Prepubertal Vaginal Bleeding: Etiology, Diagnostic Approach, and Management.

Importance: Prepubertal vaginal bleeding outside the neonatal period is always abnormal and is very alarming to parents. A variety of practitioners, including obstetrician-gynecologists and pediatricians, may be asked to see patients with this presenting complaint, yet many do not receive adequate training in pediatric gynecology.

Evidence Acquisition: Review of the published literature in PubMed, focusing on the last 20 years, regarding the incidence, etiologies, diagnosis, and management strategies for the common causes of prepubertal vaginal bleeding.

Five-level triage system more effective than three-level in tertiary emergency department.

Introduction: The study objectives were to compare reliability and validity of a 3-level (3L) triage system with a new 5-level (5L) triage system and determine the effect of nursing experience on triage reliability.

Methods: The study was conducted in a southeastern tertiary emergency department. With a stratified random sample, reliability of 3L triage ratings was measured with weighted kappa (time 1).