Pediatric emergency care
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Pediatric emergency care · Jul 2013
ReviewUtilizing E-coded data for nonfatal injury surveillance in the pediatric emergency department setting: a literature review and recommendations.
Injury surveillance in the pediatric emergency department (PED) has the potential to be an important part of program planning and clinical management. However, a lack of data has been identified as one of the critical limitations in the field of pediatric emergency services research. The aims of this article were to investigate how injury surveillance has been attempted in the PED and to develop an understanding of why E-coding has not met its full potential as an injury surveillance tool in this setting. ⋯ Two of the 5 injury surveillance articles collected injury data from questionnaires completed by physicians, which is not a long-term, sustainable approach to injury surveillance. An ideal injury surveillance system for the PED should be designed with at least 3 main elements: minimal economic and resource burden, substantial practical uses, and measures to ensure data quality.
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Pediatric emergency care · Jul 2013
Comparative StudyClinical factors and incidence of acute chest syndrome or pneumonia among children with sickle cell disease presenting with a fever: a 17-year review.
The objectives of this study were to determine the incidence of acute chest syndrome (ACS) in children with sickle cell disease (SCD) presenting with fever before and after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) and to determine clinical factors associated with ACS for a febrile child with SCD. ⋯ The incidence of ACS has decreased over time in febrile children with SCD. No effect was seen in those 2 years or younger. Children with SCD presenting with a fever had higher odds of developing ACS when accompanied by certain clinical, demographic, and laboratory features.
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Periodic fevers are acquired or inherited disorders of innate immunity, which were first described in the 1940s. The patients are typically young at onset and have regularly recurring fevers for a few days to a few weeks with systemic inflammatory symptoms that are interrupted by symptom-free periods. ⋯ This clinical review focuses on a sample of autoinflammatory disorders including familial Mediterranean fever, tumor necrosis factor receptor 1-associated periodic syndrome, hyperimmunoglobulinemia D syndrome, the cryopyrin-associated periodic syndrome, and periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome. We review the basics, pertinent clinical and laboratory features, and management of each entity.
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Pediatric emergency care · Jul 2013
Review Meta AnalysisA systematic review and meta-analysis of new interventions for peripheral intravenous cannulation of children.
Establishing intravenous access in children is often challenging for health professionals. Multiple attempts at peripheral intravenous cannulation (PIVC) cause increased pain and delayed delivery of therapy. Our objective was to synthesize and evaluate the best evidence for novel interventions designed to improve pediatric PIVC. ⋯ Near-infrared light devices might be efficacious in selected subpopulations, but the available evidence does not support an overall benefit in the pediatric population. Transilluminators modestly improve pediatric PIVC, but the clinical significance of this benefit is questionable. Nitroglycerin ointments may increase the risk of PIVC failure and are associated with adverse effects.
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Pediatric emergency care · Jul 2013
Poor access to timely pain reduction interventions for pediatric patients with supracondylar humerus fracture.
The purpose of this study was to describe the use of analgesic interventions in children with acute supracondylar fractures presenting to a pediatric emergency department (ED) and to explore the relationship between timely interventions and severity of injury. ⋯ Children presenting to a pediatric ED with a painful injury had low access to early systemic analgesics and backslab immobilization. Many factors may have played a role, including lack of mandated documentation of a formal pain score and lack of a medical directive allowing triage nurses to administer analgesics in the institution studied.