobial Resistance. Antibiotics 2023, 12, 828
