UMIN000014730 What is Known: • Children experience a low success rate (about 60% with 1 attempt and about 90% with 4 attempts) for IV access placement. • Ultrasound guidance may lead to a decreased number of attempts and shorter procedural time with comparable overall IV success rate. What is New: • Ultrasound-guided IV placement (a real-time, dual operator method) actually led to a significantly lower IV success rate than the conventional technique in children in the emergency department. • Our result warrants further trials to determine the precise population who benefits from ultrasound guidance.
Langerhans cell histiocytosis (LCH) is a rare childhood hematopoietic disease, and hence, there are few reports summarizing the course leading to the diagnosis. We described the initial symptoms and the clinical course of LCH. We carried out a retrospective review of charts from a single medical center, and 21 patients with the diagnosis of LCH were enrolled. The initial symptoms of 16 cases were caused by bone lesions; of these cases, there were 8 instances of soft tissue swelling as the initial symptom (38%) and 8 instances of bone pain without swelling (38%). Among the cases of bone lesion, 4 of 6 cases of skull lesion were painless while all vertebral body lesions and long bone lesions were accompanied by pain. LCH bone lesions caused various symptoms depending on the site of the lesion and this makes the diagnosis difficult. A detailed physical examination and imaging studies are recommended for early diagnosis.
Background
As one of the vital signs, the respiratory rate is an important index of general health in an initial examination. The duration of respiratory rate measurements is known to influence the results in adults. We examined the difference in respiratory rate measurements between two measurement durations in a pediatric population.
Methods
The prospective, cross‐sectional study was conducted from November 2017 through March 2018 at Tokyo Metropolitan Children’s Medical Center and analyzed differences in the respiratory rate in a 1 min group and 30 s group using the Bland–Altman plot.
Results
Ninety‐five patients were enrolled. The median age was 0.99 years, and 50 patients were male. The correlation between the results of the 30 s and 1 min measurement durations was good (r2 = 0.970, P < 0.001; Spearman’s rank correlation). The mean difference between the 30 s and 1 min measurement results was 0.86 (95% confidence interval: 0.27–1.45).
Conclusions
The shorter measurement duration may result in overestimation of the respiratory rate, especially in young children or children with tachypnea. Nonetheless, the shorter measurement times correlated well with the 1 min measurement, and the difference was less than one per minute compared with the 1 min measurement. Thus, this method may be able to detect life‐threatening conditions earlier than longer measurement times.
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