Pediatric emergency care
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Pediatric emergency care · Jun 1986
Can Medicaid format alter emergency department utilization patterns?
Emergency department utilization by recipients of Aid to Families with Dependent Children (AFDC) in a metropolitan children's hospital was monitored during a 36-month period (July 1982 to June 1985). There were 92,495 emergency department visits recorded in this interval. During 12 months of this period (July 1983 to June 1984) a pilot program (Citicare) for AFDC recipients requiring prior authorization by the primary care physician for emergency department utilization was in effect. ⋯ There was no corresponding decline in the number of patients admitted to the hospital through the emergency department during the monitoring period with 3,545, 3,555, and 3,922 annualized admissions respectively, for the targeted 12-month periods. These data suggest that the format of Medicaid programs can dramatically alter the utilization of emergency department services. Furthermore, the primary impact of this specific program was to decrease inappropriate emergency department use.
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Management of thyroid hormone ingestion is controversial. We present nine children with massive levothyroxine ingestion who experienced a benign course. Their serum thyroxine levels ranged from 19.9 to 84.7 micrograms/dl. ⋯ However, massive ingestion of thyroid extract or triiodothyronine may require immediate hospitalization for observation. Therapeutic interventions aimed at extracorporeal removal of excess thyroid hormones are not recommended. Specific antithyroid therapy should be reserved for those rare patients with significant symptoms of thyrotoxicosis.