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283 The Preschool Child and Anaphylaxis: Knocking Down the Blocks of Epinephrine Administration
Research Forum Abstracts Table 1. Patient Variables According to Perforated Appendicitis Status Variables Mean Temperature (°C) Mean WBC (x 103 /µL) Neutrophil (x 103 /µL) Fever (≥ 38°C) Pain localized only to RLQ Guarding
283
NonPerforated 37.3
Perforated
P value
37.9
.001
14.9
17.5
<.001
11.4
14.1
.001
49/201 (24%) 149/185 (81%) 115/172 (67%)
34/79 (43%) 47/69 (68%) 61/74 (82%)
.003 .04 .014
LR + (95% CI)
LR(95% CI)
Is There a Relationship Between Age and the Number of Laboratory Tests Performed Among Pediatric Patients in the Emergency Department?
Barata IA, Bailey K, Gurr D, Lomibao A, Rosen L, Amato CS, Benjamin L, Dietrich AM, Sharieff G, Mace SE/North Shore University Hospital, Manhasset, NY; Goryeb Children’s Hospital, Morristown, NJ; Duke University Medical Center, Durham, NC; Nationwide Children’s Hospital, Columbus, OH; Rady Children’s Hospital, San Diego, CA; Cleveland Clinic, Main Campus, Cleveland, OH 1.77 (1.24,2.51) 0.85 (0.71,1.01) 1.23 (1.06,1.43)
0.75 (0.61,0.93) 1.64 (1.04,2.58) 0.53 (0.31,0.91)
The Preschool Child and Anaphylaxis: Knocking Down the Blocks of Epinephrine Administration
Foster AA, Anderson JL, Campbell RL/Mayo Clinic, Rochester, MN
Study Objectives: Food allergy and anaphylaxis are an increasing problem in the preschool population. Epinephrine administered immediately after an allergen exposure can be life saving. Children with pre-identified allergies and an epinephrine auto-injector prescription may spend many of their waking hours in the school setting. Therefore, the care provider comfort level, ease of access to epinephrine, and knowledge about auto-injector administration are important for prompt management of anaphylaxis. While previous literature recommends anaphylaxis education be provided to all preschool staff, little is known about the efficacy of auto-injector training and staff ability to recognize and manage anaphylaxis within the school environment. We prospectively surveyed preschool employees about recognition and appropriate management of an anaphylactic reaction, and provided an educational session to all participating centers. Methods: Twenty-four preschool and daycare centers in Rochester, MN were contacted and asked to participate in a study including an initial anonymous survey completed by preschool staff, a 30-minute seminar reviewing recognition and management of anaphylaxis and a brief practice session with an auto-injector trainer. Staff included: director, teacher, assistant, teaching aide, and homevisitor. All staff that attended the seminar completed an immediate follow-up survey assessing familiarity and comfort with anaphylaxis presentation and management. Comparisons between features of interest were evaluated using Spearman rank correlation coefficients as well as Kruskal-Wallis and Wilcoxon rank sum tests. Results: Ten of the twenty-four preschools contacted agreed to participate for a total of 171 staff that participated in the pre and post-seminar survey. Over half of the participants (89) cared for 11-19 children who were ages 6 and under. Only 4% of participants (6) had administered an epinephrine auto-injector previously. Additionally, 57% of participants (98) had received prior training on recognizing anaphylaxis with 71% (120) citing prior training in administering an epinephrine auto-injector. There was a statistically significant increase in both comfort level of recognizing anaphylaxis and administering an epinephrine autoinjector from the pre- to post-seminar questionnaire (p⬍0.001). Participants reported the most common barriers to administering an epinephrine auto-injector in the school setting as uncertainty in recognizing anaphylaxis (69%) and uncertainty of how to use an auto-injector (54%). In comparing various employment roles, there was no significant difference in questions answered. Almost all participants (99%) felt that they benefitted from the seminar with 76% (126) endorsing education annually. Conclusion: The current rise in food allergy within the pediatric population necessitates preschool faculty education regarding anaphylaxis. This study illustrates a significant increase in the comfort level of identifying anaphylaxis and administering an epinephrine auto-injector after a brief educational seminar. Improved out-ofhospital management of pediatric anaphylaxis will ultimately help to reduce morbidity and mortality associated with a delay in epinephrine treatment, and the severity of anaphylaxis managed in the hospital setting.
