Pediatric emergency care
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Identification of a neonatal horseshoe kidney in the emergency department is uncommon but has implications for future healthcare planning for patients. We present a case of a neonate with bloody diapers who was evaluated with renal point-of-care ultrasound (POCUS) that identified a horseshoe kidney. ⋯ Midline interrogation is not part of the routine technique for ultrasound imaging of the kidney but should be considered when the limits of the lower pole of bilateral kidneys are difficult to visualize. This case highlights the importance of understanding normal anatomical landmarks when performing renal POCUS to identify renal anomalies.
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Pediatric emergency care · Dec 2024
Use of Emergency Telemedicine Physicians for Telephone Triage Disposition of Pediatric Patients.
Telemedicine is a growing field, with limited data around its utility supporting pediatric emergency care telephone triage. We instituted telemedicine physician support for nurse telephone triage decisions. When the nursing protocols recommended urgent or emergent care, a telemedicine physician reviewed and modified care urgency if appropriate. Our primary study objectives were to evaluate the proportion of patients who were downgraded to less urgent care and assess for potential harm related to the downgrade in care urgency. ⋯ Our data suggests that telemedicine physicians can safely downgrade nurse triage care recommendations for pediatric patients. Most downgraded patients sought outpatient care, avoiding unnecessary utilization of the emergency department without evidence of associated harm.
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Pediatric emergency care · Dec 2024
"Room of Horrors": A Proof-of-Concept Simulation Model for Error Reduction Training in the Emergency Department.
This pilot study aimed to assess the effectiveness of a "room of horrors" (RoH) simulation in identifying patient safety threats in a pediatric emergency department (PED) and to evaluate health care workers' (HCWs') perceptions of the experience. ⋯ The RoH simulation experience was effective in evaluating the level of retention of earlier training and the ability of multidisciplinary teams to correctly identify major safety threats in a PED setting. The participants found the experience valuable and engaging. Future research should focus on other means by which the retention of learned skills can be reinforced and new safety threats can be identified with a high level of alertness.
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Pediatric emergency care · Dec 2024
Pediatric Emergency Medicine Physicians' Perspectives of Concussion in Young Children.
Traumatic brain injury (TBI) during early childhood (before 6 years) is prevalent, accounting for rising rates of emergency department visits. These injuries may lead to postconcussive symptoms, which may be subtle and difficult to diagnose in young children. Inadequate discharge counseling may lead to prolonged duration of symptoms and possible developmental delays. We aimed to explore pediatric emergency medicine (PEM) physicians' perspectives on "concussion" terminology, diagnosis, and management, specifically in a young child with mild TBI. ⋯ Variability exists among PEM physicians in diagnosis and management of concussions in young children. Discomfort with lack of reliability of symptoms and underappreciation of typical early childhood characteristics may account for findings. Educational initiatives, age-appropriate clinical tools and treatment-guided outcomes research are needed to guide PEM physicians in the care of young children with head injuries.
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Pediatric emergency care · Dec 2024
External Validation of the Surgical Intervention for Traumatic Injuries Scale in Children.
The Surgical Intervention for Traumatic Injuries (SITI) scale is intended to predict the likelihood of needing surgical decompression among patients with traumatic brain injury (TBI). We sought to examine the performance of the SITI score to predict likelihood of acute neurosurgical intervention for children with TBI. ⋯ A SITI score of less than 2 is associated with nonoperative management. However, clinicians should not be falsely reassured by a low score in patients with depressed skull fractures.