1
|
Cunningham KM, Walsh JM, Beattie TF, Midgley P. Neonatal emergency transport teams and general emergency departments: Who will intubate the neonate? Emerg Med Australas 2022; 34:285-287. [PMID: 35019218 DOI: 10.1111/1742-6723.13933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Confidence treating critically ill infants presenting to general ED may be limited by inexperience, with procedures deferred until specialised transport teams arrive. METHODS This retrospective cohort study analysed critical procedures performed by referring ED physicians, compared with a neonatal emergency transport service, on infants transferred over a 12-month period. RESULTS All 150 eligible infants were included, with median (interquartile range) age 28 (16-43) days. Forty critical procedures were performed in this cohort. Of 26 intubations, 17 (65%) were performed by local ED physicians. CONCLUSION Referring ED physicians perform the majority of critical procedures where infants require inter-hospital transfer by neonatal emergency transport service.
Collapse
Affiliation(s)
- Katie M Cunningham
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK.,PIPER (Paediatric Infant Perinatal Emergency Retrieval) Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jennifer M Walsh
- PIPER (Paediatric Infant Perinatal Emergency Retrieval) Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Thomas F Beattie
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Paula Midgley
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
2
|
|
3
|
Abstract
Upper labial frenal tear in infants is classically taught as having associations with non-accidental injury. Collection of data for a 12-month period in our paediatric facial injury study revealed that this injury pattern is common in ambulant children and was associated with other facial trauma. In assessing the possibility of this injury being due to abuse, the importance of the mobility of the child and the mechanism of the injury are paramount.
Collapse
Affiliation(s)
- A J Kidd
- Accident and Emergency Department, Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK.
| | | | | |
Collapse
|
4
|
Reynolds BC, Beattie TF, Cunningham S. The impact of national guidelines on the assessment and management of acute paediatric asthma presenting at a tertiary children's emergency department. Eur J Emerg Med 2007; 14:142-6. [PMID: 17473607 DOI: 10.1097/mej.0b013e32801430b8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent Scottish Intercollegiate Guidelines Network/British Thoracic Society guidelines have highlighted best practice for asthma management. This study examines asthma management in a paediatric emergency setting before and after the publication of these guidelines. OBJECTIVES To assess the impact of Scottish Intercollegiate Guidelines Network/British Thoracic Society guidelines on asthma management. METHODS Retrospective review of patient notes over two equivalent 2-month periods in 2002 and 2003. Main outcomes were documentation of clinical history, examination, investigation, treatment and discharge; and also the use of various treatment modalities in each case. RESULTS One hundred and sixty-four children presented with asthma, 100 in 2002 and 64 in 2003. Documentation was adequate throughout, though better when nursing staff were responsible. Completeness of documentation was not related to seniority or discipline of medical staff. Measurement of peak flow was poor in both years. The 'doubling up' of inhaled steroid dose for acute episodes was the only aspect of management affected by publication of the guidelines, with significantly fewer patients receiving this in 2003 (P<0.0001). CONCLUSIONS Documentation within the centre is good but has potential for improvement. Guidelines have not impacted on this except when explicit statements are made regarding treatment.
Collapse
Affiliation(s)
- Ben C Reynolds
- Department of Medical Paediatrics, Royal Hospital for Sick Children, Edinburgh, UK
| | | | | |
Collapse
|
5
|
Abstract
A retrospective study of all paediatric fractures presenting to hospital in Edinburgh, Scotland in 2000 was undertaken. It showed that the incidence of fractures was 20.2/1000/year and that 61% of children's fractures occurred in males. Analysis of paediatric fractures shows that there are six basic fracture distribution curves with six fractures showing a bimodal distribution but most having a unimodal distribution affecting younger or older children. The incidence of fractures increases with age with falls from below bed height (<1m) being the commonest cause of fracture. The majority of fractures in children involve the upper limb. Lower limb fractures are mainly caused by twisting injuries and road traffic accidents. The incidence of fractures in cyclists and pedestrians remains relatively high whereas the incidence in vehicle occupants is low suggesting that road safety programs have been successful. Similar programs should be instituted for young cyclists. The importance of accident prevention programmes in the home is also highlighted.
Collapse
Affiliation(s)
- Louise Rennie
- Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 1LF, United Kingdom
| | | | | | | |
Collapse
|
6
|
O'Donohoe PB, Kessler R, Beattie TF. Exploring the clinical utility of blood ketone levels in the emergency department assessment of paediatric patients. Emerg Med J 2007; 23:783-7. [PMID: 16988307 PMCID: PMC2579600 DOI: 10.1136/emj.2006.035758] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Ketonuria (on standard urine testing) is a frequent finding in children presenting to emergency departments. With the advent of hand-held ketone meters, blood ketone levels can now be rapidly quantified. HYPOTHESIS Point of care testing (POCT) of blood ketone levels could provide clinically useful information on severity of illness in children and risk of hospital admission. METHODS A prospective study using POCT of blood ketone levels in a convenience sample of children <13 years old, with a typical case mix of medical problems. FINDINGS 186 children were studied. The range of ketone levels varied widely among this study population depending on the presenting complaint. Higher levels were noted in those presenting with anorexia or vomiting and fever. The median ketone level of the total study population was 0.2 (range 0-6.0, interquartile range 0.1-0.9) mmol/l. Ketone levels correlated poorly with discharge destination and duration of admission. However, receiver-operator characteristics for ketones as a predictor of admission were comparable to Pediatric Risk of Admission scores (area under the curve 0.64 and 0.72, respectively) and may represent an independent risk factor for admission. A ketone level >1.2 mmol/l has a positive predictive value of 66.7% for admission. Ketone levels correlated well with decreased oral intake (R2 = 0.25; p<0.001). CONCLUSIONS A strong association was found between ketone levels, decreased oral intake and fever. Although ketone levels do not correlate well with more traditional markers of illness severity, they can help to predict the requirement for admission to hospital when interpreted in the context of the presenting illness. They may have applications in both the emergency department and primary care settings. Further prospective testing is required to validate these findings.
