 |
|
This Month in Archives of Pediatrics & Adolescent Medicine
Arch Pediatr Adolesc Med. 2001;155:1293.
Inpatient Care for Uncomplicated Bronchiolitis: Comparison With Milliman
and Robertson Guidelines
Milliman and Robertson (M&R) guidelines are widely used by managed
care organizations to set standards for length of hospital stay. In this study
from 8 hospitals, the observed length of stay for children younger than 1
year who were admitted with uncomplicated bronchiolitis was compared with
the goal length of stay of 1 day in the M&R guidelines. The average length
of stay in these hospitals was 2.8 days; 11.5% of patients required more than
5 days of hospitalization. No hospital was able to achieve a mean length of
study commensurate with the M&R guidelines of 1 day. This study indicates
that guidelines must be based on evidence and data.
(SEE ARTICLE)
Metered Dose Inhaler: The Emergency Department Orphan
Prior studies indicate that metered dose inhalers with spacers (MDI+S)
are clinically as effective as nebulizers in both children and adults in the
delivery of bronchodilators. This survey of 375 pediatric emergency medicine
physicians in North America reported that the majority still use nebulizers
for children in the emergency department. Use of MDI+S was rare for children
younger than 2 years, and its use was reported by only 24% of physicians for
children older than 6 years with acute asthma. Despite the evidence supporting
the use of MDI+S instead of nebulizers in acute asthma, it does not seem to
be the standard of care in practice in North America.
(SEE ARTICLE)
Effectiveness of Oral or Nebulized Dexamethasone for Children With
Mild Croup
While the effectiveness of dexamethasone as a treatment for patients
with moderate to severe croup is well established, relatively few studies
have examined the use of this treatment for mild croup. Luria and colleagues
conducted a randomized controlled trial of 264 children with croup, comparing
oral dexamethasone with nebulized dexamethasone, with placebo. Children receiving
oral dexamethasone had a lower rate of treatment failure, greater improvement,
and were less likely to seek subsequent additional care for the illness. Oral
treatment is easier to use and seems to be more effective than nebulized dexamethasone.
However, 10 children with croup would need to be treated with oral dexamethasone
to prevent 1 child from returning with croup severe enough to warrant steroid
administration.
(SEE ARTICLE)
Exposure to Violence: Psychological and Academic Correlates in Child
Witnesses
While it is well known that inner-city children are frequently exposed
to violence, there is little information on the psychological and academic
effects of such exposure on young children entering school. In this longitudinal
study of 119 inner-city children and their families, Hurt and colleagues found
that 75% had heard gunshots, 60% had seen drug deals, and 10% had seen a shooting
or stabbing in the home. Exposure to violence was associated with increased
anxiety and depression and lower self-esteem. Greater exposure to violence
was also associated with lower academic success and more days absent from
school. These signs of distress are frequently not recognized by parents.
Table 1. Selected Results of TISH: Percentage of Children Exposed to
an Event 1 or More Times
(SEE ARTICLE)
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
|