Volume , . : October
284
Study Objective: This study aims to evaluate if there is a correlation between the age of the child and the number of laboratory tests performed in the emergency department (ED). Studying patterns of laboratory testing on pediatric patients may help better understand factors influencing length of stay (LOS), since laboratory testing has been shown to extend ED LOS. Methods: A prospective, observational, 24-hour consecutive sample study of pediatric emergency medicine patients was conducted on November 14, 2011 at 6 U.S. emergency departments. Data was collected at 3 children’s hospitals with pediatric EDs, 2 hospitals with separate pediatric areas within their EDs, and one hospital with an integrated ED that sees both adult and pediatric patients in the same area. Demographic information, mode of arrival and insurance information were collected. The frequency of main laboratory and point-of-care testing (POCT) testing was assessed. If subjects had the same test done in both the main laboratory and POCT, the test was only counted once. The relationship between subject’s age and the number of tests was examined using Spearman’s correlation coefficient. Results: A total of 643 subjects were enrolled. The ages ranged from 0-21 years; the mean age was 7.54 (⫾ 6.12). The sample was 52.35% male. The subjects were white (36.81%), African-American (25.28%), Hispanic (22.75%), Asian (3.48%) and other/ unknown (11.58%). Most subjects arrived by private vehicle (91.63%). Other modes of arrival included advanced life support ambulances (2.21%) and basic life support ambulances (5.53%). Managed care insurance (43.23%) was the most common payment option; other options included private insurance (26.75%), Medicaid (32.97%), self-pay (5.29%) and military insurance (3.27%). The number of laboratory tests ranged from 0-15 per subject; the majority of subjects had no laboratory tests (66.87%). There were 22 subjects with the same test conducted in the main laboratory and POCT. These tests included urinalysis, D-dimer, pregnancy test (urine), rapid strep test and “other” lab tests. There was a significant correlation between the number of laboratory tests and age ( ⫽ 0.2314, P ⬍ 0.0001). As age increased, the number of laboratory tests increased. Conversely, as age decreased, the number lab tests decreased. Conclusion: In the ED, older children had more laboratory tests performed than younger children. These results suggest the need for future research to look at how acuity and chief complaint may also impact the frequency of testing as well as LOS.
285
The Epidemiology of Fractures in an Urban Pediatric Emergency Department
Hansoti B, Fenster M, Catlin T, Paik M/University of Chicago, Chicago, IL
Study Objectives: Each year, over 25% of children have injuries requiring medical attention. By age 18, almost half of all children will have fractured at least one bone. Non-accidental injury is a fatal cause of mortality in the pediatric population. By understanding the epidemiology of accidental injury one can obtain objective evidence when evaluating non-accidental injury. Few such studies on pediatric fractures in the United States exist. We aimed to characterize the fractures in a children’s emergency department in an urban hospital in Chicago. Methods: A retrospective analysis was conducted on all patients presenting to the Comer emergency department at the University of Chicago Medical Center in 2009. We filtered the charts by ICD-9 codes to include only those with injuries, such as lacerations, fractures, trauma, and dislocations. Results: In 2009, there were 661 patients presenting to the Comer emergency department with fractures. Sixty-four percent of these patients were male. When normalized by the total number of patients presenting to the ED at each age, the number of fractures was the same between boys and girls under age 11 (2 test, p⫽0.6) (figure 1). However, in children between 11 and 16 years of age, there were significantly more fractures in boys (2 test, p⬍0.001)(figure 1). The most common mechanism of injury was a fall (table 1). Patients presented with upper extremity fractures more frequently than any other location (table 2). Infants were most likely to sustain skull fractures (table 2). Conclusion: This study examines the epidemiology of pediatric fractures in an urban emergency department. Compared to previous studies in other settings, we found more skull fractures, and fractures due to motor vehicle crashs.
