CJEM Articles: pediatrics
Displaying 1-10 of 13 results
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September
2011
13
5
Ian Wishart, Shawn K. Dowling
Introduction:
A number of studies have assessed the diagnostic accuracy of the Ottawa Ankle Rules (OAR) in children; however, the role of the OAR in guiding physician radiograph use is unclear.
Objectives:
The primary purpose of this study was to determine the extent to which Canadian pediatric emergency physicians report using the OAR. Secondary goals included determining current diagnostic and management strategies for Salter-Harris 1 (SH-1) injuries of the ankle and which fractures physicians deem to be clinically significant.
Methods:
A self-administered piloted survey was distributed by mail to 215 Canadian pediatric emergency physicians using a modified Dillman technique. Participants were selected through Pediatric Emergency Research Canada (PERC), a national network of health care professionals with an interest in pediatric emergency medicine research.
Results:
Of 209 surveys, 144 were returned, for a response rate of 68.9%. Of those, 87.5% (126 of 144) reported applying the OAR in children to determine the need for radiographs in acute ankle or midfoot injuries. Of those, 65.1% reported using the OAR always or usually, and 64.5% (93 of 144) of physicians stated that they believe all ankle fractures are clinically significant. Although physicians report that they most commonly order the radiographs, 36.2% of participants indicated that radiographs were requisitioned by nurses or other health care providers at their facilities. SH-1 fractures were reported to be most commonly managed by immobilization (83.3%; 120 of 144), with most patients going on to follow-up with an orthopedic surgeon.
Conclusions:
The majority of Canadian pediatric emergency physicians indicate that they use the OAR when assessing children with acute ankle and midfoot injuries. Most physicians believe that all ankle fractures, including SH-1, are clinically significant and have a management preference for immobilization and orthopedic follow-up.
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January
2011
13
1
Abi Sriharan, Dennis Scolnik, MSc, Rahim Valani
Globalization has opened the doors for medical students to undertake international health electives, providing an opportunity for them to gain valuable competencies and skills outside their formal curriculum. As the number of medical students embarking on these electives increases, there is a need to structure the electives with specific learning objectives and to ensure adequate educational outcomes.
We describe the International Pediatric Emergency Medicine Elective (IPEME), which is a novel global health elective that brings together students from Canada and the Middle East who are selected on the basis of a competitive application process and brought to Toronto for a 4-week living and studying experience. The program was introduced in 2004 and uses four specific areas to provide its structure: pediatric emergency medicine, global health, leadership, and peace building. The elective uses core CanMEDS competencies to foster cross-cultural dialogue, networking, and cooperation and fulfills the program's aim of using health as a bridge to peace.
The lessons learned from the curriculum planning and implementation process are highlighted and the impact of the program explored to help provide a framework for developing similar international electives. -
November
2010
12
6
Aiman Alak, Jamie A. Seabrook, Michael J. Rieder
Objective: We sought to assess compliance with evidence-based guidelines for the management of pediatric pneumonia, including the variations in tests ordered and antimicrobials prescribed. Our primary hypothesis was that compliance with the treatment recommendations from the most current guidelines would be low for antimicrobial prescriptions.
Methods: We conducted a chart review at the Children’s Hospital in London, Ont., to assess variation in the management of pediatric pneumonia. All patients aged 3 months to 18 years seen at the pediatric emergency department between Apr. 1, 2006, and Mar. 31, 2007, with a diagnosis of pneumonia were eligible for inclusion in the study.
Results: Compliance with management guidelines was 59.7% (95% confidence interval [CI] 53%–66%, n = 211) in children 5–18 years old and 83.0% (95% CI 80%–86%, n = 605) in children 3 months to 5 years old. Significant variation existed in the choice of antimicrobial agent for children with pneumonia, with nonrecommended agents frequently prescribed.
Conclusion: Significant variation existed in the management of pediatric pneumonia, and adherence to guidelines was low for the group of patients aged 5–18 years. Future studies should attempt to provide guidance to distinguish between viral and bacterial etiology to allow judicious use of antimicrobials.
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September
2010
12
5
Sara Ahronheim
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September
2009
11
5
Amanda S. Newton, Christina Haines, David W. Johnson, Philip Jacobs, Rachel A. Keaschuk, Rhonda J. Rosychuk, Samina Ali, Terry P. Klassen
Objective: We sought to determine and compare rates of pediatric mental health presentations and associated costs in emergency departments (EDs) in Alberta.
Methods: We examined 16 154 presentations by 12 589 patients (patient age ≤ 17 yr) between April 2002 and March 2006 using the Ambulatory Care Classification System, a province-wide database for Alberta. The following variables of interest were extracted: patient demographics, discharge diagnoses, triage level, disposition, recorded costs for ED care, and institutional classification and location (i.e., rural v. urban, pediatric v. general EDs).
