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 bronchiolitis from 2002 to 2011 using the National Hospital Ambulatory Medical Care Survey. Diagnostic testing (complete blood counts, radiographs) and medication use (albuterol, corticosteroids, antibiotics and intravenous fluids) in general emergency departments (GEDs) were compared with those in PEDs before and after 2006 American Academy of Pediatrics guideline publication. Weighted percentages were compared, and logistic regression evaluated the association between ED type and resource use. RESULTS:Of more than 2.5 million ED visits for bronchiolitis from 2002 to 2011, 77.3% occurred in GEDs. General emergency departments were more likely to use radiography (62.7% vs 42.1%; adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.4-4.1), antibiotics (41.3% vs 18.8%; aOR, 2.8; 95% CI, 1.5-5.2), and corticosteroids (24.3% vs 12.5%; aOR, 2.1; 95% CI, 1.0-4.5) compared with PEDs. Compared with preguideline, after guideline publication PEDs had a greater decrease in radiography use (-19.7%; 95% CI, -39.3% to -0.03%) compared with GEDs (-12.2%; 95% CI, -22.3% to -2.1%), and PEDs showed a significant decline in corticosteroid use (-12.4%; 95% CI, -22.1% to -2.8%), whereas GEDs showed no significant decline (-4.6%; 95% CI, -13.5% to 4.3%). CONCLUSIONS:The majority of ED visits for bronchiolitis in the United States occurred in GEDs, yet GEDs had increased use of radiography, corticosteroids, and antibiotics and did not show substantial declines with national guideline publication. Given that national guidelines discourage the use of such tests and treatments in the management of bronchiolitis, efforts are required to decrease ED use of these resources in infants with bronchiolitis, particularly in GEDs.
journal_name
Pediatr Emerg Carejournal_title
Pediatric emergency careauthors
Gong C,Byczkowski T,McAneney C,Goyal MK,Florin TAdoi
10.1097/PEC.0000000000001145subject
Has Abstractpub_date
2019-05-01 00:00:00pages
323-329issue
5eissn
0749-5161issn
1535-1815journal_volume
35pub_type
杂志文章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::Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication of the use of certain medications. It is being seen more often in the pediatric population because of the increasing use of both typical and atypical antipsychotics in children. Rapid recognition of NMS is important to emergency physicia...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001000
更新日期:2017-01-01 00:00:00
abstract::We report an unusual case of ventriculoperitoneal (VP) shunt intrathoracic migration, associated with massive symptomatic hydrothorax. The VP shunt was inserted 10 years before presentation, after hemorrhagic hydrocephalus caused by prenatal intraventricular hemorrhage. The pleural fluid was drained via tube thoracost...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/PEC.0b013e3182447dce
更新日期:2012-02-01 00:00:00
abstract:OBJECTIVES:Patients returning to the emergency department (ED) within 72 hours of their visit may contribute to crowding and might indicate failure to give a proper assessment, treatment, or follow-up instructions. The aim of this study was to describe the rate of return visits in a tertiary care pediatric ED (PED) and...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000230553.01917.05
更新日期:2006-08-01 00:00:00
abstract:OBJECTIVE:Treating or referring patients who are found to be anemic during pediatric emergency department (ED) encounters should lead to improved health in children and young adults. Before establishing guidelines how to approach the anemic in the pediatric ED, it is essential to determine the prevalence of anemia in t...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e31824d8a2f
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVES:Although mild stress hyperglycemia in pediatric illness is common, severe hyperglycemic responses (≥300 mg/dL [16.7 mmol/L]) to stress are unusual. We sought to determine the incidence and course of extreme stress hyperglycemia (ESH) in acute pediatric illness, including whether it is a marker of increased m...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3181ef0488
更新日期:2010-09-01 00:00:00
abstract::Hip pain and fever in children include a broad differential. Most concerning is the possible diagnosis of a septic joint, which carries significant morbidity. We describe the case of a 13-year-old boy with fever and hip pain who was referred to the emergency department with concern for septic hip. The etiology was lat...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000328
更新日期:2015-01-01 00:00:00
abstract:OBJECTIVE:Recent Pediatric Advanced Life Support (PALS) guidelines have deemphasized the use of advanced airways in short transport. It is unclear if guideline recommendations have altered practice. We sought to determine if a temporal change exists in the number of prehospital pediatric trauma intubations since the 20...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000759
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:We present a case of Kasabach-Merritt syndrome with discussion of hemangiomas of childhood relevant to the emergency physician. DESIGN:This is a case report. SETTING:The case is described in the setting of a tertiary care hospital level I pediatric emergency department. PATIENTS:A single case is discussed....
