Burns to the buttocks of a child are highly concerning for child abuse unless there is a clear history to support an alternative diagnosis. We report two cases of severe erosive diaper dermatitis ...presenting as buttocks and perineal burns caused by prolonged exposure to diarrheal stool. These cases underscore the importance of making the right diagnosis to avoid the undue psychosocial stress to families that comes with a mistaken diagnosis of inflicted injury, and further add to our understanding of diarrheal contact burns in the absence of laxative use.
Bronchiolitis is the most common cause of lower respiratory tract infections that lead to hospitalizations in infants and young children.
In this randomized controlled pilot study, we compared two ...separate nasal suction devices, namely the over counter device by the brand name of NoseFrida and the standard hospital device NeoSucker, in hospitalized children with bronchiolitis to assess equivalence of length of stay within a ± 5-h equivalence margin and to compare readmission rates and associated complications. Additionally, parental satisfaction for the NoseFrida device was measured with a six question (5-point Likert scale) survey.
There were 20 patients randomized to the NeoSucker group and 24 randomized to the NoseFrida group. The mean length of stay for the NoseFrida group was 33.5 ± 25.4 h compared to 31.0 ± 15.6 h in the NeoSucker group, which did not establish equivalence within the ±5-h equivalence margin (p = 0.352). Parents were generally satisfied with the NoseFrida. Patients treated with the two devices had similar frequencies of deep suctioning and readmission within 48 h.
Although the mean length of stay was comparable for bronchiolitis patients treated with the NoseFrida and NeoSucker, the relatively small sample size and large amount of variability precluded demonstrating equivalence. Since this was a pilot, further studies are needed to evaluate the recommendation for the use of such devices in both the hospital setting and in the outpatient management of bronchiolitis.
•Bronchiolitis is a common cause of infant hospitalizations and management is mostly supportive ranging from intravenous fluids, suctioning, supplemental oxygen to mechanical ventilation.•The role of suctioning in treating infants with bronchiolitis is not clearly defined.•NoseFrida had a high parental satisfaction rate.•Evidence that clinicians may use to guide their decision making and clinical management treating infants and young children with bronchiolitis•The results of this pilot study can be used to power a full scale randomized controlled trial to compare the two devices' length of stay and compare complication rates.
BACKGROUNDSkin and soft tissue infections (SSTIs) are a common reason for presentation to the emergency department (ED) and account for 3% of ED visits. Patients with a diagnosis of cellulitis ...requiring intravenous (IV) antibiotics have traditionally been admitted to the hospital. In our institution, these patients are placed in the ED Observation Unit (EDOU) for IV antibiotics.
OBJECTIVESThe purpose of this study is to determine if 3 doses of IV antibiotics are adequate to document clinical improvement in children with uncomplicated SSTI.
METHODSA prospective cohort study of children aged 3 months to 18 years with uncomplicated SSTI admitted (2009–2013) to the EDOU at a childrenʼs hospital for IV antibiotics was conducted.
RESULTSOne hundred six patients (mean age, 68 months) were enrolled; 57% were boys, 53% of patients had cellulitis only and 47% had cellulitis with drained abscesses. There was a significant decrease in pain scores and size of cellulitis from arrival to discharge (P < 0.001 and P < 0.001, respectively). Eighty-three percent of patients were discharged after 3 to 4 doses of antibiotics, and 17% were admitted. The location of the wound, presence of systemic symptoms, and prior use of oral antibiotics did not predict admission in our study.
CONCLUSIONSThe EDOU is a reasonable alternative to inpatient admission in the management of patients with uncomplicated SSTI requiring IV antibiotics.
BACKGROUNDPatients with bronchiolitis are increasingly being admitted to emergency department observation units (EDOUs) but often require subsequent hospitalization. To better identify ED patients ...who should be directly admitted to the hospital rather than the EDOU, the predictors of admission must be identified.
OBJECTIVESThe objective of this study was to determine the predictors of subsequent hospital admission from the EDOU in infants and young children with bronchiolitis.
METHODThis was a retrospective cohort study of patients younger than 2 years admitted to an EDOU with bronchiolitis between April 1, 2003, and March 31, 2007. Univariate analysis was followed by logistic regression to identify the significant predictors of hospital admission from the EDOU.
