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1.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 391-398, dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185136

RESUMO

Objetivos. Demostrar el efecto de simulaciones inmersivas repetidas cada 6 semanas, en comparación con su repetición cada 6 meses, sobre la evolución del rendimiento de un equipo multidisciplinar en situaciones pediátricas de riesgo vital durante un año. Método. Ensayo controlado aleatorizado unicéntrico que incluyó 12 equipos multidisciplinares (EMD) del servicio de emergencias médicas (SEM) de Francia compuesto por 4 miembros (médico/residente/enfermera/conductor de ambulancia). En el grupo experimental, 6 EMD se enfrentaron a 9 escenarios diferentes de shock pediátrico en simulaciones de alta fidelidad durante un año. En el grupo de control, 6 EMD tuvieron 3 escenarios comunes a los del grupo experimental (inicial, intermedio -después de seis meses- y final -después de un año-). Se evaluó el rendimiento técnico, mediante la Team Average Performance Assessment Scale (TAPAS) y la escala de rendimiento de acceso intraóseo (IO), y el no técnico, mediante la Clinical Teamwork Scale (CTS) y la Behavioral Assessment Tool (BAT) para los líderes. Se analizó la evolución en el tiempo y se compararon los dos grupos durante los simulacros comunes. Resultados. Las puntuaciones del rendimiento se incrementaron significativamente a lo largo del tiempo en el grupo experimental (p = 0,01 para TAPAS, p = 0,008 para IO, p = 0,03 para CTS y p = 0,02 para BAT) en comparación con el grupo control (p = 0,46 para TAPAS, p = 0,55 para IO, p = 0,62 para CTS y p = 0,58 para BAT). Todas las puntuaciones fueron más altas en el grupo experimental que en el grupo control durante la última sesión (55,8 ± 6,3 vs 31,2 ± 10,3, p = 0,01 para TAPAS; 91,7 ± 8,0 vs 62,9 ± 16,2, p = 0,01 para IO, 63,2 ± 9,3 vs 47,2 ± 13,1, p = 0,03 para CTS; y 72,8 ± 5,1 vs 51,2 ± 14,3, p = 0,01 para BAT). Se observó una diferencia significativa en las dos escalas de puntuación de rendimiento técnico (p = 0,02 para TAPAS y p = 0,03 para IO) a favor del grupo experimental durante la sesión intermedia. También hubo una estrecha relación entre los rendimientos del líder y del equipo, tanto para el rendimiento no técnico (rho > 0,9) como el técnico (rho > 0,7). Conclusiones. La formación basada en la simulación debería repetirse más de tres veces al año. Nuestros resultados favorecen la repetición de una situación poco común de alto riesgo cada seis semanas para mejorar todas las escalas de puntuación de rendimiento y garantizar puntuaciones aceptables de rendimiento técnico y no técnico durante un año


Objective. To demonstrate an effect of 1 year of training using immersive simulations repeated every 6 weeks versus every 6 months to improve the performance of multidisciplinary teams (MDTs) working with children in lifethreatening situations. Methods. Randomized controlled trial in 12 MDTs of emergency responders in France. Each MDT consisted of 4 persons: a physician, a resident, a nurse, and the ambulance driver. Six MDTs participated in 9 different high-fidelity simulations of pediatric shock over the course of a year. Six control MDTs were presented with 3 of the experimental group’s simulations at 3 time points (starting point, 6 months, and 1 year). Technical performance was assessed with the Team Average Performance Assessment Scale (TAPAS) and an intraosseous (IO) access performance scale. Nontechnical performance assessment instruments were the Clinical Teamwork Scale (CTS) and, for leadership, the Behavioral Assessment Tool (BAT). Progress over time was analyzed by comparing the 2 groups during the 3 simulations they experienced in common. Results. Performance scores rose significantly over the study period in the experimental group (P=.01 for the TAPAS score, P=.008 for IO access, P=.03 for the CTS score, and P=.02 for the BAT score) but did not change in the control group (P=.46 for TAPAS, P=.55 for IO access, P=.62 for CTS, and P=.58 for BAT). All mean (SD) scores were higher in the experimental group than in the control group in the last session: TAPAS, 55.8 ± 6.3 vs 31.2 ± 10.3, P=.01; IO access, 91.7 ± 8.0 vs 62.9 ± 16.2, P=.01; CTS, 63.2 ± 9.3 vs 47.2 ± 13.1, P=.03; and BAT, 72.8 ± 5.1 vs 51.2 ± 14.3, P=.01). The 6-month assessment showed significant between-group differences on 2 technical performance measures (P=.02 for TAPAS and P=.03 for IO access); the experimental group’s scores were higher. We also observed close correlations between the performance of the leader and the group on both nontechnical (rho > 0.9) and technical (rho􀀃> 0.7) assessments. Conclusions. Simulation-based training should be repeated more than 3 times per year. Our findings suggest the advisability of repeating simulations of infrequent, high-risk scenarios every 6 weeks to improve all performance scores and guarantee acceptable technical and nontechnical performance throughout the year


