Archives of disease in childhood
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Using current WHO guidelines, children with wheezing are being over prescribed antibiotics and bronchodilators are underutilised. To improve the WHO case management guidelines, more data is needed about the clinical outcome in children with wheezing/pneumonia overlap. ⋯ Two third of children with wheeze are not identified by current WHO ARI (acute respiratory infections) guidelines. Antibiotics are over prescribed and bronchodilators under utilised in children with wheeze. Children with wheeze constitute a special ARI group requiring a separate management algorithm. In countries where wheeze is common it would be worthwhile to train health workers in use of the stethoscope to identify wheeze.
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To determine the most likely diagnoses when infants first present with an apparent life threatening event (ALTE). ⋯ There is a wide range of diagnoses reported after evaluation of an ALTE. Differing management protocols contributed to variations in the frequency of the diagnoses. The development and validation of an evidence based management plan may contribute to the care of this common condition.
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Multicenter Study
Evaluation of the Paediatric Index of Mortality in children managed on adult intensive care units.
To evaluate the performance of the Paediatric Index of Mortality (PIM) in children cared for in adult intensive care units (ICUs) in district general hospitals in the South West Region of England. ⋯ PIM performs well as a risk adjustment method in children whose entire care remains in the adult ICU of a district general hospital. This is important should the Paediatric Intensive Care Audit Network (PICAnet) decide to extend its data collection beyond paediatric intensive care units to other units caring for critically ill children.
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Shock is often under-reported in children attending hospitals in developing countries. Readily obtainable features of shock (capillary refill time, temperature gradient, pulse volume, and signs of dehydration) are widely used to help prioritise management in the emergency assessment of critically ill or injured children. However, data are lacking on their validity, including, importantly, reproducibility between observers. ⋯ After an initial training of clinical sign recognition, there was moderate agreement for most features of cardiovascular compromise (delayed capillary refill > or =4 s, kappa = 0.49; and weak pulse volume, kappa = 0.4) and only substantial agreement for temperature gradient (kappa = 0.62). For hydration status, only in the assessment of skin turgor was there a moderate level of agreement (kappa = 0.55). Capillary refill times and assessment of pulse volume recommended by the recent American consensus guidelines achieved only a "low" moderate to poor interrater agreement, questioning the reliability of such parameters.
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To evaluate the pitfalls of incident reporting in a complex medical environment. ⋯ Incident reporting in the medical field is highly variable, and is heavily influenced by profession of the reporters as well as anonymity. When adverse event reporting is based predominantly on the observations of a single professional group, the data are grossly inaccurate.