RESULTSThere were 325 patients in the study67% were younger than 6 months, and 60% were male. Eighty-five (26%) were admitted to the hospital from the EDOU. Predictors for admission from the EDOU included parental report of poor feeding or increased work of breathing, oxygen saturation less than 93%, or ED treatment with racemic epinephrine (Vaponephrine) and intravenous fluids (IVFs).
CONCLUSIONPatients with a history of increased work of breathing or oxygen saturation less than 93% and ED treatment with IVFs are at high risk for admission from the EDOU to the hospital. Direct admission to the hospital from the ED should be considered for these patients, particularly patients treated with IVFs and having an oxygen saturation less than 93% in the ED.
OBJECTIVES:This study aimed to compare the incidence of complications and intussusception recurrences in patients in the pediatric emergency department observation unit (EDOU) who are fed early (<2 ...hours) versus late (≥2 hours) after radiologic intussusception reduction.
METHODS:This is a retrospective cohort study of children observed in the Texas Children's Hospital EDOU after radiologic intussusception reduction between April 1, 2003, and August 31, 2009. Complications were defined as the postreduction occurrence of intestinal perforation, shock, or sepsis.
RESULTS:There were 149 patients included in the study (median age, 16 months; range, 3-95 months). Oral refeeding was started early in 61 patients (41%) and late in 88 patients (59%). The median length of EDOU stay was 15.6 hours in early refeeders and 16.1 hours in late refeeders (P = 0.58). None of the patients developed any complications. There was no difference in the frequency of postreduction fever, abdominal pain, or vomiting (13% early vs 16% late, P = 0.65); imaging to assess for intussusception recurrence (20% early vs 22% late, P = 0.79); and subsequent hospitalization (3% early vs 8% late, P = 0.31) between the groups. The frequency of intussusception recurrence was higher, but not significantly so (P = 0.31), in the late refeeders (15%) compared with the early refeeders (8%).
CONCLUSIONS:There is no evidence for a difference in complication frequency, intussusception recurrence, or EDOU length of stay between patients who are fed early (<2 hours) or late (≥2 hours) after radiologic intussusception reduction. This indicates that there is no need to withhold feeds from patients after intussusception reduction.
BACKGROUND:In September 2005, Texas Children's Hospital initiated a protocol for all neonates presenting to the emergency department (ED) with hyperbilirubinemia based on the American Academy of ...Pediatrics guidelines. As part of the protocol, low-risk neonates with hyperbilirubinemia requiring phototherapy are treated in the ED observation unit (EDOU).
OBJECTIVE:The aim of the study was to compare time to phototherapy and duration of hospital stay in low-risk neonates with hyperbilirubinemia presenting to the Texas Children's Hospital ED before and after the initiation of a triage-based protocol.
DESIGN/METHODS:We performed a retrospective historical control study comparing neonates with hyperbilirubinemia treated in the EDOU between January 1 and December 31, 2006 (EDOU group), with neonates with hyperbilirubinemia admitted to the inpatient unit between January 1 and December 31, 2004 (inpatient group).
RESULTS:There were 167 neonates included in the study62 neonates were treated in the EDOU and 105 in the inpatient unit. Median time to phototherapy (inpatient6.7 hours, EDOU1.6 hours) and duration of hospital stay (inpatient41.8 hours, EDOU17.8 hours) were shorter for neonates treated in the EDOU compared with neonates treated in the inpatient unit. Of the neonates treated in the EDOU initially, 11 were admitted to the inpatient unit after 24 hours because their bilirubin level did not decline adequately.
CONCLUSIONS:Low-risk neonates with hyperbilirubinemia can be managed more efficiently in an EDOU than in an inpatient unit. Phototherapy is initiated more rapidly, and patients are discharged sooner in the EDOU than in the inpatient setting.
The prevalence of multiple antibiotic resistant bacteria in the waste dumpsite of ten poultry farms in Southwestern Nigeria was investigated. The susceptibility of 195 organisms isolated from the ...study sites to eight antimicrobial agents were tested using disc diffusion method and the minimum inhibitory concentration of cloxacillin and amoxicillin determined by the agar dilution method. Resistance to the test antibiotics ranged between 0% for gentamicin and 100% for tetracycline and ampicillin among the organisms. Overall, 70 and 90% of the isolates from Okuku, 65.2 and 95.6% from Ogbomoso, and 46.1 and 84.6% from Oyo had MIC above 512 μg/ml for amoxicillin and cloxacillin. Generally, drugs used in high volumes in the studied farms are the least active against the bacterial isolates. Results of this study shows that poultry waste can serve as environmental reservoirs of multiple antibiotic resistant bacteria and their indiscriminate dumping in the environment can expose surrounding human populations to health risks from drug resistant zoonotic pathogens.
