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Paediatric Emergency Department (paediatric + emergency_department)
Selected AbstractsEvaluation of documentation in potential abusive head injury of infants in a Paediatric Emergency DepartmentACTA PAEDIATRICA, Issue 5 2009Björn Tingberg Abstract Aim: The aim is to evaluate medical record documentation regarding potential abusive head injury (AHI) in infants presenting to a Paediatric Emergency Department (ED) with certain primary complaints known to be associated with AHI. Methods: A database search was performed to find all medical records over a period of one year relating to those children who had one AHI-related primary complaint and who had had a CT head-scan performed in conjunction with admission. Each medical record was reviewed, in order to assess whether potential abuse had been investigated and documented. Each CT-scan image was re-evaluated for missed indications of potential injuries attributable to AHI. Results: Forty-seven such medical records were found. Of these, 87% showed the diagnosis to be head injuries. The largest group of children was in the age group 0,3 months (38%). Of the children admitted to the Paediatric ED due to a head injury, 54% had a history deemed to raise suspicions of abuse but only five of them had had a documented investigation of child abuse. The re-evaluation of the CT-scans showed no missed cases. Conclusion: In this study we found that among children with known risk factors for AHI, only a few had documentation regarding potential child abuse. The use of a standardized protocol could be helpful in the important work to help staff discover potential AHI. [source] Debriefing critical incidents in the paediatric emergency department: Current practice and perceived needs in Australia and New ZealandEMERGENCY MEDICINE AUSTRALASIA, Issue 6 2009Theane Theophilos Abstract Anecdotally critical incident debriefing (CID) is an important topic for staff in paediatric ED. The present study aimed to determine current baseline CID practices and perceived needs of ED staff. A questionnaire regarding CID practice was circulated to all 13 Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites in Australia and New Zealand (including all tertiary paediatric ED), and completed by 1 senior doctor and 1 senior nurse. All PREDICT sites participated (13 nurses, 13 doctors). Seventy per cent did not currently have a hospital protocol on debriefing and 90% did not have ED-specific guidelines. The most commonly debriefed topics were death of a patient, multi-trauma and sudden infant death syndrome, also ranked highest in importance for debriefing. The median reported debriefs per department were 4 per year (range 0,12), all conducted within a week of the CI with half within 24 h. ED workers most likely to be invited to the CID session were doctors, nurses and social workers (96%). Debriefing was mostly conducted internally (62%) and most likely facilitated by a doctor (81%) or nurse (54%). Debriefing addressed both clinical and emotional issues (89%) within the same session (69%). Debriefing was rated as very important, median of 8/10 by doctors and 10/10 by nurses. Almost 90% of those surveyed indicated that they would like a CID programme and guidelines for their department. Debriefing is perceived as important by senior ED clinicians, yet few ED have formalized guidelines or programmes. Best-practice guidelines should be developed. [source] Non-urgent presentations to a paediatric emergency department: Parental behaviours, expectations and outcomesEMERGENCY MEDICINE AUSTRALASIA, Issue 5-6 2005Mary Ryan Abstract Objectives:, To identify factors that influence the attendance of children with non-urgent medical problems to a tertiary paediatric ED and to define parental expectations of the hospital visit. Methods:, A questionnaire administered to a convenience sample of 200 parents/carers who attended the paediatric ED and whose children were categorized as having non-urgent problems that had been present for at least 4 weeks. Subsequent outpatient attendances were then analysed retrospectively. Results:, Most patients had visited a general practitioner but remained unhappy with the outcome of the consultation. The hospital was expected to provide immediate diagnosis and initiate appropriate treatment by the vast majority of parent. Only four patients required admission. Conclusions:, The expectations of parents who attend the paediatric ED with children who have non-urgent chronic complaints are high. Rapid access to outpatient clinics might provide an acceptable alternative for these patients, and free valuable ED resources. [source] Prospective evaluation of the management of moderate to severe cellulitis with parenteral antibiotics at a paediatric day treatment centreJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2008Serge Gouin Aim: To assess the clinical outcome of patients with moderate to severe cellulitis managed at a paediatric day treatment centre (DTC). Methods: Prospective observational study of all patients (3 months to 18 years) with a presumed diagnosis of moderate to severe cellulitis made