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199612000-00009
更新日期:1996-12-01 00:00:00
abstract::We report a case of a patient presenting with fever, right lower leg swelling, and pain who was found to have a fluid collection between muscle planes noted on point-of-care ultrasound. Point-of-care ultrasound raised the clinician's concern for deep musculoskeletal infection, leading to prompt initiation of antibioti...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/PEC.0000000000001711
更新日期:2019-01-01 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::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:OBJECTIVES:This study aimed to describe the epidemiology and clinical burden of unintended carbon monoxide (CO) poisoning among children in the Negev region of southern Israel. METHODS:This was a cross-sectional retrospective study of CO poisoning patients admitted to Soroka University Medical Center in 2011 through 2...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001484
更新日期:2020-11-01 00:00:00
abstract::This case provides the first report of a young healthy child presenting in septic shock from Clostridium difficile colitis. This child had no identifiable risk factors for C. difficile, raising the suspicion for a hypervirulent strain. Once infection was recognized and treated appropriately, the child made a full reco...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000496
更新日期:2017-08-01 00:00:00
abstract::Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare adrenergically mediated arrhythmogenic disorder classically induced by exercise or emotional stress and found in structurally normal hearts. It is an important cause of cardiac syncope and sudden death in childhood. Catecholaminergic polymorphic ve...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3182360606
更新日期:2011-11-01 00:00:00
abstract:BACKGROUND:Pediatric nonaccidental trauma (NAT) accounts for more than 1500 deaths annually and is a source of incalculable lifelong morbidity. Evidence-based NAT evaluation protocols are available; however, compliance studies are lacking. Here, we analyze the quality of implementation of a new NAT evaluation protocol....
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001981
更新日期:2020-02-01 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::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::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::The cause of a fever of unknown origin (FUO, fever of >21 days without an identified etiology) may be a common illness, an atypical presentation of a common illness, or an unusual illness. A patient with an FUO occasionally presents to the emergency department (ED). The differential diagnosis of an FUO is extensive. A...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3181bec8df
更新日期:2009-10-01 00:00:00
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journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000238743.96606.69
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine the psychometric properties of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2-question alcohol screen within 16 Pediatric Emergency Care Applied Research Network pediatric emergency departments. This article describes the study methodology, sample chara...
journal_title:Pediatric emergency care
pub_type: 杂志文章,多中心研究
doi:10.1097/PEC.0000000000001221
更新日期:2019-11-01 00:00:00
abstract:OBJECTIVE:To compare the efficacy of a single dose of oral dexamethasone (Dex) versus 5 days of twice-daily prednisolone (Pred) in the management of mild to moderate asthma exacerbations in children. STUDY DESIGN:A prospective, randomized, double-blinded trial of children 2 to 16 years of age who presented to the emer...
journal_title:Pediatric emergency care
pub_type: 杂志文章,随机对照试验
doi:10.1097/01.pec.0000248683.09895.08
更新日期:2006-12-01 00:00:00
abstract::An 8-year-old girl presented to the pediatric emergency department (ED) with left-sided weakness. Workup consisted of labs and imaging including magnetic resonance imaging showing an acute ischemic stroke. Literature regarding pediatric acute ischemic stroke is minimal, and there are few protocols guiding care in the ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000436
更新日期:2017-03-01 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:OBJECTIVE:The aim of this study was to report an acute onset of symptoms erroneously attributed to serotonin syndrome in a child who had been given both anticholinergic and serotonergic agents. CASE SUMMARY:A 9-year-old girl with chronic anxiety and gastrointestinal problems was prescribed oral sertraline 6.25 mg dail...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000515
更新日期:2015-12-01 00:00:00
abstract:OBJECTIVES:The emergency department (ED) can be an effective site for pediatric injury prevention initiatives, including child passenger safety. The objectives of this study were to evaluate the implementation of an ED child passenger safety program and to analyze the effectiveness of a computerized screening tool to i...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000210
更新日期:2014-09-01 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:INTRODUCTION:Since 1987 the average length of stay for infants following hospital delivery has decreased 1.8 days. This study was undertaken to evaluate the null hypothesis that early discharge of newborns from nurseries does not result in increased emergency department (ED) utilization during the first 10 days of life...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199712000-00001
更新日期:1997-12-01 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