Pediatric emergency care
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Pediatric emergency care · Dec 2009
Comparative StudyAdditive value of nuclear medicine shuntograms to computed tomography for suspected cerebrospinal fluid shunt obstruction in the pediatric emergency department.
To measure the predictive value of nuclear medicine studies (cerebrospinal fluid [CSF] shuntograms) and radiographic studies (computed tomographic [CT] scans) in a cohort of children undergoing evaluation for suspected shunt obstruction in a tertiary care pediatric emergency department (ED). ⋯ Over one third of pediatric ED patients evaluated with CT and CSF shuntograms required surgical management. Sensitivity was increased with CT and CSF shuntogram compared with CT alone. Prospective studies are required to assess the use of radiographic and nuclear medicine tests for the shunt evaluation in conjunction with the development of a clinical prediction rule for the pediatric emergency physician.
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Pediatric emergency care · Dec 2009
Risk factors for extremely long length-of-stay among pediatric emergency patients.
Over time, we observed more visits in our pediatric emergency department with length-of-stay (LOS) of more than 10 hours, whereas our mean LOS was approximately 3 hours. We sought to characterize factors associated with this extremely long LOS. ⋯ In our pediatric emergency department, risk factors for LOS more than 10 hours included longer waiting time, night shift arrivals, high triage acuity, radiology studies, and subspecialty consultations. These factors may also be important considerations for quality improvement initiatives at other institutions.
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Pediatric emergency care · Dec 2009
Case ReportsGastric artery apoplexy presenting as an acute abdomen in an adolescent.
Nontraumatic abdominal apoplexy, which is the occurrence of hemorrhage into the peritoneal cavity, is uncommon in the pediatric literature. Adult case reports of nontraumatic abdominal apoplexy include visceral artery aneurysms from the aorta, splenic, celiac, hepatic, gastric, and gastroepiploic arteries as well as gynecologic pathology. We identified 2 case reports of spontaneous abdominal apoplexy due to injury of the short gastric arteries in adult patients with histories of vomiting after alcohol consumption. This is the first reported case of nontraumatic abdominal apoplexy due to injury to the short gastric arteries in a pediatric patient.
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Pediatric emergency care · Dec 2009
Changing incidence of methicillin-resistant staphylococcus aureus skin abscesses in a pediatric emergency department.
The primary objective of this study was to determine the etiology of skin abscesses in a pediatric emergency department (ED) during a 4-year period and to determine whether the incidence of methicillin-resistant Staphylococcus aureus (MRSA) skin abscesses has increased. The secondary objective was to characterize MRSA infections by antibiotic susceptibility during the same period. ⋯ The incidence of MRSA skin abscesses has increased in the pediatric ED population and now accounts for greater than 50% of all abscesses. If antimicrobial therapy is indicated for the treatment of these abscesses, cultures should be obtained, and antibiotics should be chosen to provide MRSA coverage.
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Pediatric emergency care · Dec 2009
Case ReportsBedside ultrasound diagnosis of pulmonary contusion.
A 10-year-old boy presented to the emergency department after being struck by a van while crossing the street. He complained of right side chest pain, and a chest radiography was suggestive of pulmonary contusion. The treating physician performed a bedside ultrasound that revealed a right-sided pulmonary contusion that was subsequently confirmed on computed tomography of the thorax. The sonographic features of pulmonary contusion are described, and the possible role of lung sonography in the assessment of pediatric thoracic trauma is discussed.