RESUMEN
This article focuses on the importance of monitoring and identifying those early discharged infants who are at risk for developing complications of jaundice. By utilizing standing orders in monitoring babies within 24 hours of discharge, bilirubin levels can be assessed in the home setting, required interventions can be implemented, and unplanned, emergency room visits and hospital readmissions can be averted.
Asunto(s)
Bilirrubina/análisis , Servicios de Atención a Domicilio Provisto por Hospital/normas , Ictericia Neonatal/diagnóstico , Alta del Paciente , Atención Posnatal/normas , Bilirrubina/sangre , Enfermería en Salud Comunitaria , Humanos , Recién Nacido , Ictericia Neonatal/complicaciones , Tiempo de Internación , Monitoreo Fisiológico , Readmisión del Paciente , Desarrollo de Programa , Factores de Riesgo , South Carolina , Estados UnidosRESUMEN
BACKGROUND: Injury to the pancreas is rare in pediatric trauma. Identification of pancreatic injury relies on clinical, radiographic, and laboratory data. Serum screening for pancreatic injury frequently is used but has not proven to correlate well with pancreatic injury. This study investigated utility and cost effectiveness of serum assessment of amylase and lipase. METHODS: A retrospective study of 1,821 pediatric trauma patients over 64 months was conducted. A total of 293 (16%) of these patients suffered trauma to the torso 195 (11%) of whom had confirmed intraabdominal injury. Eight pancreatic injuries (4% of abdominal injuries) were identified; 5 underwent surgery for pancreatic ductal injury. One patient not operated on had a pseudocyst that required late drainage. RESULTS: Serum amylase or lipase levels (AMY/LIP) were measured in 507 (28%) patients. A total of 116 (23%) had elevated AMY/LIP levels. Six of 8 with proven pancreatic injury underwent AMY/LIP testing; 5 had elevated values. Forty-eight percent of patients with elevated AMY/LIP levels had no evidence of intraabdominal injury. Seventy-four of 116 (64%) with elevated AMY/LIP levels underwent abdominal and pelvic computed tomography (CT) scanning, yet 38 (51%) of these had completely normal scans. Many patients with elevated AMY/LIP levels (cost, $6 per test) underwent screening CT scans (cost, $592 per test) based on AMY/LIP alone. No patient with elevated AMY/LIP levels but without clinical suspicion was proven to have pancreatic injury. Cost data are presented. CONCLUSIONS: Serum amylase and lipase determinations may support clinical suspicion in the diagnosis of pediatric pancreatic trauma but are not reliable or cost effective as screening tools. Costs incurred from routine serum amylase and lipase or from imaging tests subsequent to elevated serum values may be significant and unjustified.