Abstract:
OBJECTIVES:Pediatric refusal of medical assistance (RMA) is a potentially high-risk event with implications for both individual patient outcomes and greater emergency medical services system efficiency. The purpose of this study was to describe characteristics of pediatric RMA calls and outcomes. METHODS:Single emergency medical services agency retrospective study of calls between January 1, 2011, and December 31, 2015, for pediatric patients resulting in RMA was performed. Dispatch complaint-matched case-control group was generated from transported patients. RESULTS:The percentage of pediatric calls that resulted in RMA was 12.7%, compared with 5% adult calls (P < 0.0001). The 3 most common RMA dispatch complaints were seizures, difficulty breathing, and traffic accidents. Furthermore, 65.1% pediatric RMA calls were emergently dispatched, compared with 56.4% of transported pediatric patients (P = 0.01). Medical control was contacted for 4.6% RMA calls. The average ± SD word count for RMA patient care narratives was 179 ± 99 words, compared with 164 ± 139 words for controls (P = 0.11). Documentation of risk-benefit discussion occurred in 28.6% RMA narratives. Outcome data were available for 83.8% RMA patients. The percentage of RMA patients with documented alternative plans who completed the alternative plan was 61.6%. Within 72 hours of RMA, 5.0% of calls with known outcome resulted in unexpected emergency department visit. No unexpected emergency department visits resulted in admission. Five percent of RMA patients were admitted; 1 patient was admitted to the intensive care unit. No emergent surgeries or deaths occurred during the study period. CONCLUSIONS:Pediatric RMA is common within our study population, and two thirds involve emergent dispatch. Although outcomes are generally good, refusal documentation is sparse and medical control is seldom contacted. Multiple opportunities for systems improvement exist.
journal_name
Pediatr Emerg Carejournal_title
Pediatric emergency careauthors
Mix FM,Myers LA,Luke A,Sztajnkrycer MDdoi
10.1097/PEC.0000000000002018subject
Has Abstractpub_date
2020-01-01 00:00:00pages
26-30issue
1eissn
0749-5161issn
1535-1815pii
00006565-202001000-00005journal_volume
36pub_type
杂志文章abstract::This article reviews the mechanisms of pulmonary injury associated with smoke inhalation and the pathophysiology of carbon monoxide poisoning. In addition, the temporal stages of pulmonary injury and evaluation and treatment of the pediatric patient are discussed. Maintaining a high index of suspicion when treating th...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-198603000-00010
更新日期:1986-03-01 00:00:00
abstract::Pyogenic liver abscess (PLA) is a rare pediatric disease. Typically, PLA is found in adults with biliary disease. There are no typical physical findings or symptoms. Often, pathogenic organisms are not recovered for identification. This case illustrates a teenager presenting with prolonged episodes of fever and vomiti...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e318196fa9b
更新日期:2009-02-01 00:00:00
abstract:BACKGROUND:Pediatric trauma is a significant public health problem in resource-constrained settings; however, the epidemiology of injuries is poorly defined in Rwanda. This study describes the characteristics of pediatric trauma patients transported to the emergency department (ED) of the Centre Hospitalier Universitai...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001045
更新日期:2019-09-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to delineate pediatric emergency medicine provider opinions regarding the importance of, and to ascertain existing processes by which practitioners maintain, the following critical procedural skills: oral endotracheal intubation, intraosseous line placement, pharmacologic and electri...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000991
更新日期:2019-08-01 00:00:00
abstract::Necrotizing soft tissue infections are a serious medical emergency that involve necrosis within the soft tissue space including the dermis, subcutaneous tissue, superficial fascia, deep fascia, and muscle. Inciting factors include recent varicella infection, omphalitis, trauma, intramuscular injections, perianal traum...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001888
更新日期:2019-08-01 00:00:00
abstract:INTRODUCTION:Viral gastroenteritis with dehydration is one of the most frequent reasons for visits to pediatric emergency departments (ED). Parental intervention before presentation to the ED can make a significant difference in the course of a child's illness. There is a discrepancy between medical knowledge of dehydr...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/pec.0b013e3181d6d9de
更新日期:2010-04-01 00:00:00
abstract::A 4-month-old infant with trisomy 21 is brought to the emergency department for breathing difficulty. Subsequently, he is diagnosed with a Morgagni diaphragmatic hernia. Tachypnea in an infant with trisomy 21 may be the result of diagnosis such as congenital heart disease, infectious processes, structural anomalies, o...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000202457.64978.3d
