Enhanced urinalysis improves identification of febrile infants ages 60 days and younger at low risk for serious bacterial illness.

OBJECTIVE: Investigators have sought to establish "low-risk" criteria to identify febrile young infants who can be observed safely without antibiotics. Previous studies have used criteria for standard urinalysis to identify suspected urinary tract infection; however, cases of urinary tract infection have been missed. Enhanced urinalysis, using hemocytometer cell count and Gram stain performed on uncentrifuged urine, has been shown to have greater sensitivity and negative predictive value than standard urinalysis. The objective of this study was to evaluate the ability of criteria that incorporate enhanced urinalysis to identify febrile young infants who are at low risk for serious bacterial illness (SBI). METHODS: Institutional guidelines were established in 1999 to evaluate in a retrospective cohort study infants who were /=38.0 degrees C. "Low-risk" criteria included 1) well appearance without focal infection (excluding otitis media); 2) no history of prematurity, illness, or previous antibiotics; 3) peripheral white blood cell count (WBC) between 5 and 15 000/mm(3); 4) absolute band count

Complementary and alternative medicine use in children.

OBJECTIVE: Adults frequently use complementary and alternative medicines (CAM). Few studies have reported how often CAM therapies are used to treat children. The purpose of this study is to describe the use of alternative therapies by children visiting an emergency department (ED) and to identify sociodemographic factors that may influence the decision to use such therapies. DESIGN: Survey of families using a self-administered questionnaire. SETTING: An urban, tertiary care pediatric emergency department. PARTICIPANTS: Convenience sample of families presenting to the ED for acute care. MAIN OUTCOME MEASURE: Use of CAM therapies to treat children. Secondary measures include the type of therapies used, types of medical problems the therapies were used for, reasons for using such therapies, use of such therapies by the child's caretakers, and sociodemographic characteristics of the children and families. RESULTS: A review of 525 completed surveys identified 63 caretakers (12%) who acknowledged that they had used at least one form of CAM therapy to treat any of their children. Homeopathic and naturopathic remedies were the most common therapies used. Parents most often used CAM therapies to treat respiratory problems in their children and were most influenced by word-of-mouth. Children who were treated with CAM therapies were more likely to have a caretaker who used such therapies. Twelve (40%) of 30 families who reported using either an herbal or homeopathic remedy, also used a prescription or over-the-counter medication at the same time to treat their child. Thirty-nine of 55 families (70.9%) reported informing their child's physician of their use of CAM therapies. CONCLUSION: CAM therapies are frequently used to treat children. Most parents who use CAM therapies to treat their children use such therapies themselves. Large proportions of children who are taking herbal supplements are also taking prescription or over-the-counter medications concurrently.

Treatment of shigellosis with cefixime: two days vs. five days.

BACKGROUND: Although the recommended standard course of therapy for shigellosis is 5 days of oral ampicillin or trimethoprim-sulfamethoxazole therapy, successful outcome has been reported in adults treated with abbreviated courses of antibiotics. The purpose of this study was to compare short course (2-day) vs. 5-day therapy with cefixime for treatment of diarrheal disease caused by Shigella sonnei in children. METHODS: This was a prospective, randomized, double blind, placebo-controlled study. Patients were eligible if they were at least 6 months of age and presented to the Children's Hospital of Pittsburgh during an outbreak of diarrhea caused by S. sonnei, with (1) a history of fever and diarrhea (at least three loose or watery stools per day), (2) bloody diarrhea or (3) diarrhea and known exposure to an individual with documented shigellosis. Patients were randomized to receive either 2 days of cefixime (8 mg/kg(day) given once daily followed by 3 days of placebo or 5 days of cefixime. Telephone follow-up was performed on Days 3, 7 and 14 after enrollment. Follow-up stool cultures were obtained on Day 7 to assess bacteriologic cure. There were standardized definitions for cure, improvement, failure and relapse. RESULTS: Forty-seven patients were enrolled. Eleven were eliminated from analysis because their stool cultures were not positive for S. sonnei. There were 36 evaluable patients, 21 in the 2-day group and 15 in the 5-day group. Patients ranged in age from 6 months to 17 years. Forty-four percent of the subjects were male. Symptoms were improved or had resolved by Day 3 of therapy in all patients. There were 8 patients who experienced a clinical relapse: 5 of 21 (24%) patients in the 2-day treatment group and 3 of 15 (20%) in the 5-day group. There were 13 patients who experienced a bacteriologic failure (defined as the occurrence of a positive culture at the Day 7 follow-up visit), 11 of 20 (55%) in the 2-day group and 2 of 14 (14%) in the 5-day group (P < 0.02). CONCLUSION: Two- and 5-day treatment courses with cefixime for treatment of diarrheal disease caused by S. sonnei result in similar rates of clinical cure and clinical relapses; however, there was a higher rate of bacteriologic failure with shorter course therapy.

