Michael Tunik - Academia.edu (original) (raw)
Papers by Michael Tunik
Pediatric Emergency Care, Dec 1, 1998
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Prehospital Emergency Care, 2002
child maltreatment, is a public health concern that has reached epidemic proportions. Prehospital... more child maltreatment, is a public health concern that has reached epidemic proportions. Prehospital providers, who often witness scenes of child abuse and neglect, can fill an essential role in identifying neglect and abuse in the home, at school, and in other locations. In October 2001, a blue ribbon panel of national experts in emergency medical services (EMS), emergency medical services for children (EMSC), and child protection services (CPS) convened to discuss the prehospital provider’s role in identifying and reporting suspected child abuse and neglect. Significantly, this marked the first time national experts from the worlds of child protection and EMSC met face-to-face to address this issue. With expertise in EMS education, pediatric emergency medicine, pediatric surgery, psychiatry and psychology, social work, legal practice, law enforcement, and fire and rescue services, the participants represented the entire continuum of care for at-risk children. When all available services are used and integrated, children are kept from falling through the cracks, and the highest quality of care possible is provided for them. Guided by research findings from a national survey conducted by the Center for Pediatric Emergency Medicine (CPEM), the panel’s goals were to:
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Pediatric Clinics of North America, Oct 1, 1992
Status epilepticus is a common pediatric emergency that may result in significant morbidity and m... more Status epilepticus is a common pediatric emergency that may result in significant morbidity and mortality. This article provides a clinical update on generalized tonic-clonic status epilepticus in children and a practical approach to their initial stabilization and pharmacologic management. Only an organized approach to the initial stabilization and management of the child in status epilepticus will help prevent unnecessary complications and death.
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Elsevier eBooks, 2008
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Pediatric emergency care, Jun 1, 1990
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Pediatrics
It is unknown whether febrile infants 29 to 60 days old with positive urinalysis results require ... more It is unknown whether febrile infants 29 to 60 days old with positive urinalysis results require routine lumbar punctures for evaluation of bacterial meningitis. OBJECTIVE To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results. METHODS Secondary analysis of a prospective observational study of noncritical febrile infants ≤60 days between 2011 and 2019 conducted in the Pediatric Emergency Care Applied Research Network emergency departments. Participants had temperatures ≥38°C and were evaluated with blood cultures and had UAs available for analysis. We report the prevalence of bacteremia and bacterial meningitis in those with and without positive UA results. RESULTS Among 7180 infants, 1090 (15.2%) had positive UA results. The risk of bacteremia was higher in those with positive versus negative UA results (63/1090 [5.8%] vs 69/6090 [1.1%], difference 4.7% [3.3% to 6.1%]). There was no difference i...
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JAMA Pediatrics, 2019
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The Journal of pediatrics, Jan 6, 2018
To determine the risk of serious bacterial infections (SBIs) in young febrile infants with and wi... more To determine the risk of serious bacterial infections (SBIs) in young febrile infants with and without viral infections. Planned secondary analyses of a prospective observational study of febrile infants 60 days of age or younger evaluated at 1 of 26 emergency departments who did not have clinical sepsis or an identifiable site of bacterial infection. We compared patient demographics, clinical, and laboratory findings, and prevalence of SBIs between virus-positive and virus-negative infants. Of the 4778 enrolled infants, 2945 (61.6%) had viral testing performed, of whom 1200 (48.1%) were virus positive; 44 of the 1200 had SBIs (3.7%; 95% CI, 2.7%-4.9%). Of the 1745 virus-negative infants, 222 had SBIs (12.7%; 95% CI, 11.2%-14.4%). Rates of specific SBIs in the virus-positive group vs the virus-negative group were: UTIs (33 of 1200 [2.8%; 95% CI, 1.9%-3.8%] vs 186 of 1745 [10.7%; 95% CI, 9.2%-12.2%]) and bacteremia (9 of 1199 [0.8%; 95% CI, 0.3%-1.4%] vs 50 of 1743 [2.9%; 95% CI, 2.1...
