Characteristics of opioid prescriptions for discharged pediatric emergency department patients with acute injuries

2019 ◽  
Vol 67 (6) ◽  
pp. 1024-1027
Author(s):  
Lauren Krystine Kahl ◽  
Martha W Stevens ◽  
Andrea C Gielen ◽  
Eileen M McDonald ◽  
Leticia Ryan
Keyword(s):  
Emergency Department ◽  
Pediatric Patients ◽  
Median Number ◽  
Pediatric Emergency ◽  
Prescription Data ◽  
Prescribing Practices ◽  
Post Graduate ◽  
Frequent Use ◽  
Acute Injuries ◽  
Level Of Training

This study describes the characteristics of opioid prescriptions for pediatric patients discharged from the emergency department (ED) with acute injuries, including type, formulation, quantity dispensed, and associations with patient age group and prescriber level of training. This retrospective cohort study enrolled all acutely injured patients receiving opioid prescriptions at discharge from an urban academic pediatric ED in a 1-year period. Electronic medical records were reviewed to abstract clinical and prescription data and prescriber level of training. Descriptive statistics were used for analysis. We identified 254 patients with injuries who received opioid prescriptions at ED discharge during the study period (mean age 9.5 years, 65% male). The most common injury was fracture (71%). Oxycodone was the opioid most frequently prescribed (96.1%). Liquid formulations were prescribed in 51.6% of cases. The median number of doses prescribed per prescription was 12 (SD±9.1), with a range of 1–50. Residents wrote 72.9% of prescriptions and prescribed more doses than non-residents (15.5 vs 12.2, p=0.01). Post-graduate year 2 (PGY2) residents prescribed more doses than PGY1 or PGY3+ residents. Our data show wide variation in the number of opioid doses prescribed to acutely injured pediatric patients at ED discharge and frequent use of liquid formulation; both factors may place this population at risk for accidental ingestion. These findings also support the development of pediatric clinical guidelines to define appropriate quantities of opioids to prescribe, promote poisoning prevention strategies, and design post-graduate education for medical trainees about safe prescribing practices.

scholarly journals Evaluation of the Efficacy of a Onetime Injectable Dexamethasone Administered Orally in the Pediatric Emergency Department for Asthma Exacerbation

2017 ◽  
Vol 22 (5) ◽  
pp. 326-331
Author(s):  
Ashley McCallister ◽  
Tsz-Yin So ◽  
Josh Stewart
Keyword(s):  
Emergency Department ◽  
Asthma Exacerbation ◽  
Pediatric Patients ◽  
Pediatric Emergency ◽  
Average Weight ◽  
Pediatric Emergency Department ◽  
Routes Of Administration ◽  
Efficacious Treatment ◽  
Randomized Control ◽  
To Receive

OBJECTIVE This study assessed the efficacy of injectable dexamethasone administered orally in pediatric patients who presented to the emergency department with asthma exacerbation. METHODS This was a retrospective study of patients 0 to 18 years of age who presented to and who were directly discharged from the emergency department at Moses H. Cone Memorial Hospital between September 1, 2012, and September 30, 2015, for the diagnosis of asthma or asthma exacerbation. Patients had to receive a onetime dose of injectable dexamethasone orally prior to discharge. Patients were followed for a 30-day period to identify the number of asthma relapses. RESULTS Ninety-nine patients were included in this study. The average weight-based dose ± SD of dexamethasone was 0.35 ± 0.18 mg/kg (range, 0.08–0.62 mg/kg) and the actual dose ± SD was 10.58 ± 1.92 mg (range, 5–16 mg). Over a 30-day period, 6 patients (6%) had one repeated emergency department visit, 6 patients (6%) were admitted to the hospital, and 3 patients (3%) presented to an outpatient clinic for asthma-related symptoms. CONCLUSIONS Injectable dexamethasone administered orally may be an efficacious treatment for asthma exacerbation in pediatric patients. A randomized control trial comparing injectable dexamethasone administered orally to other dexamethasone formulations/routes of administration should be performed to adequately assess the bioequivalence and effectiveness of the former formulation.

