In infants with acute moderate-to-severe bronchiolitis who were treated in the emergency department, a single dose of 1 mg of oral dexamethasone per kilogram did not significantly alter the rate of hospital admission, the respiratory status after 4 hours of observation, or later outcomes. (ClinicalTrials.gov number, NCT00119002 [ClinicalTrials.gov].).

No abstract

No abstract

Objective To evaluate the prognostic value and test characteristics of coronary artery calcium (CAC) score for the identification of obstructive coronary artery disease (CAD) in comparison with coronary computed tomography angiography (CCTA) among symptomatic patients. Methods Retrospective cohort study at two large hospitals, including all symptomatic patients without prior CAD who underwent both CCTA and CAC. Accuracy of CAC for the identification of ≥50% and ≥70% stenosis by CCTA was evaluated. Prognostic value of CAC and CCTA were compared for prediction of major adverse cardiovascular events (MACE, defined as non-fatal myocardial infarction, cardiovascular death, late coronary revascularization (>90 days), and unstable angina requiring hospitalization). Results Among 1145 included patients, the mean age was 55 ± 12 years and median follow up 2.4 (IQR: 1.5–3.5) years. Overall, 406 (35%) CCTA were normal, 454 (40%) had <50% stenosis, and 285 (25%) had ≥50% stenosis. The prevalence of ≥70% stenosis was 16%. Among 483 (42%) patients with CAC zero, 395 (82%) had normal CCTA, 81 (17%) <50% stenosis, and 7 (1.5%) ≥ 50% stenosis. 2 (0.4%) patients had ≥70% stenosis. For diagnosis of ≥50% stenosis, CAC had a sensitivity of 98% and specificity of 55%. The negative predictive value (NPV) for CAC was 99% for ≥50% stenosis and 99.6% for ≥70% stenosis by CCTA. There were no adverse events among the 7 patients with zero calcium and ≥50% CAD. For prediction of MACE, the c-statistic for clinical risk factors of 0.62 increased to 0.73 (p < 0.001) with CAC versus 0.77 (p = 0.02) with CCTA. Conclusion Among symptomatic patients with CAC zero, a 1–2% prevalence of potentially obstructive CAD occurs, although this finding was not associated with future coronary revascularization or adverse prognosis within 2 years.

Among children with high suspicion for pneumonia, CXRs infrequently altered the initial plan for antibiotics. However, when clinical suspicion for pneumonia was low, the use of CXR may reduce unnecessary antibiotic use.

No abstract

all claims-based ICU studies are still using ICD-9 codes. Although we would not expect the ICD-10 crosswalk to yield different results, future studies are needed to address this issue.On the basis of these findings, we recommend that researchers can use ICD-9 procedure codes for mechanical ventilation alone to identify populations of mechanically ventilated patients in administrative data, with the understanding that the population captured will not represent the entire population of mechanically ventilated patients. These data suggest that researchers can be confident that identified patients will have truly been ventilated and will help characterize the patients who may have been missed by ICD-9 procedure codes. n

Objectives: While physicians provide discharge instructions to patients and families following emergency department (ED) visits, injury prevention information may not be routinely included in these instructions. This study assessed emergency physicians' knowledge and provision of child passenger safety (CPS) information to patients following motor vehicle crashes (MVCs).Methods: This study was both a survey of emergency physician knowledge and provision of CPS information and an examination of frequency of CPS information in discharge instructions at a single institution. Members of the American Academy of Pediatrics (AAP) Section on Emergency Medicine were invited to participate in the survey. Respondents were asked about their provision of CPS information to patients and knowledge of national AAP CPS recommendations. The institutional ED medical record chart review assessed the frequency of written CPS information for patients of MVC-related visits who were discharged home.Results: There were 317 survey respondents from 1,024 eligible physicians, of whom 43 began but did not complete the survey. The data analyzed are from the 274 who completed the survey. While 85% (95% confidence interval [CI] = 81% to 89%) of physicians believed that CPS information should be included in discharge instructions, only 36% (95% CI = 31% to 42%) correctly answered all knowledge questions. Of the 51 self-identified division ⁄ department chiefs, 15 (29.4%; 95% CI = 16.9% to 41.9%) reported that their EDs routinely provide CPS information in discharge instructions for pediatric passengers in MVCs. For the medical record review, of the 152 randomly selected MVC visits, 13 (8.6%; 95% CI = 4.1% to 13.0%) had documented CPS information in the discharge instructions. Patients with documented CPS information were younger, but there were no significant differences in race, sex, or maximum abbreviated injury scale score between patients with versus without CPS information. Conclusions:While emergency physicians value the use of CPS information in discharge instructions following MVCs, they do not have adequate knowledge of, nor do they regularly disseminate, this information.