The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society
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Biography Historical Article
The journal 150 & 100 years ago. November 1848 and 1898.
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Review Comparative Study
Comparison of pediatric hospitalization using the pediatric appropriateness evaluation protocol at three diverse hospitals in Louisiana.
The purpose of this study was to compare the number of inappropriate pediatric admissions and hospital days in three hospitals in Louisiana using Pediatric Appropriateness Evaluation Protocol (PAEP) criteria. The hospitals studied included an urban, nontertiary care, teaching hospital with 20 inpatient, pediatric beds (A); a private, tertiary care hospital with 30 beds (B); and a tertiary care, regional referral center with 133 pediatric beds (C). The study prospectively observed all nonintensive care pediatric admissions (> six months of age) between May 1 and June 30, 1993. ⋯ Hospital A had 99% of patients with either Medicaid or uninsured payor status compared to 35% and 84% at hospital B and C, respectively. Significant differences in the rate of inappropriate admission or subsequent hospital days were demonstrated in the three hospitals studied. Finally, the rates of inappropriate hospitalization demonstrated in this study of Louisiana hospitals were similar to previous studies using the PAEP in other regions.
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Foreign body aspiration (FBA) is a leading cause of accidental death in children less than one year old and is the cause of death in 7% of children less than four. Food items, especially peanuts, are the most common items aspirated in infants and toddlers, whereas older children are more likely to aspirate non-food items such as pen caps, pins, and paper clips. A high degree of suspicion is required to diagnose FBA. ⋯ An asymptomatic period is common after aspiration and contributes to a delay in diagnosis of greater than one week in 12% to 26% of patients. This delay in diagnosis causes increased morbidity from bronchial inflammation, obstruction, and pneumonia which is resistant to treatment. Prompt endoscopic removal of the foreign body with an open rigid bronchoscope under general anesthesia is the mainstay of therapy.
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Biography Historical Article
The Journal 150 & 100 years ago. Medicine in American painting.