Pediatrics
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Comparative Study
Changing epidemiology of bacteremia in infants aged 1 week to 3 months.
Bacteremia in young infants has remained an important ongoing concern for decades. Despite changes in prenatal screening and infant immunizations, the current epidemiology of this problem has received little attention. ⋯ Our study indicates bacteremia in young infants occurs infrequently and in only 2.2% of those who had a blood culture drawn. On the basis of the epidemiology of pathogens found in this large cohort, these data suggest a change in currently recommended presumptive antibiotic coverage in 1-week to 3-month-old infants with suspected bacteremia.
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Comparative Study
Discharged on supplemental oxygen from an emergency department in patients with bronchiolitis.
Bronchiolitis is the most common reason for hospital admission in patients aged <1 year. Admissions have been increasing with hypoxia frequently cited as the determinant. Home oxygen (O(2)) has been shown to be feasible, although safety data are lacking. The objective of this study was to evaluate the impact of a home O(2) clinical care protocol on admission rates in patients with bronchiolitis from the pediatric emergency department. ⋯ Home O(2) is an effective way to decrease hospital admissions in a select group of patients with bronchiolitis.
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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.