ABSTRACT
OBJECTIVE: To determine the accuracy of portable bedside fluoroscopy in documenting postreduction fracture alignment in the pediatric emergency department (ED). DESIGN/SETTING: Prospective trial in an urban pediatric ED. PARTICIPANTS: Convenience sample of 80 pediatric patients requiring ED reduction of isolated long bone fractures. METHODS: Patients who underwent closed fracture reduction using portable fluoroscopic guidance (FluoroScan) in the ED were enrolled in the study. Postreduction images were obtained using both bedside fluoroscopy and conventional radiographs. A pediatric orthopedic subspecialist, blinded to clinical outcome, reviewed the fluoroscopic and radiographic images for adequacy of alignment and rated the utility of conventional radiography for fracture management. RESULTS: The patients were 2.5 to 16 years of age (mean 8.3). Distal radial and radioulnar fractures comprised 96% (76/80) of cases. Sixty-three percent of the fractures were displaced, and the mean angulation of the primary fracture site was 24 degrees . Fluoroscopy was found to be 100% sensitive (75/75 cases) and 100% specific (5/5 cases) in predicting postreduction fracture position when compared to conventional radiographs. Intra-rater observer agreement on the necessity of conventional postreduction radiographs was 0.92 (95% CI 0.82-1.00) using the kappa coefficient. In no case did postreduction radiographs alter acute fracture management. CONCLUSIONS: Bedside fluoroscopy with printed fluoroscopic images are highly reliable in evaluating fracture reduction and can replace conventional radiography in documenting adequate distal forearm fracture reduction when there is no intraarticular involvement.
Subject(s)
Emergency Service, Hospital , Fluoroscopy/standards , Fracture Fixation/methods , Point-of-Care Systems , Radius Fractures/diagnostic imaging , Ulna Fractures/diagnostic imaging , Adolescent , California , Child , Child, Preschool , Documentation , Female , Fluoroscopy/instrumentation , Fluoroscopy/methods , Humans , Male , Prospective Studies , Radius Fractures/therapy , Sensitivity and Specificity , Ulna Fractures/therapyABSTRACT
Skin staples are ideal for pediatric scalp laceration closure because of their rapidity of placement and economy and ease of use. We report two cases of rotatory staple migration necessitating improvised removal techniques. Clinicians should be alert for this complication, which may result from a combination of staple design, local anatomic factors, superficial placement, and prolonged delay prior to removal.
Subject(s)
Foreign-Body Migration/etiology , Scalp/injuries , Surgical Staplers , Child , Child, Preschool , Equipment Failure , Female , Humans , Scalp/surgery , Surgical Instruments , Wound Healing/physiologyABSTRACT
From 1983 to 1992 a total of 64 children were admitted with a diagnosis of malaria to Children's National Medical Center in Washington, DC. Specific etiology is available in 59 of 64. Of these 59 cases 52 (88%) were caused by Plasmodium falciparum. Fifty-one of 52 infections were acquired in Africa, 35 (67%) of these in traveling United States citizens. Eleven (21%) of 52 children were initially admitted to the Intensive Care Unit for i.v. quinidine or quinine therapy. Eight (73%) of these 11 patients compared with 12 (29%) of 41 general ward admissions had been misdiagnosed within 10 days before admission (P = 0.012). Five of 11 Intensive Care Unit patients underwent exchange transfusion. One child died and one was left with severe neurologic deficit. Malaria must be considered in the differential diagnosis for any febrile child who has traveled to or from a malarious area within the previous 12 months. Delayed diagnosis of pediatric Plasmodium falciparum malaria is associated with an increased severity of illness. Because of the frequency of international travel, United States physicians will need to be familiar with the presentation and management of imported P. falciparum malaria.