Results: A 15% increase in pediatric mental health presentations was observed during the study period. Youth aged 13-17 years consistently represented the most common age group for first presentation to the ED (83.3%). Of the 16 154 recorded presentations, 21.4% were related to mood disorders and 32.5% to anxiety disorders. Presentations for substance misuse or abuse were the most prevalent reasons for a mental health-related visit (41.3%). Multiple visits accounted for more than one-third of all presentations. Presentations for mood disorders were more common in patients with multiple compared with single visits (29.3% v. 16.9%), and substance abuse or misuse presentations were more common in patients with single compared with multiple visits (47.4% v. 30.5%). The total direct ED costs for mental health presentations during the study period was Can$3.5 million.
Conclusion: This study provides comprehensive data on trends of pediatric mental health presentation, and highlights the costs and return presentations in this population. Psychiatric and medical care provided in the ED for pediatric mental health emergencies should be evaluated to determine quality of care and its relationship with return visits and costs. -
September
2008
10
5
James E. Colletti, Martin D. Klinkhammer
A child presenting with petechiae and fever is assumed to have meningococcemia or another form of bacterial sepsis and therefore to require antibiotics, blood cultures, cerebrospinal fluid analysis and hospital admission. A review of the literature challenges this statement and suggests that a child presenting with purpura (or petechiae), an ill appearance and delayed capillary refill time or hypotension should be admitted and treated for meningococcal disease without delay. Conversely, a child with a petechial rash, which is confined to the distribution of the superior vena cava, is unlikely to have meningococcal disease. Outpatient therapy in this context is appropriate. In other children, a reasonable approach would be to draw blood for culture and C-reactive protein (CRP) while administering antibiotics. If the CRP is normal, these children could be discharged to follow-up in 1 day, whereas children with CRP values greater than 6 mg/L would be admitted.
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January
2008
10
1
Ann M. Dietrich, Kathleen Brown, Neil E. Schamban, Sharon E. Mace, Stephen Knazik
Patient and family-centred care (PFCC) is an approach to health care that recognizes the integral role of the family and encourages mutually beneficial collaboration between the patient, family and health care professionals. Specific to the pediatric population, the literature indicates that the majority of families wish to be present for all aspects of their child's care and be involved in medical decision-making. Families who are provided with PFCC are more satisfied with their care. Integration of these processes is an essential component of quality care. This article reviews the principles of PFCC and their applicability to the pediatric patient in the emergency department; and it discusses a model for integrating PFCC that is modifiable based on existing resources.
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November
2007
9
6
Clinton T. Forsythe, Michael E. Ernst
Objective: The objective of this paper was to review the relation between fluoroquinolone (FQ) use and arthropathy in children.
Methods: The biomedical literature from January 1980 to February 2007 was searched using PubMed. Key search terms included fluoroquinolones, arthropathy, tendinopathy and children. Literature was included if it was a clinical trial or meta-analysis examining the use of 1 or more FQs in a pediatric human population and if it had a primary outcome measure of reported incidence of arthropathy or tendinopathy. Articles were excluded if the primary outcome measure was efficacy of an FQ in a particular pediatric disease state, and evaluated safety was a secondary end point.
Results: Data was reviewed from 4 large retrospective studies. Three of the 4 studies failed to find a significant link between musculoskeletal injury and FQ treatment. One study reported a correlation between use of pefloxacin and arthropathy, but the authors' conclusions supported the use of FQs in select pediatric cases.
Conclusion: Arthropathy that occurs as a result of FQ use in children has not been adequately supported by published data from safety trials in human children. Concerns about arthropathy with FQs should not preclude their use by emergency physicians when appropriate and necessary in pediatric patients.
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September
2007
9
5
Michael Wansbrough
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March
2007
9
2
Savithiri Ratnapalan, Suzan Schneeweiss
Background: Procedural sedation guidelines were established for a tertiary care pediatric emergency department (ED). We developed a pediatric procedural sedation course to disseminate these guidelines.
Objective: Our objective was to evaluate the effectiveness of a sedation course in improving physicians' knowledge of pediatric procedural sedation practices and guidelines, relative to individual self-directed learning.
Methods: We recruited emergency staff physicians and fellows as well as fourth-year pediatric residents in a tertiary care pediatric ED to participate in a randomized, controlled, educational intervention. All consenting physicians received pediatric sedation educational material for individual study 2 weeks before a learning assessment. Participants were randomly assigned to one of 2 groups. The self-directed learning group (n = 24) completed a multiple-choice examination without receiving any formal teaching. The study group (n= 24) participated in a 4-hour formal multifaceted sedation course before writing the multiple-choice examination.
Results: The groups did not differ significantly in demographic characteristics or self-perceived knowledge of pediatric sedation. The formal teaching group's median examination score (83.3%; range 75.8%-96.5%) was significantly higher (p < 0.0001) than the median examination score of participants in the self-directed study group (73.3%, range 43.5%-86.6%).
Conclusion: The multifaceted sedation course was more effective in improving physician knowledge and understanding of sedation guidelines and practices than unstructured, self-directed learning.
