Comparison of the Demographics and Visit Characteristics of Patients Who Left the Pediatric Emergency Department Without Being Seen With Those Who Were Evaluated in the Emergency Department.

BACKGROUND: We compared those patients who left without being seen (LWBS) with those who stay for evaluation and determined which subsets were more likely to depart prematurely in the largest pediatric population studied to date. METHODS: We retrospectively extracted data from the electronic medical records of all pediatric patients who visited the emergency department between January 1, 2013, and December 31, 2015. The demographics and visit characteristics were compared between patients who LWBS and those seen by a provider. Bivariate and multivariate analyses were used to determine the odds for premature departure of specific groups within the population. RESULTS: Of the 271,364 pediatric patients visiting the emergency department during the 3-year study period, 3835 (1.4%) LWBS by a provider. The mean age of those LWBS was younger, and the odds of leaving slightly decreased as the patient's age increased (odds ratio [OR], 0.98). Those triaged as having "nonurgent" medical conditions had a statistically significant increase in odds of premature departure when compared with those with "urgent" medical conditions (OR, 1.16). Patients arriving during the evening and overnight hours had a much greater odds of LWBS (OR, 6.7 and 7.3, respectively). CONCLUSIONS: Our findings demonstrated and confirmed that age, time of arrival, and acuity level upon presentation were predictors of patients leaving before evaluation. This can guide institutions with staffing and flow processes as they attempt to reduce LWBS rates but also raises further questions as to whether these subsets go forward to have worse clinical outcomes after leaving prematurely.

Pediatric psychiatric emergency department visits during a full moon.

OBJECTIVE: This study aimed to verify the hypothesis that the lunar cycle influences the number of pediatric psychiatric emergency department (ED) visits. METHODS: Pediatric psychiatric ED visits between 2009 and 2011 were obtained retrospectively. Patients aged between 4 and 21 years presenting to Miami Children's Hospital ED with a primary psychiatric complaint were included in the study. Patients with a concomitant psychiatric problem and a secondary medical condition were excluded. The number of psychiatric visits was retrieved for the full moon dates, control dates as well as the day before and after the full moon when the moon appears full to the naked eye (full moon effect). A comparison was made using the 2-sample independent t test. RESULTS: Between 2009 and 2011, 36 dates were considered as the true full moon dates and 108 dates as the "full moon effect." A total of 559 patients were included in the study. The 2-sample independent t tests were performed between the actual full moon date and control dates, as well as between the "full moon effect" dates and control dates. Our results failed to show a statistical significance when comparing the number of pediatric psychiatric patients presenting to a children's hospital ED during a full moon and a non-full moon date. CONCLUSIONS: Our study's results are in agreement with those involving adult patients. The full moon does not affect psychiatric visits in a children's hospital.

False-positive colorimetric capnometry after ingestion of carbonated beverages.

STUDY OBJECTIVE: To investigate the potential for false-positive colorimetric capnometric readings during esophageal intubation after ingestion of carbonated beverages. METHODS: The study was conducted in the human patient simulation laboratory of a tertiary care pediatric hospital. The sole outcome measurement was the capnometric indicator membrane color after expiration for 10 breaths. Readings were recorded for scenarios simulating 8 different models. RESULTS: For all carbonated beverage trials with a cuffed endotracheal tube (ETT) and those with 2 and 6 oz of beverage in the gastric sac with an uncuffed ETT, a false-positive result was observed on the capnometer's indicator for breaths 1 through 10. The sensitivity of the capnometer for the detection of CO2 after full exhalation of breath 6 for these trials was 100%. For trials containing 12 oz in the gastric sac and an uncuffed ETT, yellow was observed on the capnometer indicator for breaths 1 through 3, tan for breaths 4 through 6, and purple for breath 7. The sensitivity of the capnometer for the detection of adequate CO2 after full exhalation of breath 6 for these trials was 0%. The overall sensitivity of the capnometer for the carbonated beverage models with a cuffed ETT was 100%, whereas the combined sensitivity for the trials with an uncuffed ETT was 67%. CONCLUSIONS: Under proper circumstances, a significant potential exists for false-positive colorimetric capnometric results in the presence of even small amounts of carbonated beverages.

Heelys injuries: a review of the National Electronic Injury Surveillance System data.

OBJECTIVE: The purpose of this study was to describe the types and severity of Heelys-related injuries reported to the National Electronic Injury Surveillance System (NEISS). Strategies for prevention of these injuries may be developed using this information. METHODS: We performed a retrospective analysis of the NEISS data of the US Consumer Safety Product Commission between 2002 and 2006. RESULTS: The NEISS had 131 reported Heelys injuries in children. The mean age was 10.02 years. The upper extremity was most commonly injured, accounting for 75 (57.3%) of the 131 injuries. Fractures were the most common injuries, accounting for 66 (50.4%) of the 131 injuries. Children younger than 12 years were more likely to sustain fractures than their older counterparts (P = 0.001). Children 12 years or older were more likely to sustain sprains than the younger children (P ≤ 0.001). There was no difference in injury patterns between the sexes (P = not significant). Six children required hospital admission. There was 1 reported death. CONCLUSIONS: Most injuries sustained from Heelys use are orthopedic injuries. However, a wide variety of other injuries occur with Heelys use. Children can sustain injuries serious enough to require hospital admission. Parents and children should be educated about the importance of protective gear use while "heeling."