Analysis of pediatric hospitalizations after emergency department release as a quality improvement tool.

Study Objective: We characterize repeat pediatric emergency department visits and determine the cause for such visits as an indicator of potential need for quality improvement. We hypothesized that most repeat ED visits resulting in hospitalization do not represent medical errors.

Methods: The study was performed at a large, tertiary care, academic children's hospital.

Communicating bad news: a pediatric department's evaluation of a simulated intervention.

Objective: To determine if pediatric residents and emergency department (ED) fellows could improve their ability to counsel and inform standardized patients (SPs) about bad news.

Methodology: A crossover, self-controlled design in which trainees were their own control individuals, and SPs provided feedback after the first interview. The setting was the consultation room in the ED of a large children's hospital.

Emergency brain computed tomography in children with seizures: who is most likely to benefit?

Objective: To determine whether the recently published guidelines on neuroimaging in patients with new-onset seizures are applicable to children.

Methods: We carried out a retrospective analysis of 107 neurologically normal children (excluding children with simple febrile seizures) who had undergone neuroimaging when they presented to the emergency department with a possible "first seizure."

Results: Eight of the 107 children had nonepileptic events (gastroesophageal reflux, syncopal event, rigor).

Spontaneous passage of coins lodged in the upper esophagus.

Coin ingestion with subsequent esophageal coin impaction is common in children. Although spontaneous passage to the stomach of coins at the gastroesophageal sphincter is fairly common, spontaneous passage of coins from the upper or mid-esophagus has only rarely been reported. Thus, in an effort at cost savings, an endoscopist might forego obtaining a second set of radiographs prior to removal of an esophageal coin.