Collapse
Affiliation(s)
- P B O'Donohoe
- College of Medicine, University of Edinburgh, Edinburgh, UK.
| | | | | |
Collapse
|
7
|
Brennan SJ, Beattie TF, Kidd S. Pain relief in children: how good are we? Emerg Med J 2006; 23:887. [PMID: 17057156 PMCID: PMC2464393 DOI: 10.1136/emj.2005.029751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
8
|
Van Limbergen J, Kalima P, Taheri S, Beattie TF. Streptococcus A in paediatric accident and emergency: are rapid streptococcal tests and clinical examination of any help? Emerg Med J 2006; 23:32-4. [PMID: 16373800 PMCID: PMC2564123 DOI: 10.1136/emj.2004.022970] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Rapid streptococcal tests (RSTs) for streptococcal pharyngitis have made diagnosis at once simpler and more complicated. The American Academy of Pediatrics recommends that all RSTs be confirmed by a follow up throat culture unless local validation has proved the RST to be equally sensitive. AIMS To evaluate (a) RST as a single diagnostic tool, compared with RST with or without throat culture; (b) clinical diagnosis and the relative contribution of different symptoms. METHODS The study included 213 patients with clinical signs of pharyngitis. Throat swabs were analysed using Quickvue+ Strep A Test; negative RSTs were backed up by throat culture. Thirteen clinical features commonly associated with strep throat were analysed using backward stepwise logistic regression. RESULTS Positive results (RST or throat culture) were obtained in 33 patients; RST correctly identified 21. Eleven samples were false negative on RST. At a strep throat prevalence of 15.9%, sensitivity of RST was 65.6% (95% CI 46.8% to 81.4%) and specificity 99.4% (96.7% to 99.9%). Sensitivity of clinical diagnosis alone was 57% (34% to 78%) and specificity 71% (61% to 80%). Clinically, only history of sore throat, rash, and pyrexia contributed to the diagnosis of strep throat (p<0.05). CONCLUSION The high specificity of RST facilitates early diagnosis of strep throat. However, the low sensitivity of RST does not support its use as a single diagnostic tool. The sensitivity in the present study is markedly different from that reported by the manufacturer. Clinical examination is of limited value in the diagnosis of strep throat. It is important to audit the performance of new diagnostic tests, previously validated in different settings.
Collapse
Affiliation(s)
- J Van Limbergen
- Department of Paediatric Emergency Care, Royal Hospital for Sick Children, Edinburgh, UK.
| | | | | | | |
Collapse
|
9
|
Abstract
This series highlights a previously unreported hazard for children within the home, hair straightening irons. Thermal injury is a common reason for presentation at the emergency department. Contact burns from domestic irons and hair curling tongs are well documented in the literature. We have become aware of this new hazard in the home, which has resulted in several presentations to our department with deep partial thickness or full thickness burns.
Collapse
Affiliation(s)
- R A Duncan
- Accident and Emergency Department, Royal Hospital for Sick Children, Edinburgh, UK.
| | | | | | | |
Collapse
|
10
|
Abstract
We report a case of a 34-month-old girl who presented with acute atraumatic intermittent limp. History and examination at this stage were not suggestive of an underlying serious disorder, but routine blood testing revealed abnormal results and prompted further investigations. She was subsequently diagnosed with acute lymphoblastic leukaemia. This case illustrates how routine phlebotomy lead to early diagnosis and facilitated instant therapy resulting in a significantly improved outcome for the child.
Collapse
Affiliation(s)
- Corinna Dierkhuese
- Accident and Emergency Department, Royal Hospital for Sick Children, Edinburgh, UK.
| | | |
Collapse
|
11
|
Abstract
Four children presented to the Accident and Emergency department of the Royal Hospital for Sick Children in Edinburgh during seven days in February 2003. They shared a strikingly similar clinical picture with debilitating muscle pain in their calves. This paper discusses their clinical course and presents a literature review of the problem.
Collapse
Affiliation(s)
- L M Rennie
- Department of Accident and Emergency Medicine, Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK.
| | | | | |
Collapse
|
12
|
Affiliation(s)
- R A Knox
- Royal Preston Hospital, Sharoe Green Lane, Preston PR2 4HT, UK
| | - T F Beattie
- Royal Preston Hospital, Sharoe Green Lane, Preston PR2 4HT, UK
| |
Collapse
|
13
|
Abstract
Rickets fortunately remains rare in the United Kingdom, although its actual incidence is currently undetermined.1 Many still consider it to be a disease of poverty prevalent during the Victorian era. However, a number of recent articles have highlighted concern among British health professionals about the number of cases still being diagnosed in this country. These cases have nearly all involved non-Caucasian children who are considered to be at high risk due to skin colour, prolonged breast feeding, and low maternal vitamin D levels. Their presentations are variable ranging from failure to thrive, bone deformities, seizures, and even stridor. The diagnosis is usually made in babies and toddlers.We present a series of patients attending our accident and emergency (A&E) department, over a five month period, where the diagnosis of rickets was primarily a radiological diagnosis.
