AbstractText: To characterize alterations in Spanish language medical interpretation during pediatriccriticalcare family meetings AbstractText: Descriptive, observational study using verbatim transcripts of nine PICU family meetings conducted with in-person, hospital-employed interpreters AbstractText: A single, university-based, tertiary children's hospital AbstractText: Medical staff, family members, ancillary staff, and ...
We sought to characterize how citizens wish to be engaged in care and research in the intensive care unit (ICU).Interviewers administered questionnaires to visitors in 3 adult ICUs and 1 pediatricICU.We surveyed 202 (adult [n = 130] and pediatric [n = 72]) visitors. Adults and pediatric visitors prioritized 3 patient care topics (family involvement in rounds, improving communication between ...
AbstractText: Noise pollution in pediatricintensivecare units (PICU) contributes to poor sleep and may increase risk of developing delirium. The Environmental Protection Agency (EPA) recommends <45 decibels (dB) in hospital environments. The objectives are to assess the degree of PICU noise pollution, to develop a delirium bundle targeted at reducing noise, and to assess the effect of the bundle ...
AbstractText: The Paediatric Research in Emergency Departments International Collaborative (PREDICT) performs multicentre research in Australia and New Zealand ... on individual interests or prior work AbstractText: To identify the research priorities of paediatricemergency medicine (PEM) specialists working in Australia and New Zealand AbstractText: Online surveys were ... Keyword: PaediatricEmergency Medicine.
AbstractText: The purpose of this study was to explore clinical characteristics and primary surgical diagnoses associated with in-hospital death in pediatric surgical patients admitted to the neonatalintensivecare unit (NICU) of a tertiary hospital AbstractText: This retrospective study includes all patients admitted to our NICU for pediatric surgical diseases ...
Hernia (1), Intestinal Atresia (1), Pathologic Constriction (1), more mentions
AbstractText: Pediatricemergency tapes have been developed to support paramedics and emergency physicians when dosing drugs and selecting medical equipment in pediatricemergency situations ... of this study was to compare the accuracy of 4 pediatricemergency tapes to correctly estimate patient's weight based on a large ... strategies have to be developed to improve weight estimation in pediatricemergency situations.
The objectives are to describe the experience of children and parents in a pediatricemergency service (PED) and to determine whether there are differences of opinion between the two groups... Overall, the experience of children and parents in the pediatricemergency department in the study is positive. Some aspects of the experience in emergency are poorly rated by the children ...
... to describe the use, safety, and efficacy of olanzapine in pediatricemergency patients AbstractText: A structured chart review was performed of patients ... or younger receiving olanzapine from 2007 to 2016 in the emergency department of a pediatric level I trauma center AbstractText: A total of 285 children ... seems safe when used for a variety of conditions in pediatricemergency patients.
Neurological and Central Nervous System Diseases (1) Headache (3), Dystonia (1), Hypoxia (1), more mentions
AbstractText: To determine how many children are admitted to paediatricintensivecare unit (PICU) with life-limiting conditions (LLCs) and their outcomes ... January 2004 and 31 March 2015) were identified in the PaediatricIntensiveCare Audit Network dataset... There is an opportunity to integrate specialist paediatric palliative care services with paediatriccriticalcare to enable choice around place of care for these children ...
... of hospital characteristics associated with RV and RVA rates AbstractText: Pediatric Health Information System with survey of emergency department directors AbstractText: Adjusted return rates were calculated with generalized ... Hospitals in the highest RV rate outlier group had lower pediatricemergency medicine specialist staffing, calculated as full-time equivalents per 10 ...
Abstract: Pediatricemergency physicians at Kaplan Medical Center regularly reduce forearm fractures under point-of-care ultrasound guidance in the pediatricemergency department. We present 3 children who arrived at our department with shortened, angulated forearm fractures within the span of a single week. We report on the successful reduction of these fractures under point-of-care ultrasound and on ...