Assuntos
Humanos , Masculino , Feminino , Criança , Treinamento por Simulação/métodos , Liderança , Medicina de Emergência Pediátrica/métodos , Pesquisa Interdisciplinar , Simulação de Paciente , Choque , Análise de Variância
2.
Emergencias (Sant Vicenç dels Horts) ; 31(4): 239-244, ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182764

RESUMO

Objetivos: Validar distintos métodos destinados a estimar el peso en pacientes pediátricos en urgencias. Metodología: Serie de casos prospectivo con análisis transversal en pacientes de 1 mes hasta 14 años de edad en dos hospitales terciarios en el País Vasco (España). Se aplicaron 9 herramientas distintas de estimación de peso y se comparó el resultado con el peso real, calculando índices de concordancia (CCI), media de la diferencia y proporción de mediciones con un error del peso estimado inferior al 10% y 20% con respecto al peso real. Resultados: Se realizaron mediciones en 515 pacientes pediátricos. Todas las estimaciones presentaron una alta concordancia con respecto al peso real. La estimación parental del peso resultó la estrategia con menor margen de error (86,5% de mediciones con error < 10%), seguida de la Regla RCP del Hospital del Niño Jesús (63,5% de mediciones con error <10%). Las fórmulas de estimación basadas en edad o antropometría no ofrecieron proporciones superiores al 40% de mediciones con un error < 10%. Conclusiones: La estimación parental es una herramienta válida para la estimación del peso en niños. Cuando no está disponible esa opción, la Regla de RCP del Hospital del Niño Jesús sería la herramienta de elección


Objectives: To determine the validity of different ways of estimating body weight in children attended in the emergency department. Methods: Prospective cross-sectional study of a series of patients between 1 month and 14 years of age attended in 2 tertiary care hospitals in the Basque Country, Spain. We used 9 different ways to estimate body weight and compared the estimates to real weight by calculating the mean intraclass correlation coefficient, the mean difference between real and estimated weights, and the proportion of measurements within 10% and 20% of the real weight. Results: Five hundred fifteen pediatric patients were weighed and their weights estimated. All estimates had a high degree of agreement with real weight. A parent's weight estimate performed best: 86.5% of parental estimates were within 10% of the real weight. The next best estimate was achieved with the cardiopulmonary resuscitation (CPR) rule developed at Hospital del Niño Jesús: 65% of the estimates were within the 10% margin. Fewer than 40% of the weight estimates based on formulas using anthropometric measurements were within the 10% margin. Conclusions: A parent's estimate of weight is a valid approximation in children of all ages. When this estimate is not available, the CPR rule of Hospital del Niño Jesús would be the method of choice


Assuntos
Humanos , Masculino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Pesos e Medidas Corporais/métodos , Medicina de Emergência Pediátrica/métodos , Medicina de Emergência Pediátrica/organização & administração , Indicadores Básicos de Saúde , Antropometria/métodos , Estudos Prospectivos , Estudos Transversais , Epidemiologia Descritiva , Serviços Médicos de Emergência/estatística & dados numéricos
3.
Emergencias (Sant Vicenç dels Horts) ; 31(4): 257-260, ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182767

