Search

Bacterial meningitis is a disease primarily affecting children two years of age or younger. The condition is rare in older children, who account for approximately four percent of all cases. An ll-year study was performed to review the characteristics of the disease in 25 previously healthy children who were six years of age or older. The most significant neurological symptoms were headache, altered consciousness, and neck pain. Other symptoms included nuchal rigidity (abnormal stiffness of the neck with pain and spasm on passive motion), lethargy, somnolence (sleepiness), petechiae (skin spots); less frequently noted were stupor or coma. Eleven of the patients had no fever when they were first examined. In the 22 patients who survived, any fever that was present responded to antibiotics, either immediately or within 48 hours. The organisms primarily responsible for the disease were Haemophilus influenzae type B (10 cases); Neisseria meningitides (9 cases) and streptococcus pneumoniae (6 cases). (Consumer Summary produced by Reliance Medical Information, Inc.)

This article discusses the specific controversial areas covering the care of children brought to a hospital's emergency department (ED). It includes the initial evaluation and treatment options for a severely injured child, particularly, the personnel involved in the care of the child, and the proper use of imaging and laboratory tests. It cites the importance of an organized method for the evaluation of an injured pediatric patient in the ED.

Clinicians working in the acute care setting will certainly encounter many pediatric patients who have been injured. Injury remains the most common cause of death and disability for pediatric patients. Motor-vehicle-related injury events still rate as the most common cause of death for children across all age groups. In a recent joint policy statement endorsed by more than 20 organizations representing a variety of disciplines, guidelines for the care of children presenting for care in an emergency department (ED) setting were outlined. Although the guidelines do not outline specific details for the care of injured children in regard to testing, the guidelines certainly emphasize monitoring the overall care provided, with mechanisms in place for quality improvement to take place. Specifically, physicians who staff the ED are encouraged to have "the necessary skill, knowledge, and training in emergency evaluation and treatment of children of all ages who may be brought to the ED consistent with the services provided by the hospital." This expectation applies not only to physicians, but also to nurses and other ED healthcare providers. This review article is intended to address specific controversial areas, including both the initial evaluation and treatment decisions regarding the acutely injured child. Specific areas to be covered include personnel providing care for the pediatric patient, the appropriate use of imaging tests, and the appropriate use of laboratory testing. As more is learned about the unique aspects of pediatric trauma patients, guidelines for evaluation and treatment should be modified to strike the balance between the many factors involved in identifying injuries with minimization of risk to the patient and potential side effects of the diagnostic testing. [ABSTRACT FROM AUTHOR]

Objectives: To describe the quality of pediatric resuscitative care in general emergency departments (GEDs) and to determine hospital-level factors associated with higher quality., Methods: Prospective observational study of resuscitative care provided to 3 in situ simulated patients (infant seizure, infant sepsis, and child cardiac arrest) by interprofessional GED teams. A composite quality score (CQS) was measured and the association of this score with modifiable and nonmodifiable hospital-level factors was explored., Results: A median CQS of 62.8 of 100 (interquartile range 50.5-71.1) was noted for 287 resuscitation teams from 175 emergency departments. In the unadjusted analyses, a higher score was associated with the modifiable factor of an affiliation with a pediatric academic medical center (PAMC) and the nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. In the adjusted analyses, a higher CQS was associated with modifiable factors of an affiliation with a PAMC and the designation of both a nurse and physician pediatric emergency care coordinator, and nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. A weak correlation was noted between quality and pediatric readiness scores., Conclusions: A low quality of pediatric resuscitative care, measured using simulation, was noted across a cohort of GEDs. Hospital factors associated with higher quality included: an affiliation with a PAMC, designation of a pediatric emergency care coordinator, higher pediatric volume, and geographic location. A weak correlation was noted between quality and pediatric readiness scores., (Copyright © 2023 by the American Academy of Pediatrics.)