Abstract:
OBJECTIVES:National guidelines for routine pediatric acute asthma care recommend providing corticosteroids, and discourage routinely obtaining chest radiographs (CXRs) and using antibiotics. We examined rates of adherence to all 3 of these aspects during emergency department (ED) visits and compared performance between pediatric and general EDs. METHODS:Using the National Hospital Ambulatory Medical Care Survey, we included all nontransfer ED visits for patients younger than 19 years with a diagnosis of asthma and treatment with albuterol from 2005 to 2015. Guideline-based care, defined as (1) corticosteroids, (2) no antibiotics, and (3) no CXR, was assessed for each visit. Hospitals were categorized as pediatric or general and compared according to rates of guideline-based care. Multivariable analyses were used to identify demographic and hospital-level characteristics associated with guideline-based care. RESULTS:More than 7 million ED visits met eligibility criteria. Antibiotic provision and CXR acquisition were significantly higher in general EDs (20% vs 11%, 40% vs 26%, respectively), while steroid provision was similar (63% vs 62%). Overall, 34% of visits involved guideline-based care, with a higher rate for pediatric EDs compared with general EDs (42% to 31%). Visit at a pediatric ED (odds ratio, 1.62 [confidence interval 1.17-2.25]) and black race (odds ratio, 1.48 [confidence interval 1.07-2.02]) were independently associated with guideline-based care in a multivariate analysis. CONCLUSIONS:Guideline-based care was more common in pediatric EDs, although only one-third of all pediatric-age visits met the definition of guideline-based care. Future policy and education efforts to reduce unnecessary antibiotic and CXR use for children with asthma are warranted.
journal_name
Pediatr Emerg Carejournal_title
Pediatric emergency careauthors
Hudgins JD,Neuman MI,Monuteaux MC,Porter J,Nelson KAdoi
10.1097/PEC.0000000000001706subject
Has Abstractpub_date
2019-01-07 00:00:00eissn
0749-5161issn
1535-1815pub_type
杂志文章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:OBJECTIVES:Ondansetron has been shown to decrease admission rate and the need for intravenous fluids among pediatric emergency department (ED) patients with acute gastroenteritis, but there is limited evidence regarding its use after ED discharge. This study describes prescribing patterns for ondansetron and assesses t...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001343
更新日期:2020-03-01 00:00:00
abstract:UNLABELLED:Clavicle fractures are a common injury among pediatric patients. Few data exist regarding specific etiologies and their management in the preadolescent patient. Our objective was to determine the specific source of injury and treatment techniques used in the youngest patient population. METHODS:Study Design...
journal_title:Pediatric emergency care
pub_type: 杂志文章,多中心研究
doi:10.1097/PEC.0b013e3181bec7fc
更新日期:2009-11-01 00:00:00
abstract::The unlikely event of long-term complications in some pediatric fractures, such as midclavicular fractures, has allowed for management of these injuries with interventions that support the injured extremity rather than immobilize it while healing occurs. However, there is currently a growing body of evidence that advo...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/PEC.0b013e3181ce310c
更新日期:2010-02-01 00:00:00
abstract::The recent popularity of elastic bands on the wrist may put children at risk for acute compartment syndrome. Acute compartment syndrome is a limb-threatening condition characterized by elevated interstitial pressure in a confined fascial compartment. If left untreated, it may result in tissue necrosis, irreversible ne...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e318217b5a7
更新日期:2011-05-01 00:00:00
abstract::Sexually transmitted infection as the result of child sexual abuse in prepubertal children is uncommon. Chlamydia trachomatis conjunctivitis is an even less common entity in prepubertal children outside the newborn period. This report details the presentation of 2 children with conjunctivitis who were subsequently dia...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001449
更新日期:2020-08-01 00:00:00
abstract::Subcutaneous granuloma annulare is an inflammatory lesion occurring in otherwise healthy children. We present 3 pediatric patients with different diagnostic-therapeutic paths depending on the ward they were referred to. The lesions regress spontaneously, and medical or surgical treatments are generally not necessary. ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000591
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVES:Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect. Children with this anomaly are usually asymptomatic at birth and develop symptoms later on in life, which may mimic myocarditis. We sought to delineate clinical, laboratory, and epidemiological aspects of thi...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000511
更新日期:2016-04-01 00:00:00
abstract::Paracetamol is a common antipyretic often used to treat children with fever and pain. With the increasing administration of intravenous (IV) paracetamol, there will be the associated risk of medication dosing errors. We report a case of IV paracetamol overdose in a child with fever during hospital admission. A IV para...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001432
更新日期:2019-02-01 00:00:00
abstract:OBJECTIVES:Although National Asthma Guidelines recommend that emergency department (ED) physicians consider initiating controller medications, research suggests that this practice occurs infrequently. The goal of this study was to assess primary care pediatricians' (PCP) beliefs and attitudes regarding ED initiation of...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000389
更新日期:2015-08-01 00:00:00
abstract:OBJECTIVE:Timely delivery of β-agonists and steroids to patients with acute recurrent wheezing is a key component of the National Heart, Lung, and Blood Institute recommended emergency department (ED) asthma care. We conducted an ED improvement initiative to standardize asthma care and improve time to treatments. METH...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001249
更新日期:2017-09-01 00:00:00
abstract:OBJECTIVE:: To report a case of unexpected shaken baby syndrome, the diagnosis of which was possible after an incidental funduscopic examination. METHODS:: Observational case report. An infant was to be sent back home with an apparent unprovoked seizure diagnosis when a funduscopic examination was made because of an i...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000227385.46143.20
