Pediatric radiology
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Pediatric radiology · Nov 2008
ReviewPediatric head trauma: the evidence regarding indications for emergent neuroimaging.
Traumatic brain injury (TBI) is a leading cause of childhood death and disability worldwide. In the United States, childhood head trauma results in approximately 3,000 deaths, 50,000 hospitalizations, and 650,000 emergency department (ED) visits annually. Children presenting to the ED with seemingly minor head trauma account for approximately one-half of children with documented TBIs. ⋯ What constitutes appropriate criteria for obtaining CT scans in children after minor blunt head trauma remains controversial. Current evidence to guide clinicians in this regard is limited; however, large studies performed in multi-center research networks have recently been conducted. These studies should provide the foundation of evidence to guide CT decisions by clinicians, help identify TBIs in a timely fashion, and reduce unnecessary radiation exposure.
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Pediatric radiology · Nov 2008
Standards for radiology interpretation and reporting in the emergency setting.
The radiologist plays a pivotal role in the medical management of injury and illness in both adults and children in the emergency setting. Although the primary role of the radiologist is to assist in establishing a correct diagnosis, the radiologist's responsibility goes well beyond simple detection and documentation. ⋯ Radiologists must be familiar with both local and national practice guidelines related to the care of the patient in the emergency setting, in relation to both construction of the radiology report and appropriate communication of the results of radiologic studies. Familiarity with these aspects of the radiologists' responsibilities maximizes the chance of successful outcomes and minimizes the frequency of (and liability for) malpractice.
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Pediatric radiology · Nov 2008
Standards for clinical evaluation and documentation by the emergency medicine provider.
Pediatric emergency medicine is full of challenges. When a pediatric patient has a poor outcome after treatment in an emergency department (ED), a malpractice lawsuit is likely to result. Pediatric emergency medicine (PEM) physicians might sometimes alter their medical care and practice "defensive medicine" in hopes of avoiding a malpractice lawsuit. ⋯ On the other hand, failure to order the appropriate study or misinterpretation of a radiographic study by a radiologist or an emergency physician can result in a malpractice lawsuit. PEM physicians must work cooperatively with radiologists to improve the care for children in the ED. Together these specialists can decide on appropriate studies for children in the ED, keep radiation exposure to a minimum and ensure proper management based on these studies.
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Pediatric radiology · Nov 2008
ReviewBedside pediatric emergency evaluation through ultrasonography.
Bedside US has emerged as a valuable technology for the emergency department physician. It impacts clinical decision-making and the safety of procedures, and it decreases the time and increases the efficiency for completion of procedures. The portability, accuracy and noninvasive nature of US make it an ideal tool for the trained clinician. ⋯ Many pediatric procedures, such as vascular access, lumbar puncture and bladder catheterization, are typically performed blindly. Bedside US enhances the success of procedures, minimizes complications and limits the number of attempts necessary to complete a procedure. Bedside US can be a valuable adjunct for complicated and time-sensitive disease processes such as ectopic pregnancy, testicular torsion and hypovolemia by providing information to guide diagnostic and therapeutic interventions that subsequently improve outcomes.
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Thousands of people are injured or die from medical errors and adverse events each year, despite being cared for by hard-working, intelligent and well-intended health care professionals, working in the highly complex and high-risk environment of the American health care system. Patient safety leaders have described a need for health care organizations to make error prevention a major strategic objective while at the same time recognizing the importance of transforming the traditional health care culture. ⋯ Components of these programs are described, with an emphasis on strategies to improve pediatric patient safety. Physicians, as leaders of the health care team, have a unique opportunity to foster the culture and commitment required to address the underlying systems causes of medical error and harm.