External validation of a pediatric decision rule for blunt abdominal trauma.

INTRODUCTION: Blunt traumatic injuries are a leading cause of morbidity and mortality in the pediatric population. Contrast-enhanced multidetector computed tomography is the best imaging tool for screening patients at risk of blunt abdominal injury. The Pediatric Emergency Care Applied Research Network (PECARN) abdominal rule was derived to identify patients at low risk for significant abdominal injury who do not require imaging. METHODS: We conducted a retrospective review of pediatric patients with blunt trauma to validate the PECARN rule in a non-pediatric specialized hospital from February 3, 2013, through December 31, 2019. We excluded those with penetrating or mild isolated head injury. The PECARN decision rule was retrospectively applied for the presence of a therapeutic intervention, defined as a laparotomy, angiographic embolization, blood transfusion, or administration of intravenous fluids for pancreatic or gastrointestinal injury. Sensitivity and specificity analysis were conducted along with the negative and positive predictive values. RESULTS: A total of 794 patients were included in the final analysis; 23 patients met the primary outcome for an acute intervention. The PECARN clinical decision rule (CDR) had a sensitivity of 91.3%, a negative predictive value of 99.5, and a negative likelihood ration of 0.16. CONCLUSION: In a non-pediatric specialty hospital, the PECARN blunt abdominal CDR performed with comparable sensitivity and negative predictive value to the derivation and external validation study performed at specialized children's hospitals.

Case Management Reduces Length of Stay, Charges, and Testing in Emergency Department Frequent Users.

INTRODUCTION: Case management is an effective, short-term means to reduce emergency department (ED) visits in frequent users of the ED. This study sought to determine the effectiveness of case management on frequent ED users, in terms of reducing ED and hospital length of stay (LOS), accrued costs, and utilization of diagnostic tests. METHODS: The study consisted of a retrospective chart review of ED and inpatient visits in our hospital's ED case management program, comparing patient visits made in the one year prior to enrollment in the program, to the visits made in the one year after enrollment in the program. We examined the LOS, use of diagnostic testing, and monetary charges incurred by these patients one year prior and one year after enrollment into case management. RESULTS: The study consisted of 158 patients in case management. Comparing the one year prior to enrollment to the one year after enrollment, ED visits decreased by 49%, inpatient admissions decreased by 39%, the use of computed tomography imaging decreased 41%, the use of ultrasound imaging decreased 52%, and the use of radiographs decreased 38%. LOS in the ED and for inpatient admissions decreased by 39%, reducing total LOS for these patients by 178 days. ED and hospital charges incurred by these patients decreased by 5.8 million dollars, a 41% reduction. All differences were statistically significant. CONCLUSION: Case management for frequent users of the ED is an effective method to reduce patient visits, the use of diagnostic testing, length of stay, and cost within our institution.

Spinal cord compression from a foreign body reaction to spinal cord stimulation: a previously unreported complication.

STUDY DESIGN: Case study. OBJECTIVE: The study presents a complication that is thought to have never before been reported with this therapeutic intervention. Results from this report are discussed with intentions to inform the neurosurgery, spine and pain management community of an additional complication associated with spinal cord stimulation (SCS). SUMMARY OF BACKGROUND DATA: SCS is a common intervention used to treat refractory neuropathic pain. Complications from this procedure are uncommon, but they do occur. METHODS: A unique complication of SCS was identified and treated. A search of the entire PubMed/Medline database failed to find any similar such complication. RESULTS: An epidural mass which caused significant cervical stenosis and spinal cord compression at the site of a previous SCS electrode was identified. Decompressive laminectomies and resection of the mass were performed. The mass was characterized as fibrous tissue with foreign body giant cell reaction. CONCLUSION: This is a unique complication of SCS about which all professionals evaluating patients who have similar implanted devices, even if they have already been removed, should be made aware of.