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. Our objective was to determine the likelihood of admission and associated complications of care for such infants, particularly those at lowest risk for SBI. METHODS:This is a retrospective cohort study including multisite emergency department (ED) visits using administrative data from the Pediatric Emergency Care Applied Research Network Core Data Project. We examined uncomplicated febrile infants younger than 90 days seen in the ED from 2002 to 2012 who did not have an explicit infectious diagnosis, critical illness, or chronic condition. RESULTS:We identified 38,224 infants, among whom, 11,600 (31%) were admitted. We observed a 3% increase in ED admission every year during the study period (P < 0.05). Age less than 30 days and black race were independent predictors of admission (P < 0.01). We identified 227 complications of care in the ED. Among those with a specified cause, 49% were attributed to antibiotic use or procedures related to the diagnosis and empiric treatment of suspected infection. CONCLUSIONS:Despite the decreasing risk of SBI and diagnostic advances during the study period, the odds of hospital admission increased for febrile infants at low risk for sepsis. We also provide first data on therapeutic and diagnostic test-related adverse events in this setting. These data provide further justification for a consensus guideline on management of such infants.
journal_name
Pediatr Emerg Carejournal_title
Pediatric emergency careauthors
Nguyen DK,Fleischman RJ,Friedlander S,Zangwill KMdoi
10.1097/PEC.0000000000001262subject
Has Abstractpub_date
2020-08-01 00:00:00pages
e438-e446issue
8eissn
0749-5161issn
1535-1815journal_volume
36pub_type
杂志文章abstract::Posttraumatic pseudoaneurysms are extremely rare in pediatric populations. In many cases, pseudoaneurysms may be confused with abscesses, epidermoid cysts, arteriovenous fistula, foreign objects, and ganglion cysts, as well as tumors. They are associated with distinguishing findings of "pulsatile mass, a palpable thri...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/PEC.0000000000001236
更新日期:2019-12-01 00:00:00
abstract:PURPOSE:Multiple studies have documented the nonclinical characteristics of physician assistant (PA) practices in the emergency department (ED). This study examines the clinical care PAs provide to younger pediatric patients in a general community ED. METHODS:The electronic medical record database of an urban communit...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000949
更新日期:2017-01-01 00:00:00
abstract::The unique characteristics of the pediatric population expose them to errors in the emergency department (ED) with few standard practices for the safety of care. Young children and high-acuity patients are at increased risk of adverse events both in the prehospital and ED settings. We provide an overview of the proble...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/01.pec.0000278393.32752.9f
更新日期:2007-06-01 00:00:00
abstract::Emergency department (ED) overcrowding has been a serious issue on the national agenda for the past 2 decades and is rapidly becoming an increasingly significant problem for children. The goal of this report is to focus on the issues of overcrowding that directly impact children. Our findings reveal that although over...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/01.pec.0000280518.36408.74
更新日期:2007-07-01 00:00:00
abstract:OBJECTIVE:To assess outcomes between 2 groups of patients receiving ketamine for procedural sedations in our pediatric emergency department. Our hypothesis is that there is no difference in the number of adverse events in ketamine sedations with and without morphine pretreatment. METHODS:This was a retrospective cohor...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000221339.26873.14
更新日期:2006-06-01 00:00:00
abstract::The diagnosis of septic arthritis should be considered in all children with hip pain. We review the evaluation of children who present with fever and hip pain, emphasizing features that may assist in distinguishing septic arthritis of the hip from transient synovitis. We also discuss the impact of the increased preval...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/01.pec.0000159063.24820.73
更新日期:2005-05-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate the predictors of mortality in childhood heart failure (HF) in 2 tertiary hospitals. METHODS:A 51-month retrospective review of case notes of children with HF admitted into children's emergency rooms of 2 tertiary centers in Southern Nigeria was done. Bio-data and certai...
journal_title:Pediatric emergency care
pub_type: 杂志文章,多中心研究
doi:10.1097/PEC.0000000000001427
更新日期:2020-05-01 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:OBJECTIVES:Enterocolitis remains the most significant cause of morbidity and mortality in Hirschsprung disease (HD). It could progress into toxic megacolon (TM)-acute dilatation of the colon as accompanying toxic complication of Hirschsprung enterocolitis. It is a devastating complication, especially in infants with so...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000444
更新日期:2016-11-01 00:00:00
abstract::We present an instructive case of a 5-week-old infant seen in the emergency department with acute inspiratory stridor and depressed level of consciousness. His emergency department course identified an acute opiate intoxication. The child also developed chest wall rigidity, a rare complication of narcotic use. We disc...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000144921.85747.e0
更新日期:2004-11-01 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::Pulmonary infections due to anaerobic bacteria usually occur in children prone to aspiration. The source of the anaerobic bacteria is the oropharyngeal bacterial flora, where these organisms outnumber aerobic and facultative organisms in a 10:1 ratio. The most common lower respiratory tract infections where anaerobic ...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/01.pec.0000139751.63624.0b
更新日期:2004-09-01 00:00:00
abstract::Immune thrombocytopenia (ITP) in children is usually a benign, self-limiting disorder. An acute Epstein-Barr virus (EBV) infection usually causes atypical lymphocytosis and mild decrease in platelets. Severe thrombocytopenia is an extremely rare complication. Anti-D immunoglobulin has been used for treatment of ITP in...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e318294f3a5
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:To determine if intramuscular (IM) penicillin is more effective than oral (PO) amoxicillin in the early outpatient treatment of pediatric patients with presumed bacterial pneumonia. METHODS:Prospective, randomized, evaluator-blinded, clinical trial. SETTING:Pediatric emergency department (ED) of an urban ch...
