Pediatric emergency care
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Pediatric emergency care · Jan 2022
Group A Streptococcal Pharyngitis Testing Appropriateness in Pediatric Acute Care Settings.
Acute pharyngitis is one of the most common causes of ambulatory clinic visits; however, group A Streptococcus accounts for less than a third. National guidelines recommend against streptococcal testing in patients with viral features. This study aims to assess the rate of inappropriate streptococcal rapid antigen detection tests (RADT)s in children evaluated in urgent care clinics (UCC)s and emergency department (ED)s at a children's hospital. ⋯ Quality improvement initiatives are needed to decrease the rate of inappropriate RADTs in pediatric UCC and ED settings.
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Pediatric emergency care · Jan 2022
Association of Risk of Mortality in Pediatric Patients Transferred From Scene by Helicopter With Major But Not Minor Injuries.
Helicopter emergency medical services (HEMS) are used for 16% of pediatric trauma. National HEMS guidelines advised that triage criteria be standardized for pediatric patients. A national report found pediatric HEMS associated with decreased mortality compared with ground emergency medical services (GEMS) but did not control for transport time. We hypothesized that the rate of HEMS has decreased nationally and the mortality risk for HEMS to be similar when adjusting for transport time compared with GEMS. ⋯ The rate of HEMS in pediatric trauma has decreased. However, there is room for improvement as 14% of those with minor trauma are transported by HEMS. Given the similar risk of mortality compared with GEMS, further development of guidelines that avoid the unnecessary use of HEMS appears warranted. However, utilization of HEMS for transport of pediatric major trauma should continue.
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Pediatric emergency care · Jan 2022
The Effect of Lidocaine Delivered by Jet Injection on First Attempt Venous Access Success Rates in the Pediatric Emergency Department.
Jet injection of 1% lidocaine (J-Tip) has been used in the pediatric emergency department (PED) to reduce pain associated with venipuncture, but there are limited data on the effect of J-Tip on first-attempt venous access success rates. We sought to determine if using a J-Tip altered the first-attempt venous access success rate in the PED. Then, we examined the effect of J-Tip use on pain scores and resource utilization during peripheral venous access. ⋯ Use of J-Tip in the PED to reduce pain associated with peripheral venous access did not lead to a reduction in first-attempt success rates for peripheral venous access. J-Tip was well received among nurses and parents and was associated with improved pain scores.
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Pediatric emergency care · Jan 2022
Do Victims of Abusive Head Trauma Visit Emergency Departments More Often Than Children Hospitalized for Fever? A Case-Control Study.
During the first years of life, infant crying is a common trigger of abusive head trauma (AHT). Emergency department (ED) use by AHT victims before visits for child abuse symptoms is not well known, particularly for infant crying. Furthermore, diagnosis could be missed. In the same period, fever is a common reason for hospitalization unconnected with AHT. The main goal of our study was to compare the ED use by AHT victims before visits for child abuse symptoms and by children of the same age hospitalized for fever. ⋯ Our study suggests that AHT victims had no more ED visits before visits for child abuse symptoms, particularly not for infant crying.
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This case describes an 18-year-old woman who presented to the pediatric emergency department with 2 days of worsening right knee pain and swelling. The patient's history was remarkable for a motor vehicle accident 12 days before presentation, as well as recent treatment for a gonococcal sexually transmitted infection 9 days before presentation. Her examination was notable for a large area of fluctuance of her right knee without overlying erythema or appreciable intraarticular effusion. ⋯ This was confirmed by radiology ultrasound, and the patient was seen by an orthopedic surgeon who recommended conservative management without aspiration of the fluid collection. To our knowledge, this is the first reported case of a Morel-Lavallee lesion being diagnosed by POCUS in a pediatric patient. This case demonstrates the utility of POCUS in facilitating the prompt recognition of shear injuries in children and guiding management in the emergency department.