Pediatric emergency care
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Pediatric emergency care · Oct 1992
Risk factors for childhood sledding injuries: a case-control study.
We report the results of a case-control study designed to identify modifiable risk factors for childhood sledding injuries. Cases included all children injured while sledding (n = 17) during a five-day winter storm who presented for care to a Seattle pediatric emergency department. Two controls were chosen randomly for each case from children who presented to the same emergency department during the ensuing two months for any illness that did not require hospitalization. ⋯ Analysis of risk factors revealed a significant increase in risk of injury for children who sledded in streets versus those who sledded in a park (OR = 5.1; 95% CI = 1.1-24.1), those who sledded without adult supervision (OR = 5.6; 95% CI = 1.1-26.9), and those whose parents had an annual income > or = $50,000 (OR = 5.7; 95% CI = 1.5-20.8). No difference in risk of injury was found regarding the type of sled used, the number of children, or their position on the sled or for those children with a history of prior sledding experience. We conclude that safe alternatives to sledding in the streets and an increase in adult supervision may reduce the number of childhood sledding injuries.
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The majority of pediatric neoplasias of the brain are midline growths in the posterior fossa. These mass lesions lead to obstruction of cerebrospinal fluid circulation and cause increased intracranial pressure. Affected children typically present with insidious complaints of headache and vomiting. ⋯ In the reports describing pathognomonic clinical features of posterior fossa tumors, an accelerated presentation with minimal prodromal events has not been emphasized. This report details the case of a child with a cerebellar medulloblastoma who presented with abrupt onset of fever, nuchal rigidity, and altered mental status. Emergency department misdiagnosis occurred.
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The last decade has seen the introduction of freestanding emergency facilities, which provide an alternative to hospital emergency departments. The contribution made by these facilities to the clinical welfare of patients depends on their availability to deliver quality medical care without the need for frequent referral. This study describes the clinical experience of one such facility with pediatric patients and attempts to assess the quality of their care.