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This Month in Archives of Pediatrics & Adolescent Medicine
Arch Pediatr Adolesc Med. 2001;155:635.
Steroids for Otitis Media With Effusion
A Systematic Review
Treatment of children with otitis media with effusion continues to plague
the practicing pediatrician. One treatment option is the use of steroids,
either nasally or orally. Butler and van der Voort conducted a systematic
review of the world's literature on this topic. The 10 randomized trials that
have examined this found an overall 68% reduction in persistent effusion following
a course of antibiotics and oral steroids. However, there was no evidence
for a long-term benefit on hearing.
(SEE ARTICLE)
Self-obtained Vaginal Swabs for Diagnosis of Treatable Sexually Transmitted
Diseases in Adolescent Girls
Since sexually transmitted diseases (STDs) are relatively common and
can result in significant morbidity, routine screening of all sexually active
adolescent girls has been advocated. Smith and colleagues found that 100%
of 512 adolescent girls choose self-obtained vaginal swabs over pelvic examination
in screening for STDs. More than a quarter of the study population was found
to have 1 or more treatable STDs. The use of self-obtained swabs, combined
with newer tests, has potential to be significantly effective in controlling
STDs in adolescents.
(SEE ARTICLE)
Use of Intravenous Methohexital as a Sedative in Pediatric Emergency
Departments
Adequate sedation for children in the emergency department undergoing
procedures such as computed tomography scans is necessary but difficult to
consistently achieve. Many of the current medications are associated with
long periods of onset or recovery and are not ideal for short procedures.
This study of 55 patients in an urban pediatric emergency department found
that the administration of intravenous methohexital resulted in an onset of
sedation within 1 minute, lasted only an average of 14 minutes, and was effective
in all but 2 patients. Intravenous methohexital may represent an appropriate
choice for short-duration sedation in pediatric emergency departments.
(SEE ARTICLE)
"Love Our Kids, Lock Your Guns"
A Community-Based Firearm Safety
Counseling and Gun Lock Distribution Program
Parents and pediatricians alike are concerned about injuries caused
by firearms. One potential method to decrease such tragedies is safe storage
of firearms kept in the home. Coyne-Beasley and colleagues conducted a community-based
intervention with parents to change storage practices. The program was dramatically
successful in increasing trigger lock use, storing guns in locked compartments,
and storing guns unloaded. The intervention demonstrates that the hazards
associated with guns can be reduced.
(SEE ARTICLE)
Prophylaxis Against Possible Human Immunodeficiency Virus Exposure
After Nonoccupational Needlestick Injuries or Sexual Assaults in Children
and Adolescents
There are currently no recommendations from the Centers for Disease
Control on postexposure prophylaxis for human immunodeficiency virus in children
and adolescents. Babl and colleagues surveyed the directors of all pediatric
infectious disease programs and pediatric emergency departments in the United
States to identify recommended practices. Pediatric infectious disease experts
were more likely than pediatric emergency medicine physicians to recommend
postexposure prophylaxis for the scenarios of a 5-year-old with an accidental
needlestick injury from a needle found in a park, and for a 15-year-old after
sexual assault. There was a great deal of variability on the drugs and therapy
duration recommended. This study points out the need for a national consensus
and guidelines for postexposure human immunodeficiency virus prophylaxis in
children and adolescents.
(SEE ARTICLE)
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