Prevalence of non-accidental trauma among children at ACS verified pediatric trauma centers

Child abuse remains a national epidemic that has detrimental effects if unnoticed in the clinical setting | Journal of Trauma and Acute Care Surgery

Background: Extreme cases of child abuse, or non-accidental trauma (NAT), have large financial burdens associated with them due to treatment costs and long-term effects of abuse. Clinicians that have additional training and experience with pediatric trauma are better equipped to detect signs of NAT and have more experience reporting it. This additional training and experience can be measured by using the American College of Surgeons (ACS) Pediatric Trauma Verification. It is hypothesized that ACS verified Pediatric Trauma Centers (vPTCs) have an increased prevalence of NAT due to this additional experience and training when relative to non-ACS vPTCs.

Conclusions: The greater prevalence of NAT at vPTCs likely represents a more accurate measure of NAT among pediatric trauma patients, likely due to more experience and training of clinicians.

Full reference: Bogumil, D.D.A. et al. (2017) Prevalence of non-accidental trauma among children at ACS verified pediatric trauma centers. Journal of Trauma and Acute Care Surgery: Published online: 20 June 2017

 

Ultrasound for children with abdominal trauma

Despite evidence showing that the routine use of sonography in hospital emergency departments can safely improve care for adults when evaluating for possible abdominal trauma injuries, researchers at UC Davis Medical Center could not identify any significant improvements in care for pediatric trauma patients | ScienceDaily

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The findings, which resulted from a randomized clinical study involving 925 children with blunt torso trauma who were evaluated in the emergency department at the medical center, showed no difference in important clinical outcomes. The outcomes assessed were developed for the study mainly based on previous research in injured adults.

The UC Davis team investigated the Focused Assessment with Sonography for Trauma (FAST) to determine whether the use of the FAST examination could safely lead to a decrease in the use of computed tomography (CT) scans for children, and other outcomes. FAST is a bedside ultrasound examination using a portable ultrasound machine. It has not been routinely used in the initial emergency department evaluations of injured children. CT scans represent the “gold standard” in diagnostic imaging for clinicians, including the identification of intra-abdominal injuries, but they also pose a greater radiation risk for children than they do for adults.

The role of nurses’ clinical impression in the first assessment of children at the emergency department

This study explores the diagnostic value and determinants of nurses’ clinical impression for the recognition of children with a serious illness on presentation to the emergency department (ED) | Archives of Disease in Childhood

Main outcome measures: Diagnostic accuracy of nurses’ clinical impression for the prediction of serious illness, defined by intensive care unit (ICU) and hospital admission. Determinants of nurses’ impression that a child appeared ill.

Results: Nurses considered a total of 1279 (20.0%) children appearing ill. Sensitivity of nurses’ clinical impression for the recognition of patients requiring ICU admission was 0.70 (95% CI 0.62 to 0.76) and specificity was 0.81 (95% CI 0.80 to 0.82). Sensitivity for hospital admission was 0.48 (95% CI 0.45 to 0.51) and specificity was 0.88 (95% CI 0.87 to 0.88). When adjusted for age, gender, triage urgency and abnormal vital signs, nurses’ impression remained significantly associated with ICU (OR 4.54; 95% CI 3.09 to 6.66) and hospital admission (OR 4.00; 95% CI 3.40 to 4.69). Ill appearance was positively associated with triage urgency, fever and abnormal vital signs and negatively with self-referral and presentation outside of office hours.

Conclusion: The overall clinical impression of experienced nurses at the ED is on its own, not an accurate predictor of serious illness in children, but provides additional information above some well-established and objective predictors of illness severity.

Full reference: Zachariasse, J.M. et al. (2017)  The role of nurses’ clinical impression in the first assessment of children at the emergency department. Archives of Disease in Childhood. Published Online First: 10 June 2017

Ultrasound for children with broken arms: Accurate, faster, less painful than X-rays

Point-of-Care Ultrasound (POCUS) assessment of distal forearm injuries in children is accurate, timely, and associated with low levels of pain and high caregiver satisfaction | ScienceDaily

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There are many goals when managing children with suspected fractures of the arm. These include being fast and accurate in the diagnosis, not causing more pain and limiting exposure to radiation. Achieving these goals can result in high rates of caregiver satisfaction. Dr. Poonai’s study suggests that POCUS may be a viable alternative to x-ray with respect to diagnostic accuracy, cost effectiveness, pain, caregiver satisfaction, and procedure duration.

Read the full overview via ScienceDaily here

The original research article is available here

 Emergency hospital care for children and young people

What has changed in the past 10 years? | QualityWatch

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Image source: QualityWatch

This short research summary explores how children and young people’s use of emergency care has changed over the past 10 years and seeks to understand what this might mean for care quality.

Emergency care across the NHS in England is under great pressure. The number of people attending Accident & Emergency (A&E) departments is at an all-time high demand for beds is also at record levels and the four-hour A&E target (of seeing 95 per cent of patients arriving at A&E within four hours) has not been met since July 2013.

Discussion of the pressures on emergency care within the NHS tends to focus predominantly on older people. This is understandable – the over 65s account for the majority of emergency bed days in NHS hospitals, stay longer in A&E than the rest of the population and are more likely to be admitted to hospital in an emergency.

However, children and young people – defined as people under the age of 25 – are also frequent users of emergency care, attending A&E more frequently than the adult population. Their healthcare needs can be very different from adults, meaning they often require specialist support, and – like older people – they can be particularly vulnerable and dependent on carers.

Download the full report here

Complexity and Severity of Pediatric Patients Treated at United States Emergency Departments

Hudgins, J.D. et al. The Journal of Pediatrics | Published online: 7 April 2017

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Objective: To compare the complexity and severity of presentation of children in general vs pediatric emergency departments (EDs).

Conclusions: Pediatric EDs provided care to a greater proportion of medically complex children than general EDs and had greater rates of hospitalization. This information may inform educational efforts in residency or postgraduate training to ensure high-quality care for children with complex health care needs.

Read the full abstract here

Pediatric ENT Complaints: An Update

Weller, M.A. et al. (2017) Emergency Medicine. 49(1) pp. 8-17

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This review highlights the diagnosis and management of the three most common causes of pediatric otolaryngologic complaints seen in the ED.

Among all of the causes of ear, nose, and throat (ENT) complaints, acute otitis media (AOM), bacterial sinusitis, and streptococcal pharyngitis (SP) are the most common infections prompting pediatric presentation to the ED. Through a series of case scenarios, along with key questions to help guide the clinician’s work-up, this review covers the proper evaluation and management of pediatric ENT complaints.

Read the full review here