Journal Reviews

Sacchetti A, Warden T, Moakes ME, et al. Can sick children tell time? Emergency department presentation patterns of critically ill children. Acad Emerg Med 1999; 6:906-910.

Critically ill children present more uniformly throughout the day and do not have the same presentation patterns as ambulatory children, according to this study from Our Lady of Lourdes Medical Center in Camden, NJ.

Children show a consistent pattern of ED utilization, with increased visits in the late afternoon and evening hours. The purpose of the study was to determine whether this is equally true for critically ill children and ambulatory children, and what implications this has for ED staffing.

A total of 409,820 pediatric ED visits were examined with 688 critically ill children, and 28,344 ambulatory visits were studied. Children who weren’t critically ill showed an increase in the late afternoon and evening hours, but critically ill children presented more erratically, with visits distributed throughout the day.

ED staffing patters must consider different utilization patterns by critically ill and noncritically ill patients. The overall distribution of pediatric ED visits demonstrates a distinct diurnal pattern, with visits peaking during the evening and late-night hours. "At the very least, this study reinforces the premise that any ED caring for children must maintain the capability to manage critically ill children 24 hours per day," say the researchers.

Part-time pediatric EDs may facilitate the care of ambulatory patients, but they don’t address the needs of critically ill children. "Emergency personnel managing pediatric patients should have the same level of clinical expertise regardless of the hours they practice," the researchers conclude.

Pena BMG, Krauss B. Adverse events of procedural sedation and analgesia in a pediatric emergency department. Ann Emerg Med 1999; 34:483-491.

The adverse event rate for procedural sedation and analgesia performed by pediatric ED physicians was 2.3%, with no serious complications noted, according to this study from Children’s Hospital at Harvard Medical School in Boston.

The study targeted 1,180 patients who required intravenous, intramuscular, oral, rectal, intranasal, or inhalation agents for painful procedures or diagnostic testing. Only 2.3% experienced adverse events. The safety of children undergoing sedation and analgesia by nonanesthesiologists has become an issue of concern, as its use for outpatient procedures expands. This is the first study that distinctly separates ED physicians from the other groups of nonanesthesiologists practicing procedural sedation and analgesia in the outpatient setting.

The study showed a low adverse event rate. "All adverse events noted were transient, minor, and easily managed," say the researchers. "Our findings demonstrate that procedural sedation and analgesia is performed safely by pediatric emergency physicians."

Weiss HB. Pregnancy-associated injury hospitalizations in Pennsylvania, 1995. Ann Emerg Med 1999; 34:626-636.

Pregnant women are more likely than nonpregnant women to be hospitalized for assaults, falls, and transportation-related injuries, according to this study from Allegheny University of the Health Sciences in Pittsburgh.

The study compared injury hospitalization between pregnant women and all women of reproductive age. The leading injury causes among pregnant women were transportation-related (33.6%), falls (26.4%), poisonings (16%), and being struck by or against an object (11.4%).

The study was the first to document an increase in assaults for pregnant women, with most of the assaults occurring in the youngest women, ages 15 to 24. Some limitations were noted, such as the fact that pregnant women are more likely to be hospitalized in general for minor conditions, so overall hospitalization rates might be higher.

The study also shows that transportation-related injuries are the leading cause of hospitalization for pregnant women, and also the leading cause of hospitalization for early or threatened labor due to injury.

Health care workers should be aware of the changes in injury risks to pregnant women, both intentional and unintentional. "Ultimately, these findings should be applied to better prioritize and target a diversity of effective injury prevention efforts aimed toward young women for the benefit of the mother and the fetus."

Houry D, Feldhaus K, Thorson AC, et al. Mandatory reporting laws do not deter patients from seeking medical care. Ann Emerg Med 1999; 34:336-341.

Mandatory reporting laws do not discourage patients from seeking medical care, according to this study from Denver (CO) Health Medical Center, Carolinas Medical Center in Charlotte, NC, and the University of Colorado Health Sciences Center in Denver. This issue has been a point of contention in the medical community for several years, note the researchers.

"Mandatory reporting laws are criticized because these laws may deter victims from seeking medical care and may exacerbate the violence," they note. Others argue in favor of laws and say that they lift the burden of reporting from the victim of domestic violence and establish legal ramifications for the perpetrator.

Of 577 patients, 55% were aware of the mandatory domestic violence reporting law. While 27% said they would be more likely to seek care because of the law, only 12% stated they would be less likely to seek care for a domestic violence-related injury.

In summary, the laws rarely deterred patients from seeking care, which contradicts the commonly held belief that fear of retribution from the perpetrator would deter victims. "The benefits of mandatory reporting must be measured to ensure that they justify deterrence to a small minority of patients," the researchers conclude.