RESUMO

Objetivos: Analizar las características de las teleconsultas y triajes telefónicos pediátricos atendidos por CatSalut Respon y describir su impacto sobre la actitud y la decisión final de los padres-usuarios de acudir o no a urgencias. Método: Estudio observacional transversal. Durante la teleconsulta los pacientes se clasificaron según los niveles del sistema español de triaje. Aquellos que fueron derivados a urgencias se volvieron a clasificar en el hospital, y se compararon los niveles de triaje. Posteriormente, se realizó una llamada de verificación. Se recogieron variables sociodemográficas y clínicas. Resultados: Se analizaron 370 teleconsultas, fundamentalmente no urgentes (n = 300; 81%). Un 20,3% (n = 75) fueron derivadas a urgencias. La fiebre (p = 0,002) y las dudas de medicación (p < 0,001) fueron motivos significativos de teleconsulta no urgente. Casi un 46% de los casos con niveles de gravedad altos en el triaje de la llamada también fueron clasificados con niveles de gravedad altos en el triaje posterior realizado en el servicio de urgencias hospitalario, mostrando una concordancia moderada. Más del 50% de los padres tenían intención de acudir a urgencias antes de la teleconsulta y un 46% cambiaron de actitud tras realizar esta llamada. Conclusiones: Fiebre y dudas de medicación fueron motivos estadísticamente significativos de teleconsulta no urgente. La consulta telefónica produjo un cambio de actitud en casi la mitad de los padres


Objectives: To analyze the characteristics of remote telephone consultations (televisits) and triage of pediatric emergencies attended by the 24-hour emergency service of Catalonia (CatSalut Respon), and to describe the impact of televisits on callers' decisions about whether or not to come to the emergency department and their opinion of the call service. Methods: Observational cross-sectional study. During the call, cases were classified according the Spanish and Andorran triage system. Patients who were sent to the hospital underwent triage again, and the 2 assigned triage levels were compared. The families were later called to check data and ask their opinion of the service. Sociodemographic and clinical data related to the cases were recorded. Results: A total of 370 televisits were made. Most cases (300, 81%) were not emergencies. Seventy-five callers (20.3%) were advised to go to an emergency department. Fever (P = .002) and questions about medication (P < .001) were the problems significantly associated with nonurgent cases. Nearly 46% of the cases classified as serious during telephone triage were also considered serious when the child was brought to the emergency department. The rate of agreement between the 2 triage levels was moderate. Over half the parents stated they had intended to go to the hospital before calling the service; 46% changed their mind based on the call. Conclusions: Fever and questions about medication were significantly associated with televisits for nonurgent cases. Nearly half the parents changed their mind about going to the emergency department after a televisit


Assuntos
Humanos , Criança , Adolescente , Triagem/métodos , Consulta Remota/instrumentação , Medicina de Emergência Pediátrica/métodos , Triagem/estatística & dados numéricos , Consulta Remota/métodos , Consulta Remota/estatística & dados numéricos , Medicina de Emergência Pediátrica/estatística & dados numéricos , Febre/epidemiologia , Estudos Transversais , Consulta Remota/classificação
5.
Semin Pediatr Surg ; 28(3): 183-188, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31171155

RESUMO

Trauma is the leading cause of morbidity and mortality in the pediatric population. Due to a variety of factors, many pediatric trauma patients are initially evaluated and stabilized at adult hospitals that lack pediatric specific emergency medicine and surgical expertise. While similar to adult patients, the initial evaluation and resuscitation of pediatric patients does differ. Many of these key differences contribute to missed injury and susceptibility to error in the treatment of children. Here, we highlight a variety of differences between pediatric and adult trauma patients and clarify reasoning for these differences. Error traps that are discussed include missed cases of non-accidental trauma, missed blunt cerebrovascular injury, over use of CT (computed tomography) scans with unnecessary radiation exposure, missed small bowel or mesenteric injury, and unrecognized hemodynamic instability.


