Pediatric emergency care
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Intracranial hemorrhage secondary to head trauma is a major cause of morbidity and mortality in patients with bleeding disorders. Indications for head computerized tomographic scanning (CT scan) on patients with bleeding disorders who sustain head trauma are not well established. We retrospectively reviewed the medical records and head CT scan results of 21 patients with bleeding disorders. ⋯ In three of four patients with severe head trauma, the CT scan showed evidence of intracranial hemorrhage. In this series, all 17 patients with 24 episodes of moderate or minor head trauma had normal head CT scans. We conclude that a larger prospective study is needed to further evaluate the diagnostic value of head CT scan in hemophilia patients with minor or moderate head trauma, as defined in this study.
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Pediatric emergency care · Sep 1987
The effect of Medicaid criteria on pediatric emergency department visits.
The use of the emergency department by children on Medicaid was documented, and the effect of new adult Medicaid criteria on a pediatric emergency department was investigated. Eight percent of daytime visits by all patients were nonemergencies, compared to 15% by Medicaid patients. ⋯ Emergency department use by Medicaid patients was not decreased by the new criteria. Documentation of inappropriate denials of emergency care when criteria designed for adults were applied to pediatric patients was presented to state health officials and resulted in a change in the state Medicaid criteria for emergency care of children.
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During the period from July to November 1984, 265 consecutive febrile infants younger than one year of age were evaluated in a pediatric emergency department. None had a source of infection on physical examination, and all were admitted with the diagnosis of "rule out sepsis." During the month of July, all patients with positive urine culture results had their urine sample collected by bag. In no instance was there a clinical diagnosis of urinary tract infection because of the presence of contaminant bacteria. ⋯ The technique utilized for collecting urine for culture in infants has a major impact on the incidence of urinary tract infection. The absence of pyuria is not a reliable indicator of the absence of urinary tract infection. Infants with urinary tract infection may have a transient loss in urine concentrating ability early in the course of their infection.