AbstractText: Every year, emergency medical services agencies transport approximately 150,000 pediatric patients between hospitals ... and components of written interfacility transfer guidelines and agreements for pediatric patients via a survey sent to US hospital emergency department (ED) nurse managers during 2010 and 2013 AbstractText: Although ... Hospitals with advanced pediatric resources, such as a pediatricemergency care coordinator or EDs designated approved for pediatrics, were more likely to have guidelines or agreements than less ...
AbstractText: Pediatric returns to the emergency department (RTED) vary between 3% and 13% of the total ED volume of visits. However, the incidence and contribution of scheduled RTED on pediatricemergency department (PED) utilization is less clear. Antimicrobial stewardship programs on inpatient wards have been shown to improve judicious use of outpatient parenteral antimicrobial therapy (OPAT) in upon discharge.
Urology (2), Infectious Diseases (1), Men's Health (1) Pneumonia (2), Urinary Tract Infections (2), Cellulitis (2), more mentions
BACKGROUND: Evidence suggests emergency department (ED) overcrowding is associated with poor health outcomes. Children comprise 20-25% of general ED visits, yet few studies have examined the differential impact of ED overcrowding on pediatric and adult populations.
OBJECTIVE: The primary objective of this study was to compare flow measures, such as wait time to see a physician, length of stay (LOS), and rate of patients leaving without being seen by a physician (LWBS) between adults and children in British Columbia and Ontario, clustered by province, and then stratified by acuity level during the study period.
METHODS: We conducted a retrospective, repeated cross-sectional study using administrative data from all community EDs in Ontario and 10 EDs in the Vancouver Lower Mainland, British Columbia. Visits from January 1, 2008 and December 31, 2012 were included.
RESULTS: Visit volumes increased 13.9% per year in British Columbia and 2.2% per year in Ontario, with a more pronounced rise in adult visits. Both groups displayed a shift toward higher-acuity presentations. Adults spent more time in the ED compared to children (36 to 53 min longer), and were more likely to be admitted. Children consistently spent a greater portion of their visit awaiting assessment compared to adults.
CONCLUSIONS: In the context of system incentives to reduce overcrowding, ED LOS and the LWBS rate did not significantly change for either children or adults, despite increased visit volume and acuity. Our findings suggest that measures to improve patient flow might have provided EDs with the means to meet increased demands on departmental resources.
OBJECTIVES: For many children, the Emergency Department (ED) serves as the main destination for health care, whether it be for emergent or non-urgent reasons. Through examination of repeat utilization and ED reliance, in addition to overall ED utilization, we can identify subpopulations dependent on the ED as their primary source of health care.
METHODS: Nationally representative data from the 2010-2014 Medical Expenditure Panel Survey (MEPS) were used to examine the annual ED utilization of children age 0-17 years by insurance coverage. Overall utilization, repeat utilization (≥2 ED visits), and ED reliance (percentage of all health care visits that occur in the ED) were examined using multivariate models, accounting for weighting and the complex survey design. High ED reliance was defined as having >33% of outpatient visits in a year being ED visits.
RESULTS: A total of 47,926 children were included in the study. Approximately 12% of children visited an ED within a one-year period. A greater number of children with public insurance (15.2%) visited an ED at least once, compared to privately insured (10.1%) and uninsured (6.4%) children. Controlling for covariates, children with public insurance were more likely to visit the ED (adjusted odds ratio [aOR]: 1.55; 95% confidence interval [CI]: 1.40-1.73) than children with private insurance, whereas uninsured children were less likely (aOR: 0.64; 95% CI: 0.51-0.81). Children age three and under were significantly more likely to visit the ED than children age 15-17, whereas female children and Hispanic and non-Hispanic other race children were significantly less likely to visit the ED than male children and non-Hispanic white children. Among children with ED visits, 21% had two or more visits to the ED in a one-year period. Children with public insurance were more likely to have two or more visits to the ED (aOR: 1.53; 95% CI: 1.19-1.98) than children with private insurance whereas there was no significant difference in repeat ED utilization for uninsured children. Publicly insured (aOR: 1.70; 95% CI: 1.47-1.97) and uninsured children (aOR: 1.90; 95% CI: 1.49-2.42) were more likely to be reliant on the ED than children with private insurance.
