Chest X-ray (mania) in pediatric emergency departments

10.2223/1158 ◽  
2004 ◽  
Vol 80 (2) ◽  
pp. 163-166
Author(s):  
Jayme Murahovschi
Keyword(s):  
Emergency Departments ◽  
Pediatric Emergency ◽  
X Ray ◽  
Chest X Ray

Childhood Fever: Correlation of Diagnosis With Temperature Response to Acetaminophen

PEDIATRICS ◽  
1987 ◽  
Vol 80 (3) ◽  
pp. 315-318
Author(s):  
M. Douglas Baker ◽  
Patricia D. Fosarelli ◽  
Richard O. Carpenter
Keyword(s):  
Patient Management ◽  
Temperature Response ◽  
Pediatric Emergency ◽  
Bacterial Disease ◽  
X Ray ◽  
Chest X Ray ◽  
Antipyretic Treatment ◽  
Fever Response ◽  
Childhood Fever

Many people believe that temperature response to antipyretics in febrile children varies according to diagnosis. To evaluate the validity of this premise, we prospectively studied the temperature response to acetaminophen of febrile children who came to an urban pediatric emergency and walk-in facility. The study group consisted of 1,559 patients between the ages of 8 weeks and 6 years whose temperatures when seen were greater than 38.4°C and who had not received antipyretic treatment within the previous four hours. Acetaminophen (15 mg/kg) was administered to each child and repeat temperatures were taken one and two hours later. Patient management was unaffected by the study, and physicians were unaware of the repeat temperature measurements. Telephone follow-up was conducted with the parents of each child within five days of the initial visit. Children with cultures positive for bacterial disease or chest x-ray films positive for pneumonia had slightly greater one- and two-hour temperature decreases compared with children with other diagnoses. Although statistically significant, we do not consider these differences in response to be clinically useful. We conclude that fever response to acetaminophen is not a clinically useful indicator by which to differentiate the causes of febrile illnesses in young children.

Physician Compliance With Bronchiolitis Guidelines in Pediatric Emergency Departments

2019 ◽  
Vol 58 (9) ◽  
pp. 1008-1018 ◽  
Author(s):  
Andrea V. Rivera-Sepulveda ◽  
Terri Rebmann ◽  
James Gerard ◽  
Rachel L. Charney
Keyword(s):  
Online Survey ◽  
Pediatric Emergency ◽  
Systemic Steroid ◽  
X Rays ◽  
Chi Square ◽  
X Ray ◽  
American Academy Of Pediatrics ◽  
Physician Compliance ◽  
Chest X Ray ◽  
Viral Testing

An online survey was administered through the American Academy of Pediatrics (AAP) Section of Emergency Medicine Survey Listserv in Fall, 2017. Overall compliance was measured as never using chest X-rays, viral testing, bronchodilators, or systemic steroids. Practice compliance was measured as never using those modalities in a clinical vignette. Chi-square tests assessed differences in compliance between modalities. t tests assessed differences on agreement with each AAP statement. Multivariate logistic regression determined factors associated with overall compliance. Response rate was 47%. A third (35%) agreed with all 7 AAP statements. There was less compliance with ordering a bronchodilator compared with chest X-ray, viral testing, or systemic steroid. There was no association between compliance and either knowledge or agreement with the guideline. Physicians with institutional bronchiolitis guidelines were more likely to be practice compliant. Few physicians were compliant with the AAP bronchiolitis guideline, with bronchodilator misuse being most pronounced. Institutional bronchiolitis guidelines were associated with physician compliance.

scholarly journals Is lung ultrasonography a useful method to diagnose children with community-acquired pneumonia in emergency settings?

2018 ◽  
Vol 26 (2) ◽  
pp. 91-97 ◽  
Author(s):  
Aykut Çağlar ◽  
Emel Ulusoy ◽  
Anıl Er ◽  
Fatma Akgül ◽  
Hale Çitlenbik ◽  
...  
Keyword(s):  
Gold Standard ◽  
Radiation Risk ◽  
Pediatric Emergency ◽  
Clinical Findings ◽  
Community Acquired Pneumonia ◽  
Pediatric Emergency Department ◽  
X Rays ◽  
Lung Ultrasonography ◽  
X Ray ◽  
Chest X Ray

Background: Lung ultrasonography is a new method for diagnosing community-acquired pneumonia. Lung ultrasonography has some advantages over chest X-ray, such as lack of ionizing radiation risk, bedside performance, and cost-effectiveness. Objectives: In this study, we aimed to determine the feasibility of lung ultrasonography in emergency settings in children with community-acquired pneumonia. Methods: The study included patients younger than 18 years of age with suspicion of community-acquired pneumonia. On the first evaluation, patients with positive clinical and/or chest X-ray findings were defined to have community-acquired pneumonia, and this was accepted as the gold standard. The chest X-rays were evaluated by the chief of the pediatric emergency department, who was blinded to the patients and the lung ultrasonography results. Lung ultrasonography was performed by another pediatric emergency physician who was also blinded to the chest X-ray results and clinical findings such as fever, respiratory distress, rales, and wheezing. Results: Of the 91 patients enrolled, 71 (78.0%) were diagnosed with community-acquired pneumonia based on clinical and chest X-ray findings. The median (interquartile range) duration of the lung ultrasonography procedure was 4.0 (3.5–6.0) min. Shred sign, air bronchogram, and hepatization were significantly more frequent in the patients with community-acquired pneumonia ( p < 0.01, p < 0.01, and p = 0.01, respectively). Sensitivity and specificity of lung ultrasonography were 78.5% (67.1–87.4) and 95.2% (76.1–99.8), respectively. Conclusion: Lung ultrasonography is a useful diagnostic method for children with suspicion of community-acquired pneumonia.