Idiopathic priapism.

Idiopathic priapism is rarely seen in children. Two children with idiopathic priapism are presented, followed by a detailed discussion of priapism. Particular attention is paid to idiopathic priapism. Additionally, an algorithm for diagnosing and managing children presenting with priapism is presented.

Caterpillars: an unusual source of ingestion.

PURPOSE: To describe a series of patients seen in a pediatric emergency department with adverse effects following an ingestion of a caterpillar. METHODS: Case series. RESULTS: Ten patients presented to the emergency department following ingestion of a caterpillar. Adverse effects ranged from drooling and refusal to drink to diffuse urticaria. Six patients were admitted and five underwent direct laryngoscopy and bronchoscopy in the operating room. None of the 10 patients had an adverse outcome. CONCLUSIONS: Previously not described, significant adverse effects can occur following ingestion of a caterpillar. In addition, although not previously reported, the caterpillar of the Hickory Tussock moth can cause adverse effects in humans.

Oropharyngeal manifestations of lepidopterism.

OBJECTIVE: To describe previously unreported oropharyngeal manifestations and management of caterpillar ingestion. DESIGN: Retrospective case series. SETTING: Tertiary children's hospital. PATIENTS: A total of 733 cases of exposure to caterpillars from January 1, 1994, to November 1, 1997, were reviewed. Twenty-six patients had oropharyngeal exposure with 8 patients ingesting the caterpillar. Ages ranged from 7 months to 7 years with 14 boys and 12 girls. INTERVENTIONS: All patients had a thorough examination of the oropharynx for caterpillar spines. For children who ingested a caterpillar, direct laryngoscopy, bronchoscopy, and esophagoscopy with removal of caterpillar spines were performed. RESULTS: At the point of caterpillar contact, buried caterpillar spines with focal erythema were observed. The lips, tongue, and buccal mucosa were the most frequently involved areas. The esophagus was involved in 8 of the patients. No postoperative complications were noted. CONCLUSION: With individualized care and prompt removal of venomous caterpillar spines, complications are not likely to result from caterpillar ingestion.

Telemedicine in pediatric transport: a feasibility study.

OBJECTIVE: Investigate the hypothesis that telemedicine, in the form of real-time audiovisual transmission, would permit accurate assessment of illness severity and allow improved triage for transport. METHODS: A prospective study comparing assessments of patients examined conventionally (in person) and remotely by a telemedicine link. Fifteen patients (3 months to 14 years of age) admitted to our emergency department were evaluated as if for transport. Patients were evaluated simultaneously by a physically present pediatric emergency room physician and by a pediatric critical care physician linked to the examining room by a broadband audiovisual link. Each physician completed a patient assessment questionnaire independently. The sensitivity and specificity of the patient assessment by the audiovisually linked physician were calculated. RESULTS: Sensitivity, ie, the ability of the remote, audiovisually connected telemedicine physician to detect abnormal findings, is 87.5%. Specificity, the ability of the remote physician to detect normal findings, is 93%. It is likely that sensitivity would be markedly improved with addition of an electronic stethoscope. CONCLUSION: This study demonstrates that pediatric patients may be assessed accurately with a broadcast-quality real-time audiovisual system. Such a system may have dramatic implications for providing pediatric specialty and subspecialty care in underserved areas.

Evaluation of a new rapid antigen detection kit for group A beta-hemolytic streptococci.

OBJECTIVE: To evaluate the use of a new rapid antigen-detection kit for group A beta-hemolytic streptococcus and compare results with previously published studies. METHODS: Throat swabs were obtained prospectively from patients, aged one to 18 years, presenting to the emergency department, acute concerns clinic, and walk-in clinic of an urban tertiary care children's hospital. Throat swabs were first inoculated on a 5% sheep blood agar plate and then used for the streptococcus A optical immunoassay (OIA) kit. Results of both the throat culture and the rapid antigen-detection test were then compared. RESULTS: Two-hundred thirty-three patients were enrolled. Seventy-three patients had a positive culture and 63 patients had a positive OIA. Fifteen patients had a false negative result for the OIA kit and five patients had a false positive result. Test sensitivity was 79.5%, specificity was 96.9%, positive predictive value was 92.1%, and negative predictive value was 91.2% CONCLUSION: Although previous studies have demonstrated OIA kit sensitivities as high as 98.9% and authors have, as a result, recommended that the performance of a backup throat culture for a negative OIA test is unnecessary, our results do not support this. A sensitivity of 79.5% is not sufficiently high to justify omission of a standard throat culture. Accordingly, all OIA tests that are negative should be confirmed by the performance of a throat culture.