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https://www.readbyqxmd.com/read/28813753/pre-guideline-trends-associated-with-chest-radiograph-usage-for-pediatric-community-acquired-pneumonia-in-emergency-department-settings
#1
Eric W Jones, Benjamin Meyer, Aaron M Berg, Benson S Hsu
BACKGROUND: Health care spending in the U.S. totaled $3 trillion in 2014 and continues to increase rapidly. Minimizing waste through clinical guidelines is a promising strategy to reduce spending without compromising patient care. In 2011, clinical guidelines recommended against the use of chest X-ray (CXR) for diagnosis of community-acquired pneumonia (CAP) in pediatric ambulatory settings. However, use of CXR has not changed post-guideline. Thus, understanding the drivers of CXR utilization prior to guideline implementation could improve guideline adherence...
May 2017: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28808990/onychomadesis-in-a-9-month-old-boy-with-hand-foot-mouth-disease
#2
Ibrahim Mortada, Rola Mortada, Mohamad Al Bazzal
BACKGROUND: Nail abnormalities in childhood are generally uncommon. Recently, onychomadesis is described as a rare, late complication of hand-foot-mouth disease, which is a viral illness commonly seen in the pediatric age group. It is therefore important to elucidate the presentation of this entity, especially in the context of the hand-foot-mouth disease. CASE PRESENTATION: We report a case of onychomadesis in a 9-month old Lebanese boy who presented to the emergency department with rapidly progressing nail changes involving all four extremities...
August 14, 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28808073/unintentional-cannabis-intoxication-in-toddlers
#3
Isabelle Claudet, Sébastien Mouvier, Magali Labadie, Cécile Manin, Anne-Pascale Michard-Lenoir, Didier Eyer, Damien Dufour
BACKGROUND AND OBJECTIVES: In France, cannabis consumption is illegal. The health impact of its increasing use and higher tetrahydrocannabinol (THC) concentrations is still poorly documented, particularly that of unintentional pediatric intoxications. We sought to evaluate the French national trend of admissions for unintentional cannabis intoxication in children over an 11-year period (2004-2014). METHODS: A retrospective, national, multicenter, observational study of a pediatric cohort...
August 14, 2017: Pediatrics
https://www.readbyqxmd.com/read/28803593/predictors-of-obtaining-follow-up-care-in-the-province-of-ontario-canada-following-a-new-diagnosis-of-atrial-fibrillation-heart-failure-and-hypertension-in-the-emergency-department
#4
Clare L Atzema, Bing Yu, Noah M Ivers, Paula A Rochon, Douglas S Lee, Michael J Schull, Peter C Austin
OBJECTIVE: Patients with cardiovascular diseases are common in the emergency department (ED), and continuity of care following that visit is needed to ensure that they receive evidence-based diagnostic tests and therapy. We examined the frequency of follow-up care after discharge from an ED with a new diagnosis of one of three cardiovascular diseases. METHODS: We performed a retrospective cohort study of patients with a new diagnosis of heart failure, atrial fibrillation, or hypertension, who were discharged from 157 non-pediatric EDs in Ontario, Canada, between April 2007 and March 2014...
August 14, 2017: CJEM
https://www.readbyqxmd.com/read/28803574/retrospective-evaluation-of-the-big-score-to-predict-mortality-in-pediatric-blunt-trauma
#5
Charlotte Grandjean-Blanchet, Guillaume Emeriaud, Marianne Beaudin, Jocelyn Gravel
OBJECTIVES: This study's objective was to measure the criterion validity of the BIG score (a new pediatric trauma score composed of the initial base deficit [BD], international normalized ratio [INR], and Glasgow Coma Scale [GCS]) to predict in-hospital mortality among children admitted to the emergency department with blunt trauma requiring an admission to the intensive care unit, knowing that a score <16 identifies children with a high probability of survival. METHODS: This was a retrospective cohort study performed in a single tertiary care pediatric hospital between 2008 and 2016...
August 14, 2017: CJEM
https://www.readbyqxmd.com/read/28803186/asthma-exacerbations-and-triggers-in-children-in-tenor-impact-on-quality-of-life
#6
Bradley E Chipps, Tmirah Haselkorn, Karin Rosén, David R Mink, Benjamin L Trzaskoma, Allan T Luskin
BACKGROUND: Data examining associations between asthma exacerbations, triggers, and asthma-related quality of life (QOL) in children with severe/difficult-to-treat asthma are unavailable. OBJECTIVE: To evaluate real-world data on relationships between asthma exacerbations, triggers, and QOL in children using data from TENOR (The Epidemiology and Natural History of Asthma Outcomes and Treatment Regimens), a 3-year observational study of patients with severe/difficult-to-treat asthma, including those aged 6 to 12 years...
