Pediatrics
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The purpose of this study was to determine the overall trend of computed tomography (CT) utilization in the pediatric emergency department (PED) from 2003 to 2010 and to determine trends categorized by common chief complaints. ⋯ Our data showed no overall increase in CT utilization through 2010. In areas where alternative non-radiation-based modalities were options, there were decreased CT trends and increased use of potential alternative non-radiation-based modalities. This is the first large PED cohort study to show a decrease in CT utilization in recent years in a regional pediatric referral center and may correlate with increased awareness of radiation risk in children.
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Comparative Study
Nonconvulsive status epilepticus: the encephalopathic pediatric patient.
A high prevalence of nonconvulsive status epilepticus (NCSE) has been reported in critically ill adults and neonates. Recent prospective pediatric studies focus on critically ill children and show wide variability in the frequency of NCSE. This study examines prevalence of pediatric NCSE regardless of inpatient setting and retrospectively identifies risk factors indicating a need for urgent continuous EEG. ⋯ A high prevalence of NCSE was observed, comparable to adult studies, but within a wider range of inpatient settings. Children with acute encephalopathy should undergo continuous EEG. This evaluation is more urgent if certain clinical risk factors are present. Optimal duration of monitoring and the effect of NCSE on prognosis should be studied.
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There are limited data on the epidemiology of serious injuries due to physical abuse of children. ⋯ This is the first study to provide national US data on the occurrence of serious injuries due to physical abuse in hospitalized children. Data from the 2006 Kids' Inpatient Database on hospitalizations due to serious physical abuse can be used to track trends over time and the effects of prevention programs on serious physical abuse.
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Comparative Study
Community asthma initiative: evaluation of a quality improvement program for comprehensive asthma care.
The objective of this study was to assess the cost-effectiveness of a quality improvement (QI) program in reducing asthma emergency department (ED) visits, hospitalizations, limitation of physical activity, patient missed school, and parent missed work. ⋯ The program showed improved health outcomes and cost-effectiveness and generated information to guide advocacy efforts to finance comprehensive asthma care.
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Multicenter Study Comparative Study
A multicenter collaborative approach to reducing pediatric codes outside the ICU.
The Child Health Corporation of America formed a multicenter collaborative to decrease the rate of pediatric codes outside the ICU by 50%, double the days between these events, and improve the patient safety culture scores by 5 percentage points. ⋯ A complex process, such as patient deterioration, requires sufficient time and effort to achieve improved outcomes and create a deeply embedded culture of patient safety. The collaborative model can accelerate improvements achieved by individual institutions.