in a university-affiliated paediatric emergency department (ED) (September 2003 to September 2005). Patients treated at the DTC were given ceftriaxone or clindamycin. Results: During the study period, a presumed diagnosis of moderate to severe cellulitis was made in 224 patients in the ED. Ninety-two patients were treated at the DTC (41%). The cellulitis had a median width of 7.0 cm (range: 1.0,50.0 cm) and a median length of 6.5 cm (range: 1.0,40.0 cm). Blood cultures were performed in 95.7%; one was positive for Staphylococcus aureus. After a mean of 2.5 days of intravenous therapy (first injection in the ED and a mean of 1.5 days at the DTC), 73 patients (79.3%) were successfully discharged from the DTC and switched to an oral agent. For these patients no relapse occurred. Nineteen patients (20.7%) required inpatient admission for further therapy. No patient was diagnosed with necrotizing fasciitis in the course of therapy. Seventy-eight satisfaction questionnaires were handed in and revealed very good to excellent parental satisfaction with treatment at the DTC in 94.8%. Conclusion: Treatment with parenteral antibiotic at a DTC is a viable alternative to hospitalisation for moderate to severe cellulitis in children. [source] Antibiotic prescribing rates for acute otitis media in a paediatric emergency departmentJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2006Kai Steinmann Objective: To audit antibiotic prescribing rates for acute otitis media (AOM) at a tertiary paediatric emergency department (ED). Methods: All children who presented to the ED in 2002 (during defined 4-week periods in spring, summer, autumn and winter) and were given a diagnosis of AOM were eligible for analysis. Data were extracted retrospectively, providing information on demographics and antibiotic therapy. Results: A total of 306 patients with AOM were available for analysis. Forty-three children (14%) were <1 year, 69 (23%) 1,2 years, and 194 (63%) > 2 years of age. Sixty-eight patients (22%) were receiving antibiotics prior to presentation to the ED, and antibiotics were prescribed for 206 (67%). Antibiotic prescribing was independent of patient age. Conclusions: Despite ready access to clinical guidelines that recommend an expectant approach for children with AOM who are older than 1 or 2 years of age, antibiotic prescribing rates were high in the ED. [source] Length of the treatment and number of doses per day as major determinants of child adherence to acute treatmentACTA PAEDIATRICA, Issue 3 2010H Chappuy Abstract Objective:, To determine the rate of aftercare adherence to prescriptions from a paediatric emergency department and to identify predictors for nonadherence. Methods:, Patients discharged from a French paediatric emergency department with at least one oral drug prescription were included. A telephone interview questionnaire was used to determine whether the child had received the treatments according to the prescription. Adherence was assessed according to three items: frequency of drug administration, length of treatment and drug administering method. Complete adherence was defined as adherence to the three items mentioned above, and nonadherent as nonadherent to at least one of the items. Influence of age, sex, pathology, language spoken at home, type of medical insurance, type of medication prescribed, diagnosis, dissatisfaction with the explanation of the medical problem, number of prescribed medications, length of the treatment and number of doses per day was assessed. Results:, One hundred and five telephone interviews were exploited. The children were 60 boys (57%) and 45 girls (43%). The ages of these 105 children were between 0.2 and 12 years. The most common diagnoses were asthma and pulmonary infection. Complete adherence with the prescription was 36.2%. Three factors were significantly associated with nonadherence (p < 0.05): length of treatment, number of doses per day and male sex. Conclusion:, This study suggests that simplifying treatment schedules is an effective strategy for improving compliance in paediatric emergency departments. [source] The effect of rapid diagnostic testing for influenza on the reduction of antibiotic use in paediatric emergency departmentACTA PAEDIATRICA, Issue 10 2009E Özkaya Abstract Aim:, To determine the influence of rapid diagnosis of influenza on antibiotic prescribing to children presenting with influenza-like illness in the emergency department in a inner city hospital in ,stanbul, Turkey. Methods:, Patients aged 3 to 14 years presenting to an urban children's teaching hospital emergency department were screened for fever and cough, coryza, myalgias and/or malaise. After obtaining informed consent, patients were allocated into two groups. Group 1: patients were prescribed antibiotics after only physical examination; or Group 2: patients were prescribed antibiotics after rapid influenza testing. Nasopharyngeal swabs obtained from all patients were immediately tested in a single-blind manner with Influenza A/B Rapid Test® for influenza A and B. Results:, A total of 97 patients were enrolled, and 33 (34%) of these tested positive for