Collapse
Affiliation(s)
- L M Rennie
- Department of Accident and Emergency Medicine, Royal Hospital for Sick Children, Edinburgh, Scotland.
| | | | | | | | | |
Collapse
|
14
|
Al-Adhami AS, Brennand CM, Chiam PPS, Palmer EM, Schmieder TK, Shah AS, Sivalingam VN, Beattie TF. Clinical diagnosis of fractures in a paediatric population. Eur J Emerg Med 2005; 12:99-101. [PMID: 15756088 DOI: 10.1097/00063110-200504000-00012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Diagnosing fractures in the paediatric population is a problematical process for which there are currently no accepted clinical criteria. We studied the physical signs sought by accident and emergency staff in 126 children with suspected fractures. We found a significant correlation between 'point tenderness' and fracture, as demonstrated by plain radiograph. 'Swelling' and 'redness' approached significance. These results correlate well with previous work in this area, but further research using a larger sample is required as confirmation.
Collapse
|
15
|
Abstract
AIMS To gather information on children with minor illness or injury presenting to a paediatric accident and emergency (A&E) department and the decision making process leading to their attendance. METHODS Prospective questionnaire based survey of 465 children selected by systematic sampling from A&E attenders allocated to the lowest triage category. RESULTS The study population was statistically representative of the total population of A&E attenders. The lower deprivation categories were over represented. Educational attainment, childcare experience, and parental coping skills were important in relation to A&E attendance. More children attended with injury as opposed to illness. There were no significant demographic differences between those children who presented directly to A&E and those who made prior contact with a GP. Just under half the study population had made contact with a general practitioner (GP) before attending A&E. The majority of those children were directly referred to A&E at that point. GPs referred equivalent numbers of children with illness and injury. CONCLUSIONS Parents and GPs view paediatric A&E departments as an appropriate place to seek treatment for children with minor illness or injury.
Collapse
Affiliation(s)
- S J Hendry
- Accident and Emergency Department, Royal Hospital for Sick Children, Edinburgh, UK.
| | | | | |
Collapse
|
16
|
Abstract
BACKGROUND Children who are unwell often display signs of circulatory compromise. It has been observed that pronounced changes occur in the appearance of the photoplethysmogram (pulse oximeter tracing) in these children. The aim of the study was to discover if wavelet transforms can identify more subtle changes in the photoplethysmogram of children who are unwell. METHODS Photoplethysmograms were obtained from children attending a paediatric accident and emergency department with clinical features suggestive of significant bacterial illness or circulatory compromise. Photoplethysmograms were also obtained from a control group of well children. Wavelet transforms were applied to the traces in an attempt to separate the two groups. RESULTS 20 traces were obtained from unwell children and 12 from controls. Analysis of the entropy of the wavelet transform of the photoplethysmogram allows the differentiation of unwell children from controls (p = 0.00002). CONCLUSIONS Wavelet transform of the photoplethysmogram offers the possibility of a rapid non-invasive method of screening children for significant illness.
Collapse
Affiliation(s)
- P Leonard
- Department of Accident and Emergency Medicine, The Royal Hospital for Sick Children, Edinburgh, Scotland.
| | | | | | | |
Collapse
|
17
|
Abstract
BACKGROUND One of the most important limitations of standard pulse oximeters is the inability to detect changes in respiratory rate until oxygenation is affected. This study sought to determine if analysis of the plethysmogram by wavelet transforms would enable the determination of changes in respiratory rate at an earlier stage. METHODS Ten healthy adult volunteers were monitored, breathing at baseline and predetermined respiratory rates, using a standard pulse oximeter. Photo-plethysmograms captured in an attached lap top computer were then analysed using wavelet transforms. RESULTS Determination of baseline respiratory rate and subsequent changes including apnoea were easily identified. COMMENT Wavelet transforms permit the accurate determination of respiratory rate by a standard pulse oximeter.
Collapse
Affiliation(s)
- P Leonard
- Department of Accident and Emergency Medicine, The Royal Hospital for Sick Children, Edinburgh, Scotland.
| | | | | | | |
Collapse
|
18
|
Abstract
OBJECTIVE Sternal fracture is poorly characterised in children. The purpose of this study was to gain insight into the mechanism, radiological characteristics, and accompanying injuries of sternal fracture in children. METHODS The study was retrospective. The records of all children who underwent plain radiography of the sternum, or computed tomography of the thorax after trauma, over a 40 month period in our paediatric hospital were reviewed for evidence of sternal fracture. RESULTS 12 of 33 children identified had radiological evidence of sternal fracture. The age range of children with fractures was 5 to 12 years. Eleven children had fracture of the anterior cortex of the first or second sternebra of the body of the sternum. One child had fracture through the manubriosternal joint with posterior displacement of the body. Seven fractures resulted from direct blows to the anterior chest, five fractures resulted from hyperflexion injury of the thoracic spine. None were the result of motor vehicle crash. All fractures were isolated injuries. CONCLUSIONS Sternal fracture is uncommon in children. Injury may result from direct or indirect violence. The child's sternum is commonly fractured by more minor blunt trauma than generally recognised in the literature. All patients with sternal fracture after indirect violence should have careful examination of the spine. Patients with undisplaced anterior cortical fracture without other injury may be safely discharged from the emergency department.