Assuntos
Lesões das Artérias Carótidas/diagnóstico , Maus-Tratos Infantis , Traumatismos Craniocerebrais/diagnóstico , Hipovolemia/diagnóstico , Intestinos/lesões , Erros Médicos , Segurança do Paciente , Medicina de Emergência Pediátrica/normas , Artéria Vertebral/lesões , Ferimentos não Penetrantes/diagnóstico , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Medicina de Emergência Pediátrica/métodos
6.
Emerg Med J ; 36(7): 435-442, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31227526

RESUMO

OBJECTIVE: Non-urgent paediatric ED (PED) visits appear to contribute a large portion to the growing use of EDs globally. Several interventions have tried to curb repeated non-urgent attendances, but no systematic review of their effectiveness exists. This review examines the effectiveness of interventions designed to reduce subsequent non-urgent PED visits after a non-urgent attendance. METHOD: A systematic review design. A systematic search of four databases and key journals was conducted from their inception to November 2018. Experimental studies, involving children aged 0-18 years presenting to an ED for non-urgent care, which assessed the effectiveness of interventions on subsequent non-urgent attendance were considered. RESULTS: 2120 studies were identified. Six studies, including four randomised controlled trials (RCTs) and two quasi-experimental, were included. Studies were of moderate quality methodologically. All studies originated from the USA and involved informational and/or follow-up support interventions. Only two RCTs demonstrated the longest duration of intervention effects on reducing subsequent non-urgent PED attendance. These studies identified participants retrospectively after ED evaluation. The RCT with the largest number of participants involved follow-up support by primary physicians. Meta-analysis was impractical due to wide heterogeneity of the interventions. CONCLUSIONS: There is inconclusive evidence to support any intervention aimed at reducing subsequent non-urgent PED visits following a non-urgent attendance. The long-term impact of interventions is limited, although the effect may be maximised if delivered by primary care providers in children identified after their ED attendance. However, further research is required to evaluate the impact of any such strategies in settings outside the USA.


Assuntos
Terapia Comportamental/normas , Sobremedicalização/prevenção & controle , Medicina de Emergência Pediátrica/métodos , Adolescente , Terapia Comportamental/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Sobremedicalização/estatística & dados numéricos , Medicina de Emergência Pediátrica/tendências , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Estados Unidos
7.
Australas Emerg Care ; 22(1): 28-33, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30998869

RESUMO

BACKGROUND: The aim of this study was to identify if patients presenting to a paediatric emergency department were due National Immunisation Program recommended vaccines in order to determine missed opportunities for vaccination or vaccination referral. METHOD: A hospital chart audit assessed the documentation of an immunisation history, in comparison to the immunisation histories available from national and state immunisation databases to determine accuracy; to identify if patients were due vaccines as determined by the National Immunisation Program; and to identify factors associated with those due vaccines. RESULTS: Potential opportunities to vaccinate children due vaccines were missed (10/114, 8.8%); with less than half (4/10, 40%) correctly documented as due vaccines. Despite identification of due vaccines, no vaccines were administered. Almost one third of patients (34/114, 30%) had no immunisation history documented in the chart. 'Medically at risk' children (Odds Ratio [OR] 29.7, 95% CI 4.5-196, p<0.001) were statistically more likely to be due vaccines. Likelihood of being due vaccines was higher, but not statistically significant, for those with no identified general practitioner (OR 4.5, 95% CI 0.96-20.6, p=0.08), and for those presenting with injury rather than illness (OR 2.0, 95%CI 0.51-8.1, p=0.48). CONCLUSION: Opportunities to vaccinate children presenting to the emergency department are currently being missed. A particular focus is needed for 'medically at risk' children and those with no identified general practitioner. Larger studies may confirm other risk factors. Further research is required into the attainment of an immunisation history during the hospital admission process and the accuracy of these methods.


