Pediatrics
-
Computed tomography (CT) imaging of children is increasing in emergent settings without an understanding of parental knowledge of potential cancer risks. In children with head injuries, our primary objective was to determine the proportion of parents who were aware of the potential of CT to increase a child's lifetime risk of malignancy. We also examined willingness to proceed with recommended CT after risk disclosure and preference to be informed of potential risks. ⋯ Approximately half of the participating parents were aware of the potential increased lifetime malignancy risk associated with head CT imaging. Willingness to proceed with CT testing was reduced after risk disclosure but was a significant barrier for a small minority of parents. Most parents wanted to be informed of potential malignancy risks before proceeding with imaging.
-
Firearm violence is a leading cause of death among youth. The objectives of this study were (1) determine firearm possession rates and associated correlates among youth seeking care for assault in an emergency department (ED); (2) understand differences in risk factors for youth with firearm possession; and (3) identify firearm possession characteristics in this population: type, reason for possession, and source of firearms. ⋯ ED assault-injured youth had high rates of firearm possession (23.1%), most of which were not obtained from legal sources. Youth with firearm possession were more likely to have been in a recent serious fight, and to endorse aggressive attitudes that increase their risk for retaliatory violence. Future prevention efforts should focus on minimizing illegal firearm access among high-risk youth, nonviolent alternatives to retaliatory violence, and substance use prevention.
-
Comparative Study
Variation in emergency department diagnostic testing and disposition outcomes in pneumonia.
To describe the variability across hospitals in diagnostic test utilization for children diagnosed with community-acquired pneumonia (CAP) during emergency department (ED) evaluation and to determine if test utilization is associated with hospitalization and ED revisits. ⋯ Emergency departments that use more testing in diagnosing CAP have higher hospitalization rates than lower-utilizing EDs. However, ED revisit rates were not significantly different between high- and low-utilizing EDs. These results suggest an opportunity to reduce diagnostic testing for CAP without negatively affecting outcomes.
-
To investigate the frequency of and factors linked to medical consultation for functional somatic symptoms (FSS) among 5- to 7-year-old children. ⋯ This study adds to our understanding of health care use for FSS in childhood by highlighting the influence of parents' early consultation patterns with their child and the influence of parental perceptions of their child's health and FSS-related impact on pediatric health care use for FSS. Management of health care use in children with FSS should address these aspects.
-
The objectives were (1) to determine trends in radiograph use in emergency department (ED) care of children with asthma, bronchiolitis, and croup; and (2) to examine the association of patient and hospital factors with variation in radiograph use. ⋯ The ED use of radiographs for children with asthma increased significantly from 1995 to 2009. Reversing this trend could result in substantial cost savings and reduced radiation. Pediatric-focused EDs used significantly fewer radiographs for asthma, bronchiolitis, and croup. The translation of practices from pediatric-focused EDs to all EDs could improve performance.