Pediatric emergency care
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Pediatric emergency care · Nov 2009
Comparative StudyImpact of rapid streptococcal test on antibiotic use in a pediatric emergency department.
Acute pharyngitis is commonly seen in children. Group A beta-hemolytic Streptococcus is the most common bacterial cause of acute pharyngitis and accounts for approximately 15% to 30% of cases in children, but this condition is generally overdiagnosed and overtreated. The availability of rapid streptococcal tests (RSTs) have made this diagnosis simpler and reduced the use of antibiotics. Overuse of antibiotics leads to drug-resistant bacterial strains. Reducing the number of antibiotic prescriptions provided for upper respiratory tract infections has been strongly recommended to limit bacterial resistance. ⋯ The availability of a RST could substantially reduce the unnecessary prescription of antibiotics. This study supports the screening of all children with pharyngitis by performing an RST to guide decision making for antibiotic administration. This strategy has a significant impact on reducing the antibiotic prescription rate to almost 50%. In addition, only 2 children (0.04%) had negative rapid antigen test results with cultures positive for Streptococcus.
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Pediatric emergency care · Nov 2009
Comparative StudyThe effect of diagnosis-specific computerized discharge instructions on 72-hour return visits to the pediatric emergency department.
The number of patients returning to the pediatric emergency department (PED) within 72 hours of discharge is frequently cited as a benchmark for quality patient care. The purpose of this study was to determine whether the introduction of diagnosis-specific computer-generated discharge instructions would decrease the number of medically unnecessary return visits to the PED. ⋯ Computer-generated diagnosis-specific discharge instructions do not decrease the number of medically unnecessary repeat visits to the PED.
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Pediatric emergency care · Nov 2009
Comparative StudyThe Emergency Severity Index Version 4: reliability in pediatric patients.
The Emergency Severity Index version 4 (ESI v.4) is a triage system, which demonstrates reliability in adult populations, however, it has not been extensively studied in pediatrics. The goal of this study was to measure interrater reliability and agreement rates within and between a group of pediatric emergency medicine physicians and pediatric triage (PT) nurses using ESI v.4 in a pediatric population. ⋯ ESI v.4 is a reliable tool for triage assessments in pediatric patients when used by experienced pediatric emergency medicine physicians and PT nurses. It is a triage system with high agreement between physicians and nurses.
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Pediatric emergency care · Nov 2009
Comparative StudyGastrostomy tube-related complaints in the pediatric emergency department: identifying opportunities for improvement.
To describe the pediatric emergency medicine management of patients who present with gastrostomy tube (G-tube)-related complaints and identify opportunities for improving care and preventing G-tube complications. ⋯ Patients with G-tubes had approximately 1.25 mean ED visits per year for G-tube complaints. The most common G-tube complaint was dislodgement. Most dislodged G-tubes were replaced by ED physicians without the assistance of surgeons, but documentation of management and methods of securing the tubes was often incomplete. There were few major complications or hospitalizations. Treatment guidelines are presented that emphasize documentation of confirming G-tube location at the time of disposition from the ED.