We had an incidence of 16.0% for serious bacterial infections in febrile children with sickle cell disease, with the majority of patients diagnosed with pneumonia.

IntroductionThe objective of our study was to estimate the incidence of prescribing medication errors specifically made by a trainee and identify factors associated with these errors during the simulated resuscitation of a critically ill child.MethodsThe results of the simulated resuscitation are described. We analyzed data from the simulated resuscitation for the occurrence of a prescribing medication error. We compared univariate analysis of each variable to medication error rate and performed a separate multiple logistic regression analysis on the significant univariate variables to assess the association between the selected variables.ResultsWe reviewed 49 simulated resuscitations. The final medication error rate for the simulation was 26.5% (95% CI 13.7% – 39.3%). On univariate analysis, statistically significant findings for decreased prescribing medication error rates included senior residents in charge, presence of a pharmacist, sleeping greater than 8 hours prior to the simulation, and a visual analog scale score showing more confidence in caring for critically ill children. Multiple logistic regression analysis using the above significant variables showed only the presence of a pharmacist to remain significantly associated with decreased medication error, odds ratio of 0.09 (95% CI 0.01 – 0.64).ConclusionOur results indicate that the presence of a clinical pharmacist during the resuscitation of a critically ill child reduces the medication errors made by resident physician trainees.

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In this study, lethargy and shunt site swelling were predictive of shunt malfunction. Other signs and symptoms studied did not reach statistical significance; however, one must maintain a high index of suspicion when evaluating children with an intracranial shunt because the presentation of malfunction is widely varied. A missed diagnosis can result in permanent neurological sequelae or even death.

Sports injuries involving the hip and groin are common. Special consideration must be given to musculoskeletal injuries in children and adolescents as their immature skeletons have growth plates that are relatively weaker than the tendons and ossified bone to which they connect. We present a case of an adolescent athlete with acute-onset groin pain who was found to have an avulsion fracture of the lesser trochanter. RÉ SUMÉLes accidents du sport touchant la hanche et l'aine sont fré quents. Il faut porter une attention particuliè re aux blessures musculosquelettiques chez les enfants et les adolescents é tant donné que le squelette encore immature est constitué en partie de cartilages de conjugaison relativement plus faibles que les tendons et les piè ces ossifié es qu'ils relient. Voici le cas d'un jeune athlè te, à l'â ge de l'adolescence, chez qui est apparue une douleur subite à l'aine et qui s'est avé ré e une fracture-avulsion du petit trochanter.Keywords: adolescent, avulsion fracture, hip pain, lesser trochanter A 15-year-old African-American male presented to the pediatric emergency department (ED) with a complaint of left hip pain. The pain began while sprinting during football practice on the previous day. He reported feeling a ''pop'' deep in his left hip. This was immediately followed by severe pain and an inability to bear weight on the left lower extremity. The patient reported that he fell to the ground and required assistance from his trainers to get off the field.The patient was initially taken to another ED on the day of the injury, where he was evaluated and given the diagnosis of a muscular strain. No radiographs were obtained during that visit. He was prescribed an analgesic and a muscle relaxant and provided with crutches for ambulation.Because of the severity and persistence of the pain, the patient was brought to our pediatric ED for reevaluation. We found that he was in no distress while at rest but avoided movement of his left lower extremity. His vital signs were stable. When examined in a supine position, the patient was noted to have pain on elevation of his left leg. Rotation of the leg while in full extension did not elicit significant pain. When the patient was examined in a sitting position (with hips flexed at a 90u angle), pain was elicited with further flexion of the left hip, giving a positive Ludloff sign. The patient was noted to have an antalgic gait. A radiograph of the pelvis revealed an avulsion fracture of the apophysis of the left lesser trochanter (Figure 1). The orthopedic team was consulted and recommended non-weight bearing on the affected limb with crutches, analgesics, and clinic follow-up in 2 weeks. DISCUSSION