Search

Objective: To determine the effectiveness of a medicolegal lecture on risk-reduction documentation by residents in a pediatric emergency department., Design/methods: Pediatric residents at an academic children's hospital were offered a 1-hour lecture on reducing medicolegal risks. Residents in attendance made up the intervention group (IG) and nonattendants were the control group (CG). The primary outcome was risk-reduction documentation (RRD) using patients with chief complaints of abdominal pain, extremity fractures, and lacerations with potential foreign body., Results: For abdominal pain patients, RRD by IG improved 6.1% compared with 15.1% for the CG. For fracture patients, RRD by IG improved 20% compared with 26.5% decrease by CG. For laceration patients, RRD by IG decreased 20.8% compared with 30.6% decrease by CG. Although none reached statistical significance, the postintervention IG rates were greater., Conclusions: We showed a trend toward improvement in the rate of risk-reduction medical record documentation.

Objective: To determine the effectiveness of temporal artery thermometry (TAT) as an alternative for temperature assessment of children 1 to 4 years of age in the pediatric emergency department., Methods: Prospective cross-sectional study conducted at an urban children's hospital emergency department. TAT and rectal temperatures are compared in a convenience sample of children 1 to 4 years of age. Comparison of the temperatures is performed using Pearson correlation coefficient and regression analysis., Results: TAT and rectal temperatures are measured in 42 children 1 to 4 years of age. TAT predicts 83% of rectal temperatures. A receiver operating characteristic curve analysis shows that a cutoff of 37.7 degrees C or greater for fever in TAT is equivalent to rectal temperature greater than or equal to 38.3 degrees C with 100% sensitivity and 93.5% specificity., Conclusion: TAT is an effective screening tool in identifying fever in children 1 to 4 years of age.

A cross-sectional, retrospective review of consecutive patients who presented to 1 of 2 pediatric emergency departments with post-tonsillectomy hemorrhage was undertaken. The study population included children who had secondary hemorrhage (bleeding at greater than 24 hours after tonsillectomy). Over a period of 2 years, 90 children received emergency care for secondary post-tonsillectomy hemorrhage. The average age was 8.5 years and there were 40 (44%) males. The average time from tonsillectomy to emergency department (ED) presentation was 7.3 days. One patient was hypotensive, and 7 had hemoglobins <10 mg/dL. Signs of bleeding on examination of the tonsillar fossa were active (4), oozing (18), clots (48), and none (14). Of the 70 children with signs of bleeding, 63 (90%) were treated surgically and 7 (10%) were observed. Four (6%) of the 63 children who had signs of bleeding and were managed surgically and 3 (43%) of the 7 children who had signs of bleeding and were managed by observation had repeat episodes of bleeding. Of the 14 patients with no signs of bleeding, all were observed and none had repeat episodes of bleeding. Signs of bleeding were not documented in 6 patients. Active hemorrhage and cardiovascular compromise were uncommon in this study population. Surgical management is recommended for children who have signs of bleeding, while observation appears to be appropriate for children who have no signs of bleeding.