Efficacy, pain, and overall patient satisfaction with pediatric upper arm fracture reduction in the emergency department.

INTRODUCTION: Immediate closed reduction and cast immobilization performed under sedation in the emergency room is the mainstay management for most isolated displaced or angulated upper limb fractures in children. We aimed to determine if this approach is safe, effective and if patients, parents and staff are satisfied with this approach.Our working hypothesis was this management provides a high satisfaction rate. PATIENTS AND METHODS: Between January 2017 and October 2017 we included 118 children presenting with upper arm fractures amenable to closed reduction under our institutional analgesia protocol. Children received 0.4mg/kg of Oramorph oral solution, they were then evaluated 40minutes later, and if their Face Legs Activity Cry Consolability (for children under 16 years-old) and/or Visual Analog Scale (for children over 6 years-old) were under 4, they underwent closed reduction by an orthopaedic resident under Nitrous oxide. If their pain assessment scale was above 4, they received an extra 0.4mg/kg of Oramorph oral solution and underwent closed reduction 40minutes later under nitrous oxide. These children were managed without hospitalization, as outpatients. Children>6, families and nursing staff were also given a visual satisfaction scale (using a 1-10 score) just before being discharged from the ER in order to evaluate their experience. RESULTS: Closed reduction in the ER was judged satisfactory from an orthopedic point-of-view in 115 cases (97.6%). Parents, children and the nursing team gave the experience in the ER an average satisfaction score of 9 out of 10. CONCLUSION: ER reduction is not only safe and effective but is also associated with a high satisfaction rate amongst children, their families and the nursing staff.

Rapid Adenovirus typing method for species identification.

Adenoviruses are characterized by a large variability, reflected by their classification in species A to G. Certain species, eg A and C, could be associated with increased clinical severity, both in immunocompetent and immunocompromised hosts suggesting that in some instances species identification provides clinically relevant information. Here we designed a novel "pVI rapid typing method" to obtain quick, simple and cost effective species assignment for Adenoviruses, thanks to combined fusion temperature (Tm) and amplicon size analysis. Rapid typing results were compared to Sanger sequencing in the hexon gene for 140 Adenovirus-positive clinical samples included in the Typadeno study. Species A and C could be identified with a 100% positive predictive value, thus confirming the value of this simple typing method.