August 9, 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/28802910/inter-rater-reliability-of-physical-abuse-determinations-in-young-children-with-fractures
#7
Katherine E Buesser, John M Leventhal, Julie R Gaither, Victoria Tate, Daniel R Cooperman, Rebecca L Moles, Cicero T Silva, Lauren J Ehrlich, Melinda S Sharkey
As there is no "gold standard" in determining whether a fracture is caused by accident or abuse, agreement among medical providers is paramount. Using abstracted medical record data from 551 children <36months of age presenting to a pediatric emergency department, we examined the extent of agreement between specialists who evaluate children with fractures for suspected abuse. To simulate clinical scenarios, two pediatric orthopaedists and two child abuse pediatricians (CAPs) reviewed the full abstraction and imaging, whereas the two pediatric radiologists reviewed a brief history and imaging...
August 10, 2017: Child Abuse & Neglect
https://www.readbyqxmd.com/read/28802384/retrospective-study-of-intranasal-dexmedetomidine-as-a-prophylactic-against-emergence-delirium-in-pediatric-patients-undergoing-ear-tube-surgery
#8
Lisgelia Santana, Katherine Mills
OBJECTIVES: This study evaluated the effect of intranasal dexmedetomidine on emergence delirium (ED) in pediatric patients who underwent ear tube surgeries. Due to the brief nature of the surgery and low levels of pain experienced, an IV is rarely needed, limiting the medications available to anesthesiologists to manage postoperative delirium that may arise during recovery from inhalational anesthesia. Intravenous dexmedetomidine is an alpha-2 agonist anesthetic that is used in pediatric patients for the management of ED in various surgical procedures...
September 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28801399/a-randomised-controlled-pilot-trial-evaluating-feasibility-and-acceptability-of-a-computer-based-tool-to-identify-and-reduce-harmful-and-hazardous-drinking-among-adolescents-with-alcohol-related-presentations-in-canadian-pediatric-emergency-departments
#9
Amanda S Newton, Nadia Dow, Kathryn Dong, Eleanor Fitzpatrick, T Cameron Wild, David W Johnson, Samina Ali, Ian Colman, Rhonda J Rosychuk
OBJECTIVE: This study piloted procedures and obtained data on intervention acceptability to determine the feasibility of a definitive randomised controlled trial (RCT) of the effectiveness of a computer-based brief intervention in the emergency department (ED). DESIGN: Two-arm, multi-site, pilot RCT. SETTING AND PARTICIPANTS: Adolescents aged 12-17 years presenting to three Canadian pediatric EDs from July 2010 to January 2013 for an alcohol-related complaint...
August 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28801165/child-care-health-consultation-improves-infant-and-toddler-care
#10
Rosemary Johnston, Beth A DelConte, Libby Ungvary, Richard Fiene, Susan S Aronson
INTRODUCTION: Many families enroll their infants and toddlers in early education and child care programs. The Pennsylvania Chapter of the American Academy of Pediatrics recruited 32 child care centers that care for infants and toddlers to be linked with a child care health consultant (CCHC). METHOD: Project staff assigned the centers alternately to an immediate intervention or a 1-year delayed intervention (contrast) group. At entry into the project, and then 1 and 2 years later, an evaluator assessed center compliance with 13 standards for infants and toddler care selected from Caring for Our Children: National Health and Safety Performance Standards (3rd ed...
August 8, 2017: Journal of Pediatric Health Care
https://www.readbyqxmd.com/read/28801039/kohler-s-disease-presenting-as-acute-foot-injury
#11
Mazin Alhamdani, Christopher Kelly
Kohler's disease is rare cause of foot pain and limping in the pediatric population. The exact etiology of Kohler's disease is unknown. It usually presents as sudden and unexplained foot pain and limping. We report a case of a 5-year-old male who presented to the Pediatric Emergency Department with foot pain and inability to bear weight for two days after overactivity and acute foot injury. The patient was eventually diagnosed with Kohler's disease (avascular necrosis of the navicular bone). Although Kohler's disease is not very common, it should be considered in the differential diagnosis of foot pain in the pediatric population, as it may prevent unnecessary tests and treatments...
August 2, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28800802/special-considerations-in-the-pediatric-psychiatric-population
#12
REVIEW
Genevieve Santillanes, Ruth S Gerson
Youth with psychiatric and behavioral complaints commonly present to emergency departments (EDs), which often lack dedicated mental health staff. This article addresses techniques EDs can use to better care for children in need of psychiatric assessment and medical clearance, specifically addressing the evaluation of youth with suicidal ideation and coexisting medical and psychiatric needs. The evaluation and management of youth with agitation and aggression are also discussed. The article concludes with a discussion of systems changes needed to truly improve emergency care for psychiatrically ill youth...
September 2017: Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28797559/utilization-of-ultrasound-for-the-evaluation-of-small-bowel-obstruction-a-systematic-review-and-meta-analysis
#13
Michael Gottlieb, Gary D Peksa, Ananda Vishnu Pandurangadu, Damali Nakitende, Sukhjit Takhar, Raghu R Seethala
INTRODUCTION: Small bowel obstruction (SBO) is a common presentation to the Emergency Department (ED). While computed tomography (CT) is frequently utilized to confirm the diagnosis, this modality is expensive, exposes patients to radiation, may lead to time delays, and is not universally available. This study aimed to determine the test characteristics of ultrasound for the diagnosis of SBO. METHODS: PubMed, CINAHL, Scopus, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were assessed for prospective trials evaluating the accuracy of ultrasound for the detection of SBO...
