Search

ObjectiveTo examine pediatric emergency department (ED) visits over 5 years, trends in injury severity, and associations between injury-related ED visit outcome and patient and community-level sociodemographic characteristics.Study designRetrospective analysis of administrative data provided to the Pediatric Emergency Care Applied Research Network Core Data Project, 2004-2008. Home addresses were geocoded to determine census block group and associated sociodemographic characteristics. Maximum Abbreviated Injury Scale severity and Severity Classification System scores were calculated. Generalized estimating equations were used to test for associations between sociodemographic characteristics and admission or transfer among injury-related ED visits.ResultsOverall ED visits and injury-related visits increased from 2004 to 2008 at study sites. Of 2,833676 successfully geocoded visits, 700,821 (24.7%) were injury-related. The proportion of higher severity injury-related visits remained consistent. Nearly 10% of injury-related visits resulted in admission or transfer each year. After adjusting for age, sex, payer, and injury severity, odds of admission or transfer were lower among minority children and children from areas with moderate and high prevalence of poverty.ConclusionsPediatric injury-related ED visits to included sites increased over the study period while injury severity, anticipated resource utilization, and visit outcomes remained stable, with low rates of admission or transfer. Sociodemographic differences in injury-related visits and ED disposition were apparent. ED-based injury surveillance is essential to understand disparities, inform targets for prevention programs, and reduce the overall burden of childhood injuries.

Most pediatricians know how to prescribe oral rehydration therapy (ORT) for acute diarrhea. However, they choose intravenous rehydration for reasons of convenience, support staff preference, and financial reimbursement, according to a survey of doctors attending an American Academy of Pediatricians (AAP) conference. In addition, doctors do not give specific instructions to patients for ORT, nor do they strictly follow the American Academy of Pediatrics treatment guidelines. One-third of the 100 pediatricians surveyed incorrectly withhold ORT in patients with vomiting or moderate dehydration, and half the doctors surveyed incorrectly fail to advise patients to resume eating within 24 hours of the onset of diarrhea., Objective. To identify potential barriers to the use of oral rehydration therapy (ORT) by pediatric practitioners. Design. Cross-sectional, anonymous, self-administered survey of physicians&apos; ORT knowledge, attitudes, and practice. Setting. A national continuing medical education conference. Participants. One hundred four general pediatricians primarily in private practice (66%) who completed training after 1980 (76%). Measurements and results. Most respondents (83%) reported that ORT plays an important role in their management of dehydration. However, compliance with guidelines from the American Academy of Pediatrics for use of oral therapy is limited: 30% withhold ORT in children with vomiting or moderate dehydration, 50% fail to advise prompt refeeding, and only 3% advise use of a spoon or syringe. The degree of importance of ORT in physicians&apos; practice was negatively associated with reported lack of convenience of ORT administration in the practice setting (P < .001), support staff preference f or intravenous versus ORT (P

Infection by Haemophilus influenzae type b bacteria can lead to a variety of serious complications, including meningitis, in which the membranes that surround the brain and spinal cord become inflamed. Some population groups, including certain Native American tribes, have infection rates several times higher than the general population. To evaluate the effectiveness of a new vaccine among Navajo infants, a controlled study was carried out. Infants aged between 42 and 90 days were randomly assigned to receive either the vaccine (2,588 subjects), a conjugate of H. influenzae type b capsular polysaccharide and parts of the outer-membrane protein complex (OMPC) of Neisseria meningitidis serogroup B, or a placebo (2,602 subjects), an inactive substance. Second injections were given between the ages of 70 and 146 days. Blood samples were obtained at different points during the study and analyzed to determine the infants' levels (titers) of antibodies against H. influenzae; the safety and efficacy of the vaccine were also monitored. The study began in July 1988; by August 1990, after 23 cases of H. influenzae infection had occurred, it was decided to stop the study. The group that had received the vaccine had far fewer cases than the placebo group (1 case versus 22 cases) by the age of 18 months. Thirteen of the 22 placebo cases developed meningitis. No infections occurred in the vaccine group between the first and second doses of vaccine; eight occurred in the placebo group. Antibody levels did not increase noticeably after the second vaccination, but the vaccine was effective up until 18 months of age. The overall efficacy of the H. influenzae type b OMPC vaccine was more than 90 percent in this population. This was much higher than the efficacy reported for another conjugate vaccine in another study of Native Americans in Alaska. Use of this vaccine should eliminate H. influenzae type b infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

The feeding of a soy-based, lactose-free formula to hospitalized infants during the acute or early phase of diarrhea has been shown to decrease the output of stool and duration of illness. However, diarrhea in infants is usually treated on an outpatient basis in the US. The effectiveness of introducing a soy-based, lactose-free infant formula (early feeding group) compared with oral rehydration solution alone (control group) during the early phase of diarrhea in infants was assessed. The early feeding group, consisting of 29 infants, received a soy-based, lactose-free formula alternating with oral rehydration solution, which is intended to restore body water, from the start of therapy. The control group, consisting of 27 infants, received oral rehydration solution alone for the first 24 hours, followed by a soy-based, lactose-free formula alternating with oral rehydration solution. Diarrhea resolved after 48 hours of treatment in 21 of 29 infants in the early feeding group, and in 12 of the 27 infants in the control group. The findings indicated that the early introduction of a soy-based, lactose-free formula during the acute phase of infant diarrhea is safe, may decrease the duration of illness, and maintains adequate caloric intake. (Consumer Summary produced by Reliance Medical Information, Inc.)