Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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While it is known that trauma systems improve the outcome of injury in children, there is a paucity of information regarding trauma system function amid changes in policies and health care financing that affect emergency medical systems for children. ⋯ An increasing majority of children with trauma were cared for in trauma-designated hospitals over the study period. However, 23% of children with severe injuries, and 18.1% of pediatric deaths more than two days after injury, were cared for in non-trauma-designated hospitals. These findings demonstrate an important opportunity for improvement. If we can characterize those children who do not access the trauma system despite severe injury or death, we will be able to design clinical protocols and implement policies that ensure access to appropriate regional trauma care for all children in need.
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Rapid intravenous (IV) rehydration in the emergency department (ED) is required for certain children with acute gastroenteritis (AGE). ⋯ Administration of larger amounts of IV dextrose is associated with reduced return visits requiring admission in children with gastroenteritis and dehydration.
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Multicenter studies are becoming more common, and variability in local institutional review board (IRB) assessments can be problematic. ⋯ There was substantial variation in IRB assessment of a standard protocol in this study. The burden of the application process contributed to some investigators not participating, but the majority of investigators remain enthusiastic about multicenter research. A national IRB may streamline the review process and facilitate multicenter clinical research.
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Hypothermia of 32 degrees C-34 degrees C induced after resuscitation from cardiac arrest improves neurologic recovery, but the optimal depth of cooling is unknown. Using a rat model, the authors tested the hypothesis that cooling to 35 degrees C between hours 1 and 24 after resuscitation would improve neurologic outcome as much as cooling to 33 degrees C. ⋯ These data illustrate that hypothermia of 35 degrees C or 33 degrees C over the first day of recovery improves neurologic scores and neuronal survival after cardiac arrest in rats. The benefit of induced hypothermia of 35 degrees C appears to be similar to the benefit of 33 degrees C.
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Community consultation is a required element of research studies that use a waiver of or exception from informed consent. Its intent is to provide an additional patient safeguard in emergency research circumstances when prospective informed consent is not possible. ⋯ This article presents a brief overview of the sparse literature available on the process of community consultation since the inception of the current emergency research regulations. To determine if the process is meeting its goals, more research will be required.