Annals of Emergency Medicine S101
283
NonPerforated 37.3
Perforated
P value
37.9
.001
14.9
17.5
<.001
11.4
14.1
.001
49/201 (24%) 149/185 (81%) 115/172 (67%)
34/79 (43%) 47/69 (68%) 61/74 (82%)
.003 .04 .014
LR + (95% CI)
LR(95% CI)
Is There a Relationship Between Age and the Number of Laboratory Tests Performed Among Pediatric Patients in the Emergency Department?
Barata IA, Bailey K, Gurr D, Lomibao A, Rosen L, Amato CS, Benjamin L, Dietrich AM, Sharieff G, Mace SE/North Shore University Hospital, Manhasset, NY; Goryeb Children’s Hospital, Morristown, NJ; Duke University Medical Center, Durham, NC; Nationwide Children’s Hospital, Columbus, OH; Rady Children’s Hospital, San Diego, CA; Cleveland Clinic, Main Campus, Cleveland, OH 1.77 (1.24,2.51) 0.85 (0.71,1.01) 1.23 (1.06,1.43)
0.75 (0.61,0.93) 1.64 (1.04,2.58) 0.53 (0.31,0.91)
The Preschool Child and Anaphylaxis: Knocking Down the Blocks of Epinephrine Administration
Foster AA, Anderson JL, Campbell RL/Mayo Clinic, Rochester, MN
Study Objectives: Food allergy and anaphylaxis are an increasing problem in the preschool population. Epinephrine administered immediately after an allergen exposure can be life saving. Children with pre-identified allergies and an epinephrine auto-injector prescription may spend many of their waking hours in the school setting. Therefore, the care provider comfort level, ease of access to epinephrine, and knowledge about auto-injector administration are important for prompt management of anaphylaxis. While previous literature recommends anaphylaxis education be provided to all preschool staff, little is known about the efficacy of auto-injector training and staff ability to recognize and manage anaphylaxis within the school environment. We prospectively surveyed preschool employees about recognition and appropriate management of an anaphylactic reaction, and provided an educational session to all participating centers. Methods: Twenty-four preschool and daycare centers in Rochester, MN were contacted and asked to participate in a study including an initial anonymous survey completed by preschool staff, a 30-minute seminar reviewing recognition and management of anaphylaxis and a brief practice session with an auto-injector trainer. Staff included: director, teacher, assistant, teaching aide, and homevisitor. All staff that attended the seminar completed an immediate follow-up survey assessing familiarity and comfort with anaphylaxis presentation and management. Comparisons between features of interest were evaluated using Spearman rank correlation coefficients as well as Kruskal-Wallis and Wilcoxon rank sum tests. Results: Ten of the twenty-four preschools contacted agreed to participate for a total of 171 staff that participated in the pre and post-seminar survey. Over half of the participants (89) cared for 11-19 children who were ages 6 and under. Only 4% of participants (6) had administered an epinephrine auto-injector previously. Additionally, 57% of participants (98) had received prior training on recognizing anaphylaxis with 71% (120) citing prior training in administering an epinephrine auto-injector. There was a statistically significant increase in both comfort level of recognizing anaphylaxis and administering an epinephrine autoinjector from the pre- to post-seminar questionnaire (p⬍0.001). Participants reported the most common barriers to administering an epinephrine auto-injector in the school setting as uncertainty in recognizing anaphylaxis (69%) and uncertainty of how to use an auto-injector (54%). In comparing various employment roles, there was no significant difference in questions answered. Almost all participants (99%) felt that they benefitted from the seminar with 76% (126) endorsing education annually. Conclusion: The current rise in food allergy within the pediatric population necessitates preschool faculty education regarding anaphylaxis. This study illustrates a significant increase in the comfort level of identifying anaphylaxis and administering an epinephrine auto-injector after a brief educational seminar. Improved out-ofhospital management of pediatric anaphylaxis will ultimately help to reduce morbidity and mortality associated with a delay in epinephrine treatment, and the severity of anaphylaxis managed in the hospital setting.