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Prehospital and Disaster Medicine, 2011
PurposeThere remains a lack of comprehensive pediatric emergency preparedness planning worldwide.... more PurposeThere remains a lack of comprehensive pediatric emergency preparedness planning worldwide. A disaster or mass-casualty incident (MCI) involving pediatric patients could overwhelm existing pediatric resources within the New York City (NYC) metropolitan region. The NYC Department of Health and Mental Hygiene (DOHMH) recognizing the importance to plan for a MCI with a large number of pediatric victims, implemented a project (the Pediatric Disaster Coalition; PDC), to address gaps in the healthcare system to provide effective and timely pediatric care during a MCI.MethodsThe PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from the NYC pediatric/children's hospitals, DOHMH, Office of Emergency Management, and Fire Department (FDNY). Two committees addressed pediatric prehospital triage, transport, and pediatric critical care (PCC) surge capacities. They developed guidelines and recommendations for pediatric field triage and transp...
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Prehospital and Disaster Medicine, 2005
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Prehospital and Disaster Medicine, Feb 1, 2010
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Prehospital and Disaster Medicine, May 1, 2011
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Prehospital and Disaster Medicine, May 1, 2011
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Annals of Emergency Medicine, 2015
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Annals of emergency medicine, Oct 25, 2016
We describe presentations and outcomes of children with basilar skull fractures in the emergency ... more We describe presentations and outcomes of children with basilar skull fractures in the emergency department (ED) after blunt head trauma. This was a secondary analysis of an observational cohort of children with blunt head trauma. Basilar skull fracture was defined as physical examination signs of basilar skull fracture without basilar skull fracture on computed tomography (CT), or basilar skull fracture on CT regardless of physical examination signs of basilar skull fracture. Other definitions included isolated basilar skull fracture (physical examination signs of basilar skull fracture or basilar skull fracture on CT with no other intracranial injuries on CT) and acute adverse outcomes (death, neurosurgery, intubation for >24 hours, and hospitalization for ≥2 nights with intracranial injury on CT). Of 42,958 patients, 558 (1.3%) had physical examination signs of basilar skull fracture, basilar skull fractures on CT, or both. Of the 525 (94.1%) CT-imaged patients, 162 (30.9%) ha...
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The Journal of pediatrics, Jan 30, 2015
To examine pediatric emergency department (ED) visits over 5 years, trends in injury severity, an... more To examine pediatric emergency department (ED) visits over 5 years, trends in injury severity, and associations between injury-related ED visit outcome and patient and community-level sociodemographic characteristics. Retrospective analysis of administrative data provided to the Pediatric Emergency Care Applied Research Network Core Data Project, 2004-2008. Home addresses were geocoded to determine census block group and associated sociodemographic characteristics. Maximum Abbreviated Injury Scale severity and Severity Classification System scores were calculated. Generalized estimating equations were used to test for associations between sociodemographic characteristics and admission or transfer among injury-related ED visits. Overall ED visits and injury-related visits increased from 2004 to 2008 at study sites. Of 2 833 676 successfully geocoded visits, 700 821 (24.7%) were injury-related. The proportion of higher severity injury-related visits remained consistent. Nearly 10% of ...
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Pediatric Emergency Care
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The Journal of Emergency Medicine, 2010
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Prehospital and Disaster Medicine, 2008
In recent years, attention has been given to disaster preparedness for first responders and first... more In recent years, attention has been given to disaster preparedness for first responders and first receivers (hospitals). One such focus involves the decontamination of individuals who have fallen victim to a chemical agent from an attack or an accident involving hazardous materials. Children often are overlooked in disaster planning. Children are vulnerable and have specific medical and psychological requirements. There is a need to develop specific protocols to address pediatric patients who require decontamination at the entrance of hospital emergency departments. Currently, there are no published resources that meet this need. An expert panel convened by the New York City Department of Health and Mental Hygiene developed policies and procedures for the decontamination of pediatric patients.The panel was comprised of experts from a variety of medical and psychosocial areas.Using an iterative process, the panel created guidelines that were approved by the stakeholders and are prese...