This is a revision of the previous joint Policy Statement titled "Guidelines for Care of Children in the Emergency Department." Children have unique physical and psychosocial needs that are ...heightened in the setting of serious or life-threatening emergencies. The majority of children who are ill and injured are brought to community hospital emergency departments (EDs) by virtue of proximity. It is therefore imperative that all EDs have the appropriate resources (medications, equipment, policies, and education) and capable staff to provide effective emergency care for children. In this Policy Statement, we outline the resources necessary for EDs to stand ready to care for children of all ages. These recommendations are consistent with the recommendations of the Institute of Medicine (now called the National Academy of Medicine) in its report "The Future of Emergency Care in the US Health System." Although resources within emergency and trauma care systems vary locally, regionally, and nationally, it is essential that ED staff, administrators, and medical directors seek to meet or exceed these recommendations to ensure that high-quality emergency care is available for all children. These updated recommendations are intended to serve as a resource for clinical and administrative leadership in EDs as they strive to improve their readiness for children of all ages.
Studies characterizing hospitalizations in bronchiolitis did not identify patients receiving evidence-based supportive therapies (EBSTs). We aimed to evaluate intersite and internetwork variation in ...receipt of ≥1 EBSTs during the hospital management of infants diagnosed with bronchiolitis in 38 emergency departments of pediatric emergency research networks in Canada, the United States, Australia, New Zealand, the United Kingdom, Ireland, Spain, and Portugal. We hypothesized that there would be significant variation, adjusted for patient characteristics.
Retrospective cohort study of previously healthy infants aged <12 months with bronchiolitis. Our primary outcome was that hospitalization occurred with EBST (ie, parenteral fluids, oxygen, or airway support).
Out of 3725 participants, 1466 (39%) were hospitalized, and 1023 out of 1466 participants (69.8%) received EBST. The use of EBST varied by site (
< .001; range 6%-99%, median 23%), but not by network (
= .2). Significant multivariable predictors and their odds ratios (ORs) were as follows: age (0.9), oxygen saturation (1.3), apnea (3.4), dehydration (3.2), nasal flaring and/or grunting (2.4), poor feeding (2.1), chest retractions (1.9), and respiratory rate (1.2). The use of pharmacotherapy and radiography varied by network and site (
< .001), with respective intersite ranges 2% to 79% and 1.6% to 81%. Compared with Australia and New Zealand, the multivariable OR for the use of pharmacotherapy in Spain and Portugal was 22.7 (95% confidence interval CI: 4.5-111), use in Canada was 11.5 (95% CI: 3.7-36), use in the United States was 6.8 (95% CI: 2.3-19.8), and use in the United Kingdom was 1.4 (95% CI: 0.4-4.2). Compared with United Kingdom, OR for radiography use in the United States was 4.9 (95% CI 2.0-12.2), use in Canada was 4.9 (95% CI 1.9-12.6), use in Spain and Portugal was 2.4 (95% CI 0.6-9.8), and use in Australia and New Zealand was 1.8 (95% CI 0.7-4.7).
More than 30% of infants hospitalized with bronchiolitis received no EBST. The hospital site was a source of variation in all study outcomes, and the network also predicted the use of pharmacotherapy and radiography.
Emergency physicians have used point-of-care ultrasonography since the 1990 s. Pediatric emergency medicine physicians have more recently adopted this technology. Point-of-care ultrasonography is ...used for various scenarios, particularly the evaluation of soft tissue infections or blunt abdominal trauma and procedural guidance. To date, there are no published statements from national organizations specifically for pediatric emergency physicians describing the incorporation of point-of-care ultrasonography into their practice. This document outlines how pediatric emergency departments may establish a formal point-of-care ultrasonography program. This task includes appointing leaders with expertise in point-of-care ultrasonography, effectively training and credentialing physicians in the department, and providing ongoing quality assurance reviews.
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