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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.

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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. (Emerg Med J 2001;18:110-111) Keywords: triage category; deprivation category; child Accident and emergency (A&E) departments nationally are experiencing a year on year rise in workload. The Royal Hospital for Sick Children in Edinburgh (RHSCE) has experienced an increase in attendances from 20 200 in 1992/3, to 29 093 in 1997/8 (an increase of 44%). There are no clear reasons why this workload is increasing either locally or nationally. Recently the issue of deprivation 1 and attendance at A&E has been reported, with factors such as deprivation itself and distance from hospital 2 both being implicated in the rate of attendance. None of these studies have dealt specifically with the paediatric population.Hull et al have highlighted the need for robust markers of variation in need to be developed.3 One such marker could be the triage category of patients presenting to A&E and the purpose of this study is to investigate whether there are variations in the attendance pattern for children from diVerent deprivation groupings by triage category. Methods and resultsWe examined retrospectively all attendances at the RHSCE from 1 April 1996 to 31 March 1997. Triage categories were changed during the next 12 months to reflect National Triage criteria, making a full year comparison diYcult. The RHSCE is the only paediatric A&E department for Edinburgh City, East Lothian and Midlothian. The department sees and treats all paediatric emergencies for children aged under 13 from these areas. All attendances were coded on attendance (that is, post code) and subsequently linked to both the Carstairs Deprivation Category (DEPCAT) (based on the 1991 census) for deprivation and triage category. 4 The triage category is an objective score allocated on arrival by an experienced registered sick children's nurse for each child attending the A&E department. One of four categories could be allocated on a range from 1 to 4-1 is the most severe and requires urgent and immediate resuscitation: 4 is the least severe and treatment could be delayed in these patients. Indeed many could be seen in prim...

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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.

h Mycoplasma amphoriforme is a recently described organism isolated from the respiratory tracts of patients with immunodeficiency and evidence of chronic infection. Novel assays for the molecular detection of the organism by real-time quantitative PCRs (qPCRs) targeting the uracil DNA glycosylase gene (udg) or the 23S rRNA gene are described here. The analytical sensitivities are similar to the existing conventional M. amphoriforme 16S rRNA gene PCR, with the advantage of being species specific, rapid, and quantitative. By using these techniques, we demonstrate the presence of this organism in 17 (19.3%) primary antibody-deficient (PAD) patients, 4 (5%) adults with lower respiratory tract infection, 1 (2.6%) sputum sample from a patient attending a chest clinic, and 23 (0.21%) samples submitted for viral diagnosis of respiratory infection, but not in normal adult control subjects. These data show the presence of this microorganism in respiratory patients and suggest that M. amphoriforme may infect both immunocompetent and immunocompromised people. Further studies to characterize this organism are required, and this report provides the tools that may be used by other research groups to investigate its pathogenic potential. Mycoplasma amphoriforme was first isolated in 1999 from a patient with primary antibody deficiency (PAD) with chronic bronchitis. It has also been isolated subsequently from both immunocompromised and immunocompetent patients with respiratory tract infections (RTI) in London, Denmark, France, and Tunisia (1-3). Based on 16S rRNA sequencing, M. amphoriforme belongs to the same phylogenetic group as other human pathogenic Mycoplasma species, the pneumoniae group (1, 2). The closest species phylogenetically for which there is a whole-genome sequence is Mycoplasma gallisepticum, a bird pathogen. Phenotypic studies have demonstrated that M. amphoriforme has features in common with this group, including gliding motility, a protruding polar tip resembling that of M. gallisepticum, and a cytoskeletal structure at its polar tip with homology to that of M. pneumoniae's attachment organelle (1, 4).To understand the role that this novel agent plays in human health, better laboratory tools are required. M. amphoriforme is fastidious, requiring specialized media for cultivation, and it takes approximately 2 weeks for colonies to appear on agar. The colonial morphology resembles granular droplets, making detection difficult, as the droplets can blend into the sample matrix and be overlooked. This paper reports the development and evaluation of two real-time quantitative PCR (qPCR) assays: one assay targeting M. amphoriforme's uracil DNA glycosylase gene (udg) and one assay targeting the variable region of the 23S rRNA gene that is unique to M. amphoriforme. The new qPCR assays were compared with a previously reported 16S rRNA gene assay (2) and used to test a range of human samples from the United Kingdom. MATERIALS AND METHODSPatients, samples, and ethical approval. Clinical samples from two hospitals were u...

The prolongation of capillary refill time is a poor predictor of the need for intravenous fluid bolus or hospital admission.