This study sought to determine the incidence of delayed diagnosis of intracranial hemorrhage in the general population and the proportion of children who presented to emergency departments (EDs) with uncomplicated minor head injuries who received delayed diagnoses of intracranial hemorrhage.
This was an 8-year, retrospective, cohort study of children or =6 hours after injury) were identified.
An estimated 17,962 children (95% confidence interval [CI]: 17,412-18,511 children) with uncomplicated minor head injuries were evaluated at Calgary Health Region EDs. Two and 8 children were identified as having delayed diagnoses of intracranial hemorrhage with and without delayed deterioration in level of consciousness (Glasgow Coma Scale scores of
The objective of this study was to determine the frequency of complications associated with the use of multiple-dose activated charcoal.
The study population was drawn from 8 tertiary care hospitals in 4 North American cities. Medical records of all inpatients between March 1993 and March 1998 with a discharge diagnosis of poisoning (International Classification of Diseases, 9th edition, Clinical Modification codes 960-989.9) were reviewed to select patients who had received multiple-dose activated charcoal (defined as > or =2 doses administered within 12 hours). Medical records of patients who received multiple-dose activated charcoal were reviewed for patient demographics and clinical information regarding the occurrence of pulmonary aspiration, gastrointestinal obstruction, hypernatremia, hypermagnesemia, corneal abrasion, and other complications associated with the use of multiple-dose activated charcoal.
We reviewed 6,258 medical records, identifying 878 patients who received multiple-dose activated charcoal. We judged 5 (0.6%; 95% confidence interval [CI] 0.1% to 1.1%) patients to have had clinically significant pulmonary aspiration and none (0%; upper 95% CI 0.3%) to have had gastrointestinal obstruction. None of the patients with pulmonary aspiration died or had residual sequelae recorded. Hypernatremia (peak serum sodium >145 mEq/L [145 mmol/L]) was documented in 53 (6.0%; 95% CI 4.4% to 7.6%) patients, of whom 5 (0.6%; 95% CI 0.1% to 1.1%) had a serum sodium concentration of greater than 155 mEq/L (155 mmol/L). Hypermagnesemia (peak serum magnesium >2.5 mg/dL [1.0 mmol/L]) was documented in 27 (3.1%; 95% CI 2.0% to 4.2%) patients, of whom 3 (0.3%; 95% CI 0.1% to 1.0%) had peak values that were greater than 3.75 mg/dL (1.5 mmol/L). One patient had a corneal abrasion (0.1%; 95% CI 0% to 0.6%). No other complications were identified.
Clinically significant complications associated with the use of multiple-dose activated charcoal occur infrequently.
Comment In: Ann Emerg Med. 2003 Oct;42(4):597-8; author reply 598-914533638
Current practice and tolerance for risk in performing procedural sedation and analgesia on children who have not met fasting guidelines: a Canadian survey using a stated preference discrete choice experiment.
The objectives were to explore the tolerance of pediatric emergency medicine (PEM) physicians for risk in choosing when to perform procedural sedation and analgesia (PSA) and to describe adherence to preprocedural fasting guidelines and factors affecting the physicians' decisions.
A survey of Canadian PEM physicians who perform PSA was conducted. Respondents were asked about their PSA practices. Risk tolerance was assessed using an economics-based stated preference elicitation method called a discrete choice experiment (DCE). Using a hypothetical clinical situation of a healthy child needing PSA, three fasting scenarios (ingestion of full meal
It is uncertain whether pediatric and general emergency departments have different admitting practices regarding children with bronchiolitis. The objective of this study was to quantify the differences in admission practices between pediatric and general emergency departments of children with bronchiolitis in 1 North American metropolitan area, controlling for various factors such as clinical severity, comorbid conditions, and socioeconomic status.
Retrospective cohort review of emergency department visits from April 1992 to March 1997.
Five emergency departments (1 pediatric and 4 general) serving the Calgary Health Region, which encompasses approximately 850 000 people.
All children residing within the region who visited a regional emergency department and were diagnosed to have bronchiolitis (International Classification of Diseases, Ninth Revision code 466.1, primary or secondary diagnosis).
Population-standardized estimates of admission rates.
The medical charts of 3091 children diagnosed to have bronchiolitis during the study period were reviewed. Of this number, 2496 children were evaluated at the pediatric emergency department, and 629 (25%) were admitted. The remaining 595 (19%) were evaluated at the general emergency departments, and 221 (37%) were admitted. Controlling for age, gender, estimated family income based on postal code, medical comorbidity, and clinical severity estimated by presenting respiratory rate and room air oxygen saturation, population-standardized estimates for admission rates at the pediatric and general emergency departments were 24% (standard error: 1%) and 43% (standard error: 2%), respectively.
Children diagnosed to have bronchiolitis at the Calgary Health Region's pediatric emergency department were about half as likely to be admitted to the hospital as children diagnosed at the region's general emergency departments.