scholarly journals Comparisons of Pediatric Patients who Visited to the Pediatric Emergency Department and the General Emergency Department

2015 ◽  
Vol 2 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Hyun Noh ◽  
Do Kyun Kim ◽  
Jin Hee Lee ◽  
Young Ho Kwak ◽  
Jin Hee Jung ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pediatric Patients ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department

scholarly journals Pediatric Patients in a Local Nepali Emergency Department: Presenting Complaints, Triage and Post-Discharge Mortality

2020 ◽  
Vol 7 ◽  
pp. 2333794X2094792
Author(s):  
Samita Giri ◽  
Tine Halvas-Svendsen ◽  
Tormod Rogne ◽  
Sanu Krishna Shrestha ◽  
Henrik Døllner ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Care ◽  
Low Income ◽  
Disease Burden ◽  
Pediatric Patients ◽  
Pediatric Emergency ◽  
Low Income Countries ◽  
Post Discharge ◽  
Telephone Interviews ◽  
Pediatric Emergency Care

Background. In low-income countries, pediatric emergency care is largely underdeveloped although child mortality in emergency care is more than twice that of adults, and mortality after discharge is high. Aim. We aimed at describing characteristics, triage categories, and post-discharge mortality in a pediatric emergency population in Nepal. Methods. We prospectively assessed characteristics and triage categories of pediatric patients who entered the emergency department (ED) in a local hospital. Patient households were followed-up by telephone interviews at 90 days. Results. The majority of pediatric emergency patients presented with injuries and infections (~40% each). Girls attended ED less frequent than boys. High triage priority categories (orange and red) were strong indicators for intensive care need and for mortality after discharge. Conclusion. The study supports the use and development of a pediatric triage systems in a low-resource general ED setting. We identify a need for interventions that can reduce mortality after pediatric emergency care. Interventions to reduce pediatric emergency disease burden in this setting should emphasize prevention and effective treatment of infections and injuries.

“Sick or not sick?” A mixed methods study evaluating the rapid determination of illness severity in a pediatric emergency department

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Laura B. O’Neill ◽  
Priti Bhansali ◽  
James E. Bost ◽  
James M. Chamberlain ◽  
Mary C. Ottolini
Keyword(s):  
Emergency Department ◽  
Mixed Methods ◽  
Clinical Reasoning ◽  
Pediatric Patients ◽  
Rapid Determination ◽  
Area Under The Curve ◽  
Pediatric Emergency ◽  
Illness Severity ◽  
Respiratory Support ◽  
Think Aloud

Abstract Objectives Experienced physicians must rapidly identify ill pediatric patients. We evaluated the ability of an illness rating score (IRS) to predict admission to a pediatric hospital and explored the underlying clinical reasoning of the gestalt assessment of illness. Methods We used mixed-methods to study pediatric emergency medicine physicians at an academic children’s hospital emergency department (ED). Physicians rated patients’ illness severity with the IRS, anchored by 0 (totally well) and 10 (critically ill), and shared their rationale with concurrent think-aloud responses. The association between IRS and need for hospitalization, respiratory support, parenteral antibiotics, and resuscitative intravenous (IV) fluids were analyzed with mixed effects linear regression. Area under the curve (AUC) receiver operator characteristic (ROC) curve and test characteristics at different cut-points were calculated for IRS as a predictor of admission. Think-aloud responses were qualitatively analyzed via inductive process. Results A total of 141 IRS were analyzed (mean 3.56, SD 2.30, range 0–9). Mean IRS were significantly higher for patients requiring admission (4.32 vs. 3.13, p<0.001), respiratory support (6.15 vs. 3.98, p = 0.033), IV fluids (4.53 vs. 3.14, p < 0.001), and parenteral antibiotics (4.68 vs. 3.32, p = 0.009). AUC for IRS as a predictor of admission was 0.635 (95% CI: 0.534–0.737). Analysis of 95 think-aloud responses yielded eight categories that describe the underlying clinical reasoning. Conclusions Rapid assessments as captured by the IRS differentiated pediatric patients who required admission and medical interventions. Think-aloud responses for the rationale for rapid assessments may form the basis for teaching the skill of identifying ill pediatric patients.

