Insurance status and the variable management of children presenting to the emergency department with bronchiolitis.

OBJECTIVE: To determine if insurance type is associated with differences in the management of children presenting to the emergency department (ED) with bronchiolitis METHODS: We analyzed data from a 30-center, prospective cohort study of children younger than 2 years with bronchiolitis presenting to the ED. Insurance status was defined as private, public, and no insurance. RESULTS: Of 1450 patients, 473 (33%) had private, 928 (64%) had public, and 49 (3%) had no insurance. Multivariable analysis found that children with public insurance were less likely to receive inhaled ß-agonists (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.50-0.92) or antibiotics (OR, 0.61; 95% CI, 0.42-0.89) the week before the ED visit. Children without insurance were less likely to have a primary care provider (OR, 0.15; 95% CI, 0.04-0.57) or receive laboratory testing in the ED (OR, 0.41; 95% CI, 0.19-0.88). The children's clinical presentation (eg, respiratory rate, oxygen saturation, and retractions) and ED treatments (eg, inhaled ß-agonists, inhaled racemic epinephrine, systemic corticosteroids, and antibiotics) were similar. Likewise, hospital admission (multivariable OR 1.04; 95% CI, 0.45-2.42) was similar between insurance groups. CONCLUSIONS: We noted some pre-ED and ED management differences across insurance types for children presenting to the ED with bronchiolitis. Although these variations may reflect treatments with unproven benefits, all children regardless of insurance should receive similar care. Despite these management variations, there were no differences in medications delivered in the ED or admission rate.

Handedness effects on procedural training in pediatrics.

OBJECTIVE: To determine handedness effects on procedural training. PATIENTS AND METHODS: Pediatric trainees and attendings from 3 institutions participated in a Web-based survey examining whether handedness affected learning procedures, the hand used to perform procedures, and if handedness training was received. RESULTS AND CONCLUSIONS: Of 778 physicians, 39% completed surveys, and 11% wrote with their left hand. Learning procedures were affected in left-handed physicians (60% vs 7.7%; odds ratio [OR] = 17.9; 95% confidence interval [CI] = 7.9-40.1), and they used their non-dominant or both hands to perform procedures (48.6% vs 21%; OR = 3.6; 95% CI = 1.7-7.4). Few physicians received handedness training (20% vs 10.7%; P= .16). Left-handed physicians were affected learning lumbar puncture (29% vs 4%; OR= 10.0; 95% CI = 3.8-26.4), intubation (36% vs 5%; OR=11.0; 95% CI=4.4-27.4), and suturing (32% vs 4%; OR = 11.7; 95% CI = 4.5-30.5).

Prospective multicenter bronchiolitis study: predicting intensive care unit admissions.

OBJECTIVES: The authors sought to identify predictors of intensive care unit (ICU) admission among children hospitalized with bronchiolitis for > or =24 hours. METHODS: The authors conducted a prospective cohort study during two consecutive bronchiolitis seasons, 2004 through 2006, in 30 U.S. emergency departments (EDs). All included patients were aged <2 years and had a final diagnosis of bronchiolitis. Regular floor versus ICU admissions were compared. RESULTS: Of 1,456 enrolled patients, 533 (37%) were admitted to the regular floor and 50 (3%) to the ICU. Comparing floor and ICU admissions, multivariate ED predictors of ICU admission were age <2 months (26% vs. 53%; odds ratio [OR] = 4.1; 95% confidence interval [CI] = 2.1 to 8.3), an ED visit the past week (25% vs. 40%; OR = 2.2; 95% CI = 1.1 to 4.4), moderate/severe retractions (31% vs. 48%; OR = 2.6; 95% CI = 1.3 to 5.2), and inadequate oral intake (31% vs. 53%; OR = 3.3; 95% CI = 1.6 to 7.1). Unlike previous studies, no association with male gender, socioeconomic factors, insurance status, breast-feeding, or parental asthma was found with ICU admission. CONCLUSIONS: In this prospective multicenter ED-based study of children admitted for bronchiolitis, four independent predictors of ICU admission were identified. The authors did not confirm many putative risk factors, but cannot rule out modest associations.

Patterns in childhood sports injury.

OBJECTIVE: The purpose of this epidemiologic study is twofold: first, to determine the relative frequency of sports-related injuries compared with all musculoskeletal injuries in patients 5 to 21 years of age presenting to the emergency department (ED), and second, to evaluate the sports-specific and anatomic site-specific nature of these injuries. METHODS: Patterns of injury in patients 5 to 21 years of age presenting to four pediatric EDs with musculoskeletal injuries in October 1999 and April 2000 were prospectively studied. Information collected included age, sex, injury type, anatomical injury site, and cause of injury (sports-related or otherwise). Information about patient outcome and disposition was also obtained. RESULTS: There were a total of 1421 injuries in 1275 patients. Musculoskeletal injuries were more common in male patients (790/62%) than in female patients. The mean age of the patients was 12.2 years (95% CI, 12.0-12.4). Sprains, contusions, and fractures were the most common injury types (34, 30, and 25%, respectively). Female patients experienced a greater percentage of sprains (44% vs 36%) and contusions (37% vs 33%) and fewer fractures (22% vs 31%) than male patients. Sports injuries accounted for 41% (521) of all musculoskeletal injuries and were responsible for 8% (495/6173) of all ED visits. Head, forearm, and wrist injuries were most commonly seen in biking, hand injuries in football and basketball, knee injuries in soccer, and ankle and foot injuries in basketball. CONCLUSIONS: Sports injuries in children and adolescents were by far the most common cause of musculoskeletal injuries treated in the ED, accounting for 41% of all musculoskeletal injuries. This represents the highest percentage of sports-related musculoskeletal injuries per ED visit reported in children to date. As children and adolescents participate in sports in record numbers nationwide, sports injury research and prevention will become increasingly more important.

Preschool and school age activities: comparison of urban and suburban populations.

The objective of this study was to compare urban and suburban preschool and school age activities. A prospective survey using a convenience sample was conducted at one urban and one suburban primary care pediatric office. Questionnaires were completed for 66 urban preschool children, 70 suburban preschool children, 57 urban school age children and 61 suburban school age children during the school year. Also, questionniaires were completed for 63 suburban school age children during the summer. The suburban preschool children spent more time outdoors, were read to more frequently, visited the library more frequently and more often attended summer camp. The suburban school age children spent more time outdoors, more frequently participated in a community sport league and more often attended summer camp. The urban school age children watched more television or videos. During the summer, suburban school age children spent more time outdoors, while during the school year, suburban school age children used the library more frequently. Important differences exist between the activities of urban and suburban children in two practices in the New York metropolitan area. Pediatricians caring for urban children may have an important opportunity to promote participation in sports and educational activities.