更新日期:2006-03-01 00:00:00
abstract::The diagnosis of pulmonary thromboembolism (PE) is often delayed because it is usually misdiagnosed as pneumonia or deep vein thrombosis. We report an unusual case of PE misdiagnosed as viral pleuritis on the first arrival at the emergency department (ED) in our hospital. A 14-year-old girl with no previous significan...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001104
更新日期:2018-11-01 00:00:00
abstract::Infective uvulitis is a rare condition in children. In this report, we describe the case of a 4-year old-patient who presented a group A Streptococcus pharyngitis with uvulitis. No signs of epiglottitis were detected at nasal fibroscopy. She recovered rapidly with intravenous antibiotic therapy and 2 days of corticost...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000002258
更新日期:2020-10-07 00:00:00
abstract:BACKGROUND:Forearm fractures are common injuries in children. Displaced and angulated fractures usually require reduction. Ultrasound diagnosis and guided reduction offer several potential advantages: (1) the procedure does not involve ionizing radiation; (2) compared with fluoroscopy units, the newer ultrasound units ...
journal_title:Pediatric emergency care
pub_type: 临床试验,杂志文章
doi:10.1097/PEC.0b013e318128f85d
更新日期:2007-08-01 00:00:00
abstract::Recent epidemiological studies have shown that childhood back pain is a common complaint often prompting medical attention and that it is infrequently the result of serious etiology. This challenges the traditional view that childhood back pain was an uncommon and ominous symptom, always indicative of significant path...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3181f054a9
更新日期:2010-09-01 00:00:00
abstract::We describe the first ziprasidone overdose with quantitative serum levels of a pediatric patient in coma and with pinpoint pupils. This case is an important contribution to the pediatric ziprasidone literature because it illustrates that ingestion of just 1 pill may result to profound mental status and respiratory dep...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e31819e3775
更新日期:2009-04-01 00:00:00
abstract:UNLABELLED:Negative-pressure pulmonary edema is a rare but life-threatening complication of upper airway obstruction. Because negative-pressure pulmonary edema may occur in a large spectrum of pathologies associated with upper airway obstruction, awareness of this condition is crucial during daily clinical practice. We...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000186430.92388.a6
更新日期:2005-11-01 00:00:00
abstract::Dextromethorphan is an over-the-counter dissociative agent of increasing popularity as a drug of abuse among younger adolescents. The drug produces a range of toxicities depending upon either the dose or the components of the specific formulation that was ingested. Most cases improve with supportive care alone, but se...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/01.pec.0000148039.14588.d0
更新日期:2004-12-01 00:00:00
abstract:OBJECTIVES:Effective leadership and teamwork are imperative during pediatric cardiopulmonary resuscitations (CPR). The initial phase of pediatric CPR, termed the "first 5 minutes," has significant care delivery gaps in both leadership and team performance. The aim of the study was to describe the performance data of em...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001923
更新日期:2019-12-13 00:00:00
abstract::During a 12-month period ending on 11/30/88, data were collected on 143 pediatric patients visiting a pediatric emergency department with burns. Sixty-four percent were males. Common causes of the burns included hot water (17%), hot food (23%), hot appliances (18%), and charcoal and grills (9%). Sixty-six percent of t...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199104000-00004
更新日期:1991-04-01 00:00:00
abstract:OBJECTIVES:Early identification of children at risk for adverse outcomes is important. Serum bicarbonate is easily collected and widely available. We described the relationship between bicarbonate and adverse outcomes in children presenting to the emergency department (ED). METHODS:We conducted a retrospective cohort ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000937
更新日期:2017-11-01 00:00:00
abstract::Honeycomb gallbladder is a rare congenital malformation of the gallbladder. In some cases, it may be asymptomatic, whereas in others, it may lead to symptoms consistent with biliary colic even in the absence of cholelithiasis. We present the clinical and imaging findings of a case of a 10-year-old boy who was admitted...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000030
更新日期:2013-12-01 00:00:00
abstract:OBJECTIVES:Head trauma is one of the main causes of death in childhood and often leaves severe disability with serious neurological damage. Appropriate treatment must be provided immediately to improve outcomes. This study was performed to identify factors associated with a poor prognosis at an early stage of severe he...
