Children's Emergency Room Research Articles

Parents' VS physicians' utilities (values) for clinical outcomes in potentially bacteremic children

Our previous analyses of decision strategies in children 3–24 months with acute-onset fever ⩾,39°C and no evident bacterial focus of infection indicated that the risks of routine blood cultures (the unnecessary hospitalization and treatment of children who clear their bacteremia spontaneously) outweigh its benefits (the prevention of a few cases with major infectious sequelae). Because those analyses were based on parents' values for beneficial and adverse clinical outcomes, we wished to examine whether those values differed in physicians and, if so, whether the differences were sufficient to change the results of the decision analysis. Using a pre-tested linear analog utility (value) scale, we evaluated eight potential clinical outcomes in potentially bacteremic children by surveying 121 parents of healthy 324-month-old children attending a private pediatric group practice and 57 attending physicians of a tertiary-care children's hospital emergency room. Utilities were based on a 0–1 normalization, where 0 is the utility of the worst outcome (meningitis or other major bacterial infection, plus venipuncture), and 1 the utility of the best outcome (complete recovery without venipuncture or hospitalization), and were analyzed using a recently developed statistical model of utility. The majority of parents and physicians combined the imputed components of the outcomes (disease, pain of venipuncture, and stress of hospitalization) in a nonlinear fashion. Parents assigned substantially lower utility (i.e. greater disutility) to venipuncture, minor infection, and hospitalization than' did physicians, and these utilities were even lower in parents with other children at home. There were no consistent associations between parents' utilities and their age or years of schooling, nor between physicians' utilities and their sex or years of experience. Even based on the physicians' utilities, expected utilities [E(u)s] favored the “no blood culture”, strategy [E(u) = 0.994] over “universal blood culture” [E(u) = 0.898] or even “selective blood culture” (blood cultures only in children deemed to be at highest risk of bacteremia) [E(u) = 0.982]. Moreover, the result was insensitive to feasible ranges of probability estimates. Unless greater benefits can be demonstrated for the test, our findings suggest that physicians should either obtain fewer blood cultures or develop less aggressive protocols for treating children whose cultures are positive.

Rectal diazepam solution in the treatment of convulsions in the children's emergency room

Rectal diazepam solution was administered to 55 convulsing children in the Children's Emergency Room. In 71%, the convulsion ceased within 5 min, and in 7%, between 5 and 10 min. In 16%, rectal diazepam was ineffective but there was a rapid response to intravenous diazepam. Convulsions that had lasted less than 15 min before treatment responded more often (81%) than those that had lasted more than 15 min (46%). Four children had transient respiratory depression. Though intravenous diazepam is superior, rectal diazepam solution is adequate for controlling most acute convulsions in children, and has the advantage that it can be administered by paramedical workers.

Monitoring of hospital emergency room visits as a method for detecting health effects of environmental exposures

We excerpted from the logs of the adult and children's emergency room at Soroka Hospital Medical Center the number and types of services requested by day for the year 1980. Both total visits and visits for respiratory conditions were examined in order to test whether rain, heat, or pollutants led to increased requests for emergency room care. The total visits for adults were 72,375, of which 1,727 (2.4%) were for selected respiratory conditions. The total visits for children were 19,232, and respiratory conditions were 3,980 (20.7%). There is marked seasonal excess for respiratory visits for children in winter, and a lesser excess for adult respiratory conditions. Non-respiratory conditions and overall visits are higher in summer months. Fewer visits occur on Saturday and on Friday, with the maximum on Sunday. Otitis and bronchitis among children show little day-of-week trends. “High event” days for admissions are determined by fitting a Poisson distribution to the numbers of admissions by day for various respiratory complaints, and we then examine the concordance between these high event days and days with rain, high pollution or temperature. Adult respiratory conditions were more likely to occur on days with high total particulates (TSP) and “respirable” particulates (RSP). When the mean values of RSP and TSP for high asthma and shortness of breath days were compared with a random day for the same month, significant differences were found for RSP for adults, but not for TSP. Natural dust is the more likely cause of this association. Emergency room monitoring should be useful in locations with high levels of man-made pollutants.

