Objective Assessment of abnormal vital signs in triage is a challenge in the paediatric emergency department (PED), since vital signs may reflect anxiety, fever or pain rather than the clinical deterioration of the child. We aimed to evaluate the efficacy of subjective 'down-triage' (change of the initially determined acuity levels) of Japanese Triage and Acuity Scale ( JTAS). Methods This is a retrospective cohort study of patients in PED up to 15 years of age at a tertiary paediatric medical centre in Japan during a 1-year period. At the end of every JTAS triage process, PED nurses were allowed to 'down-triage' acuity levels of well-appearing patients with abnormal HR or RR, which were presumably attributable to fever, crying or being upset. We compared predictive performance of the triage system before and after 'down-triage' using admission rate as the primary outcome. Results Among 37 961 PED visits during the study period, we analysed 37 219 records. A total of 17 089 patients (45.9%) were 'down-triaged' after their initial triage allocation upon arrival. Admission rates after 'down-triage' (83%, 33%, 7%, 1% and 3% for levels 1-5, respectively), compared with those of unmodified initial level (16%, 11%, 6%, 2% and 6% for levels 1-5, respectively), had a better apparent relevance with the anticipated admission rates of Canadian Triage and Acuity Scale. Conclusions Modification of JTAS through 'downtriage' by experienced staff improves prediction of disposition in a PED. Further research is needed to determine an objective protocol for 'down-triage' to ensure safe practice in a PED.
Objectives
The aim of this study was to evaluate the diagnostic accuracy of the 3‐point approach with ultrasonography for confirming endotracheal tube (ETT) placement in pediatric patients.
Methods
This was a prospective study conducted at a tertiary care center in Japan between March 2014 and March 2016. Children aged 0 to 18 years requiring endotracheal intubation in our emergency department (ED) who underwent ultrasonography for confirming ETT placement were enrolled. Patients who had already undergone a tracheotomy or intubation before arrival at our ED or who had severe neck injuries hindering ultrasonography were excluded. Quantitative capnography and portable chest x‐ray imaging were used as the reference standard for the confirmation of proper ETT placement. The main outcome was the diagnostic accuracy of the 3‐point approach with ultrasonography for detecting inappropriate ETT placement.
Results
In total, 68 patients were enrolled. The median age was 17 months (interquartile range, 8–40), and 51.4% were males. Three (4.4%) and 7 (10.3%) patients had esophageal and endobronchial mainstem intubation, respectively. The patients received emergency intubation due to a dysfunction of the central nervous system (45.6%) or respiratory failure (22.0%). The sensitivity and specificity of esophageal versus tracheal intubation was 100% (95% confidence interval [CI], 54.9%–100.0%) and 100% (95% CI, 97.9%–100.0%), respectively, whereas for endobronchial mainstem intubation versus tracheal intubation, the sensitivity and specificity was 85.7% (95% CI, 56.7%–96.0%) and 98.3% (95% CI, 94.8%–99.5%), respectively. Agreement between the reviewers was high (kappa coefficient, 0.78).
Conclusion
The 3‐point approach with ultrasonography was a feasible method for detecting esophageal and endobronchial mainstem intubation in pediatric patients.
Objectives
Genital injuries among children are often associated with consumer products or specific activities. There are few descriptive studies from Asia on pediatric genital injuries seen in the emergency department (ED). The aim of this study was to describe the characteristic features of accidental genital injuries among children.
Methods
A retrospective chart review of children aged 15 years or younger who visited our ED for genital injuries between March 2010 and November 2014 was conducted. Data on age, arrival time at the ED, location of the incident, mechanism of injury, objects, injured organ, consultation with specialists, emergency operation, sedation at the ED, and outcomes were collected and analyzed.
Results
One hundred seventy-nine patients were included in this analysis. Girls comprised 71% of the subject pool. The median age was 6 years (interquartile range, 4–9 years). Straddle injuries were the most common form of injury (56%). Male genital injuries occurred mostly outdoors (64%). Common consumer products associated with pediatric genital injuries were furniture (21%), exercise equipment (17%), and bicycles (15%). Thirty-two patients were examined by a surgeon, gynecologist, or urologist. The most commonly injured organs were the penis (55%) in boys and the labia (60%) in girls. Most patients (93%) were treated at the ED and discharged.
Conclusions
The characteristics of accidental genital injuries among Japanese children were similar to those of children in other countries. The strategy for preventing genital injuries used in the West might be applicable to the East Asian context.
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