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Pediatric Emergency Care

So Hyun Paek, Jin Hee Jung, Young Ho Kwak, Do Kyun Kim, Jin Hee Lee, Jae Yun Jung, Sohee Oh
OBJECTIVES: Head and face injuries are leading causes of emergency department visits in children. There is yet no clinical decision rule on face CT such as pediatric head CT rules. The goal was to develop and validate a clinical decision rule for identifying orbital wall fractures in children with periorbital trauma in the emergency department. METHODS: This was a retrospective derivation and validation study. Children younger than 18 years who underwent orbit CT after periorbital trauma were included between January 2011 and December 2013 in 3 emergency centers...
October 9, 2017: Pediatric Emergency Care
Isaac Lazar, Yuval Cavari, Aviva Levitas, Amarilia B Mandolla, Arnon Broides
Anaphylaxis should be treated with early administration of intramuscular Adrenalin; however, fatalities may still occur even with this therapy. We report a patient with near-fatal anaphylaxis due to milk whose symptoms persisted and were resistant to any therapeutic attempt; however, the patient had a prompt resolution of the anaphylaxis shortly after a nasogastric tube placement with gastric drainage, suggesting that this procedure ended the ongoing absorption of additional allergen from the gastrointestinal tract...
October 9, 2017: Pediatric Emergency Care
Katherine L Boyle, Usha Periyanayagam, Kavita M Babu, Brian T Rice, Mark Bisanzo
OBJECTIVE: This study aims to describe pediatric poisonings presenting to a rural Ugandan emergency department (ED), identifying demographic factors and causative agents. METHODS: This retrospective study was conducted in the ED of a rural hospital in the Rukungiri District of Uganda. A prospectively collected quality assurance database of ED visits was queried for poisonings in patients under the age of 5 who were admitted to the hospital. Cases were included if the chief complaint or final diagnosis included anything referable to poisoning, ingestion, or intoxication, or if a toxicologic antidote was administered...
October 9, 2017: Pediatric Emergency Care
Joshua M Sherman, Todd P Chang, Nurit Ziv, Alan L Nager
BACKGROUND: In the pediatric emergency department (PED), resuscitations require medical teams form ad hoc, rarely communicating beforehand. Literature has shown that the medical community has deficiencies in communication and teamwork. However, we as medical providers do not know or understand the perceived barriers of our colleagues. Physicians may perceive a barrier that is different from nurses, respiratory therapists, pharmacists, or technicians. Perhaps we do not know in which area of teamwork and communication we are deficient...
October 9, 2017: Pediatric Emergency Care
Jennifer L McCarthy, Joel M Clingenpeel, Amy M Perkins, Margaret K Eason
OBJECTIVES: The aim of this study was to investigate the hypothesis that a significant percentage of urgent care center to pediatric ED transfers can be discharged home without emergency department (ED) resource utilization. METHODS: A retrospective chart review was completed for a 6-month period on all patients transferred from urgent care centers. A data collection tool focusing on demographics, diagnoses, reason for transfer, ED resource utilization, ED disposition, and 72-hour ED return was used...
October 2, 2017: Pediatric Emergency Care
Florian J Raimann, Colleen E Cuca, Detlev Kern, Kai Zacharowski, Udo Rolle, Dirk Meininger, Christian F Weber, Christian Byhahn, Haitham Mutlak
STUDY OBJECTIVE: Video laryngoscopy has primarily been developed to assist in difficult airways. Using video laryngoscopy in pediatric airway management is an up-and-coming topic. The aim of the presented study was to compare the intubation conditions obtained when using the C-MAC video laryngoscope with Miller blades sizes 0 and 1 for standard direct laryngoscopy and indirect laryngoscopy in children weighing less than 10 kg. DESIGN: This was a prospective study...
October 2, 2017: Pediatric Emergency Care
Henry P Chicaiza, Laurie Malia, Christine H Mulvey, Sharon R Smith
OBJECTIVES: This study aims to investigate the optimal outer appendiceal diameter via ultrasound for the diagnosis of acute appendicitis. METHODS: A retrospective chart review was conducted on patients (ages, 2-18 years) presenting to an urban pediatric emergency department between January 1, 2009 and December 31, 2010 with suspected acute appendicitis. Children were considered as having "suspected acute appendicitis" if they (1) presented with acute abdominal pain and had either a surgical consult or an abdominal ultrasound, or (2) presented or transferred with the stated suspicion of acute appendicitis...