scholarly journals Development and prospective validation of COVID-19 chest X-ray screening model for patients attending emergency departments

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ignat Drozdov ◽  
Benjamin Szubert ◽  
Elaina Reda ◽  
Peter Makary ◽  
Daniel Forbes ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
X Rays ◽  
First Line ◽  
X Ray ◽  
Screening Model ◽  
Valuable Adjunct ◽  
Chest X Ray ◽  
Multicentre Cohort

AbstractChest X-rays (CXRs) are the first-line investigation in patients presenting to emergency departments (EDs) with dyspnoea and are a valuable adjunct to clinical management of COVID-19 associated lung disease. Artificial intelligence (AI) has the potential to facilitate rapid triage of CXRs for further patient testing and/or isolation. In this work we develop an AI algorithm, CovIx, to differentiate normal, abnormal, non-COVID-19 pneumonia, and COVID-19 CXRs using a multicentre cohort of 293,143 CXRs. The algorithm is prospectively validated in 3289 CXRs acquired from patients presenting to ED with symptoms of COVID-19 across four sites in NHS Greater Glasgow and Clyde. CovIx achieves area under receiver operating characteristic curve for COVID-19 of 0.86, with sensitivity and F1-score up to 0.83 and 0.71 respectively, and performs on-par with four board-certified radiologists. AI-based algorithms can identify CXRs with COVID-19 associated pneumonia, as well as distinguish non-COVID pneumonias in symptomatic patients presenting to ED. Pre-trained models and inference scripts are freely available at https://github.com/beringresearch/bravecx-covid.

scholarly journals 731. Investigating Clinical Factors Contributing to Continued Antibiotic Therapy in Patients with Viral Upper Respiratory Tract Infections

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S263-S263
Author(s):  
Alexander Lawandi ◽  
Charles Frenette
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Therapy ◽  
Emergency Departments ◽  
Respiratory Virus ◽  
Respiratory Viruses ◽  
Upper Respiratory Tract ◽  
X Ray ◽  
Chest X Ray ◽  
Upper Respiratory ◽  
Tract Infections

Abstract Background It has previously been demonstrated that upwards of 50% of patients presenting to Emergency Departments with symptoms of an upper respiratory tract infection receive empirical antibiotics, and that even with a demonstrated viral infection, 70% of these patients are continued on antibiotics. However, the clinical and biochemical factors contributing to this continued therapy is unclear. This study assessed parameters that may impact antibiotic prescriptions in patients with a confirmed viral respiratory infection. Methods. Positive respiratory virus PCRs (RVPs) from nasopharyngeal aspirates performed on adult patients presenting to the McGill University Health Centre Emergency Departments and outpatient clinics over a period of 10 days during the peak of influenza season were included. For each patient, antibiotic administration pre- and post-PCR result were determined, as were the presence of leukocytosis, neutrophilia, an abnormal chest X-ray, and sepsis. Each parameter’s effect on antibiotic use was then determined. Results. During the study period, there were 123 positive RVPs included. These consisted of 34% Flu A, 43% Flu B, and 23% were a mixture of other common respiratory viruses. Antibiotics were administered in 38% of patients before the test was resulted and continued in 79% of these patients afterwards. There was no correlation between the presence of leukocytosis, neutrophilia, signs of sepsis or abnormalities on chest X-ray and continued antibiotic therapy. Conclusion. Despite identification of a respiratory virus infection, patients are routinely treated with antibiotics even without significant evidence of a bacterial process. The impact of testing for respiratory viruses in limiting antibiotic therapy could be improved by education and direct antibiotic stewardship interventions in this population. Disclosures All authors: No reported disclosures.

scholarly journals Nationwide survey on current management strategies of toddler’s fractures

CJEM ◽  
2017 ◽  
Vol 20 (5) ◽  
pp. 739-745 ◽  
Author(s):  
Jade Seguin ◽  
Daniel Brody ◽  
Patricia Li
Keyword(s):  
Emergency Departments ◽  
Management Strategies ◽  
Nationwide Survey ◽  
Pediatric Emergency ◽  
Practice Variation ◽  
Future Research ◽  
Multiple Choice Questions ◽  
Traditional Management ◽  
X Ray ◽  
Clinical Vignettes

ABSTRACTBackgroundTibial fractures are common in children less than 3 years old. The traditional management involves immobilization in an above knee cast for both confirmed (positive x-ray) and presumed (normal x-ray) toddler’s fractures. This carries health care implications and causes unnecessary burden for patients and their families. There is a paucity of literature describing the ideal immobilization strategy for this injury.ObjectivesTo determine: 1) the variation between Canadian emergency departments in management of toddler’s fractures; 2) the variation in management between confirmed and presumed toddler’s fractures; 3) the association between demographic variables and immobilization strategies.MethodsThis was an email survey of all members of the Pediatric Emergency Research Canada network. The survey consisted of 2 clinical vignettes followed by multiple-choice questions.ResultsSurvey response rate was 73% (153/211). For confirmed toddler’s fractures, 39% of physicians chose to immobilize with above knee circumferential cast, 27% with below knee circumferential cast and 20% with below knee splint. For presumed toddler’s fractures, 44% of respondents chose to manage without casting, 22% with below knee splint and 14% with above knee circumferential cast. There was significant practice variation between Canadian pediatric emergency departments for both types of fractures and between the management of confirmed and presumed toddler’s fractures.ConclusionsOur study is the first to identify nationwide variation in the management of toddler’s fractures. This variation highlights the need for future research to compare the different management strategies to determine families’ preferences and functional outcomes in children with these injuries.

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