Collapse
Affiliation(s)
- L P Ferguson
- Department of Accident and Emergency Medicine, Royal Hospital for Sick Children, Edinburgh, Scotland
| | | | | |
Collapse
|
19
|
Abstract
OBJECTIVE The purpose of this study was to establish the usefulness of capillary refill time when measured during the initial assessment of children. METHODS All children with spontaneous illness attending a paediatric accident and emergency department over a 7-month period were eligible for entry into the study. Capillary refill time was measured at the fingertip, using a standard technique, as part of the initial assessment. Each child was then followed up to ascertain clinical progress, including the need for admission, intravenous fluids, length of stay and diagnosis, as well as the white cell count when this was available. The value of capillary refill time as a predictor of the markers of illness severity was then assessed. RESULTS Capillary refill time measurements were recorded on 4878 children. There was no significant association of capillary refill time with meningococcal disease, other significant bacterial illness or the white cell count. A prolonged capillary refill time was associated with a more urgent triage category, the administration of a fluid bolus and the length of hospital stay (P<0.0001). The best performance was obtained when a capillary refill time of 3s or more is taken to be 'prolonged'. However, this gave positive predictive values of only 9% for a triage category of 1 or 2 (negative predictive value 97%), 11% for requiring a fluid bolus (negative predictive value 99%), 55% for hospital admission (negative predictive value 65%) and 22% for stay over 2 days/death (negative predictive value 91%). CONCLUSION The prolongation of capillary refill time is a poor predictor of the need for intravenous fluid bolus or hospital admission.
Collapse
Affiliation(s)
- Paul A Leonard
- Department of Accident and Emergency Medicine, Royal Hospital for Sick Children, Edinburgh, Scotland, UK.
| | | |
Collapse
|
20
|
Maciocia PM, Strachan EM, Akram AR, Hendrie RE, Kelly DN, Kemp A, McLuckie AM, Smith LM, Beattie TF. Pain assessment in the paediatric Emergency Department: whose view counts? Eur J Emerg Med 2003; 10:264-7. [PMID: 14676501 DOI: 10.1097/00063110-200312000-00004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To compare patient, guardian and professional assessment of acute pain in children presenting to an Emergency Department, and to examine whether there was a correlation between the scores obtained using the Faces and linear scales for each group. METHODS A prospective, observational cohort study of 73 children aged 4-14 years attending a paediatric hospital Emergency Department between March and April 2002 with pain caused by an acute injury. The child's pain on admission, as estimated by the child, their guardian and a healthcare professional (nurse/doctor/emergency nurse practitioner) was recorded using a Faces scale and a linear scale. RESULTS Professionals consistently score pain lower [median linear scale score 3.1; interquartile range (IQR) 1.6-5.3] than do patients (6.6; 4.9-7.4) or guardians (6.0; 3.9-7.1) using both linear and Faces scales. There is a significant correlation between pain scores obtained using the two scales for professionals [Spearman R value 0.88; 95% confidence interval (CI) 0.82-0.93], guardians (0.83; 0.74-0.89) and patients (0.42; 0.21-0.59). CONCLUSION Professionals score pain lower than do children or guardians. Similar pain scores are obtained using both a Faces and a linear scale. This study offers no support for the introduction of a uniform pain assessment tool in a paediatric Emergency Department setting.
Collapse
Affiliation(s)
- Paul M Maciocia
- The Faculty of Medicine, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Ramsay LJ, Moreton G, Gorman DR, Blake E, Goh D, Elton RA, Beattie TF. Unintentional home injury in preschool-aged children: looking for the key—an exploration of the inter-relationship and relative importance of potential risk factors. Public Health 2003; 117:404-11. [PMID: 14522155 DOI: 10.1016/s0033-3506(03)00072-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the physical, social and psychological environment of families with preschool-age children to identify the most significant risk factors for unintentional injury. DESIGN A 1-year prospective case-control study, using a health-visitor-administered questionnaire. SETTING East and Midlothian, Scotland. SUBJECTS Seventy-nine children under 5 years of age presenting to an accident and emergency (A&E) department during 1998-1999 with an unintentional home injury and 128 matched controls. RESULTS Of 264 families, 207 responded (78.4% response rate). The main carers of cases had a lower level of educational attainment than controls (P<0.01). This factor explained the case carer leaving fulltime education earlier, being less likely to be married and more often in receipt of government benefits. Cases lived in households with larger numbers of children, were more likely to have a physical illness, were less likely to have had a non-medically attended injury in the previous year (P<0.01) but more likely to have had another A&E injury attendance. Case households had lower electrical socket cover utilization (P<0.01) and fewer thought their child had adequate access to safe play areas. The main carers of cases tended to have a more negative life event experience in the preceding 6 months, but showed no significant differences in physical or mental well-being or social support. Cases seemed to be slightly more deprived members of their community. CONCLUSIONS The main carer's educational attainment and socket cover utilization were lower in case families. These risk factors could be used to target families for injury-prevention work. Initiatives to raise educational achievement in the general population could lead to reductions in childhood injuries.
Collapse
Affiliation(s)
- L J Ramsay
- Public Health Directorate, Lothian Health Board, Deaconess House, 148 The Pleasance, Edinburgh EH8 9RS, UK
| | | | | | | | | | | | | |
Collapse
|
22
|
Ryan M, Beattie TF, Husselbee K, Freeman J. Use of the infant transwarmer mattress as an external warming modality in resuscitation from hypothermia. Emerg Med J 2003; 20:487-8. [PMID: 12954701 PMCID: PMC1726179 DOI: 10.1136/emj.20.5.487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Normothermia must be established in drowning victims before death may be declared, as the myocardium may remain resistant to stimulation at subnormal temperatures, and complete neurological recovery from submersion associated hypothermia has been reported. A safe and effective method of external re-warming is described that may prove particularly useful in the paediatric population.
