Existing evidence indicates that POCUS is useful in identifying abscess in ED patients with SSTI. In cases where physical examination is equivocal, POCUS can assist physicians to distinguish abscess from cellulitis.
28 SummaryWe report the case of a 14-year-old girl who suffered from headache, fatigue, caught and a fever with body temperature up to 40 0 C for a week. The patient had abdominal enlargement and clinical examination showed the hepatomegaly +5 cm. In ELISA assays employing Em2+ antigen, high titres of specific IgG antibodies to Echinococcus multilocularis somatic antigens were found in the serum. Western blot analysis also indicated on presence of alveolar echinococcosis (AE). CT examination showed expansive foci in the right liver lobe and histological examinations of the biopsy after PAS staining confirmed the presence of alveolar echinococcosis. After 320 days of chemotherapy with albendazole, CT revealed progression of parasitic foci and new abscess lesions inside parasitic cysts were detected, with some parts being necrotic. The surgical removing of foci was performed as following -the laparotomic revision, the removal of the right liver lobe with dilatation, reconstruction of v. cavae cum prothesis PTFE in length 12 cm. Three months after the operation, the rest of the patient's left liver lobe had grownup and compensated at least a part of the removed liver.
Objective: Rapidly rising healthcare costs require a thorough analysis of all the components of care. Multiple studies of adult patients with public insurance or without private insurance have shown that they are more likely than those with private insurance to use the ambulance. Multiple studies of pediatric ambulance use have been limited in generalizability because they rely on individual hospital or single statewide databases and do not specifically look at insurance. The purpose of this study was to describe pediatric ambulance use and its association with specific health insurances using the National Hospital Ambulatory Medical Survey (NHAMCS) database.Methods: NHAMCS data between 2008 to 2010 for all pediatric (age <19 years) visits were analyzed. Multivariate logistic regression was used to model ambulance utilization on insurance status while controlling for variability in demographics and severity levels.Outcomes Measured: A total of 25,215 pediatric ED visits were included representing a national sample of approximately 97,341,191 million ED visits between 2008-2010. Non-insured (9.9%) compared to privately insured (6.6%) children had significantly higher rates of ambulance use. No significant difference in ambulance utilization was noted between those with Medicaid/State Children's Health Insurance Program (SCHIP) (5.8%) versus private (6.6%) insurance. Even after controlling for demographic and severity variables the adjusted odds ratio (1.66, 95% CI 1.30-2.13, p<0.0001) identified those visits without insurance as an independent predictor of ambulance utilization. In addition, older children (12-18 years), those of black race and residing in urban areas or the Northeast also had significantly higher odds of ambulance utilization. Visits by older children, specifically those without insurance, had increased odds of ratio of ambulance utilization (1.83, CI: 1.36-2.45, p<0.0001). Conclusions:Similar to adult patients, non-uninsured versus insured visits by pediatric patients have increased ambulance utilization. Different from the adults, public the type of insurance public versus private did not affect pediatric ambulance use. Health policies that facilitate continuous insurance coverage for children may be one way to maximize resource utilization in regards to ambulance use.
Background Temperature abnormalities in infants may be a sign of a serious infection (SI) and there is literature regarding the workup of the febrile infant to help guide management. The prevalence of SIs in hypothermic infants and the development of established guidelines for this population has not been established. Our primary objective was to determine the prevalence of SI in hypothermic infants who are 60 days old or younger presenting to the emergency department (ED). In addition, we calculated the prevalence of SI by organ system and identified its microorganism. Methods We performed a systematic review by searching the literature in Medline, Embase, Web of Science, and CINAHL. We limited our search to infants ≤ 60 days with a rectal temperature <36.5°C who presented to the ED. We defined SI as bacteremia, urinary tract infection (UTI), meningitis, herpes simplex virus infections, or pneumonia. We calculated the prevalence of SI. Quality of studies and bias was assessed using QUADAS‐2. Our study was registered with PROSPERO, 2020 CRD42020153477. Results We identified 1242 articles from our initial search in December 2019 followed by a second search in February 2021 to capture any recent publications. We identified four studies meeting our inclusion criteria. We estimated the prevalence of SI as 4.86% (95% confidence Interval [CI] 1.97–8.82) for infants ≤ 60 days old. In a subgroup analysis of infants ≤ 28 days (n = 16/374), we estimated the prevalence of SI as 5.15 (95% CI 0.95–12.0). The most common source for SI was UTI, with a prevalence of 2.16% (95% CI 1.18–3.60). Conclusion The overall prevalence of SI was 4.86% in hypothermic young infants ≤ 60 days old presenting to the ED. Infants ≤ 28 days had a slightly higher prevalence of 5.15%. The most common source for serious bacterial infection was UTI.
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