Impact of Pediatric Dental Resident Availability in the Pediatric Emergency Department.

OBJECTIVE: The purpose of this study is to describe the impact of Delaware's first pediatric dental residency program on treatment of patients presenting to the pediatric emergency department (PED). METHODS: Charts were reviewed for patients presenting to the PED with a dental chief complaint over a 9-month period with a comparison period. Chief complaint, diagnosis, treatment interventions, disposition, and demographic information were included. χ 2 , Fisher exact, and Student t tests with a P value less than 0.05 were regarded as significant. RESULTS: A total of 432 patients met inclusion criteria; 197 before dental residency commencement and 235 after residency commencement. Dental consultation significantly increased (56% vs 7%, P < 0.01) between the study periods. There were no statistically significant differences in sex, race, insurance type, admissions, or proportion of presentations of trauma or infection between the study periods. Dental residents provided in-person evaluation for 40% of patients. The proportion of patients receiving dental intervention increased significantly postresidency period (57% vs 47%, P = 0.04). Pediatric emergency department extractions and splints both occurred in a significantly larger portion of patients after the start of the residency program (17% vs 1% and 5% vs 0%, P < 0.01). A higher proportion of patients with dental complaints received procedural sedation in the PED after residency (13% vs 2%, P < 0.01). CONCLUSIONS: Pediatric dental resident availability in the PED significantly increased dental consultation and intervention. A significantly higher percentage of PED patients received definitive treatment at point of service without requiring referral to another facility.

Oral Complaint Visits to the Pediatric Emergency Department During the COVID-19 Pandemic.

OBJECTIVE: We aimed to describe differences in orofacial complaints presenting to a pediatric emergency department (PED) during the COVID-19 pandemic as compared to those presenting prior to the pandemic. STUDY DESIGN: A retrospective review was conducted in the PED from March 16, 2020, to August 16, 2020, and compared with the prior year. RESULTS: Despite a 41% reduction in total PED visits, oral visits as a percentage of PED volume increased (3% vs 2%) P < 0.01) during the pandemic. More children with dental complaints required intervention during the pandemic (48% vs 30%, P < 0.001) including extractions and splinting (15% vs 1%, P < 0.001). Compared with pre-pandemic, proportion of tooth infections increased (68% vs 40%, P < 0.001), while oral ulcers decreased (19% vs 47%, P < 0.001). CONCLUSION: Pediatric emergency department presentation decreased during the pandemic, but patients requiring interventions increased. This may reflect hesitation in seeking treatment, outpatient facility closures, and increased acuity at the time of PED presentation due to delays in seeking care.

Epidemiology and disposition of burn injuries among infants presenting to a tertiary-care pediatric emergency department.

OBJECTIVE: The objective of the study was to study the etiology of and factors determining the emergency department disposition of infants sustaining burn injuries. METHODS: A retrospective chart review was performed on all patients 12 months or younger with a burn injury presenting to our emergency department over a 5-year period. We collected the chief complaint and diagnosis, patient demographics, and circumstances surrounding the burn injury from the emergency department charts. Univariable statistics, multiple imputation, and multivariable regression were performed to determine differences between races and factors leading to admission. RESULTS: During the study period, 344 patients meeting inclusion criteria were treated in our emergency department. Scalds (53.2%) and contact burns (39.8%) were the most common causes of burns among the study group. Significant differences were observed between races for mechanism of burn, interhospital transport, and total body surface area affected (P < 0.05). White patients were more likely to have higher body surface affected and to be transferred from another facility (P < 0.05). Increased severity of burn, burns located on the hand, and concern for abuse resulted in higher likelihood of admission (P < 0.01). No significant differences in disposition or mechanism of burn were present between English-speaking and non-English-speaking patients. CONCLUSIONS: Although most infant burns in our emergency department are due to scalds, burn injuries due to contact with household objects are common. Race plays a significant role in mechanism and severity of burn sustained. Increased severity of burn, concern for abuse, and burn to the hand were all associated with increased odds of admission.

Facial nerve palsy: etiology and approach to diagnosis and treatment.

Facial nerve palsy has a broad differential diagnosis and possible psychological and anatomical consequences. A thorough investigation must be performed to determine the cause of the palsy and to direct treatment. If no cause can be found, therapy with prednisone with or without an antiviral medication can be considered and begun as early as possible after onset of symptoms. Resolution and time to recovery vary with etiology, but overall prognosis is good.