Triphasic response of pituitary stalk injury following TBI: a relevant yet uncommonly recognised endocrine phenomenon.

The triphasic response of pituitary stalk injury has previously been described in a minority of patients following intracranial surgery, however, this phenomenon can also occur after traumatic brain injury. We present the case of a 20-year-old male who experienced the triphasic response of pituitary stalk injury (central diabetes insipidus, syndrome of inappropriate antidiuretic hormone and central diabetes insipidus again) after striking his head on a concrete curb. His history and presentation highlight the importance of recognising the distinctive symptoms of each individual stage of pituitary stalk injury, and using the appropriate diagnostic tools and therapies to guide further management.

A Survey of Return Visits to the Pediatric Emergency Department: The Caretakers' Perspective.

OBJECTIVE: Approximately 5% of children return to the emergency department within 72 hours of a first evaluation. Previous literature has focused on healthcare utilization and the use of return visits as a quality metric. The goal of this study was to quantify reasons for return visits from the caretaker perspective. METHODS: Caretaker surveys were developed based on previously identified themes from focus groups. When considering reasons for return, multiple answers were allowed. Surveys were administered to a convenience sample of eligible caretakers who returned to the emergency department within 72 hours between June and August 2013. Caretakers were excluded if the return was scheduled or for an unrelated complaint. RESULTS: Of the 306 eligible caretakers, 83 (27%) participated. A majority returned because of continued (92%) or worsening symptoms (70%). More than half returned because they did not know how to help their child at home (60%), they did not understand their child's illness (59%), and/or they did not expect the persistence of symptoms (58%). Overall, caretakers felt more testing (55%), treatments (45%), medications (41%), and information (28%) should have been provided at the initial visit. Caretakers of children admitted at the second visit were significantly more dissatisfied with care at the first visit (P = 0.05). CONCLUSIONS: The most commonly reported reasons for pediatric return visits were continued symptoms and lack of illness understanding. We plan to use these data to develop targeted interventions to decrease the perceived need for return visits.