(1) To describe the demographic features and clinical course of children diagnosed with suspected peritonsillar abscess (PTA), (2) to determine the incidence of suspected and confirmed PTA in children younger than 18 years, and (3) to examine the factors associated with corticosteroid use and outpatient management of suspected PTA.
We conducted a population-based, retrospective chart review. The study was conducted within the Calgary Health Region (CHR). Patients met inclusion criteria if they were younger than 18 years, resided in the CHR, and were diagnosed with PTA (International Classification of Diseases, Ninth Revision 475) in the CHR between March 1994 and December 2001.
We identified 229 children (cases) who presented with 249 unique episodes of suspected PTA. The incidence of suspected PTA among children in the CHR was 14 cases per 100,000 person-years at risk. The incidence was highest among adolescents (40 cases per 100,000 person-years). The incidence of confirmed PTA was 3 cases per 100,000 person-years at risk. Among those with suspected PTA, surgical intervention, intravenous antibiotics, and corticosteroids were provided to 34%, 87%, and 37%, respectively. One hundred fifty-seven patients (69%) were initially managed as outpatients. Of these, 12 (8%) had subsequent uncomplicated hospital admissions.
Peritonsillar abscess is primarily a problem of adolescence, but the disease does occur in young children. Corticosteroid use was common but without either clear benefit or adverse outcomes. Two thirds of patients were managed as outpatients without any apparent increase in adverse outcomes.
Canada is among the most prosperous nations in the world, yet the health and wellness outcomes of Canadian children are surprisingly poor. There is some evidence to suggest that these poor health outcomes are partly due to clinical practice variation, which can stem from failure to apply the best available research evidence in clinical practice, otherwise known as knowledge translation (KT). Surprisingly, clinical practice variation, even for common acute paediatric conditions, is pervasive. Clinical practice variation results in unnecessary medical treatments, increased suffering, and increased healthcare costs. This study focuses on improving health outcomes for common paediatric acute health concerns by evaluating strategies that improve KT and reduce clinical practice variation.
Using a multiple case study design, qualitative and quantitative data will be collected from four emergency departments in western Canada. Data sources will include: pre- and post-implementation focus group data from multidisciplinary healthcare professionals; individual interviews with the local champions, KT intervention providers, and unit/site leaders/managers; Alberta Context Tool (ACT) survey data; and aggregated patient outcome data. Qualitative and quantitative data will be systematically triangulated, and matrices will be built to do cross-case comparison. Explanations will be built about the success or lack of success of the clinical practice guidelines (CPG) and clinical pathways (CPs) uptake based upon the cross-case comparisons.
This study will generate new knowledge about the potential causal mechanisms and factors which shape implementation. Future studies will track the impact of the CPG/CPs implementation on children's health outcome, and healthcare costs.
Acute gastroenteritis is a very common emergency department (ED) diagnosis accounting for greater than 1.5 million outpatient visits and 200,000 hospitalizations annually among children in the United States. Although guidelines exist to assist clinicians, they do not clearly address topics for which evidence is new or limited, including the use of antiemetic agents, probiotics, and intravenous (IV) fluid rehydration regimens. This study sought to describe the ED treatments administered to children with acute gastroenteritis and to compare management between Canadian and U.S. physicians practicing pediatric emergency medicine (PEM).
Members of PEM research networks located in Canada and the United States were invited to participate in a cross-sectional, Internet-based survey. Participants were included if they are attending physicians and provide care to patients
The objective was to examine utilization of ß2 agonists via metered dose inhalers with oral and inhaled corticosteroids (ICS) at discharge in children with acute asthma.
This was a retrospective medical record review at six pediatric emergency departments (EDs) of otherwise healthy children 2 to 17 years of age discharged with acute asthma. Data were extracted on history, disease severity, and pharmacotherapy used in the ED and at discharge. The primary outcome was the proportion of children prescribed "comprehensive therapy," i.e., albuterol via metered dose inhaler (MDI) with oral and ICS.
The overall rate of comprehensive therapy was 382 of 654 (58%), which varied from 30% to 84% (p
Although intravenous (IV) magnesium (Mg) can decrease hospitalizations in children with severe acute asthma, its use is often limited to resistant disease, and disposition may be determined prior to its use. Since knowledge about practice patterns of IV Mg would enhance knowledge translation and guide future research, we surveyed pediatric emergency physicians with interest in clinical research to determine the frequency, indications, adverse events, and barriers to use of IV Mg in children with severe acute asthma.
A cross-sectional online survey of two national pediatric emergency physician associations in Canada and the United States was conducted using a modified Dillman technique.
Response rates were 124 of 180 (69%) in Canada and 75 of 108 (69%) in the United States. Although 88% of participants report knowing that Mg is effective, only 14 of 199 (7%) give it to prevent hospitalizations and 142 of 199 (71%) give it to prevent admissions to the intensive care unit (ICU). Thirty-eight percent of respondents use Mg in