journal_title:Pediatric emergency care
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1998-10-01 00:00:00
abstract:OBJECTIVES:Serum amylase can be elevated in various pathological conditions, but its primary application is as a biochemical test for the diagnosis of acute pancreatitis. Acute gastroenteritis has not been widely recognized as a cause for hyperamylasemia and pancreatitis. METHODS:We describe a case of acute pancreatit...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3181ea72a8
更新日期:2010-08-01 00:00:00
abstract:OBJECTIVES:The Emergency Severity Index version 4 (ESI v.4) is the most recently implemented 5-level triage system. The validity and reliability of this triage tool in the pediatric population have not been extensively established. The goals of this study were to assess the validity of ESI v.4 in predicting hospital ad...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3182621813
更新日期:2012-08-01 00:00:00
abstract::A case history of a young girl who sustained a small posterior laceration of her cervical trachea after blunt trauma is presented. She was brought to the emergency department (ED) by her parents roughly two hours after the incident with only minor symptoms. While in the ED, she developed significant airway compromise ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199110000-00008
更新日期:1991-10-01 00:00:00
abstract::When an emergency medicine physician evaluates a child with abdominal pain and a history of appendectomy, appendicitis is often excluded from the differential. We present a case of a 16-year-old boy who developed stump appendicitis 3 years after laparoscopic appendectomy. Knowledge of this rare phenomenon in children ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e31827b54db
更新日期:2013-01-01 00:00:00
abstract::Ultrasound-guided regional anesthesia is a growing modality within the pediatric emergency department. Here we present a case where a posterior tibial nerve block was used for anesthesia during foreign body removal from the plantar foot. We further review the technique and literature regarding this straightforward and...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/PEC.0000000000001897
更新日期:2020-05-01 00:00:00
abstract::Neck pain is a relatively common pediatric complaint. Most is of benign etiology. We present an unusual case of epidural abscess with associated discitis in the cervical spine of a 12-year-old after a dental extraction. This potentially dangerous complication was diagnosed before neurological complications developed a...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3181c8c60b
更新日期:2009-12-01 00:00:00
abstract::Enterobius vermicularis may cause infections of the gastrointestinal tract and occurs approximately in 4% to 28% of children worldwide. It is most common in children aged 5 to 14 years.The most commonly reported symptoms are pruritus in the perianal region, abdominal pain, urinary tract infection, insomnia, irritabili...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000480
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:Interfacility transfers occur frequently and often involve critically ill patients. Clear communication at the time of patient referral is essential for patient safety. OBJECTIVES:The objective of this work was to study whether a standardized inter-emergency department (ED) transfer communication template f...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e318289d7c1
更新日期:2013-04-01 00:00:00
abstract::We retrospectively reviewed the emergency department records of 77 children and adolescents seen in an emergency department with the chief complaint of fainting. Upon careful review, 20 patients had not had any type of syncopal or near-syncopal episode. Of the remaining 57 patients, 40 experienced syncope, and 17 pati...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-198906000-00002
更新日期:1989-06-01 00:00:00
abstract::Pediatric rapid sequence intubation is a skill of great importance to emergency medicine physicians. Developing a systematic strategy for approaching an emergent airway aids in the proper handling of this event. This paper is a review of the current recommendations for pediatric rapid sequence intubation including cur...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/01.pec.0000125667.58561.62
更新日期:2004-05-01 00:00:00
abstract::Rhabdomyosarcoma is the most common soft tissue tumor of childhood, frequently presenting in the head and neck, genitourinary tract, or extremities. We present a case of rhabdomyosarcoma in which an 18-year-old woman presented with abrupt onset unilateral hearing loss, tinnitus, dysarthria, dysphagia, and a new painle...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3181b0a482
更新日期:2009-08-01 00:00:00
abstract::Guillain-Barré syndrome (GBS) in children can present with early symptoms of limb and back pain that progress to acute generalized paralysis. Although the clinical course of this illness may be benign with spontaneous recovery, treatment is indicated for more severe cases. We report a three-year-old patient with GBS, ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199808000-00007
更新日期:1998-08-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to assess whether increased time from emergency department (ED) triage to appendectomy is associated with a greater risk of children developing appendiceal perforation. METHODS:We performed a multicenter retrospective cohort study of children younger than 18 years hospitalized with ...
journal_title:Pediatric emergency care
pub_type: 杂志文章,多中心研究
doi:10.1097/PEC.0000000000000850
更新日期:2019-01-01 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::Malignant hypertension due to autonomic dysfunction is a known complication of Guillain-Barré syndrome. We describe a child who presented with status epilepticus secondary to hypertensive encephalopathy who, in recovery, was found to be areflexic. Nerve conduction studies confirmed the clinical diagnosis of Guillain-B...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e31814b2ddd
更新日期:2007-09-01 00:00:00
abstract::A 4-year-old Indian girl was seen in our emergency department for unintentional ingestion of topical medication oil with subsequent salicylate poisoning. Serum levels were 52 mg/dL at 12 hours after ingestion.She was started on urine alkalization therapy to enhance salicylate elimination. This was achieved by a bicarb...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3182131556
更新日期:2011-04-01 00:00:00