scholarly journals Use of Chest X-ray in the Evaluation of Acute Cough in the Pediatric Emergency Department of an Inner-City Hospital

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Joy Ekezie ◽  
Raqibat Akiyode ◽  
Sujana Rachuri ◽  
Roy Vega
Keyword(s):  
Emergency Department ◽  
Inner City ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
City Hospital ◽  
Acute Cough ◽  
X Ray ◽  
Chest X Ray

scholarly journals P016: Low risk ankle rule, high reward-a quality improvement initiative to reduce ankle x-rays in the pediatric emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S83 ◽  
Author(s):  
F. Al-Sani ◽  
M. Ben-Yakov ◽  
G. Harvey ◽  
J. Gantz ◽  
D. Jacobson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Ankle Injuries ◽  
Pediatric Emergency Department ◽  
X Rays ◽  
X Ray ◽  
Return Visits ◽  
Unnecessary Testing

Introduction: Our tertiary care institution embarked on the Choosing Wisely campaign to reduce unnecessary testing, and selected the reduction of ankle x-rays as part of its top five priority initiatives. The Low Risk Ankle Rule (LRAR), an evidence-based decision rule, has been derived and validated to clinically evaluate ankle injuries which do not require radiography. The LRAR, is cost-effective, has 100% sensitivity for clinically important ankle injuries and reduces ankle imaging rates by 30-60% in both academic and community setting. Our objective was to significantly reduce the proportion of ankle x-rays ordered for acute ankle injuries presenting to our pediatric Emergency Department (ED). Methods: Medical records were reviewed for all patients presenting to our tertiary care pediatric ED (ages 3- 18 years) with an isolated acute ankle injury from Jan 1, 2016-Sept 30, 2016. Children with outside imaging, an injury that occurred >72 hours prior, or those who had a repeat ED visit for same injury were excluded. Quality improvement (QI) initiatives included multidisciplinary staff education about the LRAR, posters placed within the ED highlighting the LRAR, development of a new diagnostic imaging requisition for ankle x-rays requiring use of the LRAR and collaboration with the Division of Radiology to ensure compliance with new requisition. The proportion of patients presenting to the ED with acute ankle injuries who received x-rays was measured. ED length of stay (LOS), return visits to the ED and orthopedic referrals were collected as balancing measures. Results: At baseline 88% of patients with acute ankle injuries received x-rays. Following our multiple interventions, the proportion of x-rays decreased significantly to 54%, (p<0.001). This decrease in x-ray rate was not associated with an increase in ED LOS, ED return visits or orthopedic referrals. There was an increase uptake of the dedicated x-ray requisition over time to 71%. Conclusion: This QI initiative to increase uptake of the LRAR, resulted in a significant reduction of ankle x-rays rates for children presenting with acute ankle injuries in our pediatric ED without increasing LOS, return visits or need for orthopedic referrals for missed injuries. Just as in the derivation and validation studies, the reductions have been sustained and reduced unnecessary testing and ionizing radiation.

Is Continuity of Care Preserved in Children Who Utilize the Pediatric Emergency Department?

PEDIATRICS ◽  
1995 ◽  
Vol 95 (1) ◽  
pp. 37-41
Author(s):  
Patrick M. Vivier ◽  
William J. Lewander ◽  
Stanley H. Block ◽  
Peter R. Simon ◽  
Anthony J. Alario ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Inner City ◽  
Health Center ◽  
Continuity Of Care ◽  
Pediatric Emergency ◽  
Health Centers ◽  
Pediatric Emergency Department ◽  
Primary Care Site

Objective. Inner city families often use multiple sites for nonemergent medical care, including the pediatric emergency department. This practice raises concerns about continuity of care. The present study examined one aspect of continuity of care: Do children who receive care in a pediatric emergency department return to their primary care site so that appropriate follow up may be obtained? Methods. Over a 4-week period two groups of neighborhood health center children were studied: Those who sought care at the pediatric emergency department and those who were "walk-ins" at the health centers. All visits during the 4-week study period which resulted in a recommendation for the child to be seen within 6 weeks at the health centers were included in the analysis. Results. During the study period there were 87 patient visits to the pediatric emergency department with a documented physician instruction to be seen at their health center within 6 weeks. In 66 (76%) of the cases, the patient was seen at one of the health centers during the 6 weeks following the pediatric emergency department visit. There were 146 "walk-in" visits to the health centers with a documented physician instruction to be seen again at the health centers during the 6 weeks following the walk-in visit. In 111 (76%) of the cases, the patient was seen during the 6-week period. Conclusion. Our study shows that revisit rates were comparable for the two groups. We conclude that the rate of compliance with follow-up recommendations is similar for those who utilized the pediatric emergency department versus those who used the primary care site.

REDUCTION OF MORBIDITY IN ASTHMATIC CHILDREN GIVEN A SPACER DEVICE

PEDIATRICS ◽  
1995 ◽  
Vol 96 (2) ◽  
pp. 395-395
Author(s):  
Peter Cvietusa
Keyword(s):  
Emergency Department ◽  
Inner City ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
School Absenteeism ◽  
Asthmatic Children

Introducing a spacer device to patients in a busy, inner-city pediatric emergency department is an effective and efficient intervention that improves the function of asthmatic children by shortening the time to resolution of cough and wheeze, and by reducing school absenteeism.

"Family Plan"-Multiple-Patient Visits From the Same Family to an Inner-City Pediatric Emergency Department

2011 ◽  
Vol 27 (5) ◽  
pp. 390-393 ◽  
Author(s):  
Nirupama Kannikeswaran ◽  
Usha Sethuraman ◽  
Seema Rao ◽  
Stephen R. Knazik ◽  
Xinguang Chen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Inner City ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Family Plan

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.

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