Pediatric emergency care
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Pediatric emergency care · Oct 2006
Cost-effectiveness analysis of sedation and analgesia regimens during fracture manipulation in the pediatric emergency department.
To conduct a cost-effectiveness analysis, from a hospital's perspective, of 4 procedural sedation and analgesia (PSA) regimens to facilitate forearm fracture manipulation in the pediatric emergency department (ED): deep sedation with ketamine/midazolam (K/M) administration, propofol/fentanyl administration, fentanyl/midazolam (F/M) administration, and axillary block. ⋯ Among PSA regimens during forearm fracture manipulation in the pediatric ED, propofol/fentanyl is the most cost-effective regimen followed by axillary block, K/M, and F/M.
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Pediatric emergency care · Sep 2006
Methods of categorizing emergency department visit urgency: a survey of pediatric emergency medicine physicians.
Between 20% and 80% of emergency department (ED) visits are nonurgent. This variability in estimates is partially due to the multiple classification methods used, none of which has undergone validity or reliability testing. Our objectives were to determine the methods thought to be most valid and to understand expert perceptions of nonurgent ED utilization. ⋯ Methods using complete medical record information are favored to determine ED visit urgency. Resource utilization and nurse triage are preferred when limited data are available. This survey will serve as the basis for endorsement of methodologically sound criteria for ED visit urgency.
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Pediatric emergency care · Sep 2006
Prevalence of tubo-ovarian abscess in adolescents diagnosed with pelvic inflammatory disease in a pediatric emergency department.
The rate of tubo-ovarian abscess (TOA) in adolescents with pelvic inflammatory disease (PID) is reported to range from 17% to 20%. However, no reports have focused specifically on the adolescent patient presenting to the emergency department (ED), regardless of whether they are treated in the inpatient or outpatient setting. Recent changes in the 2002 Centers for Disease Control and Prevention (CDC) Guidelines for the Treatment of Sexually Transmitted Diseases and sexually transmitted infection screening programs are likely to have impacted both the prevalence of PID and the rates of its complications, particularly TOA. Given that most patients with PID are treated as outpatients, it is imperative to accurately assess the prevalence of TOA in this population. Therefore, we sought to determine the rate of TOA in female adolescents diagnosed with PID in a large urban pediatric ED. ⋯ The rate of TOA in adolescents diagnosed with PID in an urban pediatric ED is much lower than the rates previously reported in adolescents. This lower prevalence may be attributed to the broader 2002 CDC guidelines for diagnosing PID. In addition, community-based screening programs for Chlamydia trachomatis and Neisseria gonorrhoeae may help to identify young women at risk for developing PID earlier in the course of infection.
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Pediatric emergency care · Sep 2006
Foreign body removal from the external auditory canal in a pediatric emergency department.
To describe the experience with external auditory canal foreign body removal in a pediatric emergency department. To identify factors associated with procedural complications and/or failed removal. ⋯ Physicians in a pediatric emergency department remove most foreign bodies from the external auditory canal successfully with minimal complications and need for operative removal. These data suggest that referral to otolaryngology be considered if more than 1 attempt or instrument is needed for removal.
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Pediatric emergency care · Sep 2006
Language and length of stay in the pediatric emergency department.
Quality and accessibility of care for patients presenting to the emergency department (ED) can be limited if they cannot communicate in the same language as their health care provider. ⋯ Language, triage score, patient age, and gender are significantly associated with LOS in the ED. Among other interventions, securing ways to accommodate non-English-speaking health providers in the ED can possibly shorten the LOS and reduce nonacute visits to the ED.