Surveillance of Health Care-Associated Violence Using Natural Language Processing.

Background And Objectives: Patient and family violent outbursts toward staff, caregivers, or through self-harm, have increased during the ongoing behavioral health crisis. These health care-associated violence (HAV) episodes are likely under-reported. We sought to assess the feasibility of using nursing notes to identify under-reported HAV episodes.

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).

Randomized Trial of Weight-Based Versus Fixed Limit High-Flow Nasal Cannula in Bronchiolitis.

Background: High flow nasal cannula (HFNC) is increasingly used to treat bronchiolitis. Although lower HFNC rates (≤8 L per minute) are commonly employed, higher weight-based flows more effectively alleviate dyspnea. The impact of higher flows on the need for care escalation is unclear.

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.

Electronic surveillance of patient safety events using natural language processing.

Objective: We describe our approach to surveillance of reportable safety events captured in hospital data including free-text clinical notes. We hypothesize that a) some patient safety events are documented only in the clinical notes and not in any other accessible source; and b) large-scale abstraction of event data from clinical notes is feasible.

Materials And Methods: We use regular expressions to generate a training data set for a machine learning model and apply this model to the full set of clinical notes and conduct further review to identify safety events of interest.

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.

Experience of pharmacy involvement in a disaster simulation exercise within a pediatric hospital emergency department: A pilot project.

Purpose: In this descriptive report, we describe a unique trial of pharmacist participation in a multidisciplinary pediatric emergency department disaster simulation exercise. With the number of disasters increasing worldwide, the role of pharmacists in disaster response is of particular interest to the profession.

Summary: This observational study describes pharmacist participation in a disaster simulation exercise.

Prediction across healthcare settings: a case study in predicting emergency department disposition.

Several approaches exist today for developing predictive models across multiple clinical sites, yet there is a lack of comparative data on their performance, especially within the context of EHR-based prediction models. We set out to provide a framework for prediction across healthcare settings. As a case study, we examined an ED disposition prediction model across three geographically and demographically diverse sites.

A Clinical Pathway for the Care of Critically Ill Patients With Asthma in the Community Hospital Setting.

Objectives: The management of severe pediatric asthma exacerbations is variable. The use of clinical pathways has been shown to decrease time to clinical recovery and length of stay (LOS) for critically ill patients with asthma in freestanding children's hospitals. We sought to determine if implementing a clinical pathway for pediatric patients who are on continuous albuterol in a community hospital would decrease time to clinical recovery and LOS.

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.

Value of point-of-care ketones in assessing dehydration and acidosis in children with gastroenteritis.

Objectives: Children with gastroenteritis often develop dehydration with metabolic acidosis. Serum ketones are frequently elevated in this population. The goal was to determine the relationship between initial serum ketone concentration and both the degree of dehydration and the magnitude of acidosis.

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.

Intravenous dextrose for children with gastroenteritis and dehydration: a double-blind randomized controlled trial.

Study Objective: We seek to determine whether an initial intravenous bolus of 5% dextrose in normal saline solution compared with normal saline solution will lead to a lower proportion of hospitalized patients and a greater reduction in serum ketone levels in children with gastroenteritis and dehydration.

Methods: We enrolled children aged 6 months to 6 years in a double-blind, randomized controlled trial of patients presenting to a pediatric emergency department. Subjects were randomized to receive a 20 mL/kg infusion of either 5% dextrose in normal saline solution or normal saline solution.

Intraosseous vascular access for in-hospital emergency use: a systematic clinical review of the literature and analysis.

Unlabelled: Intraosseous (IO) vascular access is a viable primary alternative in patients requiring emergent vascular access in the hospital emergency department (ED) (eg, resuscitation, shock/septic shock) but is underutilized.

Objectives: This review has 3 objectives: (1) review the evidence supporting the use of IO access; (2) determine the utilization of IO access as described in the literature; and (3) assess the level of specialty society support.

Methods: Electronic and hand searches were undertaken to identify relevant articles.

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.