scholarly journals Acute Abdomen in Pediatric Patients Admitted to the Pediatric Emergency Department

2008 ◽  
Vol 49 (4) ◽  
pp. 126-134 ◽  
Author(s):  
Yu-Ching Tseng ◽  
Ming-Sheng Lee ◽  
Yu-Jun Chang ◽  
Han-Ping Wu
Keyword(s):  
Emergency Department ◽  
Acute Abdomen ◽  
Pediatric Patients ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department

scholarly journals Characteristics and Treatment of Anaphylaxis in Children Visiting a Pediatric Emergency Department in Korea

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Won Seok Lee ◽  
Jaewoo An ◽  
Young-Ho Jung ◽  
Hye Mi Jee ◽  
Kyu-Young Chae ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pediatric Patients ◽  
Pediatric Emergency ◽  
Food Allergies ◽  
Study Patient ◽  
Pediatric Emergency Department ◽  
Laboratory Findings ◽  
Korean Children ◽  
Epinephrine Injection ◽  
Tryptase Level

Anaphylaxis is a serious life-threatening allergic disease in children. This study is aimed at determining the characteristics of pediatric patients who experienced anaphylaxis along with treatments administered in order to determine the usefulness of tryptase level assessment as a marker of anaphylaxis in Korean children. A total of 107 patients who were diagnosed with anaphylaxis in a single pediatric emergency center over a 3-year period were included in the study. Patient clinical characteristics, symptoms, signs, allergy history, trigger factors, treatments, and laboratory findings, including serum tryptase levels, were included in the analysis. Food allergies (39.3%) were the most commonly reported patient allergic history, and 58 patients (54.2%) were triggered by food. Among this group, nuts and milk exposure were the most common, affecting 15 patients (25.9%). History of anaphylaxis and asthma were more common in severe anaphylaxis compared to mild or moderate anaphylaxis cases. Epinephrine intramuscular injection was administrated to 76 patients (71.0%), and a self-injectable epinephrine was prescribed to 18 patients (16.8%). The median tryptase level was 4.80 ng/mL (range: 2.70–10.40) which was lower than the 11.4 ng/mL value commonly documented for standard evaluation in adults with anaphylaxis. The most common cause of pediatric anaphylaxis was food including nuts and milk. The rate of epinephrine injection was relatively high in our pediatric emergency department. The median tryptase level associated with anaphylaxis reactions in children was lower than 11.4 ng/mL. Further studies are needed to help improve diagnostic times and treatment accuracy in pediatric patients who develop anaphylaxis.

scholarly journals P006: A qualitative study of the language of satisfaction for children in the emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S80-S80 ◽  
Author(s):  
S. Ali ◽  
T. McGrath ◽  
N. Dow ◽  
S. Aziz ◽  
M. Pilarski ◽  
...  
Keyword(s):  
Emergency Department ◽  
Grounded Theory ◽  
Pain Management ◽  
Qualitative Study ◽  
Patient Experience ◽  
Pediatric Patients ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Data Coding ◽  
Age Range

