Pediatric triage variations among nurses, pediatric and emergency residents using the Canadian triage and acuity scale.

BACKGROUND: Emergency care continues to be a challenge, since patients' arrival is unscheduled and could occur at the same time which may fill the Emergency Department with non-urgent patients. Triaging is an integral part of every busy ED. The Canadian Triage and Acuity Scale (CTAS) is considered an accurate tool to be used outside Canada. This study aims to identify the chosen triage level and compare the variation between registered nurses, pediatric and adult emergency residents by using CTAS cases. METHOD: This study was conducted at King Abdulaziz Medical City,Saudi Arabia. A cross-sectional self-administered questionnaire was used, and which contains 15 case scenarios with different triage levels. All cases were adopted from a Canadian triage course after receiving permission. Each case provides the patient's symptoms, clinical signs and mode of arrival to the ED. The participants were instructed to assign a triage level using the following scale. A non-random sampling technique was used for this study. The rates of agreement between residents were calculated using kappa statistics (weighted-kappa) (95%CI). RESULT: A total of 151 participants completed the study questionnaire which include 15 case scenarios. 73 were nurses and 78 were residents. The results showed 51.3, 56.6, and 59.9% mis-triaged the cases among the nurses, emergency residents, and pediatric residents respectively. Triage scores were compared using the Kruskal Wallis test and were statistically significant with a p value of 0.006. The mean ranks for nurses, emergency residents and pediatric residents were 86.41, 73.6 and 59.96, respectively. The Kruskal Wallis Post-Hoc test was performed to see which groups were statistically significant, and it was found that there was a significant difference between nurses and pediatrics residents (P value = 0.005). Moreover, there were no significant differences found between nurses and ER residents (P value> 0.05). CONCLUSION: The triaging system was found to be a very important tool to prioritize patients based on their complaints. The results showed that nurses had the greatest experience in implementing patients on the right triage level. On the other hand, ER and pediatric residents need to develop more knowledge about CTAS and become exposed more to the triaging system during their training.

Neurological complications in children with infective endocarditis: Incidence, risk factors, and outcome: A 10-year single-center experience.

BACKGROUND AND OBJECTIVE: Despite improvement in medical management, infective endocarditis (IE) remains a serious disease that may affect children with and without preexisting cardiac conditions with significant morbidity and mortality. Neurological complications of IE represent the worst with guarded prognosis. The aim of this study is to describe the incidence, etiology, characteristics, risk factors, and outcome of children with neurological complications associated with IE. MATERIAL AND METHODS: A retrospective cohort study was conducted from 2009 to 2019 where all pediatric patients who fulfilled the modified Duke criteria for IE were included. We divided the cases into 2 groups: IE with neurological complications and IE without neurological complications control group. We compared the two groups statistically and analyzed the results. RESULTS: We identified 31 (17 male, 14 female) patients with IE. Neurological complications occurred in 7/31 (23%) patients, mainly in the form of a stroke. Gram-positive microbes were the main causative agents for IE (52%) followed by gram-negative (14%), then fungal organisms (3%). Univariate analysis identified the following risk factors for neurological complications: lower body weight, higher C- reactive protein (CRP) level, and left-sided valvular lesions with P values of (0.0003, 0.0001, and 0.04), respectively.Although mortality was higher in the neurological complications group, it was 43% in comparison to 21% in the control group and it did not reach statistical significance (P = .49). Large vegetation size (more than 10 mm) was seen in 57% of patients with neurological complications as compared to 16% in the control group (P = .052). CONCLUSION: Neurological complications occurred in almost a quarter of children with IE. Possible risk factors include lower body weight, left-sided valvular lesion, and higher levels of inflammatory markers (CRP). Stroke was the most common neurological complication encountered with possible increased risk of mortality.

Case of rupture ectopic pregnancy with emergency contraception levonorgestrel 0.075 mg in a lactating woman.

Levonorgestrel emergency contraception (LNG-EC) tends to make uterus unfavorable for implantation but does not prevent embryo implantation. Emergency contraceptives pills should be used with caution among lactating women who at the same time should be monitored closely for ectopic pregnancy.

Assessing the Inhospital Complications in Patients Postrenal Transplantation, in a Tertiary Care Center, Riyadh, Saudi Arabia.

Complications of chronic kidney disease (CKD) can range from localized to systemic manifestations that can worsen patients' outcomes. CKD results in irreversible deterioration in renal function, which ultimately progresses to end-stage renal failure and necessitates the need for renal transplantation. Our study aimed to identify patients' complications postrenal transplant during hospitalization and assess the main factors affecting these patients' outcomes and survival rates. This study is a single-centered, retrospective cohort chart review conducted from January 2016 to March 2019. The collected data parameters included patients' characteristics (e.g., gender, age, body mass index), as well as surgical-related details and postoperative complications. Microsoft Excel and IBM SPSS Statistics version 22.0 were used for data entry and analysis. The descriptive statistics were presented as frequency and percentage for the categorical variables (e.g., gender and smoking status), while the mean ± standard deviation was used for numerical variables. A total of 80 posttransplant patients who fulfilled the inclusion criteria were recruited. Urogenital complications were the most commonly seen during the postoperative period, especially developing urinary tract infections by 16%. During our study, the rate of complications was considered minimal and not significant in assessing posttransplant patients.

A rare case of cellulitis after tetanus toxoid (TT) vaccination.

Cellulitis is a bacterial infection of the deeper layers of the skin, namely, the dermis and the subcutaneous tissue. The most common organisms involved in causing cellulitis are group A ß-hemolytic streptococci and Staphylococcus organisms. Rare causes include Pseudomonas aeruginosa in case of puncture wounds, anaerobes, Eikenella, Viridans streptococci in human bites. Cellulitis is mainly a clinical diagnosis but blood counts and ESR can be done to confirm its occurrence. Risk factors for cellulitis include breaks in the skin which allows an entry point for the bacteria, other risk factors include immune deficient states such as HIV/leukemia, conditions that affect the vascular system, and skin conditions such as eczema and psoriasis. Vaccination is an extremely rare cause of cellulitis with no cases of cellulitis reported since 1998 due to complication of vaccination. In our case, patients presented signs and symptoms of cellulitis 2 days after receiving the tetanus prophylaxis vaccine. He was treated with broad-spectrum antibiotics after admission and discharged once the condition settled.