Abstract:
OBJECTIVE:Pediatric isolated skull fractures (ISFs) are common injuries that represent challenging disposition decisions for clinicians. The purpose of this study is to use a decision analysis to compare the clinical and cost-effectiveness of 3 emergency department (ED)-based disposition scenarios for a pediatric patient presenting with ISF. METHODS:We conducted a cost-effectiveness analysis comparing ED disposition scenarios that included current practice, increased at-home surveillance, and observation unit utilization. Current rates of admission, deterioration after initial diagnosis, and ED return after discharge, as well as cost of observation-only status, were obtained through literature review. Cost calculations using Healthcare Cost and Utilization Project data included total ED cost, admission without complication, and admission with deterioration. RESULTS:In current practice, 76% of subjects with ISF are admitted and 2.5% of those develop persistent or new symptoms. No patient diagnosed with ISF required neurosurgical intervention. Of those discharged home from the ED, 2.8% return with a new concern with 7.4% having new findings on imaging leading to admission. Total cost per 100 patients by current practice was US $583,587. Increasing at-home surveillance by 20% resulted in a total cost saving of US $113,176 per 100 patients while increasing returns to the ED from less than 1% to 1.1%. Admitting at the current rate to an observation unit resulted in a US $205,395 cost saving per 100 patients. CONCLUSIONS:Decreased inpatient utilization through home surveillance or observation unit use reduced cost associated with pediatric ISF management without increasing clinical risk owing to the low probability of clinical deterioration after initial diagnosis.
journal_name
Pediatr Emerg Carejournal_title
Pediatric emergency careauthors
Williams DC,Russell WS,Andrews AL,Simpson KN,Basco WT Jr,Teufel RJ 2nddoi
10.1097/PEC.0000000000001324subject
Has Abstractpub_date
2018-06-01 00:00:00pages
403-408issue
6eissn
0749-5161issn
1535-1815journal_volume
34pub_type
杂志文章abstract:OBJECTIVES:Nonoperative management of hemodynamically stable liver lacerations in pediatric trauma patients is a safe and effective management strategy for pediatric patients; approximately 90% will be successfully managed nonoperatively. No study has specifically identified risk criteria for the need for intervention ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001538
更新日期:2020-07-01 00:00:00
abstract:OBJECTIVE:Real-time audiovisual consultation (telemedicine) has been proven feasible and is a promising alternative to interfacility transfer. We sought to describe caregiver perceptions of the decision to transfer his or her child to a pediatric emergency department and the potential use of telemedicine as an alternat...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000957
更新日期:2019-03-01 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::Priapism is an adverse effect of medications used to treat psychiatric disorders. Often, this condition is self-limiting but may require urologic intervention involving aspiration and injection to induce detumescence. A case of a 15-year-old patient with priapism secondary to a long-acting stimulant is presented to de...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000485
更新日期:2015-07-01 00:00:00
abstract::We present a case of a 4-month-old girl referred to the emergency department with a provisional diagnosis of acute life-threatening event with a recent episode of heart block and a history of long-lasting fever. Soon after admission, the child suddenly deteriorated rapidly; she became pulseless with complete heart blo...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000195757.74328.68
更新日期:2006-01-01 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:OBJECTIVES:Describe the usage of observation status (OS) beds on a pediatric inpatient unit and identify diagnoses likely to be successfully discharged compared to those requiring formal inpatient admission. METHODS:Retrospective chart review of all patients (0-18 years) transferred to pediatric OS beds from the emerg...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/01.pec.0000106238.72265.5f
更新日期:2004-01-01 00:00:00
abstract::Expected clinical manifestations of intussusception include paroxysmal abdominal pain, vomiting, abdominal mass, and with time, rectal bleeding. We report a case where lethargy and vomiting are the presenting complaints. Diagnostic delay was encountered for this infant who had altered sensorium without accompanying pa...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-198706000-00015
更新日期:1987-06-01 00:00:00
abstract:OBJECTIVE:This study examined whether the withdrawal of over-the-counter cough and cold medication labeled for use in children younger than 2 years in October 2007 and the warning against use of the products in children younger than 4 years in October 2008 affected cough and cold medication ingestions by young children...
