Pediatric emergency care
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The diagnosis of pediatric appendicitis can be difficult, with a substantial proportion misdiagnosed based on clinical features and laboratory tests alone. Accordingly, advanced imaging with ultrasound (US), computed tomography (CT), and/or magnetic resonance imaging has become routine for most children undergoing diagnostic evaluation for appendicitis. ⋯ Because magnetic resonance imaging has the advantage over CT of not using contrast or ionizing radiation, it may replace CT in many instances, whether after US as part of a stepwise imaging algorithm or as a primary imaging modality. Accessibility and cost, however, limit its more widespread use currently.
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Pediatric emergency care · Jan 2019
Multicenter StudyAssociation of Delay in Appendectomy With Perforation in Children With Appendicitis.
The aim of this study was to assess whether increased time from emergency department (ED) triage to appendectomy is associated with a greater risk of children developing appendiceal perforation. ⋯ Delays in appendectomy were associated with an increase in the odds of perforation. These results suggest that prolonged delays to appendectomy might be harmful for children with appendicitis and should be minimized to prevent associated morbidity.
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Pediatric emergency care · Jan 2019
Multicenter StudyApplication of the Rochester Criteria to Identify Febrile Infants With Bacteremia and Meningitis.
The Rochester criteria were developed to identify febrile infants aged 60 days or younger at low-risk of bacterial infection and do not include cerebrospinal fluid (CSF) testing. Prior studies have not specifically assessed criteria performance for bacteremia and bacterial meningitis (invasive bacterial infection). Our objective was to determine the sensitivity of the Rochester criteria for detection of invasive bacterial infection. ⋯ The Rochester criteria identified 92% of infants aged 60 days or younger with invasive bacterial infection. However, 1 neonate 28 days or younger with meningitis was classified as low-risk.
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Pediatric emergency care · Jan 2019
ReviewPoint-of-Care Ultrasound in Pediatric Diagnostic Dilemmas: Two Atypical Presentations of Intussusception.
Diagnostic dilemmas are ubiquitous in pediatric emergency medicine because of the varied and often insidious presentations of many pediatric conditions. Point-of-care ultrasound (POCUS) in emergency departments is being used for some of these diagnostic challenges and can often provide rapid and valuable information to supplement a physician's clinical assessment. ⋯ Here we present two challenging cases of intussusception, one due to its atypical age of presentation and the other due to its unique symptoms. These cases demonstrate the benefits of point-of-care ultrasound for diagnostically challenging cases in the emergency department.
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Pediatric emergency care · Jan 2019
Review Case ReportsUnilateral Lung Whiteout in Children: Four Cases and a Discussion of Management.
Unilateral lung whiteout is not a common pediatric chest radiograph finding, but when it is encountered, timely and accurate interpretations of the radiograph are required because life-threatening respiratory failure can be associated. Lung whiteout may result from several conditions, and the differential diagnosis has a broad range. ⋯ The ultimate causal diagnosis may not be initially obvious, but valuable clues can usually be found in the conventional chest radiograph to assist with appropriate early management. Chest ultrasound provides additional information, and we recommend it as the second examination for such patients.