Outcome of Pediatric Forearm Fracture Reductions Performed by Pediatric Emergency Medicine Providers Compared With Reductions Performed by Orthopedic Surgeons: A Retrospective Cohort Study.

OBJECTIVE: The aim of this study was to describe the outcome differences between board-certified orthopedists and pediatric emergency medicine (PEM) physicians conducting forearm fracture reductions. METHODS: We performed an analysis of patients between 1 and 14 years of age who presented to the emergency department (ED) with a forearm fracture requiring reduction. Data collected included reducing provider (PEM or orthopedist) and prereduction, postreduction, and follow-up fracture angles and displacements of both radius and ulna. We collected costs of care, both in the ED and at follow-up, as well as length-of-stay data. χ Tests and Fisher exact test compared associations between categorical variables; 2-sample t tests compared the PEM and orthopedic groups. Regression models were used to control for injury severity confounders. RESULTS: Of the 222 fractures, orthopedists reduced 135, and PEM doctors reduced 87. Based on fracture angle and displacement, the orthopedic group tended to have slightly more complicated cases. After adjusting for age and time to follow-up, fractures reduced by orthopedists were less likely to require remanipulation (adjusted odds ratio, 0.30; P = 0.020). The PEM group had a significantly lower length of stay (59.4 minutes shorter; P < 0.001) and a small overall saving in charges ($273.90; P = 0.47). CONCLUSIONS: Orthopedists performed better in maintaining fracture reductions compared with PEM physicians but lengthened the ED stay for our patients. There was no significant difference in cost.

Pediatric pericardial tamponade presenting as altered mental status.

The purpose of this case report is to illustrate the diagnostic difficulties of pericardial tamponade and to suggest that focused cardiac ultrasound be included in the resuscitative care of pediatric shock. Three cases of cardiac tamponade are presented. Each patient had a syncopal episode and presented with altered mental status and hypotension. Muffled heart tones, distended neck veins, and electrocardiogram and chest radiograph abnormalities were not present. Hypotension was not responsive to intravenous volume expansion treatment. Diagnostic delays would have been prevented if focused cardiac ultrasound had been included in the resuscitative care of shock.