Foreign Body Ingestions in Children: Risk of Complication Varies With Site of Initial Health Care Contact

PEDIATRICS ◽  
1993 ◽  
Vol 91 (1) ◽  
pp. 121-127 ◽  
Author(s):  
Ronald I. Paul ◽  
Katherine Kaufer Christoffel ◽  
Helen J. Binns ◽  
David M. Jaffe ◽  
Keyword(s):  
Emergency Department ◽  
Foreign Body ◽  
Tertiary Care ◽  
Standard Of Care ◽  
Pediatric Emergency ◽  
Adverse Outcomes ◽  
Pediatric Emergency Department ◽  
Parent Supervision ◽  
Tertiary Care Hospitals ◽  
Patient Enrollment

Current recommendations for the management of pediatric foreign body ingestions are based on studies of patients cared for at tertiary care hospitals; they call for aggressive evaluation because of a high incidence of complications. Two hundred forty-four children with suspected foreign body ingestions were prospectively followed to analyze adverse outcomes, ie, procedures, complications, and hospitalizations. Patient enrollment into the study was from three sources: (1) patients who referred themselves to a tertiary pediatric emergency department, (2) patients referred to the same tertiary pediatric emergency department after an initial evaluation by another hospital or physician, and (3) Patients who reported their foreign body ingestions to a private pediatric practitioner participating in the study. Most children were well toddlers in normal circumstances, under parent supervision at the time of ingestion. Coins were the most common item ingested (46%). Procedures were done in 53 (24%) of 221 patients and complications occurred in 48 (22%) of 221. Complications were higher in patients referred to the emergency department (63%) than in emergency department self-referred patients (13%) or private practice patients (7%) (x2, P < .01). These findings demonstrate the risk of drawing conclusions regarding a universal standard of care from studies involving only hospital-based patients.

scholarly journals Foreign body aspiration in an 11-month-old child; the importance of anamnesis and respiratory examination

2020 ◽  
Vol 10 (6) ◽  
pp. 156-157
Author(s):  
Muhammet Mesut Nezir ENGİN ◽  
Fatih ERDOĞAN ◽  
Özlem KÜÇÜK ◽  
Murat KAYA
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Foreign Body ◽  
Respiratory Distress ◽  
Mortality Rates ◽  
Pediatric Emergency ◽  
Foreign Body Aspiration ◽  
Morbidity And Mortality ◽  
Pediatric Emergency Department ◽  
Delay In Diagnosis

Foreign body aspiration (FBA) is common in children. Especially in children, the majority of accidental deaths occur due to FBA. Morbidity and mortality rates increase, especially in children between the ages of one and four, and as a result of delay in diagnosis. The most common symptoms in patients with FBA are cough, dyspnea, hemoptysis, stridor and wheezing. In this case report, a patient who presented with sudden respiratory distress in the Pediatric Emergency Department was presented and the importance of anamnesis and respiratory examination in the diagnosis of FBA was emphasized.

Trends in the diagnosis and management of anaphylaxis in a tertiary care pediatric emergency department

2018 ◽  
Vol 121 (3) ◽  
pp. 348-352 ◽  
Author(s):  
Neta Cohen ◽  
Tali Capua ◽  
Dikla Pivko ◽  
Moshe Ben-Shoshan ◽  
Shira Benor ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Diagnosis And Management

scholarly journals P016: Low risk ankle rule, high reward-a quality improvement initiative to reduce ankle x-rays in the pediatric emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S83 ◽  
Author(s):  
F. Al-Sani ◽  
M. Ben-Yakov ◽  
G. Harvey ◽  
J. Gantz ◽  
D. Jacobson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Ankle Injuries ◽  
Pediatric Emergency Department ◽  
X Rays ◽  
X Ray ◽  
Return Visits ◽  
Unnecessary Testing