October 2, 2017: Pediatric Emergency Care
Kristin M Hirata, Ann H Kang, Gina V Ramirez, Chieko Kimata, Loren G Yamamoto
BACKGROUND: An accurate weight is critical for dosing medications in children. Weight errors can lead to medication-dosing errors. OBJECTIVES: This study examined the frequency and consequences of weight errors occurring at 1 children's hospital and 2 general hospitals. METHODS: Using an electronic medical record database, 79,000 emergency department encounters of children younger than 5 years were analyzed. Extreme weights were first identified using weight percentiles...
October 2, 2017: Pediatric Emergency Care
Courtney E Nelson, Richard J Scarfone
An intracranial bleed with a midline shift is a potentially life-threatening clinical condition. We present the unusual case of a 13-year-old boy with sickle cell disease who had numerous emergency department visits for a scalp hematoma and was subsequently determined to have subdural and epidural hematomas with midline shift, associated with a skull bone infarction. We review the pathophysiology of this unusual condition and emphasize the importance of including it in the differential diagnosis of any child with sickle cell anemia presenting with a nontraumatic scalp hematoma...
September 25, 2017: Pediatric Emergency Care
Courtney E Nelson, Summer Kaplan, Richard D Bellah, Aaron E Chen
BACKGROUND: Ultrasound (US) is used to differentiate abscess from cellulitis. At our institution, we observed children who had purulent fluid obtained after a negative abscess US. We sought to determine the incidence of sonographically occult abscess (SOA) of the buttock and perineum, and identify associated clinical and demographic characteristics. METHODS: Retrospective chart review including children younger than 18 years old presenting to pediatric emergency department with soft tissue infection of the buttock or perineum and diagnostic radiology US read as negative for abscess...
September 25, 2017: Pediatric Emergency Care
Heather G Zook, Anupam B Kharbanda, Susan E Puumala, Katherine A Burgess, Wyatt Pickner, Nathaniel R Payne
OBJECTIVES: The aims of this study were to determine differences in emergency department (ED) use by Native American (NA) children in rural and urban settings and identify factors associated with frequent ED visits. METHODS: This cross-sectional, cohort study examined visits to 6 EDs: 2 rural, 2 midsize urban, and 2 large urban EDs from June 2011 to May 2012. Univariate and multiple regression analyses were conducted. Frequent ED visitors had more than 4 visits in the study period...
September 25, 2017: Pediatric Emergency Care
Emilie Bougie, Sabrina Cugno
Closed digital artery injury is a very rare phenomenon, even more so in children, with only 5 cases reported in the literature. We report a case of closed digital arterial interruption in a child after crush injury to the left hand. We further discuss possible etiologies and describe adequate management as found in the pertinent literature. Digital arterial injury should be suspected even in closed hand trauma because a delay in recognition may lead to devastating consequences.
September 25, 2017: Pediatric Emergency Care
Larry Bruce Mellick, James E Sinex, Robert W Gibson, Kim Mears
BACKGROUND: The time window for possible salvage and survival of a torsed testicle is commonly thought to be 6 to 8 hours. However, survival of torsed testicles with or without subsequent atrophy is known to occur outside that critical time window. In this article, we performed a systematic review of the English literature to provide a more accurate understanding of reported time frames of testicle survival after a torsion event. OBJECTIVES: The primary research question was to determine the relationship between time to treatment and the rate of survival for testicles of male patients presenting with testicular torsion (TT)...
September 25, 2017: Pediatric Emergency Care
Michael A Blasco, Aron Kandinov, Peter F Svider, Nathan J Gonik, Curtis Hanba, Giancarlo F Zuliani, Mahdi A Shkoukani, Michael A Carron
OBJECTIVE: The aim of this study was to determine the national incidence of facial trauma among toddlers and delineate patterns of injury and their causes. METHODS: A retrospective review was designed to explore patterns of maxillofacial trauma within toddler-aged children using the National Electronic Injury Surveillance System from the Consumer Product Safety Commission. The database was searched for emergency department visits involving facial trauma sustained by children 12 months through 3 years of age from 2010 through 2014 and analyzed for patient demographics, primary diagnosis, and associated products/activities...
