A child with abdominal pain and hyperglycemia: is it diabetic ketoacidosis?

Hyperglycemia, abdominal pain, and vomiting are the most common manifestations of diabetic ketoacidosis in pediatric patients. The absence of ketonemia in these patients should prompt a consideration of acute pancreatitis. We report a case of an 11-year-old girl with acute necrotizing pancreatitis, who was initially diagnosed as having new onset diabetes with nonketotic hyperglycemia.

Latex-induced anaphylactic reaction in a child with spina bifida.

Allergy to natural rubber latex presents a unique challenge in the emergency department. Latex allergy in children is most commonly identified in patients who have undergone multiple operations for neural tube defects or genitourinary anomalies. We report a life-threatening anaphylactic reaction to latex in a patient with spina bifida even with latex-free precautions.

Parental perception of waiting time and its influence on parental satisfaction in an urban pediatric emergency department: are parents accurate in determining waiting time?

OBJECTIVE: The objective of this study was to determine whether parental perception of waiting time in an urban pediatric emergency department (ED) is accurate and whether the actual waiting times or their perception of waiting times impact on parental satisfaction. METHODS: A prospective convenience sample study in which the on-duty emergency physicians randomly administered a questionnaire at the time of the ED visit was used. During a 3-week period from December 15, 1999, through January 7, 2000, 500 parents or legal guardians of children who visited our ED were questioned about their perceived waiting time, and the responses were compared with the actual waiting time. The parents or guardians were also asked if they were satisfied with the waiting time. RESULTS: The majority (84%) of parents overestimated waiting time in the ED (median difference, 26 min; interquartile range, 9-50 min). Parents with perceived or actual waiting times that exceeded 2 hours were significantly more likely to be dissatisfied than parents with actual or perceived waiting times that were 1 hour or less (P < 0.001). Satisfaction was not related to the age (P = 0.35), sex (P = 0.30), race/ethnicity (P = 0.90), or mode of arrival (P = 0.28). CONCLUSION: Parents tend to overestimate waiting time. Both perceived and actual waiting times that exceed 2 hours were associated with parental dissatisfaction. ED administrators may need to keep this in mind when arranging ED staffing patterns to match peak patient hours to achieve optimal parental satisfaction.