Introduction: Our tertiary care institution embarked on the Choosing Wisely campaign to reduce unnecessary testing, and selected the reduction of ankle x-rays as part of its top five priority initiatives. The Low Risk Ankle Rule (LRAR), an evidence-based decision rule, has been derived and validated to clinically evaluate ankle injuries which do not require radiography. The LRAR, is cost-effective, has 100% sensitivity for clinically important ankle injuries and reduces ankle imaging rates by 30-60% in both academic and community setting. Our objective was to significantly reduce the proportion of ankle x-rays ordered for acute ankle injuries presenting to our pediatric Emergency Department (ED). Methods: Medical records were reviewed for all patients presenting to our tertiary care pediatric ED (ages 3- 18 years) with an isolated acute ankle injury from Jan 1, 2016-Sept 30, 2016. Children with outside imaging, an injury that occurred >72 hours prior, or those who had a repeat ED visit for same injury were excluded. Quality improvement (QI) initiatives included multidisciplinary staff education about the LRAR, posters placed within the ED highlighting the LRAR, development of a new diagnostic imaging requisition for ankle x-rays requiring use of the LRAR and collaboration with the Division of Radiology to ensure compliance with new requisition. The proportion of patients presenting to the ED with acute ankle injuries who received x-rays was measured. ED length of stay (LOS), return visits to the ED and orthopedic referrals were collected as balancing measures. Results: At baseline 88% of patients with acute ankle injuries received x-rays. Following our multiple interventions, the proportion of x-rays decreased significantly to 54%, (p<0.001). This decrease in x-ray rate was not associated with an increase in ED LOS, ED return visits or orthopedic referrals. There was an increase uptake of the dedicated x-ray requisition over time to 71%. Conclusion: This QI initiative to increase uptake of the LRAR, resulted in a significant reduction of ankle x-rays rates for children presenting with acute ankle injuries in our pediatric ED without increasing LOS, return visits or need for orthopedic referrals for missed injuries. Just as in the derivation and validation studies, the reductions have been sustained and reduced unnecessary testing and ionizing radiation.

53: MRI Utilization Trends In a Large Tertiary Care Pediatric Emergency Department

2010 ◽  
Vol 56 (3) ◽  
pp. S18-S19 ◽  
Author(s):  
J. Ramirez ◽  
J. Thundiyil ◽  
K.J. Cramm-Morgan ◽  
L. Papa ◽  
C. Dobleman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Large Tertiary Care

scholarly journals Trends in use in a Canadian pediatric emergency department

CJEM ◽  
2014 ◽  
Vol 16 (05) ◽  
pp. 405-410 ◽  
Author(s):  
Quynh Doan ◽  
Emerson D. Genuis ◽  
Alvis Yu
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Ed Overcrowding ◽  
Secondary Outcomes ◽  
Ed Crowding

ABSTRACTIntroduction:Emergency department (ED) crowding is a significant problem in Canada and has been associated with decreased quality of care in general and pediatric emergency departments (PEDs). Although boarding of admitted patients in the ED is the main contributor to adult ED overcrowding, factors involved in PED crowding may be different. The objective of this study was to report the trend in PED services use and to document the degree of overcrowding experienced in a Canadian PED.Methods:A retrospective cohort study was conducted using administrative data from a tertiary care PED from 2002 to 2011. The primary outcome was PED use (total volume of visits and case severity per triage levels using the Canadian Triage and Acuity Scale [CTAS] score and admissions). Secondary outcomes included measures of PED overcrowding, such as rates of patients leaving without being seen (LWBS) and length of stay (LOS).Results:Total volumes increased by 30% over the 10-year study period, whereas hospitalizations remained stable at approximately 10%. Trends in CTAS levels did not indicate meaningful changes in the severity of cases treated at our PED. LWBS proportions among CTAS 3, CTAS 4, and CTAS 5 groups and LOS for all CTAS groups progressively and statistically increased from year to year.Conclusions:Over the course of the study period, there was a substantial increase in PED visits,which likely contributed to the worsening markers of PED flow outcomes. Further study into the effects of PED crowding on patient outcomes is warranted.

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