Pediatric emergency care
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Pediatric emergency care · Dec 2024
Changes in Emergency Department Practices After Implementation of a Standardized Heavy Menstrual Bleeding Guideline.
The aim of the study is to assess the effect of an emergency department (ED) standardized clinical guideline for adolescent heavy menstrual bleeding on the rate of return ED visits and ED provider history-taking and management of this condition. ⋯ Implementation of a clinical guideline pathway improved provider documentation and history taking, increased referrals to specialist care, and significantly decreased return ED visits within 3 weeks for heavy menstrual bleeding complaints.
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Pediatric emergency care · Dec 2024
Missed Opportunity for Initial Diagnosis in Children With Complex Appendicitis.
Delayed diagnosis of acute appendicitis in children may result in complex appendicitis with appendiceal perforation. Delayed diagnosis can result from missed opportunity for initial diagnosis (MOID) despite medical attention. Studies report MOID of less than 5% in pediatric emergency departments (EDs), but we hypothesized that many MOID occurs outside tertiary care facilities. Our goals were to determine the MOID rate in all presenting facilities in children with complex appendicitis and to identify associated risk factors. ⋯ Missed opportunity for initial diagnosis of complex appendicitis occurs in nontertiary care facilities, is more common in younger children and non-English/Spanish speakers, and is associated with worse outcomes, highlighting the need for interpreters and algorithmic evaluation in nontertiary care facilities.
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Pediatric emergency care · Dec 2024
Accuracy of ICD-10 Codes for Suicidal Ideation and Action in Pediatric Emergency Department Encounters.
According to the ideation-to-action framework of suicidality, suicidal ideation and suicidal action arise via distinct trajectories. Studying suicidality under this framework requires accurate identification of both ideation and action. We sought to assess the accuracy of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for suicidal ideation and action in emergency department encounters. ⋯ Many cases of suicidality may be missed by relying on only ICD-10-CM codes. Accuracy of ICD-10-CM codes is high for suicidal ideation but low for action. To scale the ideation-to-action model for use in large populations, better data sources are needed to identify cases of suicidal action.
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Pediatric emergency care · Dec 2024
Intensive Asthma Therapy and Intravenous Magnesium Sulfate in the Emergency Department Management of Pediatric Asthma.
The aim of the stud is to determine whether intravenous magnesium sulfate (IVMg) is associated with hospitalization and time to albuterol every 4 hours in a cohort of children who received intensive asthma therapy (IAT) in the emergency department (ED). ⋯ Children who received IAT and IVMg in the ED for management of an acute asthma exacerbation had significantly higher odds of hospitalization without any improvement in the time to albuterol every 4 hours for admitted patients. The results of this observational study underscore the need for randomized controlled trials to determine the efficacy of IVMg for acute pediatric asthma.
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Pediatric emergency care · Dec 2024
Incidence of Sexually Transmitted Infections and Pregnancy Among Adolescents Experiencing Sex Trafficking.
There is a lack of data regarding the incidence of sexually transmitted infections (STIs) and pregnancy among adolescents experiencing sex trafficking. This study aimed to determine the incidence proportion of STIs and pregnancy among adolescents evaluated for sex trafficking at an urban tertiary children's hospital compared to the community adolescent population. ⋯ Adolescents experiencing sex trafficking have a significantly higher rate of STIs and pregnancy than the community adolescent population.