Pediatric emergency care
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The objectives of this study were to determine reasons for leaving a pediatric emergency department before physician evaluation, any adverse outcomes of those leaving, and to assess whether the presence of an ombudsman altered the pattern. This was a prospective follow-up study of all patients who left the pediatric emergency department of the Children's Hospital of Michigan before physician evaluation between October 24, 1991 and January 30, 1992. Information was obtained from medical records and a telephone questionnaire with the parent or guardian one week later. ⋯ No deaths occurred. Hospitalization rates were significantly lower for patients who left compared with patients who stayed over the same period of time (7/419 vs 1931/16,990, P < 0.0001). The presence of an ombudsman was associated with an increase in walk-outs.(ABSTRACT TRUNCATED AT 250 WORDS)
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Pediatric emergency care · Apr 1994
Review Case ReportsThe use of autotransfusion in pediatric chest trauma.
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Pediatric emergency care · Apr 1994
Comparative StudyPediatric emergency training: an alternative teaching-patient care model.
We describe a cost-effective alternative to the pediatric and general emergency department (ED), the emergent/urgent care clinic (EUC). The vast majority of pediatric Medicaid-eligible patients are rerouted from the ED to the EUC, where they receive care from pediatric residents and faculty. ⋯ The cost of care in the EUC is significantly less than that in the ED, although the educational opportunities for house staff and patients are superior to those obtained in the traditional ED setting. A patient population that historically seeks episodic care in EDs is provided with continuity of care and disease prevention through screening, guidance, and up-to-date immunizations.
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Pediatric emergency care · Apr 1994
Comparative StudyThe role of bacterial antigen detection tests in the diagnosis of bacterial meningitis.
We sought to determine the circumstances under which cerebrospinal fluid (CSF) bacterial antigen detection tests. (BADT) are indicated. The medical records of 146 consecutive patients with bacterial meningitis seen from 1986 to 1991 were reviewed retrospectively (mean age 16 months; median eight months). Bacterial meningitis was defined as a positive CSF culture or a positive CSF BADT, in association with the clinical presentation and response to antibiotic treatment consistent with bacterial meningitis. ⋯ In this group, 15/61 (25%) of pretreated patients had a negative CSF culture but a positive CSF BADT. All 85 patients who did not receive antibiotics before lumbar puncture had positive CSF cultures and 52/75 (69%) had positive CSF BADT. Because prior antibiotic therapy may impair bacterial growth from the CSF, a CSF BADT should be performed whenever the patient has received prior antibiotic treatment.