influenza. Although frequency of positive results for influenza between the groups was similar (36% vs 32%, respectively), patients in Group 2 were less likely to be prescribed antibiotics when compared to those in Group 1 (32% vs 100%, respectively, p < 0.0001). Conclusion:, Rapid diagnosis of influenza in the paediatric emergency department may allow a significant reduction in the over-prescription of antibiotics. [source] Mastitis in early infancyACTA PAEDIATRICA, Issue 2 2005T Stricker Abstract Aim: To evaluate the clinical features and microbiological findings in young infants with mastitis. Methods: Retrospective review of medical records of 18 infants with breast inflammation during the first 3 mo of life seen in the paediatric emergency department between 1992 and 2002. Results: All were full-term infants with female,male ratio of 3.5,1. The age ranged from 12 to 45 d, with a peak in the 4th and 5th weeks of life. Only five patients had systemic manifestations, and five were pretreated with oral antibiotics (amoxicillin-clavulanic acid). The latter as well as seven additional cases required incision and drainage due to abscess formation. Bacterial cultures grew Staphylococcus aureus in 10 cases including all pretreated infants. In four of these cases, Gram stain showed the pathogen. After antimicrobial treatment, no recurrence was observed in any of the patients. Conclusions: These findings suggest that mastitis in early infancy should be treated with parenteral antibiotics guided by Gram stain when available and informative. Otherwise, ,-lactamase-resistant antibiotics are a reasonable empirical initial treatment pending culture results. Optimizing the management of infants with mastitis is important especially since abscess formation requiring incision may be detrimental for later breast development. [source] Presentation of aggressive children and adolescents to paediatric emergency departmentsJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2003P Birleson No abstract is available for this article. [source] Length of the treatment and number of doses per day as major determinants of child adherence to acute treatmentACTA PAEDIATRICA, Issue 3 2010H Chappuy Abstract Objective:, To determine the rate of aftercare adherence to prescriptions from a paediatric emergency department and to identify predictors for nonadherence. Methods:, Patients discharged from a French paediatric emergency department with at least one oral drug prescription were included. A telephone interview questionnaire was used to determine whether the child had received the treatments according to the prescription. Adherence was assessed according to three items: frequency of drug administration, length of treatment and drug administering method. Complete adherence was defined as adherence to the three items mentioned above, and nonadherent as nonadherent to at least one of the items. Influence of age, sex, pathology, language spoken at home, type of medical insurance, type of medication prescribed, diagnosis, dissatisfaction with the explanation of the medical problem, number of prescribed medications, length of the treatment and number of doses per day was assessed. Results:, One hundred and five telephone interviews were exploited. The children were 60 boys (57%) and 45 girls (43%). The ages of these 105 children were between 0.2 and 12 years. The most common diagnoses were asthma and pulmonary infection. Complete adherence with the prescription was 36.2%. Three factors were significantly associated with nonadherence (p < 0.05): length of treatment, number of doses per day and male sex. Conclusion:, This study suggests that simplifying treatment schedules is an effective strategy for improving compliance in paediatric emergency departments. [source] Strategy for increasing detection rates of drug and alcohol abuse in paediatric emergency departmentsACTA PAEDIATRICA, Issue 10 2009E Kozer Abstract Aim:, To determine whether implementation of criteria for performing a toxicology screen and increasing staff awareness improve detection of substance abuse among adolescents presenting to the emergency department. Methods:, Patients 12 to 18 years of age presenting to one of three emergency departments in Israel were included in a prospective cohort study. In the ,study' hospital, a set of criteria for urine toxicology screen and measurements of ethanol serum level were implemented. No specific interventions were implemented in the two other hospitals. The main outcome measure was the rate of substance abuse detection. Results:, The number of adolescents seen in the participating centres was 3200 at the study hospital, and 3493 and 2792 at the two other hospitals. High blood ethanol concentrations were found in 49 patients at the study hospital compared with 30 and 19 patients at the two other hospitals (p < 0.001). Illicit drugs were detected in 13, 4 and 1 patients, respectively (p = 0.002). Conclusions:, Introducing structured guidelines for ordering toxicological screening increases the detection of alcohol and drug of abuse among adolescents presenting to paediatric emergency departments. [source] | ||||||||||