July 29, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28796651/ultrasound-assisted-reduction-of-displaced-and-shortened-fractures-by-pediatric-emergency-physicians
#14
Eric Scheier, Uri Balla
Pediatric emergency physicians at Kaplan Medical Center regularly reduce forearm fractures under point-of-care ultrasound guidance in the pediatric emergency department. We present 3 children who arrived at our department with shortened, angulated forearm fractures within the span of a single week. We report on the successful reduction of these fractures under point-of-care ultrasound and on the maintenance of anatomic alignment at follow-up 1 week postreduction.
August 7, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28796552/diagnostic-accuracy-of-mri-versus-ct-for-the-evaluation-of-acute-appendicitis-in-children-and-young-adults
#15
Sonja Kinner, Perry J Pickhardt, Erica L Riedesel, Kara G Gill, Jessica B Robbins, Douglas R Kitchin, Timothy J Ziemlewicz, John B Harringa, Scott B Reeder, Michael D Repplinger
OBJECTIVE: Appendicitis is frequently diagnosed in the emergency department, most commonly using CT. The purpose of this study was to compare the diagnostic accuracy of contrast-enhanced MRI with that of contrast-enhanced CT for the diagnosis of appendicitis in adolescents when interpreted by abdominal radiologists and pediatric radiologists. SUBJECTS AND METHODS: Our study included a prospectively enrolled cohort of 48 patients (12-20 years old) with nontraumatic abdominal pain who underwent CT and MRI...
August 10, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28794889/ambient-ozone-and-asthma-hospital-admissions-in-texas-a-time-series-analysis
#16
Julie E Goodman, Ke Zu, Christine T Loftus, Ge Tao, Xiaobin Liu, Sabine Lange
BACKGROUND: Many studies have evaluated associations between asthma emergency department (ED) visits, hospital admissions (HAs), and ambient ozone (O3) across the US, but not in Texas. We investigated the relationship between O3 and asthma HAs, and the potential impacts of outdoor pollen, respiratory infection HAs, and the start of the school year in Texas. METHODS: We obtained daily time-series data on asthma HAs and ambient O3 concentrations for Dallas, Houston, and Austin, Texas for the years 2003-2011...
2017: Asthma research and practice
https://www.readbyqxmd.com/read/28794661/focused-assessment-with-sonography-for-trauma-current-perspectives
#17
REVIEW
Sorravit Savatmongkorngul, Sirote Wongwaisayawan, Rathachai Kaewlai
Focused assessment with sonography for trauma (FAST) is a part of resuscitation of trauma patients recommended by international panel consensus. The purpose of FAST is to identify free fluid, which necessarily means blood in acute trauma patients. In this article, the authors focused on various aspects of FAST in the emergency department, prehospital care, pediatric setting, training and general pearls/pitfalls. Detailed techniques and interpretation of FAST are beyond the scope of this article.
2017: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/28792258/utilization-of-intravenous-catheters-by-prehospital-providers-during-pediatric-transports
#18
Timothy VanderKooy, Kelsey Spaur, Lina Brou, Sean Caffrey, Kathleen M Adelgais
INTRODUCTION: Prehospital intravenous (IV) access in children may be difficult and time-consuming. Emergency Medical Service (EMS) protocols often dictate IV placement; however, some IV catheters may not be needed. The scene and transport time associated with attempting IV access in children is unknown. The objective of this study is to examine differences in scene and transport times associated with prehospital IV catheter attempt and utilization patterns of these catheters during pediatric prehospital encounters...
August 9, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28782193/resident-responses-to-after-hours-otolaryngology-patient-phone-calls-an-overlooked-aspect-of-residency-training
#19
Ashton E Lehmann, Elliott D Kozin, Rosh K V Sethi, Kevin Wong, Brian M Lin, Stacey T Gray, Michael J Cunningham
OBJECTIVES/HYPOTHESIS: Otolaryngology residents are often responsible for triaging after-hours patient calls. However, residents receive little training on this topic. Data are limited on the clinical content, reporting, and management of otolaryngology patient calls. This study aimed to characterize the patient concerns residents handle by phone and their subsequent management and reporting. STUDY DESIGN: Retrospective review. METHODS: Five hundred consecutive after-hours patient calls in a tertiary pediatric hospital were reviewed...
August 7, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28777774/symptom-guided-emergency-department-discharge-instructions-for-children-with-concussion
#20
Talia M Brooks, Marissa M Smith, Renee M Silvis, Trudy Lerer, Christine Henry Mulvey, Ralynne Maitland, Amy L Dunn, Kelsey Logan, Sharon R Smith
OBJECTIVES: The objective was to evaluate the use and utility of a novel set of emergency department discharge instructions (DIs) for concussion based on a child's ongoing symptoms: symptom-guided DIs (symptom DIs). Differences in clinical outcomes were also assessed. METHODS: A convenience sample of 114 children aged 7 to 17 years presenting to an urban pediatric emergency department with a complaint of concussion was assembled. Children were randomized to standard DIs or symptom DIs...
August 2017: Pediatric Emergency Care
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