Pediatric emergency care
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Pediatric emergency care · Feb 2020
A Prospective Study of the Causes of Bruises in Premobile Infants.
This study had 2 objectives. First, to determine the behavior of physicians evaluating premobile infants with bruises. Second, and most importantly, to learn whether infants with unexplained bruising who had been initially evaluated by primary care and emergency department (ED) physicians are as likely to have their bruises attributed to child abuse as those children evaluated by child abuse physicians. ⋯ More than half of premobile infants with initially unexplained bruises were found to be abused. Abuse was as likely for infants identified by primary care and ED providers as for those identified by CAPs. Currently, physicians often do not obtain full abuse evaluations in premobile infants with unexplained bruising. Their initial clinical judgment about abuse likelihood was inadequate. Bruised infants often have clinically occult abusive injuries or will sustain subsequent serious abuse. Bruised infants should have full abuse evaluations and referral for Protective Services and police assessments.
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Pediatric emergency care · Feb 2020
Multicenter StudyReasons for Interfacility Emergency Department Transfer and Care at the Receiving Facility.
The aims of this study were to (1) assess the reasons for pediatric interfacility transfers as identified by transferring providers and review the emergency medical care delivered at the receiving facilities and (2) investigate the emergency department (ED) care among the subpopulation of patients discharged from the receiving facility. ⋯ Approximately 4 of 10 interfacility transfers are discharged by the receiving facility, suggesting an opportunity to provide more comprehensive care at referring facilities. On the basis of the care provided at the receiving facility, potential interventions might include increased subspecialty access and developing both ultrasound and sedation capabilities.
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Pediatric emergency care · Feb 2020
ReviewEarly Recognition and Emergency Treatment of Sepsis and Septic Shock in Children.
Early diagnosis and treatment of sepsis and septic shock in children results in improved outcomes. However, diagnosis is hampered by lack of specific diagnostic tests and relies on the recognition of the alterations of vital signs and protean systemic manifestations associated with infections, signs that mimic many critical illnesses. As a result, the early diagnosis of sepsis is usually presumptive and is based on the suspicion or presence of an infection in combination with the systemic changes. ⋯ To best accomplish these tasks, contemporary guidelines suggest that the use of a "recognition bundle" containing a trigger tool for rapid identification, a "resuscitation and stabilization bundle" to enable adherence to best practice, and a "performance bundle" to identify and overcome barriers to best practice be used. Although there are no universally acceptable tools to accomplish these tasks, the various iterations used in quality improvement initiatives have consistently demonstrated better care processes and outcomes. In this article, we outline the contemporary approach to sepsis in the first hours after presentation.
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Pediatric emergency care · Feb 2020
Utility of Postreduction Radiographs After Fluoroscopy-Guided Reduction and Casting of Uncomplicated Pediatric Forearm Fractures.
The aim of the study was to determine efficacy of performing postreduction radiographs in managing uncomplicated pediatric forearm fractures after reduction and casting under fluoroscopic guidance. ⋯ Performance of postreduction radiographs in children with uncomplicated pediatric forearm fractures that are reduced and casted under fluoroscopy has little clinical utility and contributes to increased radiation exposure, patient health care cost, and time spent in the ED. Patients with mid-shaft forearm fractures involving both radius and ulna (especially if angulated or displaced) are at risk for unacceptable reduction after casting and may be the target group in which performing post reduction radiographs has potential benefit.
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Pediatric emergency care · Feb 2020
Identifying Nonprovider Factors Affecting Pediatric Emergency Medicine Provider Efficiency.
The aim of this study was to create a multivariable model of standardized relative value units per hour by adjusting for nonprovider factors that influence efficiency. ⋯ Several nonprovider factors affect provider efficiency. These factors should be considered when designing productivity-based incentives.