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Disaster Medicine and Public Health Preparedness, 2010
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Pediatric Emergency Care, Dec 1, 1998
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Prehospital Emergency Care, 2002
child maltreatment, is a public health concern that has reached epidemic proportions. Prehospital... more child maltreatment, is a public health concern that has reached epidemic proportions. Prehospital providers, who often witness scenes of child abuse and neglect, can fill an essential role in identifying neglect and abuse in the home, at school, and in other locations. In October 2001, a blue ribbon panel of national experts in emergency medical services (EMS), emergency medical services for children (EMSC), and child protection services (CPS) convened to discuss the prehospital provider’s role in identifying and reporting suspected child abuse and neglect. Significantly, this marked the first time national experts from the worlds of child protection and EMSC met face-to-face to address this issue. With expertise in EMS education, pediatric emergency medicine, pediatric surgery, psychiatry and psychology, social work, legal practice, law enforcement, and fire and rescue services, the participants represented the entire continuum of care for at-risk children. When all available services are used and integrated, children are kept from falling through the cracks, and the highest quality of care possible is provided for them. Guided by research findings from a national survey conducted by the Center for Pediatric Emergency Medicine (CPEM), the panel’s goals were to:
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Pediatric Clinics of North America, Oct 1, 1992
Status epilepticus is a common pediatric emergency that may result in significant morbidity and m... more Status epilepticus is a common pediatric emergency that may result in significant morbidity and mortality. This article provides a clinical update on generalized tonic-clonic status epilepticus in children and a practical approach to their initial stabilization and pharmacologic management. Only an organized approach to the initial stabilization and management of the child in status epilepticus will help prevent unnecessary complications and death.
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Elsevier eBooks, 2008
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Pediatric emergency care, Jun 1, 1990
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Pediatrics
It is unknown whether febrile infants 29 to 60 days old with positive urinalysis results require ... more It is unknown whether febrile infants 29 to 60 days old with positive urinalysis results require routine lumbar punctures for evaluation of bacterial meningitis. OBJECTIVE To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results. METHODS Secondary analysis of a prospective observational study of noncritical febrile infants ≤60 days between 2011 and 2019 conducted in the Pediatric Emergency Care Applied Research Network emergency departments. Participants had temperatures ≥38°C and were evaluated with blood cultures and had UAs available for analysis. We report the prevalence of bacteremia and bacterial meningitis in those with and without positive UA results. RESULTS Among 7180 infants, 1090 (15.2%) had positive UA results. The risk of bacteremia was higher in those with positive versus negative UA results (63/1090 [5.8%] vs 69/6090 [1.1%], difference 4.7% [3.3% to 6.1%]). There was no difference i...
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JAMA Pediatrics, 2019
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The Journal of pediatrics, Jan 6, 2018
To determine the risk of serious bacterial infections (SBIs) in young febrile infants with and wi... more To determine the risk of serious bacterial infections (SBIs) in young febrile infants with and without viral infections. Planned secondary analyses of a prospective observational study of febrile infants 60 days of age or younger evaluated at 1 of 26 emergency departments who did not have clinical sepsis or an identifiable site of bacterial infection. We compared patient demographics, clinical, and laboratory findings, and prevalence of SBIs between virus-positive and virus-negative infants. Of the 4778 enrolled infants, 2945 (61.6%) had viral testing performed, of whom 1200 (48.1%) were virus positive; 44 of the 1200 had SBIs (3.7%; 95% CI, 2.7%-4.9%). Of the 1745 virus-negative infants, 222 had SBIs (12.7%; 95% CI, 11.2%-14.4%). Rates of specific SBIs in the virus-positive group vs the virus-negative group were: UTIs (33 of 1200 [2.8%; 95% CI, 1.9%-3.8%] vs 186 of 1745 [10.7%; 95% CI, 9.2%-12.2%]) and bacteremia (9 of 1199 [0.8%; 95% CI, 0.3%-1.4%] vs 50 of 1743 [2.9%; 95% CI, 2.1...
