Children In Emergency Department Research Articles

The Association of Chlamydia pneumoniae Infection and Reactive Airway Disease in Children

To determine the possible association of Chlamydia pneumoniae infection and reactive airway disease in children. Prospective observational study. Pediatric emergency department in Children's Medical Center of Brooklyn (NY), Kings County Hospital Center. One hundred eighteen children with acute episodes of wheezing and 41 age- and sex-matched healthy controls, aged 5 to 16 years. Children with cultures positive for C pneumoniae were treated with antibiotics. Cultures for C pneumoniae and serum samples for antibody testing were obtained from subjects and healthy controls. We isolated C pneumoniae from 13 (11%) children with wheezing and from two (4.9%) controls. Seven (58.3%) of 12 children with positive cultures had no detectable antibody to C pneumoniae and only three (25%) children had serologic evidence of acute infection. Six children had positive cultures on multiple occasions, ranging from 1 to 5 months. The children with wheezing were treated with erythromycin or clarithromycin, a new macrolide antibiotic approved for use in adults; all eventually had a negative culture. Nine (75%) of these children demonstrated clinical and laboratory improvement of the reactive airway disease after the eradication of chlamydial infection. Infection with C pneumoniae can trigger acute episodes of wheezing in children with asthma. Treatment of C pneumoniae infection may improve the course of reactive airway disease in these patients.

Computed tomography imaging in children with head trauma: utilization and appropriateness from a quality improvement perspective.

Computed tomography (CT) imaging plays an important role in the acute evaluation and management of children with head trauma. When routine quality improvement (QI) meetings with representatives from the Children's Hospital radiology and emergency departments revealed disagreement regarding the utilization and appropriateness of CT in children presenting with head trauma, an interdepartmental QI team was formed to address this issue. Because formal criteria for obtaining CTs for head trauma were unavailable, internal institutional criteria were developed by consensus after literature review. Contrary to perceptions of some staff members, the majority (95%) of children who received CT met at least one of the established criteria over a one-year study period. There was little relationship between the presence of criteria and abnormal CT results, but decisions whether to admit patients to the hospital or to send them home were influenced by CT results. Follow-up studies suggested that patients who were discharged home with a normal CT or no CT had uniformly good outcomes.

Use of children's accident and emergency department for infants

Use of children's accident and emergency department for infants

Clinical predictors of bacterial versus aseptic meningitis in childhood

To assess the reliability of meningeal signs and other physical findings in predicting bacterial and aseptic meningitis at various ages. Children requiring lumbar puncture were evaluated prospectively for meningeal signs and other physical parameters before lumbar puncture. Emergency department of Children's Hospital of Wisconsin. One hundred seventy-two children, aged 1 week to 17 years, with meningitis (53 bacterial and 119 aseptic). Nuchal rigidity was present in 27% of infants aged 0 to 6 months with bacterial meningitis versus 95% of patients 19 months or older (P = .0001). Three percent of infants 0 to 6 months old with aseptic meningitis had nuchal rigidity versus 79% of patients 19 months or older (P = .0005). Seventy-two percent of infants 12 months of age or younger with bacterial meningitis has at least one positive meningeal sign versus 17% of infants with aseptic meningitis (P = .0001). Eighty-five percent of children older than 12 months with meningitis had at least one positive meningeal sign, 93% with bacterial meningitis, and 82% with aseptic meningitis. Despite a lack of meningeal signs, a high index of suspicion for meningitis is essential when evaluating the febrile infant 12 months of age or younger.

Use of an east end children's accident and emergency department for infants: a failure of primary health care?

To ascertain why parents use an accident and emergency department for health care for their infants. Prospective one month study. One accident and emergency department of a children's hospital in the east end of London. Parents of 159 infants aged < 9 months attending as self referrals (excluding infants attending previously or inpatients within one month, parents advised by the hospital to attend if concerned about their child's health, infants born abroad and arrived in Britain within the previous month). Details of birth, postnatal hospital stay, contact with health professionals, perceptions of roles of community midwife and health visitor, and current attendance obtained from a semistructured questionnaire administered in the department by a research health visitor; diagnosis, discharge, and follow up. 152(96%) parents were interviewed, 43(28%) of whom were single parent and 68(45%) first time mothers. Presenting symptoms included diarrhoea or vomiting, or both (34, 22%), crying (21, 14%), and feeding difficulties (10, 7%). Respiratory or gastrointestinal infection was diagnosed in 70(46%) infants. Only 17(11%) infants were admitted; hospital follow up was arranged for 27(20%) infants not admitted. Most (141, 94%) parents were registered with a general practitioner; 146(27%) had contact with the community midwife and 135(89%) the health visitor. Most attendances were for problems more appropriately dealt with by primary care professionals owing to patients' perceptions of hospital and primary health care services. Closer cooperation within the health service is needed to provide a service responsive to the real needs of patients.