journal_title:Pediatric emergency care
pub_type: 杂志文章,多中心研究
doi:10.1097/PEC.0000000000001321
更新日期:2018-12-01 00:00:00
abstract::To determine the accuracy and reliability of a labeled leukocyte imaging technique in the early diagnosis of pediatric appendicitis, we prospectively studied patients presenting to the pediatric emergency department with abdominal pain suggestive of appendicitis. Patients scheduled for urgent laparotomy were excluded,...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199510000-00005
更新日期:1995-10-01 00:00:00
abstract::We report an extremely rare case of homicidal lithium battery ingestion in a neonate hitherto unreported in the medical literature. Although a definitive diagnosis was initially missed in the baby, the patient survived with no complications whatsoever even after retention of the said foreign body for 10 days. ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e31825d23df
更新日期:2012-07-01 00:00:00
abstract:OBJECTIVES:QTc interval is significant because prolongation may lead to ventricular dysrhythmia. Computerized electrocardiogram machines typically measure QT interval length and, using an algorithm assessment of multiple leads, calculate a QTc value. Manual measurement of the QT interval used to calculate the QTc value...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000002125
更新日期:2020-06-01 00:00:00
abstract::We describe 2 cases of child maltreatment who presented as common pediatric conditions: preseptal cellulitis and gastroenteritis. The first case is an 8-year-old girl who presented with progressive right eye pain, swelling, and discharge. She was initially treated for preseptal cellulitis, but eye cultures ultimately ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001686
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVE:To evaluate the utility of a simple scoring system as a predictor of obtaining a positive throat culture for group A streptococci (GAS). DESIGN:Prospective descriptive study. Scores were assigned prior to the availability of the results of throat cultures. SETTING:Emergency department and walk-in clinic of ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199804000-00005
更新日期:1998-04-01 00:00:00
abstract::Serious intra-abdominal injuries in neonates are very rare. In addition, the signs and symptoms of hemoperitoneum caused by bleeding from solid viscera are vague and nonspecific and often are not recognized before the onset of hypovolemic shock or death. In this report, we describe a 2-day-old infant who presented wit...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/00006565-200002000-00009
更新日期:2000-02-01 00:00:00
abstract:OBJECTIVES:To ascertain the incidence, determinants, and outcome of sepsis workup in febrile infants aged 0-90 days with respiratory syncytial virus (RSV) infection. DESIGN:Retrospective chart review. RESULTS:191 infants with RSV, 21.5% younger than 28 days, were identified; 101 (52.9%) were febrile and 90 were afebr...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/01.pec.0000092576.40174.28
更新日期:2003-10-01 00:00:00
abstract::Corn starch powder is widely used for routine infant skin care as a substitute for talcum powder, as it is believed to have fewer respiratory hazards. We describe a one-month-old infant who presented to an emergency department with respiratory failure and a severe pneumonitis from aspiration of corn starch powder. The...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199604000-00011
更新日期:1996-04-01 00:00:00
abstract::Esophageal coins are typically seen as radiopaque disks on anteroposterior chest radiographs. This radiographic finding is generally considered classic for identifying "swallowed" coins as being in the esophagus. We report the case of an 11-year-old girl with an esophageal coin seen end-on on an anteroposterior chest ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000181421.94847.60
更新日期:2005-10-01 00:00:00
abstract::Young female patients with gynecologic complaints, including vaginal discharge, commonly seek care in the emergency department. Prepubertal vaginal discharges have various potential etiologies including nonspecific vulvovaginitis, infections, inflammatory or dermatologic processes, precocious puberty, malignancy, anat...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/pec.0b013e31815c9dd2
更新日期:2007-12-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to examine differences between general and pediatric emergency departments (PEDs) in adherence to the American Academy of Pediatrics bronchiolitis management guidelines. METHODS:We conducted a nationally representative study of ED visits by infants younger than 24 months with bronch...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001145
更新日期:2019-05-01 00:00:00