A comparison of self-reported risk and protective factors and the death implicit association test in the prediction of future suicide attempts in adolescent emergency department patients.

BACKGROUND: Concerns have been raised about the utility of self-report assessments in predicting future suicide attempts. Clinicians in pediatric emergency departments (EDs) often are required to assess suicidal risk. The Death Implicit Association Test (IAT) is an alternative to self-report assessment of suicidal risk that may have utility in ED settings. METHODS: A total of 1679 adolescents recruited from 13 pediatric emergency rooms in the Pediatric Emergency Care Applied Research Network were assessed using a self-report survey of risk and protective factors for a suicide attempt, and the IAT, and then followed up 3 months later to determine if an attempt had occurred. The accuracy of prediction was compared between self-reports and the IAT using the area under the curve (AUC) with respect to receiver operator characteristics. RESULTS: A few self-report variables, namely, current and past suicide ideation, past suicidal behavior, total negative life events, and school or social connectedness, predicted an attempt at 3 months with an AUC of 0.87 [95% confidence interval (CI), 0.84-0.90] in the entire sample, and AUC = 0.91, (95% CI 0.85-0.95) for those who presented without reported suicidal ideation. The IAT did not add significantly to the predictive power of selected self-report variables. The IAT alone was modestly predictive of 3-month attempts in the overall sample ((AUC = 0.59, 95% CI 0.52-0.65) and was a better predictor in patients who were non-suicidal at baseline (AUC = 0.67, 95% CI 0.55-0.79). CONCLUSIONS: In pediatric EDs, a small set of self-reported items predicted suicide attempts within 3 months more accurately than did the IAT.

Is routine heparin lock placement beneficial in the evaluation and treatment of febrile children?

INTRODUCTION: Nurses often use intravenous heparin locks (HL) with pediatric patients while obtaining laboratory studies to evaluate fever without a source. The purpose of the HL is to avoid an intramuscular injection if parenteral antibiotics are subsequently ordered. The objectives of this study were to determine if HL placement in patients undergoing laboratory evaluation for fever without a source (1) results in fewer injections and (2) is associated with increased use of antibiotics. METHODS: A retrospective chart review of ED patients aged 3 to 36 months was performed. Patients included in the review had fever with no identified source of infection, and a complete blood cell count and/or blood culture had been ordered. For analysis, patients who received an HL were compared with patients who did not receive an HL. RESULTS: A total of 439 patients had laboratory studies for fever without a source, with 345 (79%) in the HL group. No statistically significant differences were found in antibiotic administration, number of needle sticks, age, temperature, or white blood cell count between the groups. DISCUSSION: The use of an HL in young febrile ED patients did not change the total number of needle sticks or the likelihood of antibiotic administration.

Clinical factors associated with focal infiltrates in wheezing infants and toddlers.

It can be challenging to determine which findings are associated with focal infiltrates in young wheezing children. A prospective study of wheezing children < or = 18 months of age revealed focal infiltrates on chest radiograph in 23%. By use of multivariate analysis, findings significantly associated with focal infiltrates included grunting (OR 4.1, 95% CI, 2.0, 8.6) and oxygen saturation < or = 93% (OR 2.2, 95% CI, 1.1, 4.8); with a sensitivity and specificity of 12.5% and 97%, respectively. Variables not associated with focal infiltrates included first-time wheezing, fever, and tachypnea. The combination of grunting and oxygen saturation < or = 93% is highly specific and can be used to help diagnose pneumonia in wheezing infants and toddlers.

Chest radiographs in the pediatric emergency department for children < or = 18 months of age with wheezing.

There are no widely accepted predictors of pneumonia in wheezing infants and toddlers who present to the emergency department (ED). A 10-month retrospective review of ED visits of wheezing children < or = 18 months of age revealed the following chest radiograph (CXR) results: normal (21%), findings consistent with uncomplicated bronchiolitis or asthma (61%), focal infiltrates (18%), and other abnormalities (< 1%). Patients with focal infiltrates on CXR were more likely to have the following: a history of fever (p = 0.03, OR 2.1, 95% CI 1.0, 4.4), temperature > or = 38.4 degrees (p = 0.01, OR 2.5, 95% CI 1.1, 5.8) or crackles on examination (p < 0.0005, OR 3.9, 95% CI 1.7, 9.0). Selective use of CXRs has the potential to save health care dollars and limit unnecessary radiation.