Assuntos
Imunização/métodos , Criança , Pré-Escolar , Feminino , Humanos , Imunização/estatística & dados numéricos , Programas de Imunização/métodos , Esquemas de Imunização , Lactente , Masculino , Razão de Chances , Medicina de Emergência Pediátrica/métodos , Medicina de Emergência Pediátrica/estatística & dados numéricos
8.
Medicina (Kaunas) ; 55(4)2019 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-30974881

RESUMO

Background: Sepsis is the leading cause of death in children worldwide. Early recognition and treatment are essential for preventing progression to lethal outcomes. CRP and Complete Blood Count (CBC) are the initial preferred tests to distinguish between bacterial and viral infections. Specific early diagnostic markers are still missing. Aim: To investigate diagnostic value of Neutrophil-Lymphocyte Ratio (NLR), Mean Platelet Volume (MPV) and Platelet-MPV ratio (PLT/MPV) to distinguish sepsis/bacteremia and viral infection. Methods: We conducted a retrospective data analysis of case records of 115 children from 1 month to 5 years of age. All cases were divided into two groups-sepsis/bacteremia (n = 68) and viral (n = 47) patients, and further subdivided according to the time of arrival into early or late (≤12 or 12-48 h post the onset of fever, respectively). Analysis of CBC and CRP results was performed. NLR and PLT/MPV were calculated. Results: Sepsis/bacteremia group demonstrated higher absolute platelets count (370.15 ± 134.65 × 108/L versus 288.91 ± 107.14 × 108/L; p = 0.001), NLR (2.69 ± 2.03 versus 1.83 ± 1.70; p = 0.006), and PLT/MPV (41.42 ± 15.86 versus 33.45 ± 17.97; p = 0.001). PLT/MPV was increased in early arrival sepsis/bacteremia infants (42.70 ± 8.57 versus 31.01 ± 8.21; p = 0.008). NLR and MPV were significantly lower in infants (≤12 months) with viral infection on late arrival (1.16 ± 1.06 versus 1.90 ± 1.25, p = 0.025 for NLR and 8.94 ± 0.95fl versus 9.44 ± 0.85fl, p = 0.046 for MPV). Conclusion: Together with standard blood biomarkers, such as CRP, neutrophils, or platelets count, PLT/MPV is a promising biomarker for clinical practice to help discriminate between viral disease or sepsis/bacteremia in all children, especially in early onset of symptoms. NLR and MPV could support exclusion of sepsis/bacteremia in late arrival cases.


Assuntos
Bacteriemia/sangue , Bacteriemia/diagnóstico , Medicina de Emergência Pediátrica/métodos , Viroses/sangue , Viroses/diagnóstico , Biomarcadores/sangue , Pré-Escolar , Diagnóstico Diferencial , Diagnóstico Precoce , Serviço Hospitalar de Emergência , Feminino , Hospitais Universitários , Humanos , Lactente , Lituânia , Contagem de Linfócitos , Linfócitos , Masculino , Volume Plaquetário Médio , Neutrófilos , Projetos Piloto , Contagem de Plaquetas , Estudos Retrospectivos , Estatísticas não Paramétricas
9.
J Emerg Med ; 56(5): 571-579, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30857833

RESUMO

BACKGROUND: Although concussion-related emergency department (ED) visits increased after the passage of concussion laws, little is known about how the laws may disproportionately impact ED utilization and associated health care costs among children in different demographic groups. OBJECTIVE: Our aim was to examine the patient and clinical characteristics of pediatric ED visits and associated health care costs for sports- and recreation-related concussions (SRRCs) before and after concussion law enactment. METHODS: We retrospectively analyzed ED visits for SRRCs by children ages 5-18 years between 2006 and 2014 in the Pediatric Health Information System database (n = 123,220). ED visits were categorized as "pre-law," "immediate post-law," and "post-law" according to the respective state concussion law's effective date. Multinomial logistic regression models were used to assess the impact of the law on ED utilization. RESULTS: The majority of visits were by males (n = 83,208; 67.6%), children aged 10-14 years (n = 49,863; 40.9%), and privately insured patients (n = 62,376; 50.6%). Female sex, older age, and insured by Medicaid/Medicare were characteristics associated with increased ED visits during the immediate post-law and post-law periods compared to their counterparts. A significant decrease in proportion of imaging use was observed from pre-law to post-law (adjusted odds ratio 0.49; 95% confidence interval 0.47-0.50; p < 0.0001). While annual adjusted costs per ED visits decreased, annual total adjusted costs per hospital for SRRCs increased from pre-law to post-law (p < 0.0001). CONCLUSIONS: Concussion laws might have impacted pediatric concussion-related ED utilization, with increased annual total adjusted costs. These results may have important implications for policy interventions and their effects on health care systems.


