Ensuring Diagnostic Accuracy in Pediatric Emergency Medicine

Thompson, Graham C.; deForest, Erin Kate; Eccles, Robin

doi:10.1016/j.cpem.2011.04.003

Cited by 8 publications

(18 citation statements)

References 40 publications

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“…There has been proposals to break down demand side barriers to the access to health care services in developing countries (6) . The use of clinical algorithms have helped to standardize and improve the quality of care and resolution in pediatrics over the last decade (7) , which is exemplified by an Israeli experience aiming to improve the performance of physicians through advanced life support courses (8) . Receptivity is a proposal for reorganizing services in order to guarantee access, resolution and humanized care, in an attempt to minimize barriers (9) .…”

Section: Introductionmentioning

confidence: 99%

A difícil realidade do pronto atendimento infantojuvenil mostrando a situação de saúde de uma cidade

Peixoto

Piazzetta

Rischini

et al. 2013

Rev. paul. pediatr.

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Objective: To analyze the epidemiological profile of children and adolescents aged between 0 to 19 years, assisted by the emergency department of a City School Hospital in order to monitor the health care system of São Carlos, São Paulo, Southeast Brazil.Method: This is a descriptive and cross-sectional study that collected data from medical records, from August 2008 to September 2009 (14 months). The random sample was taken from 15 days of each month, 50% of the total of 26,678 patients seen during that period of time, accounting for 13,339 medical records. The Epi-Info software was used to build the database; results were evaluated by descriptive statistical analysis.Results: Among the analyzed medical reports, 48.3% were female patients, 55% of the patients were aged between 0 and 4 years. Most of the children (95%) came by spontaneous demand. During that period, 41% of the population aged 0 to 19 years-old sought for only this type of health care. The most prevalent diseases were respiratory diseases, which showed 48.5% incidence during fall and winter. Most patients came from the north, northeast, and northwest regions of São Carlos, which have high-population density. Conclusions:The results showed a sad reality, with high spontaneous demand of children aged from zero to four years-old for pediatric emergency care. Most patients had not received prior care from other doctors. The health network situation indicates the need for urgent measures to strengthen the primary care assistance for basic health care centers and family physicians.Key-words: emergency care; health profile; emergency service; child health; Unified Health System. resumo Objetivo: Analisar o perfil epidemiológico de crianças e adolescentes na faixa etária de 0 a 19 anos atendidos no pronto atendimento do Hospital Escola Municipal, de maneira a monitorar a rede de saúde de São Carlos, no estado de São Paulo.Método: Estudo descritivo e transversal com coleta dos dados de prontuários, entre agosto de 2008 e setembro de 2009 (14 meses), sendo uma amostra aleatória, ao acaso, de 15 dias dos atendimentos em 50% das consultas mensais, somando-se 13.339 prontuários de um total de 26.678 atendimentos. Foi construído um banco de dados no programa Epi-Info para análise descritiva.Resultados: Do total, 48,3% dos pacientes eram do sexo feminino, 55% com idades entre zero e quatro anos e 95% oriundos de demanda espontânea. Isso corresponde a um esboço de 41% da população entre 0 e 19 anos de idade que teve somente este tipo de atendimento. Houve predomínio das doenças do aparelho respiratório (48,5%), nos meses de outono e inverno. As regiões que mais utilizaram o pronto The harsh reality of children and youth emergency care showing the health status of a cityatendimento compreenderam bairros das regiões norte, nordeste e noroeste de São Carlos, as quais possuem ampla densidade populacional.Conclusões: Os resultados apontaram a difícil realidade, com alta demanda espontânea, de crianças de zero a quatro anos no pronto atendimento pediátrico, s...

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Section: Introductionmentioning

confidence: 99%

A difícil realidade do pronto atendimento infantojuvenil mostrando a situação de saúde de uma cidade

Peixoto

Piazzetta

Rischini

et al. 2013

Rev. paul. pediatr.

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“…[11][12][13][14] These tests are limited by suboptimal accuracy, limited availability, or potential for adverse effects 15 in the pediatric population, compelling health care providers to seek better diagnostic strategies for children presenting to the emergency department (ED) with suspected appendicitis. Recent evidence demonstrates that combining these strategies into clinical pathways may be an effective way to improve diagnostic accuracy; [16][17][18][19] however, the extent to which this knowledge has been translated into practice in EDs is not known.…”

