ContextFollow-up strategies after emergency department (ED) discharge, alias safety netting, is often based on the gut feeling of the attending physician.ObjectiveTo systematically identify evaluated safety-netting strategies after ED discharge and to describe determinants of paediatric ED revisits.Data sourcesMEDLINE, Embase, CINAHL, Cochrane central, OvidSP, Web of Science, Google Scholar, PubMed.Study selectionStudies of any design reporting on safety netting/follow-up after ED discharge and/or determinants of ED revisits for the total paediatric population or specifically for children with fever, dyspnoea and/or gastroenteritis. Outcomes included complicated course of disease after initial ED visit (eg, revisits, hospitalisation).Data extractionTwo reviewers independently assessed studies for eligibility and study quality. As meta-analysis was not possible due to heterogeneity of studies, we performed a narrative synthesis of study results. A best-evidence synthesis was used to identify the level of evidence.ResultsWe summarised 58 studies, 36% (21/58) were assessed as having low risk of bias. Limited evidence was observed for different strategies of safety netting, with educational interventions being mostly studied. Young children, a relevant medical history, infectious/respiratory symptoms or seizures and progression/persistence of symptoms were strongly associated with ED revisits. Gender, emergency crowding, physicians’ characteristics and diagnostic tests and/or therapeutic interventions at the index visit were not associated with revisits.ConclusionsWithin the heterogeneous available evidence, we identified a set of strong determinants of revisits that identify high-risk groups in need for safety netting in paediatric emergency care being related to age and clinical symptoms. Gaps remain on intervention studies concerning specific application of a uniform safety-netting strategy and its included time frame.
Background and aims Childhood accidents are the leading cause of health problems, death and disability that can be prevented. Accidents can be predicted and avoided by identifying the risks. The aim of this study is to investigate the characteristics of paediatric forensic cases and to reveal the relationship between judicial decisions and trauma scores. Methods Forensic reports of the Children under 18 admitted to our emergency department of Van Military Hospital, a second level hospital, between January and November 2013 were retrospectively evaluated. Demographic data of the patients and life threat decisions were investigated and trauma scores were calculated. P-value under 0,05 was considered to be significant. Results Forty-four (15.1%) of 290 forensic cases admitted to our emergency department were under 18. Of the patients, 43.2% (19) were female and the mean age was 8.7 ± 5.41 (minmax: 0-17). Ten (22.7%) of them were traffic accident, 8 (18.2%) were falling from height, 12 (27.3%) were assault, 2 (4.5%) were burn, 10 (22.7%) were poisoning and suicide. Four of all patients (9.1%) were having life threat and 9 (20.5%) patients were having no injury requiring simple medical intervention. In the evaluation of the cases; Injury Severity Score (ISS) was 1.93 ± 2.27 (1-16), Revised Trauma Score (RTS) was 99.72 ± 0.17 (99-99.83), Trauma score-injury severity score (TRISS) was 7,082 ± 0.15 (7,841) and New Injury Severity Score (NITS) was 2.55 ± 3.52 (1-16). Conclusions Traffic accidents, falls, assaults and poisonings are the most common forensic cases in childhood and we found a significant relationship between life threat decision and anatomical and physiological trauma scores.
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