Utility of Temporal Bone Computed Tomography in Pediatric Emergency Medicine.

Objective: Temporal bone computed tomography (CT) requires a relatively high radiation dose to produce high-resolution images required to define surgical anatomy. In the acute setting, the need for this detailed evaluation of temporal bone pathology may not be required for nonsurgical management and clinical decision-making. We performed a retrospective review of the clinical characteristics and subsequent management of children who underwent CT of the temporal bone with the goal of optimizing clinical decision-making and mitigating the risks of radiation exposure in children.

Emergency Department Point-of-Care Ultrasonography Can Reduce Length of Stay in Pediatric Appendicitis: A Retrospective Review.

Objectives: Appendicitis is the most common pediatric surgical emergency. Ultrasonography is recommended as first-line imaging for appendicitis in children; however, this is often followed by more advanced imaging. Our goal was to determine if point-of-care ultrasonography (POCUS) could reduce cost and length-of-stay (LOS) in suspected pediatric appendicitis.

Assessing the Necessity for the "Joint Above and Below" Radiography Approach for Lower-extremity Long Bone Fractures in Children.

Objectives: A common strategy for evaluation of extremity fractures is the "joint above and below" (JAB) radiograph approach, which includes dedicated imaging of the joint proximal and distal to a fracture independent of clinical suspicion for an injury involving the joint. The incidence of concomitant ipsilateral lower-extremity fractures or dislocations associated with lower-extremity long bone fractures in children has not been commonly reported and represents an evidential gap for determining a radiograph approach. Our purpose was to determine the frequency of and risk factors for concomitant ipsilateral lower-extremity fractures or dislocations.

Point-of-Care Ultrasound Diagnosis of Ureteropelvic Junction Obstruction in a Child With Recurrent Abdominal Pain and Vomiting.

A case is described of a 4 year-old girl who presented with chronic episodic abdominal pain with vomiting. Physical examination was unremarkable aside from hypertension. Point-of-care renal ultrasound showed hydronephrosis, leading to a diagnosis of ureteropelvic junction obstruction presenting with Dietl crisis (episodic abdominal pain secondary to urinary tract obstruction).

Reducing Antibiotic Prescription Errors in the Emergency Department: A Quality Improvement Initiative.

Introduction: Discharge prescription errors from the pediatric emergency department (ED) are common. Despite the implementation of clinical pathways for common infections recommending specific antibiotic therapy and aids built into the electronic health record, errors in antibiotic prescriptions for patients discharged home from the ED persist.

Methods: We developed and implemented ED antibiotic discharge order panels for urinary tract infection (UTI) and skin and soft tissue infections (SSTI) that modeled antibiotic therapy from our institutional clinical pathways.

Appropriateness of Antibiotic Prescriptions for Urinary Tract Infections.

Introduction: Urinary tract infections (UTI) are a common indication for antibiotic use in the emergency department (ED). With antibiotic resistance on the rise, it is essential that antibiotics be prescribed appropriately for UTIs. Our objective was to evaluate the appropriateness of antibiotic prescriptions by ED providers for uncomplicated cystitis and pyelonephritis.

Reducing Invasive Care for Low-risk Febrile Infants Through Implementation of a Clinical Pathway.

Background And Objectives: Significant variation in management of febrile infants exists both nationally and within our institution. Risk stratification can be used to identify low-risk infants who can be managed as outpatients without lumbar puncture (LP) or antibiotics. Our objective was to reduce invasive interventions for febrile infants aged 29 to 60 days at low risk for serious bacterial infection (SBI) through implementation of a clinical pathway supported by quality improvement (QI).

Hypothermia: A Sign of Sepsis in Young Infants in the Emergency Department?

Objectives: Diagnosis of sepsis in young infants can be challenging due to the nonspecific signs, which can include hypothermia. Whether the presence of hypothermia in young infants should prompt evaluation for serious infection is unclear. The objectives were to measure the prevalence of serious infection among infants ≤60 days of age with hypothermia in the emergency department (ED) and determine other clinical features of hypothermic infants who have serious infection.

Trampoline Park and Home Trampoline Injuries.

Background And Objective: Trampoline parks, indoor recreational facilities with wall-to-wall trampolines, are increasing in number and popularity. The objective was to identify trends in emergency department visits for trampoline park injuries (TPIs) and compare TPI characteristics with home trampoline injuries (HTIs).

Methods: Data on trampoline injuries from the National Electronic Injury Surveillance System from 2010 to 2014 were analyzed.

Childhood primary angiitis of the central nervous system with metachronous hemorrhagic infarcts: a postmortem study with clinicopathologic correlation.

This neuropathologic case study illustrates the discovery of metachronous hemorrhagic infarcts insinuating round mass-like lesions by magnetic resonance imaging in the setting of childhood primary angiitis of the central nervous system (cPACNS) raising diagnostic awareness of this unusual presentation in a clinical and neuroimaging context. The report underscores the importance of recurrent vasculitis-induced ischemic brain damage as a pathologic correlate of relapsing cPACNS and offers a critical reappraisal of common imitators as well as a clinicopathologic approach to differential diagnosis. Attention is drawn to the caveat that although magnetic resonance imaging findings at initial presentation may not be typical for stroke, they later exhibit attributes of cerebral infarction at both the subacute and chronic stages.

Predictors of functional outcome after revision total knee arthroplasty following aseptic failure.

Background: There are a limited number of studies related to quality of life and functional outcome after revision total knee arthroplasty (TKA). The present study aimed to identify predictors of functional outcome after revision TKA for aseptic failure.

Methods: One hundred seventy-five patients with mean age of 66.