Diphtheria, pertussis, and tetanus: evidence-based management of pediatric patients in the emergency department

Diphtheria, pertussis, and tetanus are potentially deadly bacterial infections that are largely preventable through vaccination, though they remain in the population. This issue reviews the epidemiology, pathophysiology, diagnosis, and current recommended emergency management of these conditions. Disease-specific medications, as well as treatment of the secondary complications, are examined in light of the best current evidence. Resources include obtaining diphtheria antitoxin from the United States Centers for Disease Control and Prevention and best-practice recommendations with regard to testing, involvement of government health agencies, isolation of the patient, and identification and treatment of close contacts. Most importantly, issues regarding vaccination and prevention are highlighted.

An unusual case of a central nervous system tumor presenting as a chief complaint of depression.

Patients presenting to the emergency department with a psychiatric chief complaint often undergo a medical clearance examination. There is much debate in the literature as to the value of routine laboratory and other diagnostic studies in the initial evaluation of these patients. We report on a patient presenting to the pediatric emergency department with a chief complaint of depression who ultimately was found to have diabetes insipidus and a primary intracranial germ cell tumor. Although a rare outcome to a relatively common scenario in the emergency department, this case underscores the value of a detailed history, careful physical examination, and consideration of laboratory and other diagnostic studies in patients presenting to the emergency department for psychiatric evaluation.

Local weather effects on emergency department visits: a time series and regression analysis.

OBJECTIVE: The ability to forecast atypical emergency department (ED) volumes may aid staff/resource allocation. We determine whether deviations from short-term predictions of weather can be used to forecast deviations from short-term predictions of ED volumes. METHODS: In this retrospective study, we attempted to predict the volume of patient visits to an academic pediatric ED based on short-interval local weather patterns (2000). Local temperature and precipitation data in 1- and 3-hour increments were obtained. Precipitation was coded to be present if it exceeded 0.04 in and subclassified as cold rain/snow if the ambient temperature was lower than 40 degrees F. ED visits were categorized as injuries, emergent, or nonemergent visits. For each category of visit, Box-Jenkins Auto-Regressive Integrated Moving Average time-series models were created of natural trends and cycles in temperature and patient volumes. From these models, differences (residuals) between predicted and observed values of these variables were estimated. The correlation between residuals for temperature and ED volumes was derived for various kinds of ED visit, after controlling for type/volume of precipitation. RESULTS: Residuals for ambient temperature controlled for precipitation correlated poorly with residuals for patient volumes, accounting for 1% to 6% of the variability in the volume of injuries, emergent, and nonemergent visits (R2 = 1%, 1%, and 6%, respectively). CONCLUSIONS: Deviations from short-term predictions of temperature correlate poorly with deviations from predictions of patient volume after adjusting for natural trends and cycles in these variables and controlling for precipitation. These weather variables are of little practical benefit for predicting fluctuations in the rates of ED utilization.