Journal Reviews

Goldman RD, Scolnik D. Underdosing of acetaminophen by parents and emergency department utilization. Pediatr Emerg Care 2004; 20:89-93.

Because parents frequently bring children to the ED for fever, these researchers studied the accuracy of parental administration of acetaminophen and to identify if parents who did not give an optimal dose would have decided not to come to the ED if the fever had diminished at home.

The study involved 248 caregivers of children whose chief complaint was fever and who had been given acetaminophen in the preceding 24 hours. (Enrollment in the study was 86%.)

The researchers found that 100 of the parents (47%) gave acetaminophen in the recommended dose, 26 parents (12%) gave an overdose, and 87 (41%) gave an underdose of acetaminophen.

Half of the parents (54%) reported that if the fever had subsided after using the treatment at home, they would not have come to the ED. Even children with significantly higher maximal temperature at home would not have been taken to the ED if the fever had subsided.

The data also revealed that parents who speak English as the primary language at home gave the recommended dose of acetaminophen more frequently than non-English-speaking parents.

The researchers concluded that "a significant portion of our population gives an underdose of acetaminophen, reflecting lack of knowledge or misuse."

Most ED visits for fever might be prevented if more parents correctly administered acetaminophen, which makes educational efforts worthwhile, they said.

However, the researchers acknowledged that factors other than underdosing of acetaminophen also probably encourage parents of febrile children to visit the ED.

Clark S, Bock SA, Gaeta TJ, et al. Multicenter study of emergency department visits for food allergies. J Allergy Clin Immunol 2004; 113:347-352.

ED management of patients with acute allergic reaction remains uncertain because relatively little is known about the characteristics of those patients, these researchers said. Anaphylaxis guidelines suggest treatment with epinephrine, teaching about self-injectable epinephrine, and referral to an allergist, but this study focuses on the management of food-related acute allergic reactions.

The researchers performed a chart review study in 21 North American EDs, using 678 charts of patients who presented with food allergy.

They found that patients had an average age of 29 years and the cohort was 57% female, 40% white. The ED visit was prompted by an allergic reaction to a variety of foods including nuts (21%), crustaceans (19%), fruit (12%), and fish (10%).

Although exposure to these foods can be life-threatening, only 18% of patients came to the ED by ambulance.

Seventy-two percent of the patients received antihistamines, 48% received systemic corticosteroids, and 16% received epinephrine. Thirty-three percent received respiratory treatments such as inhaled albuterol. Fifty-five percent of the patients had severe reactions, and 24% of that group received epinephrine.

Almost all patients (97%) were discharged to home. Sixteen percent of the patients were discharged with self-injectable epinephrine, and 12% were referred to an allergist.

Because epinephrine use was relatively low compared to the anaphylaxis guidelines, the researchers concluded there is a need for "a new collaboration between professional organizations in allergy and emergency medicine and the development of educational programs and materials for ED patients and staff."

Sethi D, Watts S, Zwi A, et al. Experience of domestic violence by women attending an inner-city accident and emergency department. Emerg Med J 2004; 21:180-184.

These researchers studied 198 women seeking emergency care at an inner-city hospital over 22 nursing shifts covering all times of day and week. They excluded women who were intoxicated, confused, or critically ill.

The data revealed that physical assault by a sexual partner was the reason for seeking emergency care for 1% of the women surveyed, but another 6% said they had been physically assaulted by a partner in the previous 12 months.

One in three women, almost 35%, confessed that they had been the victims of domestic violence at some point in their lives; and 10% said the abuse had been life-threatening. Seventy-five percent of the women said they did not mind being asked questions about domestic violence, and 60.5% said they thought it was a good idea to routinely ask women in the ED about the issue.

While the authors acknowledged the practical difficulty of asking all women in a busy ED about domestic violence, they said the study results clearly indicate that women find it easier to report and discuss the problem when ED staff ask them directly instead of waiting for them to volunteer.

Because of the high prevalence of domestic violence among female ED patients, the authors recommended ED physicians and staff take a more proactive approach to inquiring about the problem so the women can be referred to other services.