RESUMEN
PURPOSE: The management of children presenting with an isolated skull fracture (ISF) posttrauma is highly variable. We sought to estimate the risk of neurologic deterioration in children with a Glasgow coma score (GCS) 15 and ISF to reduce unnecessary hospital admissions. METHODS: A retrospective review at a level I pediatric trauma referral center was conducted for patients with ISF on head computed tomography from 2003 to 2008. Patients were excluded for injury greater than 24 hours prior, GCS less than 15, intracranial pathology, significant fracture depression, or complex fractures involving facial bones or skull base. RESULTS: A total of 235 patients were identified with an ISF. The median age was 11 months, with falls accounting for 87% of the injuries. One hundred seventy-seven patients were admitted, and 58 patients were discharged from the emergency department after a period of observation (median, 3.3 hours). Median length of stay for those admitted to the hospital was 18.2 hours. One patient developed vomiting following overnight observation and a repeat computed tomography scan demonstrated a small extra-axial hematoma that required no intervention. The mean total costs for patients discharged from the emergency department were $291 vs $1447 for those admitted for observation (P < .001). CONCLUSION: Patients with a presenting GCS of 15 and an ISF can be safely discharged from the emergency department after a short period of observation if they are asymptomatic and have a reliable social environment. This could result in significant savings by eliminating inpatient costs.
Asunto(s)
Tiempo de Internación , Alta del Paciente , Fracturas Craneales/terapia , Adolescente , Amnesia/epidemiología , Amnesia/etiología , Enfermedades Asintomáticas , Manejo de Caso , Niño , Preescolar , Ahorro de Costo , Mareo/epidemiología , Mareo/etiología , Urgencias Médicas/economía , Femenino , Escala de Coma de Glasgow , Cefalea/epidemiología , Cefalea/etiología , Hospitalización/estadística & datos numéricos , Hospitales Pediátricos/economía , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Tiempo de Internación/estadística & datos numéricos , Masculino , Examen Neurológico , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Fracturas Craneales/complicaciones , Fracturas Craneales/economía , Fracturas Craneales/epidemiología , Centros Traumatológicos/economía , Centros Traumatológicos/estadística & datos numéricos , Inconsciencia/etiología , Vómitos/epidemiología , Vómitos/etiologíaRESUMEN
OBJECTIVE: Our objective was to describe young children injured through the use of infant carrier car seats, comparing them with children injured through other fall mechanisms. METHODS: We performed a retrospective chart review of children 18 months or younger with a fall mechanism of injury presenting to the emergency department of a tertiary care level 1 pediatric trauma center from August 2004 to December 2005. The primary outcome measure of the study was to determine the pattern of injuries sustained by infants falling from infant carrier seats. RESULTS: Eight hundred three children were identified. There were 62 patients (7.7%) with infant carrier falls with a mean age of 4.4 months. Of these patients, 87.1% were not buckled into their carriers. Infant carrier-related falls resulted in 22 hospitalizations (35.5%), including 6 pediatric intensive care unit admissions (9.7%). Thirteen patients in the group with infant carrier-related falls sustained intracranial injuries (ICIs; subdural hematoma, 8; epidural hematoma, 3; cerebral contusion, 1; and subarachnoid hemorrhage, 1); 1 patient required a craniotomy. Ten patients had isolated skull fractures, and 11 of the 13 patients with ICIs also had skull fractures. The 62 carrier patients were compared with 741 children with other fall mechanisms. The carrier group had more ICIs (P < 0.001) and hospitalizations (P < 0.001). When carrier injuries were compared with falls down stairs, there were more ICIs (13/62 vs. 2/68, P = 0.002) resulting from carrier injuries. CONCLUSIONS: Falls from infant carriers are common, often involve children unbuckled in their car seats, and represent a significant source of morbidity. Injury prevention measures such as education and manufacture labeling may be effective strategies.
Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Equipo Infantil , Heridas y Lesiones/epidemiología , Distribución de Chi-Cuadrado , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The aim of this study was to determine if 2 doses of oral dexamethasone are as effective as a 5-day course of oral prednisone in preventing relapse for pediatric asthma exacerbations. Patients presenting to the emergency department with an asthma exacerbation were randomized to receive 0.6 mg/kg of dexamethasone or 2 mg/kg of prednisone in a prospective, double-blind study. The primary outcome was relapse within 10 days, and the secondary outcome was vomiting in the emergency department. Eighty-nine patients completed the study: 38 in the prednisone group and 51 in the dexamethasone group. In all, 3 patients in the prednisone group (8%) and 8 patients in the dexamethasone group (16%) required an unscheduled follow-up visit (P = .27). In all, 7 patients in the prednisone group (18%) and 5 patients in the dexamethasone group (10%) had vomiting ( P = .24). No difference was found in the relapse rate or incidence of vomiting between patients given prednisone and dexamethasone for pediatric asthma exacerbations.
Asunto(s)
Asma/tratamiento farmacológico , Dexametasona/administración & dosificación , Glucocorticoides/administración & dosificación , Prednisona/administración & dosificación , Administración Oral , Adolescente , Distribución de Chi-Cuadrado , Niño , Preescolar , Método Doble Ciego , Servicio de Urgencia en Hospital , Femenino , Humanos , Lactante , Masculino , Estudios Prospectivos , Recurrencia , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
This study was conducted to assess parents' understanding of Pediatric Emergency Medicine and the roles of different providers in a pediatric emergency department. Parents were surveyed regarding these subjects and given a sheet explaining provider roles. Of 102 questionnaires completed, 82% of questions on attending roles were answered correctly and 70% of questions about pediatric emergency medicine were answered correctly. Ninety percent of parents felt the information sheet made understanding provider roles easier. Many parents were informed regarding emergency department provider roles. Certain aspects of these roles and the practice of pediatric emergency department are less well understood. An informational sheet can help educate parents about provider roles and the practice of pediatric emergency medicine.
Asunto(s)
Comprensión , Servicio de Urgencia en Hospital/organización & administración , Personal de Salud/organización & administración , Padres , Pediatría , Percepción Social , Niño , Encuestas de Atención de la Salud , HumanosRESUMEN
OBJECTIVES: The aim of the study was to assess the impact of an observation unit (OU) on hospital resource utilization for patients with croup. METHODS: A retrospective review with the use of a historical control was performed for 2 years of nondischargeable emergency department (ED) patients with croup. RESULTS: The total number of ED patients with croup was 694 in the first year and 789 in the second year. Hundred seventy patients were enrolled, 66 in the first year and 104 in the second year (76 admitted to the OU and 33 admitted to the ward). There was a reduction in the ward admission rate from 9.5% to 4.2% (P < .0001) from the first to the second year. The median length of stay for the pre-OU group was 27.2 vs 21.3 hours for the post-OU group (P = .03). The median charge for the pre-OU group was $1685 vs $1327 for the post-OU group (P = .03). CONCLUSIONS: After the introduction of the OU, hospitalization was reduced, and the overall resource utilization for the care of nondischargeable ED patients with croup was reduced.
Asunto(s)
Crup/terapia , Servicio de Urgencia en Hospital/organización & administración , Precios de Hospital , Unidades Hospitalarias/organización & administración , Tiempo de Internación/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Niño , Preescolar , Servicio de Urgencia en Hospital/economía , Femenino , Unidades Hospitalarias/economía , Humanos , Lactante , Tiempo de Internación/economía , Masculino , Admisión del Paciente/economía , Evaluación de Programas y Proyectos de Salud , Estudios RetrospectivosRESUMEN
Cases of pediatric nonenvironmental hypothermia are uncommon. When presenting to the emergency department, these patients are often evaluated for possible sepsis/shock, brain tumors, endocrine disorders, and drug ingestions. We report a case of a 5-year-old girl who presented to the pediatric emergency department on two occasions with hypothermia and lethargy. She was found to have an unusual cause of her symptoms: episodic spontaneous hypothermia with hyperhidrosis.