Introduction: Measures of satisfaction are essential to understanding patient experience, and pain management. Currently, there are no validated tools to quantify children’s satisfaction. To develop such a tool, we must first understand which words children use to communicate satisfaction. Our objectives were to (A) to identify the words commonly used by children of different ages to communicate satisfaction, in general, and in the context of pain management, and (B) to determine if this vocabulary is similar to that used by their caregiver. Methods: A qualitative study of 105 children-parent pairs, aged 3-16 years, who were evaluated at a pediatric emergency department (PED) from July-November 2014 was conducted. Children were interviewed using a semi-structured format of ten open-ended questions. They were asked to describe their feelings when 1) they received something they wanted/needed, 2) their expectations were met or not met in the ED, and 3) their pain was or was not relieved. A written survey was also completed by the caregiver. Interviews were transcribed and grounded theory was employed for data coding and analysis. Results: 105 child interviews were completed (n=53 female, mean age 9.91 SD 3.71, age range 4-16). 105 caregiver surveys were completed (n=80 female). “Good”, “better,” and “happy” were most commonly used by all children (n=99) to express satisfaction with pain management (27%, 21% and 22%, respectively), with PED care (31%, 14% and 33%) and in general (13%, 5% and 49%). Children (n=99) used the words “sad”, “bad,” and “not good” to communicate dissatisfaction with pain management (21%, 7% and 11% respectively), and with PED care (21%, 13% and 12%, respectively). Only 55% of children understood the meaning of the word ‘satisfaction’. Children used words that were similar to their caregiver 14% of the time. Conclusion: The word “satisfaction” should not be used to communicate with children in the emergency department, as many lack understanding of the term. The vocabulary that children use to describe satisfaction does not largely vary with context and involves simpler words than their parents. Caregiver vocabulary should not be used as a surrogate for pediatric patients. This study will inform the development of a validated tool to measure children’s satisfaction with pain management.

scholarly journals Effectiveness of a Training Course on Accuracy of Triaging of Pediatric Patients

2019 ◽  
Vol 7 (15) ◽  
pp. 2533-2537
Author(s):  
Mona Azzam ◽  
Enas Elngar ◽  
Ayman A. Gobarah
Keyword(s):  
Emergency Department ◽  
Health Care Professionals ◽  
Pediatric Patients ◽  
Surrogate Marker ◽  
Armed Forces ◽  
Pediatric Emergency ◽  
Training Course ◽  
Admission Rates ◽  
Significant Difference ◽  
Correct Determination

BACKGROUND: In the context of a new but busy Pediatric Emergency Department, the risk of missing patients who need more emergent care can be reduced by timely and accurate triaging. In the emergency department of King Fahad Armed Forces Hospital, the Canadian Triage and Acuity Scale had already been implemented, including the pediatric version (PaedCTAS). However, a common observation remained that critical patients did not always receive priority with subsequent delays in management. To improve this accuracy, a training course was administered to health care professionals responsible for triaging of pediatric patients. AIM: To determine the effectiveness of a training course on accuracy of triaging of Pediatric Patients. METHODS: A triage training course was conducted over two months, with patient encounter sheets reviewed before the course for 6 months and after the course for 12 months. Accuracy was calculated by comparing it to level as determined by two pediatric emergency physicians. Also, admission rates were used as a surrogate marker to also determine accuracy. RESULTS: A total of 31 053 patient sheets were reviewed. There was a considerable improvement in the correct determination of all triage levels, with accuracy ranging from 56.5% to 78.3% before the course, and reaching from 79.1% to 90.8% after the course with a statistically significant difference. Triaging errors still present were mainly in the form of down-triage. CONCLUSION: Our training course in triage has a significant impact on the accuracy of triaging of ill pediatric patients. Further improvement can be obtained by repeated courses and direct feedback with debriefing sessions on challenges to triage level determination.

scholarly journals Pediatric Emergency Department Responses to COVID-19: Transitioning From Surge Preparation to Regional Support

2020 ◽  
pp. 1-7
Author(s):  
Emily A. Hartford ◽  
Ashley Keilman ◽  
Hiromi Yoshida ◽  
Russell Migita ◽  
Todd Chang ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
Pediatric Patients ◽  
The United States ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
The Novel ◽  
Global Pandemic ◽  
The World ◽  
Novel Coronavirus

ABSTRACT In the midst of a global pandemic, hospitals around the world are working to meet the demand for patients ill with the 2019 coronavirus disease (COVID-19) caused by the novel coronavirus first identified in Wuhan, China. As the crisis unfolds, several countries have reported lower numbers as well as less morbidity and mortality for pediatric patients. Thus, pediatric centers find themselves pivoting from preparing for a patient surge to finding ways to support the regional response for adults. This study describes the response from 2 West Coast freestanding academic children’s hospitals that were among the first cities in the United States impacted during this pandemic.

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