Pediatric emergency care
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Pediatric emergency care · Dec 2023
Assessment of the Interval to Diagnosis in Pediatric Bone Sarcoma.
The timely diagnosis of primary bone malignancies in pediatric patients is critical to clinical outcomes. The purpose of this study is to investigate the initial presentation of pediatric bone sarcoma patients to an academic health care system and assess the current interval to diagnosis. ⋯ We found pediatric patients with primary bone sarcoma present with an average interval to diagnosis of 20 days. Twenty percent of patients had a significantly prolonged interval to diagnosis of 54 days. Clinical features suggest night pain is not a sensitive indicator. In patients of appropriate age with persistent unilateral pain in suspicious locations, early advanced imaging with magnetic resonance imaging should be considered.
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Pediatric emergency care · Dec 2023
Observational StudySocial Determinants of Health Are Associated With Visits for Ambulatory Care Sensitive Conditions.
Population health experts have described the link between social factors and health, but few studies link specific social needs to disease processes. Nationwide Children's Hospital implemented a universal, annual screener for social determinants of health (SDH) in 2018. Early analyses have shown that patients identifying an SDH need were more likely to have an emergency department (ED) or inpatient stay. The objective of this study is to identify links between SDH and ED presentation for ambulatory care sensitive conditions (ACSCs). ⋯ The odds of ED presentation for ACSCs are higher in patients with expressed social needs. Further delineating the connections between specific SDH and health outcomes can inform timely and appropriate interventions.
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Pediatric emergency care · Dec 2023
Accidental and Abusive Mandible Fractures in Infants and Toddlers.
Mandible fractures are uncommon injuries in infants and young children and may raise concern for nonaccidental trauma. Our study describes several children with mandible fractures to identify features that might differentiate abuse from accident. ⋯ Infants and young children can sometimes sustain mandible fractures accidentally after well-described short falls with evidence of facial impact. Abuse remains in the differential diagnosis, and children should be evaluated accordingly. We propose that accidental injury be considered when a well-evaluated child with an isolated mandible fracture has a history of a short fall.
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Pediatric emergency care · Dec 2023
Nucleated Red Blood Cells Are Predictive of In-Hospital Mortality for Pediatric Patients.
We sought to establish whether nucleated red blood cells (NRBCs) are predictive of disposition, morbidity, and mortality for pediatric patients presenting to the emergency department (ED). ⋯ The presence of NRBCs is an independent predictor for mortality, including in-hospital mortality, ICU admission, CPR, and readmission within 30 days for children presenting to the ED.
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Sudden, Unexplained Death in Childhood (SUDC) is a term that encompasses apparently natural deaths in children over one year of age with no discernible cause despite a thorough assessment. Definitive underlying causes vary but most cases remain largely unexplained. Research has furthered the view that SUDC is not an accident, but rather a sentinel medical event for which a thorough postmortem investigation is indicated. Emerging evidence in genetics, neurology, and neuropathology point to heterogeneous causes that in some cases share features of recognized diseases.