4.59 Involuntary Patients in the Pediatric Emergency Department: A Retrospective Chart Review

Background. Observation is necessary following racemic epinephrine (RE) for patients with croup. The ideal length of this observation period is unclear. Objective. To compare the rate of failed outpatient management utilizing different observation times after RE administration for croup. Methods. We performed a retrospective chart review of children with croup who required RE. Failure of treatment was defined as requiring a second RE treatment and/or returning to the pediatric emergency department for croup symptoms within 24 hours of discharge. Results. The primary analysis considered patients observed between 2.1 and 3 hours compared with those observed for 3.1 to 4 hours. The patients in the 2.1- to 3-hour group had a higher rate of treatment failure (16.7% vs 7.1%, OR = 2.44, P < .01). Conclusions. Patients requiring RE for croup are more likely to have treatment failure if observed for between 2.1 and 3 hours as opposed to 3.1 to 4 hours.

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Process Mapping in a Pediatric Emergency Department to Minimize Missed Urinary Tract Infections

International Journal of Pediatrics ◽

10.1155/2016/2625870 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Morgan Black ◽

Valene Singh ◽

Vladimir Belostotsky ◽

Madan Roy ◽

Deborah Yamamura ◽

...

Keyword(s):

Emergency Department ◽

Urinary Tract ◽

Chart Review ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

Process Mapping ◽

Number Of Children ◽

Positive Urine ◽

Tract Infections

Urinary tract infections (UTIs) are common in young children and are seen in emergency departments (EDs) frequently. Left untreated, UTIs can lead to more severe conditions. Our goal was to undertake a quality improvement (QI) initiative to help minimize the number of children with missed UTIs in a newly established tertiary care pediatric emergency department (PED). A retrospective chart review was undertaken to identify missed UTIs in children < 3 years old who presented to a children’s hospital’s ED with positive urine cultures. It was found that there was no treatment or follow-up in 12% of positive urine cultures, indicating a missed or possible missed UTI in a significant number of children. Key stakeholders were then gathered and process mapping (PM) was completed, where gaps and barriers were identified and interventions were subsequently implemented. A follow-up chart review was completed to assess the impact of PM in reducing the number of missed UTIs. Following PM and its implementation within the ED, there was no treatment or follow-up in only 1% of cases. Based on our results, the number of potentially missed UTIs in the ED decreased dramatically, indicating that PM can be a successful QI tool in an acute care pediatric setting.

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What are kids getting into these days? A retrospective chart review of substance use presentations to a Canadian pediatric emergency department

CJEM ◽

10.1017/cem.2015.13 ◽

2015 ◽

Vol 17 (4) ◽

pp. 345-352 ◽

Cited By ~ 1

Author(s):

G. Emmi Driedger ◽

Kathryn A. Dong ◽

Amanda S. Newton ◽

Rhonda J. Rosychuk ◽

Samina Ali

Keyword(s):

Emergency Department ◽

Substance Use ◽

Chart Review ◽

Social Issues ◽

Admission Rate ◽

Retrospective Chart Review ◽

Pediatric Emergency ◽

Problematic Substance Use ◽

Level Of Consciousness ◽

Problematic Substance

AbstractObjectivesGoals for this study were to characterize the substances being used by youth who presented to an emergency department (ED), their demographic descriptors, and to describe the associated acute morbidity and mortality.MethodsWe conducted a retrospective review of all youth, ages 10–16 years, who presented to a pediatric ED with complaints related to recreational drug use (n=641) for 2 years ending on December 31, 2009.ResultsThe median age of patients was 15 years; 56% were female. Six percent of patients were homeless, and 21% were wards of the state. The most frequent ingestions included ethanol (74%), marijuana (20%), ecstasy (19%), and medications (15%). Over one third of patients had ingested two or more substances. Ninety percent of patients were brought to the ED by the emergency medical services; 63% of these activations were by non-acquaintances. Of the 47% of youth who presented with a decreased level of consciousness, half had a Glasgow Coma Scale less than 13. The Canadian Triage and Acuity Scale score was 1 or 2 for 44% of patients. Sixty-eight percent received IV fluids, 42% received medication, and 4% were intubated. The admission rate was 9%.ConclusionsYouth who presented to the ED for substance use represented a socially vulnerable population whose use of recreational substances resulted in high medical acuity and significant morbidity. Improved clinical identification of such high-risk youth and subsequent design of interventions to address problematic substance use and social issues are urgently needed to complement the acute medical care that youth receive.