Collapse
Affiliation(s)
- M Ryan
- Paediatric Emergency Department, Royal Hospital for Sick Children, Edinburgh, UK.
| | | | | | | |
Collapse
|
23
|
Abstract
OBJECTIVES To determine the clinical impact of positive results from blood cultures sent from a busy paediatric accident and emergency department. METHODS All children who attended the department over a seven month period and had blood culture investigations were identified. Case notes of patients who had any growth on blood culture were reviewed to determine whether the organism was felt to be pathogenic and how the result affected clinical management. RESULTS 1159 children had blood cultures sent, 26 of these grew an organism that was felt to be pathogenic. However, only five significantly influenced clinical management. CONCLUSIONS Blood cultures sent from an accident and emergency department rarely influence clinical management. A more focused approach to bacteriological investigation is recommended.
Collapse
Affiliation(s)
- P Leonard
- Department Of Accident and Emergency Medicine, The Royal Hospital for Sick Children, Edinburgh, Scotland.
| | | |
Collapse
|
24
|
Affiliation(s)
- L P Ferguson
- Department of Accident and Emergency Medicine, Royal Hospital for Sick Children, Edinburgh EH9 1LF
| | | |
Collapse
|
25
|
O'Donnell JJ, Maurice SC, Beattie TF. Emergency analgesia in the paediatric population. Part III non-pharmacological measures of pain relief and anxiolysis. Emerg Med J 2002; 19:195-7. [PMID: 11971825 PMCID: PMC1725874 DOI: 10.1136/emj.19.3.195] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- J J O'Donnell
- Accident and Emergency Department, Royal Hospital for Sick Children, Edinburgh, UK.
| | | | | |
Collapse
|
26
|
Abstract
There is debate as to the optimal management of children with hip joint effusions especially regarding the decision to aspirate. The objective of this study was to determine whether there is a need to aspirate hip joint effusions detected on ultrasound in patients with clinical transient synovitis (TS) and to identify the natural history of these effusions. Twenty-five children with proven hip joint effusions were followed up sequentially by clinical and radiological examination until symptom free. The mean age was 6 years with equal right/left distribution. No child underwent hip aspiration and no cases of sepsis were missed. The median size of hip effusion detected on ultrasound at presentation was 9 mm. At 7 days 60% (15/25) of patients had a normal clinical examination with no detectable effusion on ultrasound. At 14 days 16% (4/25) had an effusion detectable on ultrasound but they were all pain and limp free and their effusions were reducing in size. These results support the known benign nature of TS and that it will settle with conservative treatment.
Collapse
Affiliation(s)
- J Skinner
- Department of Accident and Emergency Medicine, Royal Hospital for Sick Children, Edinburgh, UK
| | | | | | | |
Collapse
|
27
|
Affiliation(s)
- S C Maurice
- Accident and Emergency Department, Wythenshawe Hospital, Manchester, UK.
| | | | | |
Collapse
|
28
|
Abstract
The objective of this study was to assess analgesic use and the use of a pain scoring system on those children presenting to a paediatric accident and emergency (A&E) department with a history of injury due to trauma. A random sample of patients who presented to a paediatric A&E department over a 6-week period with a history of limb trauma were prospectively studied. Pain severity scores were assessed on arrival and at 10, 30 and 60 minutes using the Douhit Faces Scale and any analgesia given or plaster application was noted. One hundred and seventy-two patients were studied. The median age was 10 years (range 3-13 years) and the majority, 56%, were male. The mean initial pain scores were 2.7 (range 1-4) for boys and 3.0 (range 1-4) for girls. The presenting injuries were 103 upper or lower limb fractures and 69 'soft tissue' injuries. Only 84 (49%) patients received analgesic medication in the department (30% morphine; 70% paracetamol); analgesia was not given to the remaining 88 (51%). Of these, 7 declined analgesia, and 5 had already taken analgesia on arrival to A&E. Despite prompt triage (median time 2 minutes, range 0-10 minutes), the median time from arrival to paracetamol administration was 20 minutes (range 4-105 minutes) and for morphine was 14 minutes (range 2-57 minutes). Pain is a common symptom in patients presenting to A&E. Because children's pain can be particularly difficult to assess, a pain scoring system such as the Douhit Faces Scale can be a useful means of pain assessment in the A&E setting. Despite increased awareness, pain is still under treated in the A&E department.
Collapse
Affiliation(s)
- J O'Donnell
- Accident & Emergency Department, Royal Hospital for Sick Children, Edinburgh, UK
| | | | | |
Collapse
|
29
|
Beattie TF. Handbook of pediatric emergencies, 3rd edn: Edited by G A Baldwin. ($39.95). Lippincott Williams and Wilkins, 2001. ISBN 0-7817-2236-5. Emerg Med J 2002. [DOI: 10.1136/emj.19.2.187-c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
30
|
Abstract
Children frequently present to the accident and emergency (A&E) department in pain. Most presentations are acute, but children with pain of longer duration also present. Children also often undergo painful procedures in A&E in the process of diagnosis or treatment. These papers review recent literature to examine factors involved in the provision of emergency analgesia in the paediatric population. This will include a discussion of current practice and make recommendations for future management of children's pain and anxiety in the A&E department. Part I: Current practice and perspectives. Part II: Pharmacological methods of paediatric analgesia. Part III: Non-pharmacological methods of pain control and anxiolysis. Part IV: Paediatric sedation in accident and emergency.