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confidence: 99%

Variation in the Diagnosis and Management of Appendicitis at Canadian Pediatric Hospitals

et al. 2015

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Objectives: The objective was to characterize the variations in practice in the diagnosis and management of children admitted to hospitals from Canadian pediatric emergency departments (EDs) with suspected appendicitis, specifically the timing of surgical intervention, ED investigations, and management strategies.Methods: Twelve sites participated in this retrospective health record review. Children aged 3 to 17 years admitted to the hospital with suspected appendicitis were eligible. Site-specific demographics, investigations, and interventions performed were recorded and compared. Factors associated with afterhours surgery were determined using generalized estimating equations logistic regression.Results: Of the 619 children meeting eligibility criteria, surgical intervention was performed in 547 (88%). After-hours surgery occurred in 76 of the 547 children, with significant variation across sites (13.9%, 95% confidence interval = 7.1% to 21.6%, p < 0.001). The overall perforation rate was 17.4% (95 of 547), and the negative appendectomy rate was 6.8% (37 of 547), varying across sites (p = 0.004 and p = 0.036, respectively). Use of inflammatory markers (p < 0.001), blood cultures (p < 0.001), ultrasound (p = 0.001), and computed tomography (p = 0.001) also varied by site. ED administration of narcotic analgesia and antibiotics varied across sites (p < 0.001 and p = 0.001, respectively), as did the type of surgical approach (p < 0.001). After-hours triage had a significant inverse association with after-hours surgery (p = 0.014).Conclusions: Across Canadian pediatric EDs, there exists significant variation in the diagnosis and management of children with suspected appendicitis. These results indicate that the best diagnostic and management strategies remain unclear and support the need for future prospective, multicenter studies to identify strategies associated with optimal patient outcomes.ACADEMIC EMERGENCY MEDICINE 2015;22:811-822 © 2015 by the Society for Academic Emergency Medicine A ppendicitis is the most common nontraumatic surgical emergency in children, 1,2 yet it continues to present diagnostic and management uncertainty.3 Current strategies for diagnosing appendicitis include the use of clinical scoring systems, 4-7 laboratory markers of infection and inflammation, [8][9][10] and

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“…However, the literature shows there is no consistency in the way that an activity is represented. Different shapes such as rectangular boxes with rounded (Thompson, et al, 2011) or square corners (Chu & Cesnik, 1998), (Panzarasa, et al, 2002), (Royall, et al, 2014), plain text (Dickinson, et al, 2000), or even arrows (Gopalakrishna, et al, 2016) have been used. In some cases, activities that lead to different mutually exclusive pathways are presented by a diamond (Panzarasa, et al, 2002), (Ye, et al, 2009), (van de Klundert, et al, 2010), (Li, et al, 2014).…”

Section: Structurementioning

confidence: 99%

“…The literature lacks a clear description as to whether a caremap should have an entry and an exit point. In some cases neither is present (Houltram & Scanlan, 2004), (Thompson, et al, 2011) (Royall, et al, 2014), while in others these points are an implicit (van de Klundert, et al, 2010), (Li, et al, 2014), (Michelson, et al, 2018) or explicit part of the diagram (Panzarasa, et al, 2002). Finally, most of the reviewed caremaps contain multiple pathways and they are often presented as multi-level flow charts (Chu & Cesnik, 1998), (Panzarasa, et al, 2002), (Ye, et al, 2009).…”

Section: Structurementioning

confidence: 99%

“…Terminological disagreement persists as to whether caremaps are a separate format of clinical tool (Kehlet, 2011), (Solsky, et al, 2016), (Zander, 1992), or simply another name for care pathways, clinical pathways, critical pathways and care plans (Campbell, et al, 1998), (Holocek & Sellards, 1997), (Li, et al, 2014), (O'Neill & Dluhy, 2000). This terminology confusion is further exemplified when we observe flow diagrams that internally describe themselves as a "care map", yet are captioned 'clinical pathway' by the author such as observed in Figure 1 of (Thompson, et al, 2011) and Figure 5 on p45 of (Yazbeck, 2014). Yazbeck (2014) goes on to present a range of similar flow diagrams for care management, describing them using a range of titles including 'care map', 'care pathway', and 'algorithm'.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Caremap Development: How Can Caremaps Standardise Care When They Are Not Standardised?

McLachlan

Kyrimi

Dube

et al. 2019

Proceedings of the 12th International Joint Conference on Biomedical Engineering Systems and Technologies

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Caremaps were developed to standardise care. They have evolved from text-based descriptions to flow-based diagrams. Standardising care is seen to improve patient safety and outcomes, and to reduce the costs of providing healthcare services but contemporary caremaps are not standardised. This research investigates contemporary caremaps and proposes a standardised model for caremap content, structure and development. The proposed model is evaluated through two case studies to create caremaps for obstetric care during labour and birth and management and for women with gestational diabetes mellitus, finding that use of this model is an effective method for creating standardise caremaps.

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Ensuring Diagnostic Accuracy in Pediatric Emergency Medicine

Cited by 8 publications

References 40 publications

A difícil realidade do pronto atendimento infantojuvenil mostrando a situação de saúde de uma cidade

A difícil realidade do pronto atendimento infantojuvenil mostrando a situação de saúde de uma cidade

Variation in the Diagnosis and Management of Appendicitis at Canadian Pediatric Hospitals

Clinical Caremap Development: How Can Caremaps Standardise Care When They Are Not Standardised?

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