Assuntos
Artéria Celíaca/anormalidades , Doença Celíaca/diagnóstico , Constrição Patológica/diagnóstico , Fasciite/diagnóstico , Hemossiderose/diagnóstico , Hiperbilirrubinemia Neonatal/diagnóstico , Pneumopatias/diagnóstico , Miosite/diagnóstico , Dor Abdominal/etiologia , Adolescente , Criança , Fasciite/microbiologia , Feminino , Hemoptise/etiologia , Hemossiderose/etiologia , Humanos , Recém-Nascido , Icterícia Neonatal/etiologia , Pneumopatias/etiologia , Síndrome do Ligamento Arqueado Mediano , Limitação da Mobilidade , Miosite/microbiologia , Dor/etiologia , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes , Redução de Peso , Hemossiderose PulmonarRESUMO
An 18-year-old woman with a complex past medical history presented with 2 days of vomiting and lower abdominal pain. She had been admitted for the majority of the previous 5 months for recurrent pancreatitis and had undergone a cholecystectomy. Additional symptoms included nausea, anorexia, constipation, and a 40-lb weight loss over 4 months. She appeared uncomfortable, and an examination was remarkable for tachycardia, hypertension, and diffuse abdominal tenderness to light palpation. Her initial laboratory test results revealed mildly elevated liver enzymes (aspartate aminotransferase 68 U/L, alanine aminotransferase 80 U/L) and a normal lipase. She was admitted for pain control and nutritional support. Over the next few days, the lipase increased to 1707 U/L. Despite optimizing her management for acute pancreatitis, the patient's symptoms persisted. Further history gathering and laboratory testing ultimately revealed her diagnosis. Our expert panel reviews her hospital course and elucidates the management of our eventual diagnosis.
Assuntos
Dor Abdominal/etiologia , Dor Crônica/etiologia , Porfiria Aguda Intermitente/complicações , Porfiria Aguda Intermitente/diagnóstico , Doença Aguda , Adolescente , Colecistectomia , Constipação Intestinal/etiologia , Diagnóstico Diferencial , Feminino , Hemina/uso terapêutico , Humanos , Fígado/enzimologia , Debilidade Muscular/etiologia , Náusea/etiologia , Pancreatite/diagnóstico , Pancreatite/cirurgia , Parestesia/etiologia , Porfiria Aguda Intermitente/tratamento farmacológico , Recidiva , Redução de PesoRESUMO
BACKGROUND: The Joint Commission's 2009 National Patient Safety Goals aimed to improve identification of and response to clinical deterioration in hospital-ward patients. Some hospitals implemented intermediate-care units for patients without intensive care-level support needs. No studies have evaluated what effect changes associated with a move to a pediatric cardiovascular step-down unit (CVSDU) has on process-of-care outcomes. METHODS: A retrospective cohort study comparing process-of-care outcomes in units caring for children with congenital heart disease (n=1415) 1 year before (July 1, 2010-June 30, 2011) and 1 year after (August 1, 2011-July 30, 2012) implementation of a CVSDU following the move to a new hospital building. Units caring for noncardiac tracheostomy and/or ventilator-dependent patients were used as controls (n=606). Primary outcomes included length of stay (LOS) and transfers to higher levels of care. Secondary outcomes included rapid response team, cardiopulmonary arrest, and code blue rates. Mann-Whitney U and z tests were used for all analyses. RESULTS: When compared with a medical-surgical unit, cardiac patients admitted to a CVSDU had a significantly decreased total LOS (median 7.0 vs 5.4 days, P=.03), non-ICU LOS (median 3.5 vs 3.0 days, P=.006), and rapid response team/code blue rate per 1000 non-ICU patient days (11.2 vs 7.0, P=.04). No significant differences in primary or secondary outcomes were seen within the control group. CONCLUSIONS: Changes associated with a new CVSDU were associated with decreased LOS and lower rates of rapid response and code blue events for patients with congenital heart disease.