CONCLUSIONS: Health insurance coverage was associated with overall ED utilization, repeat ED utilization, and ED reliance. Demographic characteristics, including gender, age, income, and race/ethnicity were important predictors of ED utilization and reliance. This article is protected by copyright. All rights reserved.
Abstract: We present a case of an adolescent patient with multiple mandibular fractures diagnosed by point-of-care ultrasound in the pediatricemergency department. Sonographic findings consistent with fracture were identified in our patient, and early consultation expedited interdepartmental coordination and disposition. The role of ultrasound in identifying various traumatic orthopedic and maxillofacial injuries is discussed.
OBJECTIVES: To characterize pediatric patient contacts with their primary care clinic in the 2 days preceding a visit to the emergency department (ED) and explore how the type of clinic contact relates to ED resource use.
STUDY DESIGN: We conducted a retrospective chart review of 368 pediatric ED visits in the first 7 days of each month, from September 2012 to August 2013. Visits were included if the family contacted their child's general pediatric clinic in the study health system in the 2 days preceding the ED visit. Descriptive statistics were calculated. Primary outcomes were ED resource use (tests, treatments) and disposition (admission or discharge). Outcomes by type of clinic contact were compared with χ(2) statistics.
RESULTS: Of 1116 records with ED visits in the 12 study weeks extracted from the electronic medical record, 368 ED visits met inclusion criteria. Most ED visits followed a single clinic contact (78.8%). Of the 474 clinic contacts, 149 were in-person visits, 216 phone calls when clinic was open, and 109 phone calls when clinic was closed. ED visits that followed an in-person clinic contact with advice to go to the ED had significantly greater rates of testing and admission than those advised to go to the ED after phone contact and those never advised to go to the ED.
CONCLUSIONS: In-person clinic visits with advice to go to the ED were associated with the greatest ED resource use. Limitations include a study of a single health system without a uniform process for triaging patients to the ED across clinics.
BACKGROUND: Investigators have derived cervical spine injury (CSI) decision support tools from physician observations. There is a need to demonstrate that prehospital emergency medical services (EMS) providers can use these tools to appropriately determine the need for spinal motion restrictions and make field disposition decisions.
OBJECTIVE: To determine the inter-observer agreement between EMS and emergency department (ED) providers for CSI risk assessment variables and overall gestalt for CSI in children after blunt trauma.
METHODS: This was a planned, sub-study of a four-site, prospective cohort of children <18 years transported by EMS to pediatric EDs for evaluation of CSI after blunt trauma. Inclusion criteria were trauma team activation and/or EMS-initiated spinal motion restriction. Exclusion criteria were penetrating trauma, transfer to another facility for definitive care, state custody or substantial language barrier. For each eligible child, the transporting EMS provider and treating ED provider independently recorded their clinical assessment for CSI. This included mechanism of injury and patient history and physical examination findings. We assessed each paired variable for inter-observer agreement between EMS and ED provider using kappa (κ) analysis. We considered variables with κ lower confidence interval (LCL) values ≥0.4 to have moderate or better agreement.
RESULTS: We obtained 1,372 paired observations for 29 variables. After adjusting for finding prevalence and observer bias, all variables achieved moderate to better agreement including eight variables previously shown to be independently associated with CSI in children: diving mechanism, high-risk motor vehicle crash, altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, and predisposing medical condition. EMS and ED providers, however, showed less than moderate agreement for their overall gestalt for CSI in children. Of note, both EMS and ED providers did not assess for neck pain, inability to move the neck and/or cervical spine tenderness in more than 10% of study patients.
CONCLUSION: EMS and ED providers achieved at least moderate agreement in the assessment of CSI risk factors in children after blunt trauma. However, EMS and ED providers did not achieve moderate agreement on gestalt for CSI and some risk factors went unassessed by providers. These findings support the development of a pediatric CSI risk assessment tool for EMS and ED providers to reduce interventions for those children at very low-risk for CSIs while still identifying all children with injury. This article is protected by copyright. All rights reserved.