Collapse
Affiliation(s)
- S C Maurice
- Accident and Emergency Department, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK.
| | | | | |
Collapse
|
31
|
McKechnie MD, Beattie TF. Assessment of the child with altered level of consciousness. Eur J Emerg Med 2001; 8:251-2. [PMID: 11785589 DOI: 10.1097/00063110-200112000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Abstract
The objective of this research was to examine the speed of onset and effectiveness of pain relief between oral and intravenous morphine in acutely injured children. An observational study of children aged 3 to 13 years with closed forearm fractures was performed in three accident and emergency departments. The study gathered information on age, gender, body weight, time of arrival, dose, route and time of morphine administration. Pain assessment using a Faces Scale was documented on arrival and repeated at 10, 30 and 60 minutes after morphine was given. Forty-seven children were studied. Of these, 25 were given intravenous morphine, 22 were given oral morphine. There was no statistically significant difference in age, body weight or time until morphine was administered. The change in median pain scores was analysed using the Mann-Whitney U test. This showed that there was a statistically significant reduction in pain score in the intravenous group compared with the oral group between arrival and 10 minutes after giving morphine and between arrival and 60 minutes after giving morphine. Intravenous morphine appears to give more rapid onset and more prolonged pain relief than oral morphine for children with acute injuries. We recommend that in accident and emergency departments where staff are experienced in paediatric cannulation, morphine should be given via the intravenous route in acutely injured children. However we do not advocate inexperienced staff attempting multiple venepunctures in a child resulting in increased anxiety.
Collapse
Affiliation(s)
- J P Beale
- Accident and Emergency Department, Royal Infirmary, Edinburgh, UK
| | | | | | | | | |
Collapse
|
33
|
Beattie TF, Gorman DR, Walker JJ. The association between deprivation levels, attendance rate and triage category of children attending a children's accident and emergency department. Emerg Med J 2001; 18:110-1. [PMID: 11300180 PMCID: PMC1725559 DOI: 10.1136/emj.18.2.110] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the relation between deprivation category, triage score and accident and emergency (A&E) attendance for children under the age of 13. DESIGN Retrospective study of all children attending an A&E department over one year. SETTING A paediatric teaching hospital in Edinburgh. SUBJECTS All children attending the A&E department who had a postcode and a triage score documented on attendance. The postcode was used to determine the deprivation category and the triage scored the severity of illness or injury. MAIN OUTCOME MEASURE The relation between deprivation category, triage score and frequency of attendance. RESULTS There is a trend towards increased attendance in all triage categories for deprivation categories 6 and 7. CONCLUSIONS Attendance at A&E is not only related to severity of injury but also to deprivation category. The reason why people from disadvantaged areas attend more frequently needs further evaluation.
Collapse
Affiliation(s)
- T F Beattie
- Edinburgh Sick Children's NHS Trust, University of Edinburgh, Department of General Practice
| | | | | |
Collapse
|
34
|
Affiliation(s)
- T F Beattie
- Accident and Emergency Department, Royal Hospital for Sick Children, Edinburgh, UK
| |
Collapse
|
35
|
White PM, Boyd J, Beattie TF, Hurst M, Hendry GM. Magnetic resonance imaging as the primary imaging modality in children presenting with acute non-traumatic hip pain. Emerg Med J 2001; 18:25-9. [PMID: 11310457 PMCID: PMC1725511 DOI: 10.1136/emj.18.1.25] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The role of magnetic resonance imaging (MRI) in children presenting with acute non-traumatic hip pain was evaluated prospectively. Hip MRI was performed in addition to standard investigations (arthrosonography +/- hip radiographs) in 50 children presenting to the accident and emergency department of a paediatric hospital. MRI was performed on an open 0.23T system and comprised gradient echo T1 weighted coronal, fast spin echo T2 weighted coronal and inversion recovery spin echo (IRSE) axial sequences. Diagnostic quality MRI examinations were obtained in 94% of children. The IRSE sequence was the most reliable at determining underlying disorder (p<0.002). Interobserver agreement on the MRI examinations was very good with unweighted kappa value of 0.89, 95% confidence intervals 0.79, 0.99. Sensitivity of MRI was 0.79 (0.68, 0.90, specificity 1.00 (0.89, 1.00), accuracy 0.81 (0.70, 0.92), PPV 1.00 (0.89, 1), NPV 0.36 (0.25, 0.47). Sensitivity of standard imaging was 0.70 (0.54-0.86), specificity 0.57 (0.41, 0.73), accuracy 0.72 (0.56, 0.88), PPV 0.91 (0.75, 1.00), NPV 0.24 (0.08, 0.40). MRI correctly identified all seven children with serious underlying disorder whereas conventional imaging correctly diagnosed only two. Pelvic musculoskeletal infection was associated with the combination of marked alteration in signal in tissues adjacent to a symptomatic hip and an erythrocyte sedimentation rate of >20 mm 1st h (p<0.0001). In conclusion, MRI is a practical, well accepted and accurate non-invasive imaging technique in children presenting with acute non-traumatic hip pain. Combined with inflammatory markers MRI can be used to determine those children who require aggressive management. Where it is available, MRI is the imaging modality of choice in this condition.