Assuntos
Traumatismos em Atletas/economia , Concussão Encefálica/economia , Medicina de Emergência Pediátrica/economia , Adolescente , Traumatismos em Atletas/epidemiologia , Concussão Encefálica/epidemiologia , Criança , Pré-Escolar , Custos e Análise de Custo , Serviço Hospitalar de Emergência/organização & administração , Feminino , Custos de Cuidados de Saúde , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Medicina de Emergência Pediátrica/métodos , Estudos Retrospectivos
10.
Pediatr Emerg Care ; 35(3): 237-240, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30817707

RESUMO

Transient erythroblastopenia of childhood is a form of pure red cell aplasia that is self-limited and occurs in children 4 years old and younger. It is characterized by an absence or a significantly reduced quantity of erythroblasts in the bone marrow without underlying congenital red blood cell abnormalities. Transient erythroblastopenia of childhood should be considered in previously healthy children who present with normocytic anemia and lack of reticulocytosis without evidence of blood loss, hemolysis, or other causes of bone marrow suppression. Evaluation should be targeted at ruling out other causes of anemia. Management is mainly supportive, although some children may require blood transfusions for symptomatic anemia. Most patients demonstrate a return of hematopoiesis within two weeks of diagnosis and normalization of blood counts within two months.


Assuntos
Anemia Hemolítica Congênita/diagnóstico , Medicina de Emergência Pediátrica/métodos , Anemia Hemolítica Congênita/terapia , Pré-Escolar , Diagnóstico Diferencial , Transfusão de Eritrócitos/métodos , Feminino , Humanos , Lactente
12.
Emerg Med J ; 36(5): 273-280, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30327413

RESUMO

OBJECTIVE: To describe senior paediatric emergency clinician perspectives on the optimal frequency of and preferred modalities for practising critical paediatric procedures. METHODS: Multicentre multicountry cross-sectional survey of senior paediatric emergency clinicians working in 96 EDs affiliated with the Pediatric Emergency Research Network. RESULTS: 1332/2446 (54%) clinicians provided information on suggested frequency of practice and preferred learning modalities for 18 critical procedures. Yearly practice was recommended for six procedures (bag valve mask ventilation, cardiopulmonary resuscitation (CPR), endotracheal intubation, laryngeal mask airway insertion, defibrillation/direct current (DC) cardioversion and intraosseous needle insertion) by at least 80% of respondents. 16 procedures were recommended for yearly practice by at least 50% of respondents. Two procedures (venous cutdown and ED thoracotomy) had yearly practice recommended by <40% of respondents. Simulation was the preferred learning modality for CPR, bag valve mask ventilation, DC cardioversion and transcutaneous pacing. Practice in alternative clinical settings (eg, the operating room) was the preferred learning modality for endotracheal intubation and laryngeal mask insertion. Use of models/mannequins for isolated procedural training was the preferred learning modality for all other invasive procedures. Free-text responses suggested the utility of cadaver labs and animal labs for more invasive procedures (thoracotomy, intercostal catheter insertion, open surgical airways, venous cutdown and pericardiocentesis). CONCLUSIONS: Paediatric ED clinicians suggest that most paediatric critical procedures should be practised at least annually. The preferred learning modality depends on the skill practised; alternative clinical settings are thought to be most useful for standard airway manoeuvres, while simulation-based experiential learning is applicable for most other procedures.