journal_title:Pediatric emergency care
pub_type: 杂志文章,多中心研究
doi:10.1097/PEC.0b013e3182587b0c
更新日期:2012-06-01 00:00:00
abstract:OBJECTIVE:To describe the clinical course and determine the minimal observation period required following isopropanol ingestion in children. METHODS:The emergency department records of children less than 6 years of age with isopropanol ingestion who presented between June 1992 and December 1998 were identified. Demogr...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-200008000-00005
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVES:To evaluate changes in imaging practices for pediatric head trauma after publication of the Pediatric Emergency Care Applied Research Network (PECARN) guidelines, explore areas for quality improvement regarding neuroradiology referrals. We also sought to determine the prevalence of incidental findings discov...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000002124
更新日期:2020-06-12 00:00:00
abstract:OBJECTIVE:The aims of the study were to determine the frequency at which each emergency medicine evaluation and management (E/M) code is used, to identify factors associated with their use by academic pediatric emergency departments (PEDs), and to compare PED E/M code utilization rates with rates reported by Centers fo...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000177193.60784.c2
更新日期:2005-09-01 00:00:00
abstract::Etizolam (ETZ) is an antidepressive thienodiazepine drug that is used worldwide. The most frequent adverse effects in adults are drowsiness and muscle weakness, and this can rarely cause paradoxical excitation; however, no information exists on intoxication in children. Furthermore, evidence bearing on its safety in c...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000280511.13537.bd
更新日期:2007-07-01 00:00:00
abstract:OBJECTIVE:Recent research suggests that increasing numbers of caregivers are bringing their children to the emergency department (ED) for mental health services and that a large proportion of these children have Medicaid as their insurance. The objective of this study was to examine the characteristics of children with...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000336
更新日期:2015-07-01 00:00:00
abstract::Superior ophthalmic vein thrombosis (SOVT) usually results from inflammatory, infectious, or malignant causes. This case describes a 2-year-old boy with severe prolapsing chemosis and proptosis due to thrombosis of the right superior ophthalmic vein resulting from midfacial and right orbital fractures 1 week after the...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000066
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVE:Major studies (PECARN [Pediatric Emergency Care Applied Research Network], CATCH [Canadian Assessment of Childhood Head Injury]) that regulate the use of computed tomography (CT) algorithms in children with minor head trauma (MHT) have been conducted among children presenting in 24 hours after injury. In this...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000002011
更新日期:2020-01-10 00:00:00
abstract::Medical directors of pediatric emergency departments were surveyed by mail to determine the present role of their pediatric hospitals in general, and emergency departments in particular, in the evaluation and management of pediatric sexual assault and abuse. Seventy-four percent of the responses were from communities ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-198809000-00003
更新日期:1988-09-01 00:00:00
abstract:OBJECTIVE:To validate a previously published clinical decision rule to predict risk of urinary tract infection in febrile young girls. METHODS:We performed a retrospective case-control study at a children's hospital emergency department in a different city than that in which the original derivation study took place. G...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000081238.98249.40
更新日期:2003-06-01 00:00:00
abstract:OBJECTIVES:This study aimed to estimate the incidence of emergency department (ED) visits in the neonatal period in a nationally representative sample and to examine variation by race. METHODS:The National Hospital Ambulatory Medical Care Survey is a nationally representative survey of utilization of ambulatory care s...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000120
更新日期:2014-05-01 00:00:00
abstract::A 5-year-old female with Charcot-Marie-Tooth neuropathy and a history of constipation presented to the emergency department with a new blistering buttocks rash, which was initially concerning for nonaccidental burn. Upon further investigation, it was found that Ex-Lax had been given to the patient for constipation. Th...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001498
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVE:The objective was to derive a simple clinical scoring instrument for assessing children with croup by telephone for use in clinical research studies. METHODS:We reviewed published literature on croup scores, surveyed experienced pediatric emergency nurses and physicians, and conducted a prospective cohort st...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000796
更新日期:2016-05-01 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::Pneumomediastinum is a relatively uncommon occurrence in pediatric patients. After mediastinal air leak, air may dissect through a variety of tissue planes within the chest, neck, and abdomen. We report the case of a 16-year-old adolescent boy who presented with spontaneous pneumomediastinum accompanied by the presenc...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e31828a38ad
更新日期:2013-04-01 00:00:00
abstract::Forty-three nonhemophiliac, confirmed HIV-positive children followed by the Children's Hospital AIDS Program made 184 visits to the children's Emergency Department (ED) during 1988 and 1989. The mean age was 30 +/- 28 months with a median of 25 months, a mode of 10 months, and a range from two days to 19 years. CD4 co...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199310000-00002
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVES:The goals of this study were to (1) conduct a cost-benefit analysis, from a hospital's perspective, of using a pediatrician in triage (PIT) in the emergency department (ED) and (2) assess the impact of a physician in triage on provider satisfaction. METHODS:This was a prospective, controlled trial of PIT (i...
journal_title:Pediatric emergency care
pub_type: 杂志文章,多中心研究
doi:10.1097/PEC.0b013e31826c6dc4
更新日期:2012-10-01 00:00:00
abstract::The umbilical hernia is common in children. Most of the cases have a spontaneous regression around the age of 3 years. Complications are very rare, and thus surgery is not routinely indicated before the age of 3 years. We report an exceptional case of spontaneous rupture of an umbilical hernia with emphasis on the man...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000002200
更新日期:2020-09-01 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:OBJECTIVES:Pediatric care is increasingly regionalized, increasing rates of interfacility transport (IFT). However, it is unknown what conditions most frequently require IFT. This study's objective was to identify high-frequency pediatric conditions requiring IFT. METHODS:This is a statewide retrospective observationa...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001578
更新日期:2018-09-11 00:00:00
abstract::We describe two related cases of pertussis infection ("whooping cough"). This disease entity was almost completely eradicated through successful mass immunization programs. In the past decade it has demonstrated a steady rise in incidence. The epidemiology, clinical manifestations, treatment, and current vaccines for ...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:
更新日期:1993-08-01 00:00:00
abstract:OBJECTIVES:Sickle cell disease is the most common hemoglobin variant in the world and can present with recurrent vaso-occlusive painful crises. Pain control in these patients is often difficult and requires a multimodal approach. In patients with uncontrolled pain after traditional pain control methods, ketamine infusi...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/PEC.0000000000000978
更新日期:2019-01-01 00:00:00