Community Validation of an Approach to Detect Delayed Diagnosis of Appendicitis in Big Databases.

Background: Detection of delayed diagnosis using administrative databases may illuminate the healthcare settings at highest risk. A method for detection of delays in claims has been validated in children's hospitals. We sought to further validate the method in community emergency departments (EDs).

Clinician factors associated with delayed diagnosis of appendicitis.

Objectives: To evaluate the association of clinician demographics and practice patterns with delayed diagnosis of appendicitis.

Methods: We included children with appendicitis at 13 regional emergency departments (EDs). We screened patients with a previous ED visit within 7 days for delayed diagnosis by chart review.

Delayed diagnosis of serious paediatric conditions in 13 regional emergency departments.

Objective: To evaluate rates, risk factors and outcomes of delayed diagnosis of seven serious paediatric conditions.

Methods: This was a retrospective, cross-sectional study of children under 21 years old visiting 13 community and tertiary emergency departments (EDs) with appendicitis, bacterial meningitis, intussusception, mastoiditis, ovarian torsion, sepsis or testicular torsion. Delayed diagnosis was defined as having a previous ED encounter within 1 week in which the condition was present per case review.

Carbon Monoxide Poisoning In Children: Diagnosis And Management In The Emergency Department.

Approximately 5000 children present to the emergency department annually with unintentional carbon monoxide poisoning. Children may be more vulnerable to carbon monoxide poisoning because of their increased metabolic demand and their inability to vocalize symptoms or recognize a dangerous exposure, and newborn infants are more vulnerable to carbon monoxide poisoning because of the persistence of fetal hemoglobin. Mild carbon monoxide poisoning may present as viral symptoms in the absence of fever.

A prospective study of 113 deep neck infections managed using a clinical practice guideline.

Objectives/hypothesis: Retropharyngeal abscesses are a difficult to diagnose condition in children. Though some children with such abscesses can be managed with intravenous (IV) antibiotics alone, our group has argued that surgical drainage is the gold standard for safe management and likely leads to shorter hospital stays. We present prospective data on children with retropharyngeal infections who were managed according to a clinical practice guideline that emphasizes reliance on computed tomography and prompt surgical drainage when pus is felt to be present.

Glass table-related injuries in children.

Objectives: To investigate the patterns of injury sustained from glass table-related accidents to estimate whether tempered glass would prevent injuries.

Methods: We conducted a retrospective cohort analysis of all patients in an urban pediatric emergency department between October of 1995 and May for 2007 for glass table-related accidents. Data collected included age, sex, injury characteristics, examination findings, radiographic imaging, interventions, and disposition.

Veinlite transillumination in the pediatric emergency department: a therapeutic interventional trial.

Objectives: We hypothesized that transillumination would increase peripheral intravenous (IV) insertion success rates in pediatric emergency department patients. Primary outcome was success in first attempt, and secondary outcome was success within 2 attempts.

Methods: We evaluated IV insertion by pediatric emergency department physicians and nurses using the Veinlite (TransLite, Sugar Land, Tex).

Management of esophageal coins.

Purpose Of Review: Coins are the most commonly ingested foreign body encountered in the pediatric population. Coins that are in the esophagus and are causing symptoms (cough, stridor, respiratory distress, drooling or pain) are managed with immediate removal via various methods. Asymptomatic coins have been a perplexing problem to the clinician for decades, with some advocating for immediate removal while others are proponents of "watchful waiting".

The use of routine laboratory studies as screening tools in pediatric abdominal trauma.

Background: Standard laboratory panels were shown to play an important role in the evaluation of pediatric blunt abdominal trauma before the routine use of computed tomography (CT) scan. Recently, only a few relatively limited studies have evaluated the use of these "trauma panels."

Objective: To evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of routine "trauma panels" for evaluating intra-abdominal injury in pediatric blunt trauma patients.

A randomized clinical trial of the management of esophageal coins in children.

Context: Children frequently ingest coins. When lodged in the esophagus, the coin may cause complications and must either be removed or observed to pass spontaneously.

Objectives: (1) To compare relatively immediate endoscopic removal to a period of observation followed by removal when necessary and (2) to evaluate the relationship between select clinical features and spontaneous passage.

Bispectral index monitoring quantifies depth of sedation during emergency department procedural sedation and analgesia in children.

Study Objective: The bispectral index monitor uses processed electroencephalogram signals to measure sedation depth on a unitless scale from 0 to 100 (0, coma; 40 to 60, general anesthesia; 60 to 90, sedated; 100, awake). It has been validated in the operating room as an objective measure of sedation depth with nondissociative general anesthesia; however, its usefulness in the pediatric emergency department (ED) for procedural sedation and analgesia has not been established. We determine the ability of the bispectral index to monitor depth of nondissociative procedural sedation and analgesia in children.