Scaphoid Fractures in Children: Do We Need to X-ray? A Retrospective Chart Review of 144 Wrists.

Objectives: The purpose of this study is to determine the predictive value of clinical suspicion for scaphoid fracture in children aged 4 to 11 years, to look at the efficiency and practicality of current management of children presenting to the emergency department, and to help quantify the burden of the treatment strategy of immobilization for 10 to 14 days on clinical grounds despite negative or equivocal x-rays on presentation.

Methods: We performed a retrospective chart review study of a consecutive sample of all children aged 4 to 11 years old who presented to a tertiary pediatric emergency department from January 1, 2009, to December 31, 2013, within 24 hours of a wrist injury, with a clinical suspicion sufficient to order a scaphoid x-ray. Our primary outcome of interest was the positive predictive value of clinical suspicion of a scaphoid fracture.

Esophageal Apoplexy.

Oesophageal apoplexy or intramural haematoma of the oesophagus (IHE) is a rare condition with a pattern of presentation that can mimic sinister pathologies. Diagnosis requires a high index of suspicion, and the exclusion of an oesophageal perforation or oesophageal malignancy is important. Investigations include computer topography (CT) and contrast swallow studies as well as a gastroscopy.

Time-series analysis of ondansetron use in pediatric gastroenteritis.

Objective: Emergency department use of ondansetron in children with gastroenteritis is increasing; however, its effect on clinical outcomes is unknown. We aimed to determine whether increasing ondansetron usage is associated with improved outcomes in children with gastroenteritis.

Methods: A retrospective cohort study was conducted at The Hospital for Sick Children, Toronto, Canada.

Population-based incidence of herpes zoster after introduction of a publicly funded varicella vaccination program.

Background: Past varicella infection (chicken pox) may reactivate into herpes zoster (shingles). Varicella vaccination leads to a reduction in cases of varicella that may in turn increase herpes zoster rates due to reduction in the immune boosting effect of exposure to varicella zoster virus against varicella reactivation. We assessed the impact of childhood varicella vaccination in Ontario, Canada on zoster incidence and healthcare visits, and established baseline zoster rates prior to zoster vaccine introduction.

Management of uncomplicated nail bed lacerations presenting to a children's emergency department.

Objective: This study examined the mechanisms of injury and the pattern of care for children who presented to the emergency department with uncomplicated nail bed lacerations.

Methods: A retrospective chart review was conducted from January 2004 to December 2007 for all children younger than 18 years who presented to a tertiary children's hospital with an uncomplicated nail bed laceration.

Results: There were 84 cases of uncomplicated nail bed injuries for more than a 4-year period.

Oral ondansetron administration in emergency departments to children with gastroenteritis: an economic analysis.

Background: The use of antiemetics for children with vomiting is one of the most controversial decisions in the treatment of gastroenteritis in developed countries. Ondansetron, a selective serotonin receptor antagonist, has been found to be effective in improving the success of oral rehydration therapy. However, North American and European clinical practice guidelines continue to recommend against its use, stating that evidence of cost savings would be required to support ondansetron administration.

Impact of varicella vaccination on health care outcomes in Ontario, Canada: effect of a publicly funded program?

Varicella vaccines have been available for private purchase in Canada since 1998. Ontario introduced publicly funded varicella vaccination in 2004. We assessed the effects of private availability of varicella vaccines and subsequent implementation of a publicly funded vaccination program on varicella-related hospitalizations, emergency department (ED) use, and visits to physicians' offices in Ontario.