The spectrum and frequency of illness presenting to a pediatric emergency department

Knowledge of the spectrum and relative frequencies of pediatric emergencies is an important factor in developing appropriate training curricula for physicians treating children in emergency departments. To provide these data, we reviewed the records for four one-week periods (January, April, July, and October) of a large pediatric emergency department to describe the population in terms of age, chief complaints, diagnoses, time of arrival, seasonal variation, and disposition. There were 3796 log entries. Complete information on all variables was obtained on 3784 patients. Age ranged from one day to 39 years, and the mean age was 6.0 +/- 6.15 years. One half of all emergency department visits were by children three years old or younger. On the other hand, 12% of visits were by adolescents (ages 13 to 18), and one in 25 visits was made by an adult (greater than 18 years old). The majority of chief complaints and final diagnoses were related to infection and trauma. More than half of the patients arrived on the evening shift, between 4 pm and 12 am. Eleven percent of the children seen on day and evening shifts and 13% from the night shift were admitted. From the analysis of our data we recommend expanded skills in the management of minor trauma for pediatric residents, an emphasis on management of infections for nonpediatric emergency specialists, and extensive training in both pediatric and adult trauma for physicians in pediatric emergency medicine fellowships.

Chest Pain in Children

During a 1-year period, 407 children with chest pain were seen in the Emergency Department of Children's Hospital of Philadelphia. Analysis of the clinical data of these children was reported previously. The authors successfully followed 149 of these children for 6 months or more, and 51 for 2 years or more. These patients returned for an average of 3.4 visits during the follow-up period. Thirty-four percent of the initial diagnoses were altered. Usually, during the follow-up period, the authors concluded that chest pain resulted from nonorganic causes. A new organic etiology was uncovered in only 12 of 149 cases. Only 1 child was found to have a heart abnormality (mitral valve prolapse), and 3 were found to have asthma. Chest pain did not resolve during the follow-up period in 43 percent of those followed. Children with chest pain should have follow-up care because of the persistence of symptoms, but serious disease is unlikely to be found over time.

From Gesture to Language in Hearing &amp; Deaf Children ed. by V. Volterra, C. Erting (review)

From Gesture to Language in Hearing &amp; Deaf Children ed. by V. Volterra, C. Erting (review)

Parental Presence in the Emergency Department

To the Editor.— The article by Baucher et al1 is of interest to me because I have taken care of children in emergency departments where parents were not allowed. In my experience throughout the years the advisability of having a parent in the room when a procedure is being done depends entirely on the character of the parent and the relationship between the parent and the child. In my personal experience, I have had a 2 1/2-year-old child with a severe laceration of the forehead which I sewed up under local anesthesia without restraining the him because the mother, who had a superb rapport with the child, was present.

Occult Bacteremia in Children With Simple Febrile Seizures

Sir. —The recent article by Chamberlain and Gorman in AJDC examined the incidence of bacteremia in children with simple febrile convulsions. Of note was that all five instances of bacteremia documented were caused by Streptococcus pneumoniae . Similarly, Hamrick and Murphy 1 found a high rate (80%) of S pneumoniae isolated in bacteremic children who experienced febrile convulsions, and McIntyre et al 2 found that a high percentage of children with S pneumoniae occult bacteremia experienced seizures with fever. I surveyed the results of blood cultures performed on children evaluated from 1985 to 1988 in the Emergency Department of Children's Hospital of Wisconsin, Milwaukee, for febrile convulsions. During this time, there were 17 instances of bacteremia in those children who fulfilled criteria for simple febrile convulsions (patient age between 6 months and 5 years, generalized seizure activity of 39°C], and no underlying neurologic disorder identified [including