Angulation of the pediatric cervical spine with and without cervical collar.

STUDY OBJECTIVE: To determine whether semirigid cervical collars eliminate cervical spine (CS) flexion in children on back boards. DESIGN: Prospective clinical study. SETTING: An urban pediatric emergency department. PARTICIPANTS: Eighteen head-injured children < 8 years of age undergoing CS radiographs. INTERVENTIONS: Children were secured to back boards, and semirigid cervical collars were applied. Following CS clearance, the collar was removed, and an additional lateral film without collar was obtained. C2-C6 lateral Cobb angles were measured on both lateral films. MAIN RESULTS: Mean flexion with collar was 3.4 +/- 9.9 degrees and 5.6 +/- 6.8 degrees without a collar P > 0.05 CONCLUSION: Most children < 8 years, when immobilized on back boards have flexed CSs. Semirigid cervical collars do not eliminate flexion. Further study is needed to develop and test different methods of CS immobilization as present equipment is unable to position the CS optimally.

Use of emergency services by unaccompanied minors.

STUDY OBJECTIVE: The objective of the study was to describe the use of emergency services by minors who are unaccompanied by their parents or guardians and how they are managed in emergency departments. DESIGN: Self-administered survey. TYPE OF PARTICIPANTS: The ED directors of 71 emergency medicine training programs, 82 Michigan community EDs, and 56 pediatric EDs. MEASUREMENTS AND MAIN RESULTS: One hundred eighteen (58%) surveys were returned. A median of five unaccompanied minors (range 0.2 to 150) were seen weekly by responding EDs. Pediatric EDs saw the most unaccompanied minors weekly (ten) compared with training programs (five) and community EDs (three) (P less than .01). Emergency medicine training programs had the greatest percentage (3.0%) of minors who were unaccompanied compared with pediatric EDs (2.2%) and community EDs (2.6%) (P less than .05). For all conditions surveyed, only 3.8% of patients would be refused medical care without parental consent. However, 36.8% of patients would have medical care delayed even for conditions that might be painful or harmful if left untreated for some time. Most EDs (85.5%) screen patients and treat those who are acutely ill, but some (11.1%) treat all regardless of severity. CONCLUSION: Protocols should be developed for unaccompanied minors to ensure that delays in obtaining consent do not jeopardize the child and that the rights of minors for confidentiality and consent are recognized.

Comparison of rectal, axillary, and tympanic membrane temperatures in infants and young children.

STUDY OBJECTIVE: To evaluate the reliability of a tympanic membrane thermometer in detecting fever in young children presenting to the emergency department. SETTING: Pediatric emergency department in an urban teaching hospital, DESIGN/MEASUREMENT/PARTICIPANTS: Temperature measurements were obtained sequentially at three body sites in children less than 3 years old presenting to the pediatric ED. Axillary and rectal temperatures were obtained with an electronic thermistor probe (Diatek 500), and tympanic membrane temperatures were obtained with a noncontact, infrared sensing device (First TEMP). Patients were stratified by age, ear canal patency, presence of otitis media, and rectal temperature. RESULTS: Of 224 patients enrolled, 87 (39%) were febrile. Overall correlation of axillary and tympanic membrane measurements to rectal for all strata was .75 (P = .001) and .81 (P = .001), respectively. Sensitivity in detecting fever for axillary and tympanic membrane sites was .48 and .55, respectively. Otitis media and ear patency did not influence correlation of tympanic membrane measurements. Low tympanic membrane temperature sensitivity may be a result of probe configuration. CONCLUSION: Tympanic membrane and axillary temperatures should be viewed with caution in children less than 3 years old as neither can detect fever reliably.