Faculty Disclosures. Objectives. Best Pediatric Emergency Medicine Articles for 2012

Transcription

1 Faculty Disclosures Best Pediatric Emergency Medicine Articles for 2012 Evelyn Porter MS, MD I do not have any significant financial interest or other relationships with the manufacturers of any products or providers of services I intend to discuss Objectives Review a variety of new pediatric emergency medicine literature Topics include infectious disease, cardiology, radiology, non accidental trauma, sedation, communication Describe research findings, limitations, and clinical applications 1

2 Fever is common, work up is variable Rochester, Boston and Philadelphia criteria Epidemiological changes Study Question: What are the rates of positive cultures in febrile infants younger than 2 months Retrospective review, X 2 years Inclusion: < 60 days old Fever Blood, urine and/or CSF culture in ED Results: 207 patients Kids <28 days: 2.7% Blood culture positive 10% Urine culture positive Kids days: 1.5% Blood culture positive 8% Urine culture positive One S pneumoniae, 0 H influenza cases Limitations: Retrospective Not all patients got CSF studies Smaller study Take Home Points: E coli is the most common organism in young infants 2

3 15-20% of children experience a syncopal episode Mostly benign ED goal: Identify high risk patients with cardiac abnormalities Current recommendations are to obtain an EKG Study Questions: Describe epidemiology related to syncope Are we following guidelines? Retrospective observational Ages 7-18 presenting to ED with syncope Results: >600,000 cases Syncope is more common in females, teens, and those patients with private insurance EKG obtained in 69% of cases CT obtained in 24% Study Limitations: Retrospective No detailed clinical information Take Home Point: Get an EKG for syncope 3

4 25-30% of febrile seizures are complex AAP recommends against imaging for first simple febrile seizure No recommendations for first complex febrile seizure Study Question: What is the risk of intracranial pathology requiring immediate intervention in a kid presenting with first complex febrile seizure Retrospective cohort review 6-60 months, X13 years 1st complex febrile seizure Excluded: neurosurgical patients, traumas, epilepsy, immunocompromised, generalized febrile seizure where meds were given before 15 minutes 4

5 Results: 526 kids 268 (50%) had emergent head CT 4 patients with clinically significant findings Only 1/4 had a normal physical examination Limitations: Retrospective Those who did not have CT and did not return were assumed to be negative Take Home Point: CT head in complex febrile seizure unlikely to be positive if no abnormal physical exam findings are present Limited information on the severity of abuse Study Questions: Estimate the number of children with serious abuse Describe their demographic characteristics Determine the associated cost 5

6 Retrospective cohort Utilized the Kid s Inpatient Database (KID) Inclusion: ICD-9 and E Codes Take Home Point: Keep abuse on your radar!!! 6

7 Commonly used agent for procedural sedation Widely held concern that Ketamine increases intraocular pressure (IOP) Study Question: Does Ketamine sedation cause a clinically significant elevation in IOP? Prospective study Convenience sample of 25 patients Ketamine sedation IOP at 1, 3, 5, 15 and 30 minutes Limitations: Small study Additional confounding medications Variety of procedures 7

8 Take Home Point: Ketamine unlikely to cause clinically significant elevations in IOP Language barriers have an effect on patient care Many patients with limited English proficiency do not receive adequate language assistance Study Questions: How do interpreter types compare Identify interpreter error types, numbers and their clinical significance Prospective cross sectional 30 months, audiotaped ED visits of Spanish speaking limited English proficient patients, caregivers and their interpreters Transcripts reviewed for errors and error types Omission, addition, substitution, editorialization, false fluency 8

9 Results: No difference in the number of errors Professionals made fewer false fluency and omissions errors 18% of interpretation errors had potential clinical consequence: Professional made fewer clinically significant errors Among professional interpreters, those with more training had fewer errors Limitations: Only Spanish Phone interpreters not assessed Not blinded Take Home Point: Use a professional interpreter Summary Think E coli Don t forget the history, it may save a life CT, proceed with caution Keep abuse on your radar Ketamine likely little effect on IOP Use a professional interpreter Thank You 9

10 Anderson AB, Czosek RJ, Cnota J, et al. Pediatric syncope: national hospital ambulatory medical care survey. AM J Emerg MEd Jan;30(1): Enright K, Turner C, Roberts P, et al. Primary cardiac arrest following sport or exertion in children presenting to an emergency department: chest compressions and early defibrillation save lives, but is intravenous epinephrine always appropriate? Pediatr Emerg Care Apr;28(4): Rodday AM, Triedman JK, Alexander ME. Electrocardiogram screening for disorders that caused sudden cardiac death in asymptomatic children: a meta analysis. Pediatrics Apr;129(4):e999-e1010. Section on cardiology and cardiac surgery. Pediatric sudden cardiac arrest. Pediatrics Apr;129(4):e Greenhow TL, Hung YY, Herz AM. Changing epidemiology of bacteremia in infants aged 1 week to 3 months. Pediatrics Mar;129(3):e590-6 Leventhal JM, Martin KD, Gaither JR. Using us data to estimate the incidence of serious physical abuse in children. Pediatrics Mar;129(3): Kimia AA, Ben-Joseph E, Prabhu S et al. Yield of emergent neuroimaging amng children presenting with a first complex febrile seizure. Pediatr Emerg Care Apr;28(4): Flores G, Abreu M, Barone CP, et al. Errors of medical interpretation and their potential clinical consequences: a comparison of profession versus ad hoc versus no interpreters. Ann Emerg Med Nov;60(5): Cantor R, Sadowitz PD. Neonatal emergencies. The McGraw Hill Companies p179 Drayna PC, Estrada C, Wang W, et al. Ketamine sedation is not associated with clinically meaningful elevation of intraocular pressure.am J Emerg Med.2012 Sep;30(7):