更新日期:2006-07-01 00:00:00
abstract::Acute disseminated encephalomyelitis is a rare central nervous system demyelinating disease that occurs most frequently in children. It usually runs a monophasic course, beginning with fever, headache, and meningeal signs and rapidly progressing to coma when appropriate diagnosis and treatment are not provided. We rep...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:
更新日期:1998-02-01 00:00:00
abstract:OBJECTIVE:To assess whether Web-based teaching is at least as effective as traditional classroom didactic in improving the proficiency of pediatric novice learners in the image acquisition and interpretation of pneumothorax and pleural effusion using point-of-care ultrasound (POCUS). METHODS:We conducted a randomized ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001482
更新日期:2020-07-01 00:00:00
abstract::We report an unusual case of deep vein thrombosis following minor trauma in an adolescent who presented with a swollen, tender, lower extremity. Work-up consisted of a venogram which demonstrated occlusion of the deep venous system in the proximal leg. The patient was hospitalized for intravenous heparin followed by o...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-198906000-00008
更新日期:1989-06-01 00:00:00
abstract:OBJECTIVE:Pediatric aeromedical transport (AT) is highly challenging. We aim to describe a series of 96 cases of children requiring medical transport in terms of the indication, modalities, and related adverse events. METHODS:In this single-center retrospective study, we included air-transported patients less than 18 ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001308
更新日期:2020-01-01 00:00:00
abstract::Inadvertent knotting of urethral catheters and enteric feeding tubes is a rare complication in pediatric patients. If a small flexible tube is used and advanced too far, upon withdrawal, the catheter may knot in the bladder. Surgical intervention for retrieval is required in most cases. We present a case of a 26-day-o...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000751
更新日期:2017-03-01 00:00:00
abstract:OBJECTIVE:This study aimed to investigate the management of pediatric patients with diabetic ketoacidosis (DKA) presenting to emergency departments (EDs) participating in the Illinois Emergency Medical Services for Children (EMSC) Facility Recognition program. METHODS:In 2010, Illinois EMSC conducted a survey (includi...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3182768bfc
更新日期:2012-12-01 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:BACKGROUND AND OBJECTIVES:Febrile infants younger than 90 days are often subjected to invasive diagnostic evaluation and hospitalization to monitor for serious bacterial infection (SBI) despite recent changes in SBI risk and advances in diagnostics. Nationwide provider practices, over time, are unknown for this group. ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001262
更新日期:2020-08-01 00:00:00
abstract::Pediatric bilateral facial nerve paralysis (FNP) is a rare condition, representing less than 2% of all cases of FNP. The differential diagnosis of FNP is extensive (ranging from infectious, traumatic, neurologic, to idiopathic) and often can present as a diagnostic challenge. In contrast to unilateral presentation, bi...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001648
更新日期:2020-11-01 00:00:00
abstract::We present a case of acute Candida epiglottitis in an otherwise healthy and Haemophilus influenzae type B-immunized 4-year-old child. A query of the literature reveals this disease to be commonly found in patients who are immunocompromised by problems including human immunodeficiency virus disease and lymphoma and leu...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/PEC.0000000000001082
更新日期:2019-02-01 00:00:00
abstract::Yersinia enterocolitica infection, or yersiniosis, is a common cause of gastroenteritis in developing nations, but the disease is less common in the developed world. Yersiniosis typically presents as a self-limited gastroenteritis in an immunocompetent patient and rarely progresses to the more fulminant disseminated f...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001873
更新日期:2019-07-01 00:00:00
abstract::Baclofen is a muscle relaxant used in both adults and children with neuromuscular disorders to control spasticity. In children, relatively few cases of overdose have been previously reported. We report two cases of baclofen overdose occurring in two siblings. One sibling with cerebral palsy was being treated with bacl...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/00006565-200104000-00008
更新日期:2001-04-01 00:00:00
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::Astemizole (Hismanal-Janssen, New Brunswick, NJ) is a nonsedating antihistamine that has the advantage of a once-daily dosage schedule. This article reports the case of a 14-year-old female who intentionally ingested 270 mg of Astemizole and developed torsade de pointes, a form of polymorphic ventricular tachycardia t...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199302000-00008
更新日期:1993-02-01 00:00:00
abstract:OBJECTIVE:Injury and poisoning from metallic mercury has become a rare event. Review of the literature and a case report of pediatric metallic mercury injury are presented. DESIGN:A case report. SETTING:The Emergency Department at St. Louis Children's Hospital. PATIENTS OR PARTICIPANTS:A 15-year-old boy. INTERVENTI...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/00006565-199704000-00008
更新日期:1997-04-01 00:00:00
abstract::We present the case of a 9-year-old female who presented after minor blunt abdominal trauma during a sporting event. On focused assessment with sonography for trauma, she was found to have an incidental renal mass, which was ultimately diagnosed as a renal cell carcinoma. In this report, we focus on the use of bedside...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000242
更新日期:2014-10-01 00:00:00
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 emerge...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000002018
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVES:To assess the effect of adding a shared research nurse on patient enrollment in an ongoing clinical study. DESIGN:Before/after comparison of recruitment rates and consent rates involving patients eligible for a study of blood culture collection strategies for methods on the detection of bacteremia and deter...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199610000-00004
更新日期:1996-10-01 00:00:00