Annals of emergency medicine
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We sought to identify the historical factors and physical examination findings typical of infants who have sustained isolated skull fracture (ISF)--in the absence of associated intracranial injury--after head trauma. We also assessed the risk of clinical deterioration (and therefore the need for inpatient observation) in infants with ISF. ⋯ A diagnosis of ISF should be considered even in infants with minor mechanisms of head injury who appear well. However, infants with ISF rarely present without local signs of head injury on physical examination. If no other specific clinical concerns necessitate hospital admission, infants with ISF who have reliable caretakers may be considered for discharge home.
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To address the need for coordinated care for children and their families during the acute care phase of their hospitalization. ⋯ One designated individual is essential during the acute care phase who can assist the family with gaining information and resources to ensure a successful transition to community services and resources. This article provides a framework for acute care facilities and providers to use in planning services and working with acutely ill and injured children. Several recommendations highlight the need for care coordination to be initiated early in the child's hospitalization. An overview of services and resources (both health and educational) that a child and family may need is also provided. Such services and resources include identifying a care coordinator, working with the family to identify a primary care provider before hospital discharge, and building bridges with community-based health and education services.
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To determine patient understanding of how to properly gain access to urgent and emergency medical care under TennCare, a government-mandated managed health care initiative designed to replace Medicaid in Tennessee. ⋯ Improvements in communication of pertinent information must be implemented in managed care systems such as TennCare to better inform participants of the proper use of the system. MCOs will not reduce inappropriate use of the ED if patients are not aware of their responsibilities and do not know their PCPs or how to gain access to them. PCP responsiveness to patients must also be improved.
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To determine the characteristics and health care experiences of patients who identify the ED as their usual source of care. ⋯ Low income, perceived mistreatment by health care providers, and misperception about charges contribute to use of the ED as a regular site for health care. These factors suggest the difficulty of altering health care use patterns in this group.