Arch Pediat Adol Med
-
Arch Pediat Adol Med · Nov 1999
Medical evaluation of sexual abuse in children without disclosed or witnessed abuse.
To investigate why sexual abuse was suspected and what physical findings were present among children referred for the evaluation of sexual abuse without a verbal disclosure or witnessed abuse, and to determine if the reasons for requesting medical evaluation varied by referral source. ⋯ Physicians are more likely than public agencies to refer children for sexual abuse evaluation for reasons other than disclosure by the child. For most of these children, examination is unlikely to influence the suspicion of abuse. Improved physician training and selected referrals are indicated.
-
Arch Pediat Adol Med · Oct 1999
Clinical TrialConscious sedation with remifentanil and midazolam during brief painful procedures in children.
To test the hypothesis that remifentanil, because of its favorable pharmacokinetic properties, would be advantageous to use in combination with midazolam to provide analgesia and sedation during brief painful procedures. ⋯ The use of remifentanil and midazolam during brief, painful procedures results in rapid times to discharge but is complicated by a high incidence of life-threatening respiratory depression at subtherapeutic levels.
-
To determine the likelihood of spontaneous passage of esophageal coins to the stomach in children and to determine the effect of initial coin location on spontaneous passage. ⋯ Children with a single esophageal coin seen within 24 hours of ingestion, who have no history of esophageal disease and no respiratory compromise on presentation, have a 28% chance of spontaneous passage of the coin to the stomach. Coins in the upper as well as the lower esophagus pass spontaneously. Observing these children for 12 to 24 hours prior to invasive procedures will reduce complications and costs.
-
Arch Pediat Adol Med · Sep 1999
The role of serial radiographs in the management of pediatric torus fractures.
To assess the utility of radiographs taken immediately after the application of a cast in the management of pediatric torus (or buckle) fractures and to determine the need for serial radiographs taken at follow-up visits. ⋯ Postcast studies of torus fractures are unnecessary. Multiple radiographs taken during follow-up visits, especially early in the healing process, do not change fracture management. Relying on the clinical examination, perhaps combined with a single follow-up study, is a more appropriate regimen for the management of pediatric torus fractures and translates into a cost savings of over $ 10000 for our 70 patients.
-
Arch Pediat Adol Med · Sep 1999
A chronology of pain and comfort in children with sickle cell disease.
To examine the patterns of children's and caregivers' descriptions of pain and the comfort measures used to relieve the pain of sickle cell disease (SCD) at home and in the hospital. ⋯ A chronology of the pain and comfort experiences for children and adolescents during a vasoocclusive event of SCD emerged from the descriptive data of this study. Findings need to be examined further in larger, quantitative, longitudinal studies that examine more closely the duration, intensity, and character of pain at different times during vaso-occlusive episodes as well as the comfort measures used during specific phases of the pain event.