A plan for strengthening pediatric emergency care: establishment of pediatric certified emergency center

Pediatric patients (younger than 19 years) account for approximately 25% of all emergency patients. Pediatric patients have large proportions of toddlers (aged 1–5 years), low severity, illness (rather than injury), and after-hours visits. Considering these features, the authors, affiliated with the policy research team in the Korean Society of Pediatric Emergency Medicine, suggest the establishment of the pediatric certified emergency center (PCEC) to stratify Korean pediatric emergency medical system according to the Korean Acuity and Triage Scale (KTAS). The PCEC is a facility dedicated to the emergency care for a large population of KTAS 3–4 patients (i.e., mildly ill). In addition, the PCEC may perform early stabilization and transfer to the pediatric emergency centers for pediatric patients having KTAS 1–2 illnesses and injuries. To facilitate the application of emergency centers for the PCEC, the designation criteria should be flexible in terms of manpower, facility, and equipment. Financial support from the government is essential for sustainable PCEC.

Long-term Outcome of Graded Inferior Oblique Recession

PURPOSE: To evaluate the efficacy and prognosis of graded inferior oblique recession in inferior oblique overaction. METHODS: We reviewed the records of 92 patients (184 eyes) who had been diagnosed with inferior oblique overaction and who had undergone an inferior oblique recession in both eyes. All were followed up for a minimum of 1 year postoperatively, and preoperative exclusion criteria included superior oblique palsy, history of vertical rectus muscle surgery, and previously performed inferior oblique muscle surgery. Inferior oblique overaction was graded from +1 (mild overaction) to +4 (severe overaction) and each group had 6 mm, 8 mm, 10 mm, and 14 mm inferior oblique recessions performed, respectively. Cases of postoperative inferior oblique overaction under +1 were considered successful. (In the group initially graded as +1, a postoperative grade of 0 was considered a success.) On the other hand, a grade over +1 was considered a failure. RESULTS: The average postoperative follow-up time was 43.7 months (12~159 months). On final examination, 6-mm inferior oblique recession (5 eyes) resulted in 100% success, 8-mm inferior oblique recession (76 eyes) resulted in a 94.7% success rate, 10-mm inferior oblique recession (97 eyes) resulted in an 87.5% success rate, and 14-mm inferior oblique recession (6 eyes) resulted in a 50% success rate. The overall success rate was 89.7% (165 eyes of the 184 eyes). CONCLUSIONS: Graded inferior oblique recession in patients diagnosed with inferior oblique overaction was an effective procedure with stable, long-term outcomes.

Clinical Manifestations of Optic Nerve Hypoplasia

PURPOSE: To estimate the baseline demographic and ocular characteristics of patients with optic nerve hypoplasia (ONH), and to analyze the different features and frequency of coexistent CNS abnormalities and pituitary hormone deficiency. METHODS: The authors reviewed the medical records of the patients who were seen between January 1988 and July 2005. Eyes with disc-to-macula / disc diameter ratio of 3.0 or more were eligible. The study comprised 70 patients (45 male, 25 female) and the average age was 6.4 years. RESULTS: Ocular manifestations included strabismus and nystagmus in 60 patients (85.7%) and 23 patients (32.9%), respectively. Eighty-four patients (87.5%) had visual acuity of 0.3 or less. Neuroradiologic examination of 27 patients revealed two with septo-optic dysplasia, two with pituitary hypoplasia, one with an absence of corpus callosum, one with diffuse encephalomalacia, one with a cerebral infarction in the right cerebral hemisphere, and one with a cerebellar injury. Of 12 patients who had undergone a clinical laboratory test, two had isolated growth hormone deficiency, one had a combined deficiency of growth hormone and gonadotropin and one had a combined deficiency of growth hormone and thyrotropin. CONCLUSIONS: Ocular features frequently associated with ONH are strabismus, nystagmus and poor vision. ONH is often associated with a wide variety of central nervous system abnormalities and pituitary hormone defect, so a systematic approach to patients with ONH is always recommended.