Current opinion in pediatrics
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Curr. Opin. Pediatr. · Jun 2010
ReviewCommunity-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections.
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has become increasingly important as a cause of skin and soft tissue infections (SSTIs), particularly abscesses, in patients seen in the emergency department setting. The antibiotic sensitivity profile of Staphylococcus aureus isolates from SSTIs has changed over time in many geographic locations. Whether antibiotics are needed in the management of skin abscesses, and, if so, when, is controversial. ⋯ CA-MRSA has become an important cause of SSTIs. Current data suggest that most abscesses can be treated successfully with incision and drainage alone. Antibiotic choice is more crucial for management of cellulitis and should be guided by the prevalence of CA-MRSA in the community and its antibiotic susceptibility profile.
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Interest in the areas of global health and international emergency medicine has increased dramatically in recent years. This article discusses some of the knowledge gained in these areas, particularly as it pertains to the delivery of pediatric emergency care in resource-limited settings. ⋯ Tremendous advances have been made in global health but there are still major obstacles to overcome. One of the areas that have yet to receive much attention is the delivery of pediatric emergency care. By working with our colleagues around the world and disseminating what we have learned, we can improve emergency care for all children.
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Curr. Opin. Pediatr. · Jun 2010
ReviewAccess to pediatric trauma care: alignment of providers and health systems.
Injury is a leading cause of pediatric death and disability. Although adult trauma care in the United States has been celebrated as a model system of emergency care, it is not clear that pediatric trauma care is as well organized. We seek to describe in this review the current state of pediatric trauma care and suggest next steps required to ensure the efficient delivery of pediatric trauma care. ⋯ Trauma centers improve outcome for injured patients with care at pediatric-focused centers superior to that provided at nonpediatric centers. However, access to high-level trauma care varies geographically and is not available to all children in a timely fashion. Future studies should correlate access to outcome and guide policy makers to optimize trauma systems for children.
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This review will examine mild closed head injury (CHI) and the current evidence on head computed tomography (CT) imaging risks in children, prediction rules to guide decisions on CT scan use, and issues of concussion after initial evaluation. ⋯ It is clear that CT scan use should be as safe and limited in scope as possible for children. Common decisions on the use of CT imaging for mild head injury can now be guided by a prediction rule for clinically important traumatic brain injury. Parameters for the follow-up care of patients with mild CHI after emergency department discharge are needed in the future to assure that postconcussive symptoms are adequately screened for full resolution.
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To report on recent advances in quality initiatives in emergency departments (EDs), with a special focus on applicability to pediatric EDs (PED) RECENT FINDINGS: Although healthcare quality improvement has made great strides in the last couple of decades, quality improvement efforts in pediatrics have lagged behind. Over the last decade, as quality initiatives have matured in adult hospitals, there has been a downstream effect on general EDs, as system-wide clinical guidelines are usually initiated through the ED--such efforts are being reported in the literature. There is significant overlap in quality improvement efforts in adult and pediatric EDs. In this article, we review the recent relevant articles, with particular emphasis on pediatrics where appropriate. ⋯ There is an opportunity in pediatric emergency medicine to reduce practice variability, decrease cost and improve efficiency of care. There is an urgent need to report the successes and failures of these initiatives, so we can develop benchmarks and optimize services provided in the PED.