ABSTRACT
Not all pediatric fractures require emergent orthopedic attention. The information needed to assess and provide the appropriate interventions to children and their families following an extremity fracture is discussed in this article. A case study is used to describe a fracture that requires emergent intervention. The role of the pediatric orthopaedic nurse practitioner in the emergency department, inpatient, and outpatient setting is also illustrated.
Subject(s)
Emergencies/nursing , Extremities/injuries , Fractures, Bone , Nursing Assessment/organization & administration , Triage/organization & administration , Aftercare/organization & administration , Child, Preschool , Continuity of Patient Care/organization & administration , Emergency Nursing/organization & administration , Fractures, Bone/diagnosis , Fractures, Bone/therapy , Health Services Needs and Demand , Humans , Incidence , Male , Medical History Taking , Nurse Practitioners/organization & administration , Nurse's Role , Orthopedic Nursing/organization & administration , Parents/education , Patient Discharge , Patient Education as Topic , Pediatric Nursing/organization & administration , Physical Examination/nursingABSTRACT
BACKGROUND: The splenic injury computed tomographic (CT) grade is used to guide nonoperative management. A study was conducted to determine whether this grade correlates with patient physiology. METHODS: Records of consecutive children with isolated spleen injuries were reviewed. Vital signs, fluids administered, urine output, and hematocrit values from the scene through 120 hours after admission were retrieved. A blinded radiologist reviewed CT scans. Statistical analyses were conducted to test for a linear relationship between injury grade and physiologic parameters. RESULTS: Eighty-two patients with isolated splenic injuries and available CT scans were located. CT injury grade correlated directly with pulse, systolic blood pressure, and diastolic blood pressure and inversely with hematocrit. No correlation was found with pulse pressure, urine output, or maximum temperature. CONCLUSION: The CT grade of splenic injury correlates directly with pulse, systolic blood pressure, and diastolic blood pressure and inversely with hematocrit. CT injury grade correlates with physiologic impact and may guide management decisions.
Subject(s)
Monitoring, Physiologic , Spleen/diagnostic imaging , Spleen/injuries , Tomography, X-Ray Computed , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Injury Severity Score , Male , Retrospective StudiesABSTRACT
PURPOSE: In 1998, the American Pediatric Surgical Association (APSA) recommended evidence-based guidelines for the management of hemodynamically stable patients with isolated liver or spleen injuries. A clinical practice guideline (CPG) was developed using the APSA guidelines. This study analyzes the impact of the CPG on the care of these children in a single institution. METHODS: Patients treated with the CPG between September 1998 and June 2002 were compared with a similar cohort admitted from February 1992 to October 1997, before the CPG was instituted. Groups were analyzed for age, computerized tomographic organ injury grade, hematocrits obtained, Injury Severity Score (ISS), length of intensive care unit (ICU) and hospital stay, follow-up imaging studies performed, and outcome. RESULTS: CPG patients had a shorter ICU length of stay (0.4 +/- 0.6 v 1.4 +/- 0.6 days; P <.001), shorter hospital stay (3.8 +/- 1.2 v 7.2 +/- 1.4 days; P <.001), fewer hematocrits obtained (4.7 +/- 2.2 v 9.2 +/- 3.1; P <.001), and fewer follow-up imaging studies (0.3 +/- 0.4 v 2.1 +/- 1.1; P <.001). One patient in the CPG group was readmitted for delayed hemorrhage. No urgent operations were performed in either group. CONCLUSIONS: Application of an APSA-based CPG resulted in decreased length of ICU stay, decreased hospital stay, and decreased resource utilization without any noted effect on outcome.
