Success Rates for Reduction of Pediatric Distal Radius and Ulna Fractures by Emergency Physicians.

BACKGROUND: Emergency physicians are trained in urgent fracture reduction. Many hospitals lack readily available in-house orthopedic coverage. OBJECTIVES: The aim of this study was to determine success rates for reduction of pediatric distal radius or ulna fractures by emergency department (ED) physicians. METHODS: We conducted a retrospective study of children younger than 18 years presenting to a large, urban, freestanding children's hospital from January 1, 2009, to December 31, 2010, with forearm fracture. Exclusions included open fracture, those requiring immediate surgical intervention, or additional fractures. The primary end point was the proportion of successful closed forearm fracture reductions in the ED, as defined by orthopedic follow-up. RESULTS: All reductions were performed by a board-certified/eligible pediatric emergency medicine (PEM) physician or PEM fellow. Two hundred ninety-five fractures were reduced in the ED during the study period. Mean age was 8.27 years (median, 8 years; range, 1-16 years), and males comprised 69.2% (n = 204). A total of 222 fractures (76%) were of the distal forearm, and 70 involved the midshaft (24%). Orthopedic follow-up was completed in 77.3%. A total of 33 patients (11%) required remanipulation; 24 in the distal forearm fracture group (22 closed reductions, 2 open reductions with internal fixation) versus 9 in the midshaft group (7 closed reductions, 2 open reductions with internal fixation) (P = 0.948). CONCLUSIONS: The literature reveals 7% to 39% of children with fracture reductions performed in the ED by orthopedic surgeons/residents require remanipulation. Our rate of 11% is consistent within that range. With training, PEM physicians have similar success rates as orthopedists in forearm fracture reductions.

Single breath counting for the evaluation of pediatric respiratory function: derivation of a "normogram".

Single breath counting (SBC) is the measurement of how far an individual can count in cadence with a metronome set at 2 beats per second in a normal speaking voice following a maximal effort inhalation. Previous work has demonstrated that it correlates well with standard measures of pulmonary function. The objective of this study is to derive a "normogram" of healthy children showing the expected SBC value as a function of easily measured physiologic parameters (age, gender, height, and weight). This was a prospective observational study of a convenience sample of healthy children presenting for well-child checks or non-respiratory complaints at a large tertiary care center. Correlation was determined by the Pearson's product correlation coefficient (r) and r (2) determined as a measure of shared variance. Multiple regression analysis was performed on demographic data to determine a best linear fit with calculation of the coefficient of determination (R (2)). A total of 105 children served as the basis for analysis; 54 (51.4 %) were male and average age was 9.7 (median 10, range 3-15) years. For both males and females, height correlated most strongly with SBC score (r = 0.730 and 0.725, respectively). In both genders, height alone accounted for more than 50 % of the observed variance in the results (r (2) = 0.533 and 0.526, respectively). Breath counting, an easy to perform test that appears to correlate well with standard measures of pulmonary function and shows promise for measuring asthma severity in children. We present an equation for predicting normal results (a "normogram").