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Prehospital and Disaster Medicine, 2011
PurposeThere remains a lack of comprehensive pediatric emergency preparedness planning worldwide.... more PurposeThere remains a lack of comprehensive pediatric emergency preparedness planning worldwide. A disaster or mass-casualty incident (MCI) involving pediatric patients could overwhelm existing pediatric resources within the New York City (NYC) metropolitan region. The NYC Department of Health and Mental Hygiene (DOHMH) recognizing the importance to plan for a MCI with a large number of pediatric victims, implemented a project (the Pediatric Disaster Coalition; PDC), to address gaps in the healthcare system to provide effective and timely pediatric care during a MCI.MethodsThe PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from the NYC pediatric/children's hospitals, DOHMH, Office of Emergency Management, and Fire Department (FDNY). Two committees addressed pediatric prehospital triage, transport, and pediatric critical care (PCC) surge capacities. They developed guidelines and recommendations for pediatric field triage and transp...
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Prehospital and Disaster Medicine, 2005
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Prehospital and Disaster Medicine, Feb 1, 2010
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Prehospital and Disaster Medicine, May 1, 2011
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Prehospital and Disaster Medicine, May 1, 2011
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Annals of Emergency Medicine, 2015
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Annals of emergency medicine, Oct 25, 2016
We describe presentations and outcomes of children with basilar skull fractures in the emergency ... more We describe presentations and outcomes of children with basilar skull fractures in the emergency department (ED) after blunt head trauma. This was a secondary analysis of an observational cohort of children with blunt head trauma. Basilar skull fracture was defined as physical examination signs of basilar skull fracture without basilar skull fracture on computed tomography (CT), or basilar skull fracture on CT regardless of physical examination signs of basilar skull fracture. Other definitions included isolated basilar skull fracture (physical examination signs of basilar skull fracture or basilar skull fracture on CT with no other intracranial injuries on CT) and acute adverse outcomes (death, neurosurgery, intubation for >24 hours, and hospitalization for ≥2 nights with intracranial injury on CT). Of 42,958 patients, 558 (1.3%) had physical examination signs of basilar skull fracture, basilar skull fractures on CT, or both. Of the 525 (94.1%) CT-imaged patients, 162 (30.9%) ha...
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The Journal of pediatrics, Jan 30, 2015
To examine pediatric emergency department (ED) visits over 5 years, trends in injury severity, an... more To examine pediatric emergency department (ED) visits over 5 years, trends in injury severity, and associations between injury-related ED visit outcome and patient and community-level sociodemographic characteristics. Retrospective analysis of administrative data provided to the Pediatric Emergency Care Applied Research Network Core Data Project, 2004-2008. Home addresses were geocoded to determine census block group and associated sociodemographic characteristics. Maximum Abbreviated Injury Scale severity and Severity Classification System scores were calculated. Generalized estimating equations were used to test for associations between sociodemographic characteristics and admission or transfer among injury-related ED visits. Overall ED visits and injury-related visits increased from 2004 to 2008 at study sites. Of 2 833 676 successfully geocoded visits, 700 821 (24.7%) were injury-related. The proportion of higher severity injury-related visits remained consistent. Nearly 10% of ...
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Pediatric Emergency Care
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The Journal of Emergency Medicine, 2010
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Prehospital and Disaster Medicine, 2008
In recent years, attention has been given to disaster preparedness for first responders and first... more In recent years, attention has been given to disaster preparedness for first responders and first receivers (hospitals). One such focus involves the decontamination of individuals who have fallen victim to a chemical agent from an attack or an accident involving hazardous materials. Children often are overlooked in disaster planning. Children are vulnerable and have specific medical and psychological requirements. There is a need to develop specific protocols to address pediatric patients who require decontamination at the entrance of hospital emergency departments. Currently, there are no published resources that meet this need. An expert panel convened by the New York City Department of Health and Mental Hygiene developed policies and procedures for the decontamination of pediatric patients.The panel was comprised of experts from a variety of medical and psychosocial areas.Using an iterative process, the panel created guidelines that were approved by the stakeholders and are prese...
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Disaster Medicine and Public Health Preparedness, 2010
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