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1.
J Pediatric Infect Dis Soc ; 12(10): 553-555, 2023 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-37756491

RESUMO

In our prospective cohort of 192 children with a physician-diagnosed erythema migrans (EM) lesion, two-tier Lyme disease serology had higher sensitivity in children with multiple EM lesions (76.8% multiple lesions vs. 38.1% single EM; difference 38.7%, 95% confidence interval 24.8%-50.4%). The diagnosis of cutaneous Lyme disease should be based on careful physical examination rather than laboratory testing.


Assuntos
Eritema Migrans Crônico , Doença de Lyme , Humanos , Criança , Estudos Prospectivos , Doença de Lyme/complicações , Doença de Lyme/diagnóstico , Eritema Migrans Crônico/diagnóstico , Eritema Migrans Crônico/patologia
2.
Am J Hematol ; 98(4): 620-627, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36606705

RESUMO

Children with sickle cell disease (SCD) commonly experience vaso-occlusive pain episodes (VOE) due to sickling of erythrocytes, which often requires care in the emergency department. Our objective was to assess the use and impact of intranasal fentanyl for the treatment of children with SCD-VOE on discharge from the emergency department in a multicenter study. We conducted a cross-sectional study at 20 academic pediatric emergency departments in the United States and Canada. We used logistic regression to test bivariable and multivariable associations between the outcome of discharge from the emergency department and candidate variables theoretically associated with discharge. The study included 400 patients; 215 (54%) were female. The median age was 14.6 (interquartile range 9.8, 17.6) years. Nineteen percent (n = 75) received intranasal fentanyl in the emergency department. Children who received intranasal fentanyl had nearly nine-fold greater adjusted odds of discharge from the emergency department compared to those who did not (adjusted odds ratio 8.99, 95% CI 2.81-30.56, p < .001). The rapid onset of action and ease of delivery without intravenous access offered by intranasal fentanyl make it a feasible initial parenteral analgesic in the treatment of children with SCD presenting with VOE in the acute-care setting. Further study is needed to determine potential causality of the association between intranasal fentanyl and discharge from the emergency department observed in this multicenter study.


Assuntos
Anemia Falciforme , Medicina de Emergência Pediátrica , Humanos , Criança , Feminino , Masculino , Fentanila , Alta do Paciente , Estudos Transversais , Dor/etiologia , Dor/complicações , Anemia Falciforme/complicações , Serviço Hospitalar de Emergência , Analgésicos Opioides
4.
Am J Hematol ; 94(6): 689-696, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30916794

RESUMO

Vaso-occlusive pain events (VOE) are the leading cause of emergency department (ED) visits in sickle cell anemia (SCA). This study assessed the variability in use of intravenous fluids (IVFs), and the association of normal saline bolus (NSB), on pain and other clinical outcomes in children with SCA, presenting to pediatric emergency departments (PED) with VOE. Four-hundred charts of children age 3-21 years with SCA/VOE receiving parenteral opioids at 20 high-volume PEDs were evaluated in a retrospective study. Data on type and amount of IVFs used were collected. Patients were divided into two groups: those who received NSB and those who did not. The association of NSB use on change in pain scores and admission rates was evaluated. Among 400 children studied, 261 (65%) received a NSB. Mean age was 13.8 ± 4.9 years; 46% were male; 92% had hemoglobin-SS. The IVFs (bolus and/or maintenance) were used in 84% of patients. Eight different types of IVFs were utilized and IVF volume administered varied widely. Mean triage pain scores were similar between groups, but improvement in pain scores from presentation-to-ED-disposition was smaller in the NSB group (2.2 vs 3.0, P = .03), while admission rates were higher (71% vs 59%, P = .01). Use of NSB remained associated with poorer final pain scores and worse change in pain scores in our multivariable model. In conclusion, wide variations in practice utilizing IVFs are common. NSB is given to >50% of children with SCA/VOE, but is associated with poorer pain control; a controlled prospective trial is needed to determine causality.


Assuntos
Anemia Falciforme/tratamento farmacológico , Serviço Hospitalar de Emergência , Manejo da Dor , Dor/tratamento farmacológico , Solução Salina/administração & dosagem , Doenças Vasculares/tratamento farmacológico , Adolescente , Adulto , Anemia Falciforme/complicações , Anemia Falciforme/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Dor/etiologia , Dor/fisiopatologia , Estudos Retrospectivos , Doenças Vasculares/etiologia , Doenças Vasculares/fisiopatologia
5.
Acad Emerg Med ; 18(9): 966-71, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21854488

RESUMO

OBJECTIVES: Peripheral intravenous catheter (PIV) placement is a common, painful, and frequently difficult procedure in children. The VeinViewer is a device that delineates subcutaneous veins using near-infrared light and video technology. To the best of our knowledge, the benefit of this device for PIV placement in children in the emergency department (ED) has not been studied. METHODS: The authors enrolled a prospective, randomized sample of children aged 0 to 17 years who required a nonemergent PIV in a tertiary care pediatric ED. Participants were randomized to standard PIV cannulation (SC) or PIV cannulation with the VeinViewer (VV). The primary outcome measure was time to PIV placement. Secondary outcome measures included number of PIV attempts and pain scores as reported by the child, parent or guardian, and nurse using a 100-mm visual analog scale (VAS). RESULTS: A total of 323 patients completed the study: 174 boys and 149 girls. Age, sex, and body mass index (BMI) were not different between groups. There were no differences in time to PIV placement, number of PIV attempts, or pain scores for the overall study group. However, a planned subgroup analysis of children age 0 to 2 years (n = 107) did yield significant results for the geometric mean time to place the PIV (121 seconds [VV] vs. 167 seconds [SC], p = 0.047) and for nurses' perception of pain (median VAS 34 [VV] vs. 46 [SC], p = 0.01). CONCLUSIONS: While no results were significant for the overall study group, subgroup analysis of children age 0 to 2 years suggests that the VeinViewer may decrease the time to PIV placement.


Assuntos
Cateterismo Periférico/métodos , Serviço Hospitalar de Emergência , Veias , Adolescente , Fatores Etários , Índice de Massa Corporal , Pré-Escolar , Feminino , Humanos , Raios Infravermelhos , Masculino , Medição da Dor/métodos , Estudos Prospectivos , Fatores de Tempo
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