Assuntos
Educação Médica Continuada/métodos , Ensino/normas , Adulto , Comportamento de Escolha , Competência Clínica/normas , Estudos Transversais , Educação Médica Continuada/normas , Medicina de Emergência/educação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medicina de Emergência Pediátrica/métodos , Medicina de Emergência Pediátrica/estatística & dados numéricos , Inquéritos e Questionários , Ensino/estatística & dados numéricos , Fatores de Tempo
13.
Eur J Emerg Med ; 26(1): 34-40, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28763311

RESUMO

BACKGROUND: Paediatric early warning score (PEWS) assessment tools can assist healthcare providers in the timely detection and recognition of subtle patient condition changes signalling clinical deterioration. However, PEWS tools instrument data are only as reliable and accurate as the caregivers who obtain and document the parameters. OBJECTIVE: The aim of this study is to evaluate inter-rater reliability among nurses using PEWS systems. DESIGN: The study was carried out in five paediatrics departments in the Central Denmark Region. Inter-rater reliability was investigated through parallel observations. A total of 108 children and 69 nurses participated. Two nurses simultaneously performed a PEWS assessment on the same patient. Before the assessment, the two participating nurses drew lots to decide who would be the active observer. Intraclass correlation coefficient, Fleiss' κ and Bland-Altman limits of agreement were used to determine inter-rater reliability. RESULTS: The intraclass correlation coefficients for the aggregated PEWS score of the two PEWS models were 0.98 and 0.95, respectively. The κ value on the individual PEWS measurements ranged from 0.70 to 1.0, indicating good to very good agreement. The nurses assigned the exact same aggregated score for both PEWS models in 76% of the cases. In 98% of the PEWS assessments, the aggregated PEWS scores assigned by the nurses were equal to or below 1 point in both models. CONCLUSION: The study showed good to very good inter-rater reliability in the two PEWS models used in the Central Denmark Region.


Assuntos
Medicina de Emergência Pediátrica/métodos , Criança , Dinamarca , Humanos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Sinais Vitais
14.
Pediatr Emerg Care ; 34(11): 810-815, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30395072

RESUMO

Pediatric stroke is relatively rare, with approximately 1000 childhood strokes in the United States per year. However, the occurrence of stroke in children leads to significant morbidity and mortality, warranting the development proven screening tools, protocols, and treatment options. Because significant delays in seeking medical attention can occur, time to recognition of pediatric stroke in the emergency department is uniquely challenging and critical. Once recognized, a trained multidisciplinary team with a multifaceted approach is needed to provide the best possible outcome for the patient. Key elements of the pediatric stroke protocol should include recognition tools, stroke alert mechanism, stroke order sets, timely imaging, laboratory evaluation, and treatment options. Substantial advancements have been made in the field of pediatric stroke protocols mainly due to formation of international consortiums and clinical trial. Despite significant progress, treatment options remain controversial.


Assuntos
Medicina de Emergência Pediátrica/métodos , Acidente Vascular Cerebral/diagnóstico , Criança , Serviço Hospitalar de Emergência , Fibrinolíticos/uso terapêutico , Humanos , Fármacos Neuroprotetores/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico
15.
Pediatr Clin North Am ; 65(6): 1119-1134, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30446052

RESUMO

In caring for critically ill children, recognition and management often begins in the pediatric emergency department. A seamless transition in care is needed to ensure appropriate care to the sickest of children. This review covers the management of critically ill children in the pediatric emergency department beyond the initial stabilization for conditions such as acute respiratory failure and pediatric acute respiratory distress syndrome, traumatic brain injury, status epilepticus, congenital heart disease, and metabolic emergencies.


Assuntos
Cuidados Críticos/métodos , Estado Terminal/terapia , Medicina de Emergência Pediátrica/métodos , Adolescente , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos
16.
Pediatr Clin North Am ; 65(6): 1167-1190, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30446055

RESUMO

Adult patients often present to the pediatric emergency department (ED) for treatment of a wide variety of diseases. However, pediatric emergency medicine physicians are primarily trained to provide specialized care for children. Studies have shown that the number of adult patients presenting to pediatric EDs has increased significantly since the introduction of the Emergency Medicine Transfer and Active Labor Act in 1986. This article discusses the management of common adult complaints presenting to the pediatric ED. The focus is on stabilization in the pediatric ED and safe transfer to a more appropriate facility.