Collapse
Affiliation(s)
- P M White
- Department of Radiology, Royal Hospital for Sick Children, Edinburgh, UK
| | | | | | | | | |
Collapse
|
36
|
Abstract
OBJECTIVE To determine factors associated with vomiting after minor head injury in a paediatric population with the intention of defining the role of vomiting in management decisions. METHODS A prospective study of all patients presenting with minor head injury to the Royal Hospital for Sick Children, Edinburgh, between 1 May and 30 June 1997. Information regarding basic demographics, features of the head injury and past and family history was noted on a proforma. This included mechanism of injury, site of impact, presence or absence of scalp haematoma, skull fracture or brain injury and intrinsic factors such as age, family history of migraine and a personal history of migraine, its childhood variants and associated conditions. The relation between vomiting and these features was analysed using chi2 and Fisher's exact tests. RESULTS 563 children aged from birth to 13 years presented with minor head injury. Complete data were obtained on 463 patients. Some 15.8% vomited after minor head injury. Comparing vomiters with non-vomiters the only associated factors that could be identified were a past history of recurrent vomiting or motion sickness (p= 0.0035, p=0.036 respectively). CONCLUSIONS Vomiting after minor head injury seems to be related to individual intrinsic factors rather than specific features of the head injury and its role in management decisions needs to be explored further.
Collapse
Affiliation(s)
- F D Brown
- Accident and Emergency Department, The Royal Hospital for Sick Children, Edinburgh.
| | | | | |
Collapse
|
37
|
Leonard PA, Beattie TF. Presenting features of paediatric meningococcal disease--a five year experience from a paediatric accident and emergency department. Health Bull (Edinb) 2000; 58:148-51. [PMID: 12813845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVES To determine the clinical features, initial management and outcome of meningococcal disease presenting to a paediatric accident and emergency (A&E) department. DESIGN A retrospective study of all cases of meningococcal disease seen in the department over a five year period. SETTING A paediatric A&E department which treats approximately 30,000 patients a year. SUBJECTS All children under the age of 13 years with a discharge diagnosis of meningococcal disease RESULTS Fifty patients, forty-six with microbiological confirmation of their diagnosis were identified. Sixty six percent of patients were seen first by their general practitioner. However only 28% had received prehospital parenteral antibiotics. Twenty six percent of children had neither meningism nor a classical purpuric rash, 60% showed signs of shock and 66% had an altered conscious level. The case fatality rate was 4%, with 78% making a full recovery. CONCLUSION Classical features of meningococcal disease are often absent. Assessing simple clinical parameters such as capillary refill, respiratory rate and conscious level adds to the detection of the disease. If meningococcal disease is suspected parental benzylpenicillin should be given and the child transferred to hospital.
Collapse
Affiliation(s)
- P A Leonard
- Accident and Emergency Department, Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh
| | | |
Collapse
|
38
|
Leonard PA, Beattie TF, Gorman DR. Under representation of morbidity from paediatric bicycle accidents by official statistics--a need for data collection in the accident and emergency department. Inj Prev 1999; 5:303-4. [PMID: 10628924 PMCID: PMC1730539 DOI: 10.1136/ip.5.4.303] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the accuracy of currently available data on bicycle related injuries in children. SETTING A paediatric accident and emergency (A&E) department which annually treats approximately 30000 new patients under the age of 13 years. METHODS Data on all attendances with bicycle related injuries over a four week period were compared with that currently available from police road traffic accident data (Stats 19) and the International Classification of Diseases, 10th revision, hospital discharge coding. RESULTS Eighty six children attended the A&E department. Only two bicycle related injuries were identified from Stats 19, and 10 from hospital discharge data. CONCLUSION Currently available official data do not give an accurate representation of the incidence of bicycle related injuries in children. If health promotion measures are to be assessed properly data collection needs to be improved.
Collapse
Affiliation(s)
- P A Leonard
- Accident and Emergency Department, Royal Hospital for Sick Children, Edinburgh, UK
| | | | | |
Collapse
|
39
|
Abstract
We investigated the epidemiology, assessment and outcome of acute atraumatic limp in 243 children under the age of 14 years presenting to a paediatric accident and emergency department (AED) over a period of six months. Data were collected at presentation and medical notes were re-examined after 18 to 21 months. The incidence of limp was 1.8 per thousand. The male:female ratio was 1.7:1 and the median age 4.35 years. Limp was mainly right-sided (54%) and painful (80%); 33.7% of the children had localised pain in the hip. A preceding illness was found in 40%. The main diagnosis was 'irritable hip'/transient synovitis (39.5%); Perthes' disease accounted for 2%. Most patients (77%) were managed entirely in the AED. Acute atraumatic limp is a common problem in children presenting to the AED. Most can be safely managed there if guidelines are followed and will have a benign outcome. Further studies are needed to identify the role of preceding illness in the aetiology of acute atraumatic limp.
Collapse
Affiliation(s)
- S U Fischer
- Accident and Emergency Department, Royal Hospital for Sick Children, Edinburgh, Scotland, UK
| | | |
Collapse
|
40
|
|
41
|
Affiliation(s)
- TF Beattie
- Royal Hospital for Sick Children, Edinburgh, UK
| |
Collapse
|
42
|
Abstract
OBJECTIVES To measure the age and sex distribution of self reported sports and leisure injuries in a 12 month retrospective recall period among a representative national sample of Scottish adolescents, and to examine the characteristics (gender, age, handedness, and level of sports participation) of sports related injuries in relation to injuries sustained during other activities. DESIGN/SETTING Self completion questionnaire survey administered in schools during April-June 1994. SUBJECTS 4710 pupils aged 11, 13, and 15 years drawn from a representative sample of 270 classes with returns from 224 classes (83% completion rate). RESULTS 42.1% of the sample reported a medically attended injury. These were significantly more frequent among boys but there were no significant age differences in overall frequency of injury. Sport related injuries accounted for 32.2% of all medically attended injuries. As with all injuries, frequency was greater in boys than girls at all ages, and there are differences in the pattern of lesions in sports and nonsports injuries. Lower limb injuries were more frequent than upper limb injury in sports (57.6 v 23.9%), whereas there were no differences in non-sports injuries (31.5 v 31.3%). Age and handedness differences in sports injury rates were also identified. High sports participation was significantly associated with a higher risk of injury in general and sports related injury in particular. CONCLUSION Age, gender, handedness, and level of sports participation have been shown to be implicated in differential risk of sports related injury. Reducing sports injury among adolescents should be a priority, but research into the injury profiles of different sports is needed before detailed injury prevention strategies can be developed.