Volume , . : October
284
Study Objective: This study aims to evaluate if there is a correlation between the age of the child and the number of laboratory tests performed in the emergency department (ED). Studying patterns of laboratory testing on pediatric patients may help better understand factors influencing length of stay (LOS), since laboratory testing has been shown to extend ED LOS. Methods: A prospective, observational, 24-hour consecutive sample study of pediatric emergency medicine patients was conducted on November 14, 2011 at 6 U.S. emergency departments. Data was collected at 3 children’s hospitals with pediatric EDs, 2 hospitals with separate pediatric areas within their EDs, and one hospital with an integrated ED that sees both adult and pediatric patients in the same area. Demographic information, mode of arrival and insurance information were collected. The frequency of main laboratory and point-of-care testing (POCT) testing was assessed. If subjects had the same test done in both the main laboratory and POCT, the test was only counted once. The relationship between subject’s age and the number of tests was examined using Spearman’s correlation coefficient. Results: A total of 643 subjects were enrolled. The ages ranged from 0-21 years; the mean age was 7.54 (⫾ 6.12). The sample was 52.35% male. The subjects were white (36.81%), African-American (25.28%), Hispanic (22.75%), Asian (3.48%) and other/ unknown (11.58%). Most subjects arrived by private vehicle (91.63%). Other modes of arrival included advanced life support ambulances (2.21%) and basic life support ambulances (5.53%). Managed care insurance (43.23%) was the most common payment option; other options included private insurance (26.75%), Medicaid (32.97%), self-pay (5.29%) and military insurance (3.27%). The number of laboratory tests ranged from 0-15 per subject; the majority of subjects had no laboratory tests (66.87%). There were 22 subjects with the same test conducted in the main laboratory and POCT. These tests included urinalysis, D-dimer, pregnancy test (urine), rapid strep test and “other” lab tests. There was a significant correlation between the number of laboratory tests and age ( ⫽ 0.2314, P ⬍ 0.0001). As age increased, the number of laboratory tests increased. Conversely, as age decreased, the number lab tests decreased. Conclusion: In the ED, older children had more laboratory tests performed than younger children. These results suggest the need for future research to look at how acuity and chief complaint may also impact the frequency of testing as well as LOS.
285
The Epidemiology of Fractures in an Urban Pediatric Emergency Department
Hansoti B, Fenster M, Catlin T, Paik M/University of Chicago, Chicago, IL
Study Objectives: Each year, over 25% of children have injuries requiring medical attention. By age 18, almost half of all children will have fractured at least one bone. Non-accidental injury is a fatal cause of mortality in the pediatric population. By understanding the epidemiology of accidental injury one can obtain objective evidence when evaluating non-accidental injury. Few such studies on pediatric fractures in the United States exist. We aimed to characterize the fractures in a children’s emergency department in an urban hospital in Chicago. Methods: A retrospective analysis was conducted on all patients presenting to the Comer emergency department at the University of Chicago Medical Center in 2009. We filtered the charts by ICD-9 codes to include only those with injuries, such as lacerations, fractures, trauma, and dislocations. Results: In 2009, there were 661 patients presenting to the Comer emergency department with fractures. Sixty-four percent of these patients were male. When normalized by the total number of patients presenting to the ED at each age, the number of fractures was the same between boys and girls under age 11 (2 test, p⫽0.6) (figure 1). However, in children between 11 and 16 years of age, there were significantly more fractures in boys (2 test, p⬍0.001)(figure 1). The most common mechanism of injury was a fall (table 1). Patients presented with upper extremity fractures more frequently than any other location (table 2). Infants were most likely to sustain skull fractures (table 2). Conclusion: This study examines the epidemiology of pediatric fractures in an urban emergency department. Compared to previous studies in other settings, we found more skull fractures, and fractures due to motor vehicle crashs.
Annals of Emergency Medicine S101