Assuntos
Medicina de Emergência Pediátrica/métodos , Ressuscitação/métodos , Adulto , Emergências , Serviço Hospitalar de Emergência , Humanos , Transferência de Pacientes/métodos , Guias de Prática Clínica como Assunto
17.
Pediatr Clin North Am ; 65(6): 1229-1246, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30446059

RESUMO

Advances in technology are continuously transforming medical care, including pediatric emergency medicine. The increasing adoption of point-of-care ultrasound examination can improve timely diagnoses without radiation and aids the performance of common procedures. The recent dramatic increase in electronic health record adoption offers an opportunity for enhanced clinical decision-making support. Simulation training and advances in technologies can provide continued proficiency training despite decreasing opportunities for pediatric procedures and cardiorespiratory resuscitation performance. This article reviews these and other recent advances in technology that have had the greatest impact on the current practice of pediatric emergency medicine.


Assuntos
Tecnologia Biomédica/métodos , Serviços Médicos de Emergência/métodos , Medicina de Emergência Pediátrica/métodos , Criança , Educação Médica/métodos , Humanos , Sistemas Automatizados de Assistência Junto ao Leito
18.
Pediatr Clin North Am ; 65(6): 1247-1256, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30446060

RESUMO

This article discusses the implications of health care reform on the pediatric emergency department (ED). The author briefly discusses the health care costs and outcomes in the United States in comparison to other developed nations. The article discusses the impact of the Affordable Care Act and insurance expansion on the pediatric ED. Then the article addresses the impacts of the growing patient financial responsibility on ED use. There will be a discussion of the development of pediatric accountable care organizations and how payment mechanisms are evolving, and the challenges the pediatric ED may face in these new payment strategies.


Assuntos
Assistência à Saúde/métodos , Serviço Hospitalar de Emergência/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Medicina de Emergência Pediátrica/métodos , Criança , Assistência à Saúde/economia , Serviço Hospitalar de Emergência/normas , Feminino , Humanos , Masculino , Patient Protection and Affordable Care Act/economia , Medicina de Emergência Pediátrica/economia , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estados Unidos
20.
Emerg Med J ; 35(11): 681-684, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30181161

RESUMO

OBJECTIVE: The majority of paediatric ED visits result in discharge but little is known about what ED resources are deployed for these visits. The goal of this study was to understand the utilisation of diagnostic testing, procedures and hospital admission for paediatric ED visits triaged as 'non-urgent'. STUDY DESIGN: We examined US ED visits for children aged 0-17 years from 1 January 2009 to 31 December 2011 in the National Hospital Ambulatory Medical Care Survey. Visits triaged on arrival as 'non-urgent' (level 5) were compared with urgent visits (triage levels 1-4) for resource use and disposition. Sensitivity and specificity of triage for predicting resource use and disposition were assessed. RESULTS: Among 21 052 observations, representing 86 620 988 visits, 11.1% were triaged as 'non-urgent'. Diagnostic services were provided during 37.6% (95% CI 33.9% to 41.4%) of non-urgent and 55.2% (95% CI 53.3% to 57.2%) of urgent visits. Procedures were performed in 23.9% (95% CI 20.4% to 27.3%) of non-urgent and 33.9% (95% CI 31.2% to 35.9%) of urgent visits. 1.7% (95% CI 0.09% to 2.6%) of the non-urgent visits resulted in admission, with 0.08% (95% CI 0% to 0.2%) to critical care units, compared with 4.4% (95% CI 3.6% to 5.2%) of the urgent visits, with 0.3% (95% CI 0.2% to 0.4%) to critical care. Despite some substantial differences in the rates of resource use, triage score had poor sensitivity for identifying patients who did not receive ED tests, procedures or admission. CONCLUSION: A significant percentage of ED patients with non-urgent ED triage scores received ED testing and procedures. More work is needed to improve methods of prospectively identifying patients with low acuity complaints who do not need significant ED resources.


Assuntos
Alocação de Recursos/estatística & dados numéricos , Triagem/classificação , Adolescente , Criança , Pré-Escolar , Custos e Análise de Custo , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino , Medicina de Emergência Pediátrica/métodos , Medicina de Emergência Pediátrica/estatística & dados numéricos , Alocação de Recursos/economia , Índice de Gravidade de Doença , Triagem/métodos , Triagem/estatística & dados numéricos
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