September 25, 2017: Pediatric Emergency Care
Jung Heon Kim, Jae Hyun Kwon, Jong Seung Lee, Jeong-Min Ryu, Kyoung Soo Lim, Won Young Kim
OBJECTIVES: The aim of this study was to investigate the association between increased weight status (IWS), a weight for age/sex at greater than the 95th percentile, and fall-induced intracranial hemorrhage (ICH) in children aged 4 years or younger. METHODS: In 7072 children aged 4 years or younger with head injury who visited a tertiary care hospital emergency department in Korea from 2013 through 2015, the presence of fall-induced ICH was reviewed. The association between IWS and ICH was investigated by multivariable logistic regression...
September 25, 2017: Pediatric Emergency Care
Satoshi Kamidani, Kensuke Shoji, Eiki Ogawa, Takanori Funaki, Hiroki Mishina, Isao Miyairi
OBJECTIVES: Fever of 39°C or higher and a white blood cell (WBC) count of 15,000/μL or greater are known predictors of occult bacteremia (OB). However, because of a decreasing prevalence of OB, WBC counts have become poor predictors of OB in populations of routinely immunized children. Thus, we aim to evaluate the clinical characteristics of OB in Japanese children and identify potential risk factors for OB. METHODS: We conducted an observational study of children aged 3 to 36 months old with positive blood cultures for Streptococcus pneumoniae or Haemophilus influenzae at an emergency department in a tertiary care children's hospital between April 2002 and December 2015...
September 25, 2017: Pediatric Emergency Care
Taylor Bagwell, Amanda Hollingsworth, Tonya Thompson, Thomas Abramo, Mary Huckabee, Di Chang, Leroy Crawley, James M Robbins
OBJECTIVES: Croup occasionally requires medical intervention for respiratory distress. Mainstays of treatment are corticosteroids and nebulized epinephrine. Diagnosis and assessment of severity remain clinical. Safety of discharge from an emergency department (ED) after treatment with corticosteroids and 1 nebulized epinephrine has been established. No evidence exists regarding risk associated with discharge after multidose nebulized epinephrine. Many patients requiring multidose nebulized epinephrine are reflexively admitted...
September 25, 2017: Pediatric Emergency Care
Larry Bruce Mellick, James Sinex
A subset of testicular torsion patients report resolution of their initial severe pain that is followed by variable periods of hours to days of reduced or absent pain. Other patients report only mild pain that is described as gradual in onset. Because of delayed initial presentations or less than timely returns for secondary evaluation, these pain honeymoons may be partially responsible for poor clinical outcomes of the torsed spermatic cords and ischemic testicles.
September 18, 2017: Pediatric Emergency Care
Heather G Zook, Nathaniel R Payne, Susan E Puumala, Katherine M Ziegler, Anupam B Kharbanda
OBJECTIVE: To assess the variation between racial/ethnic groups in emergency department (ED) treatment of asthma for pediatric patients. METHODS: This study was a cross-sectional analysis of pediatric (2-18 years) asthma visits among 6 EDs in the Upper Midwest between June 2011 and May 2012. We used mixed-effects logistic regression to assess the odds of receiving steroids, radiology tests, and returning to the ED within 30 days. We conducted a subanalysis of asthma visits where patients received at least 1 albuterol treatment in the ED...
September 18, 2017: Pediatric Emergency Care
Jung Heon Kim, Jeong-Yong Lee, Jae Hyun Kwon, Hyung-Rae Cho, Jong Seung Lee, Jeong-Min Ryu
OBJECTIVES: The aim of this study was to evaluate whether point-of-care ultrasound (POCUS) for intussusception screening streamlines the workflow of clinically nonspecific intussusception (CNI), an intussusception presenting with only 1 manifestation of the classic triad, and/or vomiting. METHODS: We reviewed 274 consecutive children with intussusception, aged 6 years or younger, who visited a tertiary care hospital emergency department between May 2012 and April 2016...
September 18, 2017: Pediatric Emergency Care
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