Pediatric emergency care
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Pediatric emergency care · Dec 2009
Case ReportsBruising in infants: those with a bruise may be abused.
Bruising in the young infant is rare, and if present, this may be a manifestation of physical child abuse. Early signs of abuse, such as bruising, are often overlooked or their significance goes unrecognized resulting in poor patient outcomes. ⋯ This brief report presents 3 cases of nonmobile infants who presented to health care providers with bruising before a subsequent fatal or near-fatal event. These cases emphasize the importance of including abusive trauma in the differential diagnosis of an infant with a bruise or a history of easy bruising and the importance of initiating a thorough trauma evaluation immediately and concomitantly with any other workup for the causes of bruising in the noncruising infant.
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Pediatric emergency care · Dec 2009
Case ReportsBedside ultrasound diagnosis of pulmonary contusion.
A 10-year-old boy presented to the emergency department after being struck by a van while crossing the street. He complained of right side chest pain, and a chest radiography was suggestive of pulmonary contusion. The treating physician performed a bedside ultrasound that revealed a right-sided pulmonary contusion that was subsequently confirmed on computed tomography of the thorax. The sonographic features of pulmonary contusion are described, and the possible role of lung sonography in the assessment of pediatric thoracic trauma is discussed.
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Pediatric emergency care · Dec 2009
Comparative StudyAnalysis of parental and nurse weight estimates of children in the pediatric emergency department.
To evaluate the accuracy of parent and triage nurse estimates of children's weights in the pediatric emergency department. ⋯ Parents were more accurate at estimating children's weights than triage nurses but were within 10% of the children's actual weights only 79% of the time. Nurse estimates were highly inaccurate. Other methods to estimate patient weights should be used when actual patient weights are unobtainable.
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Pediatric emergency care · Dec 2009
Comparative StudyEvaluation of decision rules for identifying serious consequences of traumatic head injuries in pediatric patients.
We evaluated the existing decision rules and developed our own decision rule for use with pediatric patients having head injuries to see how good they are for identifying serious complications. ⋯ All the 3 existing decision rules tested had high sensitivities for at least complicated head trauma, but rather low specificity. Because the most optimal decision rule based on the present data was not superior to the existing ones, we conclude that it is difficult to develop a rule that would be markedly better than that of NEXUS II. Use of the NEXUS II rule would have resulted in reduced hospitalization and imaging rates in our hospital, where no decision rules are currently used.
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Pediatric emergency care · Dec 2009
Comparative StudyAdditive value of nuclear medicine shuntograms to computed tomography for suspected cerebrospinal fluid shunt obstruction in the pediatric emergency department.
To measure the predictive value of nuclear medicine studies (cerebrospinal fluid [CSF] shuntograms) and radiographic studies (computed tomographic [CT] scans) in a cohort of children undergoing evaluation for suspected shunt obstruction in a tertiary care pediatric emergency department (ED). ⋯ Over one third of pediatric ED patients evaluated with CT and CSF shuntograms required surgical management. Sensitivity was increased with CT and CSF shuntogram compared with CT alone. Prospective studies are required to assess the use of radiographic and nuclear medicine tests for the shunt evaluation in conjunction with the development of a clinical prediction rule for the pediatric emergency physician.