Feasibility of providing child restraint devices after a motor vehicle crash in a pediatric emergency department.

OBJECTIVE: Motor vehicle crashes (MVCs) cause disproportionate childhood morbidity and mortality. Ensuring that children are placed in appropriate child restraint devices (CRDs) would significantly reduce injuries and deaths as well as medical costs. The goal of the study is to evaluate the feasibility of providing child restraint devices after an MVC in a pediatric emergency department (PED). METHODS: A guideline was developed to assess the need for CRDs for patients discharged from a PED after an MVC. Providers were educated on the use of the guideline. Caregivers were provided a brief educational intervention on legislation, proper installation, and best practices prior to distribution of a CRD. Quality assurance was conducted weekly to monitor for any missed opportunities. RESULTS: From August 31, 2015, to August 31, 2016, 291 patients <7 years were evaluated in the PED of a level 1 trauma center following an MVC. Two hundred forty-seven children were correctly identified according to the guidelines (84.9%). Of these, 187 (75.7%) were identified as not requiring a replacement seat and 60 (24.3%) required a CRD replacement based on crash mechanisms and restraint use status and received a CRD replacement. Of the remaining 44 children, 38 (86.4%) whose crash mechanisms were severe enough or who were inappropriately restrained were not provided a CRD and thus missed; 6 (13.6%) received a replacement seat even though criteria were not met. Thus, PED providers correctly identified 61.2% (60/98) of children who required CRD replacement after an MVC. CONCLUSION: Caring for children who present for evaluation after an MVC offers an opportunity for ED personnel to provide education to caregivers about the appropriate use of CRDs and state legislation. Establishing guidelines for the provision of a CRD for children who present to an ED following an MVC may help to improve the safety of children being transported in motor vehicles. Having a systematic process and adequate supply of CRDs readily available contributes to the success of children being discharged with the appropriate age- and weight-based CRD after being treated in an ED following an MVC.

[Giant cell in maxillary pseudotumors]. / La célula gigante en los seudotumores maxilares.

A research on lesions apparently tumorous that appear on jawbones and are not exactly tumors is developed. These lesions are clinically silent, although they produce deformity and, perhaps because of that, an early diagnosis with biopsy or other procedures is needed. The image research can be very characteristic or otherwise, it can be very complex, non specific and not provide everything expected to make the diagnosis. The difference between radiolucent and radiopaque images that produce the querubism-fibrous displasia, prove both extremes in which the diagnosis judgment made by image can or cannot be significant. We have to highlight the presence of giant cells with an osteoclastic nature in most of these pseudo tumorous lesions.