Welcome to 3 Articles PEM Clinicians Should Read Right Now, a recurring HipPEMcrates series where we ask leaders across pediatric emergency medicine to share three papers they think every clinician should have on their radar today. Each installment features a new guest author highlighting the research shaping their practice – and yours.
Here are three articles selected by Dr. Daniel Tsze from Columbia University Irving Medical Center.
- Freedman SB, et al; Pediatric Emergency Research Canada Innovative Clinical Trials Study Group. Multidose Ondansetron after Emergency Visits in Children with Gastroenteritis. N Engl J Med. 2025 Jul 17;393(3):255-266. doi: 10.1056/NEJMoa2503596. PMID: 40673584.
When sending home the kid with gastroenteritis and vomiting, there remains a multitude of opinions as to whether you should send them home with ondansetron. To help shed light on what you should do in your own practice, read the multicenter prospective trial from the Pediatric Emergency Research Canada (PERC) network that enrolled over 1000 children with gastroenteritis-associated vomiting to determine if there was any benefit to sending families home with ondansetron. See if the findings reaffirm or add new-found consternation to your current practice.
Editor’s Note: Check out Dr. Andzelika Dechnik’s recent HipPEMcrates post breaking down this article! ~JB
- Dribin TE, et al; Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Timing of repeat epinephrine to inform paediatric anaphylaxis observation periods: a retrospective cohort study. Lancet Child Adolesc Health. 2025 Jul;9(7):484-496. doi: 10.1016/S2352-4642(25)00139-7. PMID: 40506197; PMCID: PMC12279388.
Another fun (and never-ending) conversation is deciding how long you should watch a child in the ED after they received a dose of IM epinephrine for anaphylaxis. Every person (and guideline) has their own reasons for why their observation period is as long as it is, but every person (and guideline) should also consider the data presented in this retrospective 31-site Pediatric Emergency Medicine Collaborative Research Committee (PEM-CRC) study. Recommendations are made regarding potential safe period of observation (I’m not going to tell you what they are, you have to read the article yourself!), but is the reported associated risk of requiring additional epinephrine acceptable to you? To the family you are caring for? And what about what this data says about how the patient initially presented (e.g., with or without respiratory or CVS involvement)? Do you think this matters and would you factor this into your own decision-making process?
- Tsze DS, et al. Optimal Dose of Intranasal Midazolam for Procedural Sedation in Children: A Randomized Clinical Trial. JAMA Pediatr. 2025 Sep 1;179(9):979-986. doi: 10.1001/jamapediatrics.2025.2181. PMID: 40720114; PMCID: PMC12305440.
So after disclosing my obvious bias and conflict of interest (yes, this is my study), I will say that this is one of those papers where half the readers will care and the other half will not. Intranasal midazolam has been increasingly used in pediatric emergency medicine over the years, but there remains a large variation in dosing practice (ranging any from 0.2 to 0.5 mg/kg) and a fair number of people who are quite unsatisfied with intranasal midazolam’s ability to provide anxiolysis. One of the reasons we conducted this study because we believed that much of this dissatisfaction was related to using an inadequate dose (in addition to not starting the procedure at a pharmacokinetically-appropriate time – check out PMID 28992870). Again, half of readers won’t care about this paper because they are already using 0.4 or 0.5 mg/kg. But the other half now have a chance to fall in love all over again with intranasal midazolam (when using an appropriate dose), or at the very least, have new evidence that they can share with their respective oversight committees to get that order in Epic changed from 0.2 mg/kg to… something higher.
Dr. Daniel Tsze, MD, MPH, is a board-certified pediatric emergency medicine physician and Professor of Pediatrics (in Emergency Medicine) at the Columbia University Irving Medical Center. He currently practices in the Pediatric Emergency Department at the NYP-Morgan Stanley Children’s Hospital. Dr. Tsze conducts research that aims to improve and optimize the treatment of pain and distress and provision of procedural sedation for children in the emergency department.. He can be reached at dst2141@cumc.columbia.edu.
