Pediatric blast lung injury from a fireworks-related explosion.

Blast injuries related to explosions have been described in the literature but are uncommon in children. We describe a multisystem blast injury in a child resulting from a commercial firework-related explosion in her home. She presented with respiratory failure, shock, altered level of consciousness, and multiple orthopedic injuries. The patient required immediate stabilization and resuscitation in the emergency department and a prolonged hospitalization. This report reviews the spectrum of injuries that are seen in blast-related trauma and the emergency measures needed for rapid stabilization of these critical patients.

Charges and complications associated with the medical evaluation of febrile young infants.

BACKGROUND: Since 1983, no study has evaluated the costs and complications involved in the inpatient evaluation of antibiotic therapy for febrile infants aged 29 to 60 days. METHODS: A prospective quality indicator/quality assurance study of low-risk febrile young infants (FYIs) was conducted during a 16-month period after a retrospective pilot study. One investigator (C.C.) followed the medical course of enrolled FYIs, including 3 standardized scheduled phone follow-ups with the subject's parent and primary care provider (PCP) within the 2 weeks after discharge. RESULTS: Sixty-two subjects were enrolled during the 16-month period (58 admitted and 4 discharged subjects). Two (3%) subjects who met low-risk criteria developed a serious bacterial infection, both urinary tract infections. No cases of true bacteremia or bacterial meningitis were diagnosed. Seventeen subjects (29.3%) developed a complication during the admission. The mean length of inpatient stay was 49.0 hours (range, 18.1-65.4 hours). The mean charge for hospitalization was $6202 (range, $2818-$9880). Scheduled phone follow-up was successful on days 2 (77.4%), 7 (85.4%), and 14 (83.9%) after discharge. All patients were reported as improved (100%), and most parents preferred discharge to admission (66%-70%). In the 2 weeks after discharge, only 45 (72.6%) of 62 subjects had followed up with their PCPs. CONCLUSIONS: This prospective quality indicator/quality assurance study demonstrates that inpatient evaluation of low-risk FYIs results in high charges and potentially preventable complications. Hospitalization is contrary to the wishes of most parents in this study; however, the rate of appropriate follow-up with a PCP in this study is concerning.

Psychiatric patients in the pediatric emergency department undergoing routine urine toxicology screens for medical clearance: results and use.

OBJECTIVE: We sought to determine the use and results of urine toxicology screens (UTS) in psychiatric patients undergoing a UTS test for medical clearance in a pediatric emergency department. METHODS: A structured retrospective study was conducted over a 6-month period. All emergency department (ED) charts were reviewed of patients 8 to 17 years who had a UTS. Urine toxicology screens were identified as medically indicated or routine-driven. Medically indicated UTS were patients who presented with seizures, syncope, headache, altered mental status, ingestion, chest pain/palpitation, shortness of breath, sexual assault, or those who were brought in for motor vehicle accident (MVA). Routine-driven UTS were uncomplicated psychiatric patients who presented with aggressive or out of control behavior, intentional self-inflicted wounds, or symptoms of depression, all of whom presented without any evidence of drug or alcohol ingestion or altered mental status. Routine-driven UTS were quantified for positive tests. In addition, we determined the change in management and disposition of those patients. We also determined the concordance of provided drug use history with UTS result. RESULTS: Of the 652 charts reviewed, 267 UTS were medically indicated; 385 were routine-driven. Of the routine-driven UTS group, 254/267 (95%) patients with negative screens and 115/118 (97%) with positive screens were referred for psychiatric treatment after psychiatric evaluation. Fisher exact test of the comparison of the disposition after psychiatric assessment with the UTS result was nonsignificant. The UTS result also had no effect on the type of psychiatric disposition (ie, outpatient therapy, partial hospitalization, inpatient hospitalization). Concordance with provided history of illicit drug use was significant. CONCLUSIONS: Routine-driven UTS in uncomplicated pediatric psychiatric patients being evaluated in the ED offered little additional information, did not influence management, and potentially increased both ED cost and time. Patients with straightforward psychiatric complaints may be medically cleared without a UTS.