Survey In Young Children Research Articles

Development of Guidelines for Skeletal Survey in Young Children With Intracranial Hemorrhage.

As evidenced by the variation and disparities in evaluation, there is uncertainty in determining which young children with intracranial hemorrhage (ICH) should undergo evaluation with skeletal survey (SS) for additional injuries concerning for abuse. We aimed to develop guidelines for performing initial SS in children <24 months old presenting with ICH by combining available evidence from the literature with expert opinion. Using the RAND/UCLA Appropriateness Method, a multispecialty panel of 12 experts used the literature and their own clinical expertise to rate the appropriateness of performing SS for 216 scenarios characterizing children <24 months old with ICH. After a moderated discussion of initial ratings, the scenarios were revised. Panelists re-rated SS appropriateness for 74 revised scenarios. For the 63 scenarios in which SS was deemed appropriate, the panel rated the necessity of SS. Panelists concluded that SS is appropriate for 85% (63), uncertain for 15% (11), and inappropriate for 0% of scenarios. Panelists determined that SS is necessary in all scenarios deemed appropriate. SS was deemed necessary for infants <6 months old and for children <24 months old with subdural hemorrhage that is not tiny and under a skull fracture. For children 6 to 23 months old with epidural hemorrhage, necessity of SS depended on the child's age, history of trauma, signs/symptoms, and ICH characteristics. The resulting clinical guidelines call for near-universal evaluation in children <24 months old presenting with ICH. Detailed, validated guidelines that are successfully implemented may decrease variation and disparities in care.

Development of hospital‐based guidelines for skeletal survey in young children with bruises

Child: Care, Health and DevelopmentVolume 41, Issue 3 p. 501-502 CURRENT LITERATURE Development of hospital-based guidelines for skeletal survey in young children with bruises Richard Reading, Richard ReadingSearch for more papers by this author Richard Reading, Richard ReadingSearch for more papers by this author First published: 11 April 2015 https://doi.org/10.1111/cch.12247_3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume41, Issue3May 2015Pages 501-502 RelatedInformation

G49 Skeletal surveys in patients &lt;2 yo presenting with fractures to the ed department: when are they appropriate?

Aims To audit current practice and develop guidelines on the ordering of skeletal surveys in patients Methods We used the guideline published in Paediatrics: “Development of Guidelines for Skeletal Survey in Young Children with Fractures”. 1 Using our online server we reviewed data over two years (2012–2013). Patients Results 59 patients were identified over the two year period (range 22 days–23 months). 20.3% (n = 12) were between 0–11 ms, 79.7% (n = 47) were between 12–23 ms. 1 patient (1.7%) aged 9 ms had a skeletal survey. If the above guideline had been applied, 40.7% of this patient cohort would have warranted a skeletal survey, and 75% (n = 9) of our 0–11 agegroup and 31.9% (n = 15) of our 12–23 agegroup would have qualified for a skeletal survey. Conclusion In a busy ED department with short physician-patient interaction a systematic approach to child protection is of paramount importance. This data suggests that our centre is under-utilising skeletal surveys in the management of children under the age of 2 presenting with fractures to our ED department. Significant cultural differences may impact on the relevance of this guideline for our patient population. We are developing a new protocol to help ED doctors decide when a skeletal survey is appropriate in vulnerable children. Reference Wood JN, Fakeye O, Feudtner C, et al . Development of guidelines for skeletal survey in young children with fractures. Pediatrics . Originally published online June 16 2014, DOI: 10: 10.1542/peds.2013-3242.

Development of Hospital-Based Guidelines for Skeletal Survey in Young Children With Bruises

Development of Hospital-Based Guidelines for Skeletal Survey in Young Children With Bruises

Guidelines Developed for Skeletal Survey in Young Children With Fractures

Guidelines Developed for Skeletal Survey in Young Children With Fractures

Development of guidelines for skeletal survey in young children with fractures

Child: Care, Health and DevelopmentVolume 40, Issue 5 p. 757-757 CURRENT LITERATURE Development of guidelines for skeletal survey in young children with fractures Richard Reading, Richard ReadingSearch for more papers by this author Richard Reading, Richard ReadingSearch for more papers by this author First published: 11 August 2014 https://doi.org/10.1111/cch.12179_5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume40, Issue5September 2014Pages 757-757 RelatedInformation

Development of guidelines for skeletal survey in young children with fractures.

To develop guidelines for performing initial skeletal survey (SS) in children <24 months old with fractures, based on available evidence and collective judgment of experts from diverse pediatric specialties. Following the Rand/UCLA Method, a multispecialty panel of 13 experts applied evidence from a literature review combined with their own expertise in rating the appropriateness of performing an SS for 525 clinical scenarios involving fractures in children <24 months old. After discussion on the initial ratings, panelists re-rated SS appropriateness for 240 revised scenarios and deemed that SSs were appropriate in 191 scenarios. The panelists then assessed in which of those 191 scenarios SSs were not only appropriate, but also necessary. Panelists agreed that SS is "appropriate" for 191 (80%) of 240 scenarios rated and "necessary" for 175 (92%) of the appropriate scenarios. Skeletal survey is necessary if a fracture is attributed to abuse, domestic violence, or being hit by a toy. With few exceptions, SS is necessary in children without a history of trauma. In children <12 months old, SS is necessary regardless of the fracture type or reported history, with rare exceptions. In children 12 to 23 months old, the necessity of obtaining SS is dependent on fracture type. A multispecialty panel reached agreement on multiple clinical scenarios for which initial SS is indicated in young children with fractures, allowing for synthesis of clinical guidelines with the potential to decrease disparities in care and increase detection of abuse.

Development of Guidelines for Skeletal Survey in Young Children With Fractures

Development of Guidelines for Skeletal Survey in Young Children With Fractures

Measurement, analysis and interpretation of examiner reliability in caries experience surveys: some methodological thoughts

Data obtained from calibration exercises are used to assess the level of agreement between examiners (and the benchmark examiner) and/or between repeated examinations by the same examiner in epidemiological surveys or large-scale clinical studies. Agreement can be measured using different techniques: kappa statistic, percentage agreement, dice coefficient, sensitivity and specificity. Each of these methods shows specific characteristics and has its own shortcomings. The aim of this contribution is to critically review techniques for the measurement and analysis of examiner agreement and to illustrate this using data from a recent survey in young children, the Smile for Life project. The above-mentioned agreement measures are influenced (in differing ways and extents) by the unit of analysis (subject, tooth, surface level) and the disease level in the validation sample. These effects are more pronounced for percentage agreement and kappa than for sensitivity and specificity. It is, therefore, important to include information on unit of analysis and disease level (in validation sample) when reporting agreement measures. Also, confidence intervals need to be included since they indicate the reliability of the estimate. When dependency among observations is present [as is the case in caries experience data sets with typical hierarchical structure (surface-tooth-subject)], this will influence the width of the confidence interval and should therefore not be ignored. In this situation, the use of multilevel modelling is necessary. This review clearly shows that there is a need for the development of guidelines for the measurement, interpretation and reporting of examiner reliability in caries experience surveys.