Prolonged pediatric fever is most often due to a self-limiting infectious illness, but can sometimes be a sign of much more serious disease. The care of children with prolonged fever can be challenging, since there is significant variation in the definition of prolonged pediatric fever, and evidence-based decision support tools to guide evaluation and management of children with prolonged fever are limited. This issue constructs a framework for initial emergency department evaluation and management of children with fever lasting ≥5 days and fever of unknown origin lasting ≥8 days.

Colitis presents as an inflammatory diarrhea that is often accompanied by abdominal pain. The differential diagnosis of colitis is broad and depends on the presenting symptoms and age of the patient. Although infectious colitis in an immunocompetent child is often self-limited, complications of colitis can be serious, and early recognition can expedite critical medical interventions and surgical consultation. This issue provides an evidence-based approach to the evaluation and management of colitis and associated acute complications in adolescent patients in the emergency department.

Hematuria is a common finding in the pediatric population. The differential diagnosis for pediatric hematuria is wide, ranging from isolated benign causes to serious progressive renal or urologic diseases. Emergency clinicians must be able to identify high-risk features that raise suspicion for a serious underlying pathology while limiting unnecessary workup. This issue reviews key considerations in the evaluation and initial management of pediatric hematuria in the emergency department, including evidence-based recommendations on initial laboratory and imaging choices.

The clinical presentation for ear complaints can often overlap with other common pediatric conditions. As such, the differential diagnosis for ear complaints is broad, warranting a thorough history and targeted physical examination. Optimizing the approach for a definitive ear examination is essential when evaluating a pediatric patient with an ear concern. A systematic approach will improve the accuracy of diagnoses and the appropriateness of management. This issue provides an evidence-based approach to the diagnosis, workup, and management of common ear complaints in pediatric patients.

Testicular torsion is a urologic emergency, accounting for up to 15% of cases of acute scrotal pain. Rapid recognition and management are essential to ensure viability of the testis. Doppler ultrasound can be used to confirm the diagnosis of testicular torsion; however, recent studies suggest that a more judicious use of ultrasound may be safe, decrease delays in surgical management, and avoid unnecessary utilization of resources. This issue reviews the epidemiology and historical and physical examination findings of testicular torsion and other common causes of acute scrotal pain. The existing literature is reviewed and recommendations are provided to guide the emergency clinician in appropriate management and disposition of boys with acute scrotal pain.

COVID-19, the disease caused by SARS-CoV-2, has been disruptive worldwide. It was primarily a respiratory disease that affected many of the medically vulnerable, but the true impact of postacute sequelae of SARS-CoV-2 (PASC), which has been demonstrated to involve all organ systems, is now coming to light. In addition, a new disease entity emerged, multisystem inflammatory syndrome in children (MIS-C), which has had significant morbidity and mortality associated with it. This issue reviews the presentation, evaluation, and management of patients with COVID-19, MIS-C, and PASC. Additionally, the current literature supporting public health measures, as well as COVID-19 vaccinations and their complications are discussed.

Adolescent substance use continues to be a prevalent problem and is a cause of morbidity, mortality, and high rates of resource utilization. The variability in presentations of drug intoxication can make accurate identification of the ingested substance, and thus efficient treatment, challenging. This issue provides a review of typical presenting signs, symptoms, and physical examination findings of commonly used drugs. Evidence-based recommendations are offered for a general approach to managing adolescent patients who present with drug intoxication, with specific guidance, when indicated.

Although rare in children, spinal epidural abscess (SEA) is a rapidly progressive clinical entity that can lead to irreversible neurologic damage if untreated. The rarity and variability in presentation can lead to initial misdiagnosis. Diagnosis requires a high index of suspicion and is often delayed until neurologic deficits are present. This issue reviews key findings on the history and physical examination that are associated with SEA, provides guidance for the laboratory tests and imaging studies that are indicated once SEA is suspected, and discusses treatment options based on current evidence.

A review of the uses and evidence for the Shock Index, Pediatric Age-Adjusted (SIPA), which predicts mortality in children with blunt trauma.