Collapse
Affiliation(s)
- J M Williams
- Department of Psychology, University of Edinburgh, Scotland, UK
| | | | | | | |
Collapse
|
43
|
Abstract
Many different methods for assessing injury severity have appeared in the literature. This paper discusses the commonly used measures, many of which are subjective and depend on clinical practice or sociological factors. Even if apparently objective measures are used their appropriateness for use in children is questionable. Particular problems occur with scoring or categorising events such as poisoning, choking, and near drowning. Researchers need to reach a consensus on injury severity reporting to ensure comparability between studies and programs for injury prevention.
Collapse
Affiliation(s)
- T F Beattie
- Accident and Emergency Department, Royal Hospital for Sick Children, Edinburgh, UK
| | | | | | | |
Collapse
|
44
|
O'Donnell J, Brown FD, Beattie TF. Accidental child poisoning. Child resistant packaging should be used on all over the counter drugs. BMJ 1998; 316:1460-1. [PMID: 9572771 PMCID: PMC1113130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
45
|
Beattie TF. Prehospital emergency care. Eur J Emerg Med 1998; 5:47-51. [PMID: 10406419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Prehospital care is a diverse and complex entity. Recent studies have begun to emphasize the importance of all aspects of care in the community, leading through to critical analysis of the process of prehospital care provision. This paper examines the various aspects of prehospital care and discusses the various elements which need to be considered to provide effective care prior to patients being attended to at hospital.
Collapse
Affiliation(s)
- T F Beattie
- The Accident and Emergency Department, The Royal Hospital for Sick Children, Edinburgh, UK
| |
Collapse
|
46
|
|
47
|
Abstract
Head injury is common in children, although the incidence of brain injury is much lower. Most children who sustain an injury to the head will only have a minor injury. Careful history, examination, and judicious use of radiology will identify those children at risk of brain injury. Children with no significant risk of brain injury may be safely discharged home to the care of responsible adults. Further work is needed to address sequelae after minor head injury.
Collapse
Affiliation(s)
- T F Beattie
- Accident and Emergency Department, Royal Hospital for Sick Children, Edinburgh
| |
Collapse
|
48
|
Abstract
Injuries are the major cause of morbidity among children and adolescents in developed countries, but there is a lack of consensus on the relationship between socioeconomic status and risk of injuries. A self-complete questionnaire survey, to gather information on non-fatal injuries and sociodemographic details, was administered in schools during April-June 1994 to a national sample of 4710 Scottish adolescents aged 11, 13 and 15 years. Although there was no evidence of a socioeconomic gradient in the total incidence of medically attended injuries among adolescents, based on the Registrar General's classifications of paternal occupation and a composite measure of family affluence, marked socioeconomic variation in the circumstances in which injuries occurred was observed. There were also socioeconomic differences in the extent and type of risk behaviours reported by adolescents, indicating differential rates of risk exposure. The finding that socioeconomic status affects the kinds of injury events adolescents experience and levels of risk behaviour has implications for the design of injury prevention strategies.
Collapse
Affiliation(s)
- J M Williams
- Department of Psychology, University of Edinburgh, U.K
| | | | | | | | | |
Collapse
|
49
|
Affiliation(s)
- J P Wyatt
- Department of Accident and Emergency Medicine, Royal Hospital for Sick Children, Edinburgh
| | | | | | | | | | | |
Collapse
|
50
|
Abstract
OBJECTIVE To determine the incidence and severity of injuries sustained by children who present to an accident and emergency (A&E) department following rollerblading accidents. DESIGN A prospective case-control study. SETTING The A&E department of a city centre paediatric teaching hospital. METHODS Data were collected on a specially designed proforma on each child presenting with an injury sustained while rollerblading. The injury severity score was calculated for each patient and details were taken of the length of admission or outpatient follow up where appropriate. RESULTS Seventy four children (37 male; 37 female) presented with injuries over a three month period. The age range was 6-13 years in both groups. Half the injuries occurred at weekends. Fractures (n = 37) and soft tissue injuries (n = 28) were the most prevalent; 89% of injuries involved the limbs. Sixty eight children (92%) required treatment in A&E. Four (3%) were admitted to hospital and required operative procedures under general anaesthetic. The injury severity score ranged from 1 to 9 with a mean of 2.8. The length of hospital stay for admissions was 1-3 days; 47 children required follow up in the outpatient department (1-3 visits). Average length of outpatient contact was 18 days. CONCLUSIONS This study shows a greater incidence of rollerblading injuries than has been reported elsewhere. No figures are at present available for the United Kingdom as a whole.
Collapse
Affiliation(s)
- D McGrath
- Accident and Emergency Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | | |
Collapse
|