Learning how to prepare the child to face difficult experiences

This paper presents some considerations about the importance of nursing students learning to prepare children to face difficult situations. The author focuses on her experience as an instructor of undergraduate nursing students in a children's emergency room. She tells how she perceives the students and his learning experience in preparing children for these situations. She describes how facilitates this learning process for the student, by promoting an atmosphere of understanding, respect, trust and freedom to perceive, reflect and act.

Acute drug ingestions in a children's hospital emergency room

Abstract This paper is a retrospective review of patients treated in a pediatric hospital emergency room for non‐accidental acute drug ingestions during a twelve month period. Typically, patient charts contained little information relevant to attempts to evaluate the lethality potential of such life threatening behavior. The types of drugs, post‐emergency room dispositions, demographic data of patients, and time of admissions were analyzed to learn who was treated, for what drug reactions, and what occurred following emergency room medical treatment. Few patients or their parents were seen by a mental health professional prior to being discharged from the emergency room.

Triage, technicians, and teaching in a children's emergency room

In a children's teaching hospital the number of emergency visits increased to such an extent that they began to encroach upon the education of the house staff. Triage of some of the patients with minor medical problems to a staff physician in an adjacent but separate emergency room has provided relief for the pediatric house officers and better teaching for medical students. Technicians have sutured over 3000 lacerations per year, greatly reducing the load on the surgical house staff. These innovations provide a flexible way to maintain an appropriate balance between education and service.

Evaluation of the preparedness of the children’s emergency rooms (CHER) in Southern Nigeria for service delivery

Background: The Children Emergency Room (CHER) is the first point of call for many sick children. A significant proportion of childhood and under five deaths in tertiary institutions takes place in the CHER. There is thus need for a high level skilled manpower and infrastructure in the CHER in readiness for service delivery.Objective: To assesses the preparedness of the children emergency room in tertiary institutions in southern Nigeria to successful management of children presenting to the emergency rooms.Methods: This study was a cross sectional, descriptive multicentre study carried out among nine Tertiary Hospitals in Southern Nigeria. Three tertiary hospitals were randomly selected from each of the three Geo political zones (South-South, South- East and South -West) in Southern Nigeria. A structured questionnaire was used to collect data about the Children Emergency Rooms in these hospitals. The obtained data was entered and analysed using SPSS version 21 and is presented as table.Results: All the centres have an emergency room. The number of doctors in CHER ranged from 7 to 22 while the number of nurses ranged from 10 to 24 persons with a nurse: bed ratio of 1:3-15. In all the centres, the CHER had a side laboratory, well stocked emergency drug shelf, pulse oximeters, oxygen cylinders, electrical and manual suction machines, ambu bags and nebulizers. However, none of the centres has functional manual defibrillator or an Automated External Defibrillator (AED). In 5 (55.6%) of the studied centres, the doctors and nurses have training on emergency triage. Also 5 (55.6%) centres have doctors with certification in emergency care, but none of the nurses in all the centres have any certification in emergency care. Three (33.3%) centres had staff trained with skills on the use of AED while in 4(44.4%) centres they were skilled on the use of manual defibrillators. All the centres have a waiting area for patients’ relatives but only one (11.1%) has a television installed. All the CHERs have toilet facilities for patients relatives but only 5 (55.6%) have bathrooms. Running water is regularly available in the toilets of only 4 (44.4%) of the centres.Conclusion/Recommendation: We conclude that limitation abounds with regards to personnel, high technology infrastructure, personnel skill and patient friendly infrastructure. It is recommended that concerted efforts should be made by the government and all key players to make available the necessary equipment and facilities and ensure that health personnel acquire the necessary skills so that the standard of practice in our tertiary hospitals will be comparable to international best practices.