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Resuscitation interventions in a tertiary level pediatric emergency department: implications for maintenance of skills

CJEM ◽

10.2310/8000.2011.110230 ◽

2011 ◽

Vol 13 (02) ◽

pp. 90-95 ◽

Cited By ~ 19

Author(s):

F. Jonathan Guilfoyle ◽

Ruth Milner ◽

Niranjan Kissoon

Keyword(s):

Emergency Department ◽

Demographic Data ◽

Rare Event ◽

Pediatric Intensive Care ◽

Retrospective Chart Review ◽

Pediatric Emergency ◽

Working Relationships ◽

Pediatric Emergency Department ◽

Successful Resuscitation ◽

Central Lines

ABSTRACT Objective: To describe the frequency and proportion of successful resuscitation interventions in a pediatric emergency department (PED). Methods and Material: This was a retrospective chart review of children at the BC Children's Hospital (BCCH) PED who were admitted to the BCCH pediatric intensive care unit (PICU) in 2004 and 2005. Demographic data, diagnosis, and resuscitation interventions in the PED and within the first 24 hours of PICU admission were recorded. The training of the operator and the number of attempts needed were also recorded. Results: There were 75,133 PED visits; 304 of 329 (92.4%) who met inclusion criteria were reviewed. Diagnoses included respiratory distress (n = 115, 35%), trauma (n = 50, 15%), sepsis (n = 36, 11%), seizures (n = 37, 11%), and cardiac disease (n = 22, 7%). Ninety-nine patients required intubation. Intubations in the PED were performed by residents (20%), pediatric emergency medicine (PEM) fellows (15%), PEM attending staff (29%), and PICU fellows (12%); 81% of these were successful on the first attempt. In the PED, seven central lines were placed, seven intraosseous needles were inserted, 15 patients required inotropes, and 9 patients required chest compressions. Conclusion: Critical illness in our emergency department is a rare event; hence, opportunities to resuscitate, secure airways, and place central venous catheters are limited. Additional training, close working relationships between the PED and the PICU teams, and resuscitation protocols for early PICU involvement may be needed.

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Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation

CJEM ◽

10.2310/8000.2013.131131 ◽

2014 ◽

Vol 16 (04) ◽

pp. 304-313 ◽

Cited By ~ 4

Author(s):

Geneviève Tourigny-Ruel ◽

Dubravka Diksic ◽

Elise Mok ◽

David McGillivray

Keyword(s):

Emergency Department ◽

Status Epilepticus ◽

Chart Review ◽

Positive Airway Pressure ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Pediatric Emergency ◽

Seizure Duration ◽

Triage Category ◽

Seizure Episode

ABSTRACTObjective:To evaluate the efficacy and safety of a simple linear midazolam-based protocol for the management of impending status epilepticus in children up to 18 years of age.Methods:This is a descriptive, quality assessment, retrospective chart review of children presenting with the chief complaint of seizure disorder in the emergency department (ED) of a tertiary care pediatric hospital and a triage category of resuscitation or urgent from April 1, 2009, to August 31, 2011. In children with at least one seizure episode in the ED treated according to the linear protocol, three main outcomes were assessed: compliance, effectiveness, and complications.Results:Of the 128 children meeting the above study criteria, 68 had at least one seizure episode in the ED, and treatment was required to terminate at least one seizure episode in 46 of 68 patients (67.6%). Fifty-five seizure episodes were treated in the 46 patients: 51 of 55 seizure episodes were treated with midazolam (92.7%) and 4 of 55 with lorazepam or diazepam (7.3%). Of those treated with midazolam, 86.3% (44 of 51) were successfully treated with one or two doses of midazolam. The median seizure duration for all treated patients was 6 minutes. Of the 42 patients treated with midazolam, 7 required either continuous positive airway pressure or intubation, and two patients were treated for hypotension. One patient died of pneumococcal meningitis.Conclusion:This simple linear protocol is an effective and safe regimen for the treatment of impending status epilepticus in children.

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