SOFT-TISSUE SWELLING WITH FRACTURES - ABUSE VERSUS NONINTENTIONAL
PEDIATRIC EMERGENCY CARE
DOSSANTOS, L. M., Stewart, G., Meert, K., Rosenberg, N. M.
1995; 11 (4): 215-216
Abstract
The objectives were to 1) define the amount of postfracture swelling at presentation in long bone fractures, and 2) to study the relationship between suspected abuse and/or neglect (A/N) and degree of postfracture swelling at presentation. This was a prospective study of 37 patients less than 11 years of age presenting with long bone fractures to the emergency department (ED) of the Children's Hospital of Michigan between August 1992 and December 1992. Data were recorded at the time of the ED visit and from medical records which were reviewed four to six months later. Of the patients enrolled in the study, eight were categorized as A/N and 29 as nonintentional. There was no difference in reported injury age between the two groups (15.5 +/- 24.5 hours vs 14.0 +/- 17.7, P = 0.8). At presentation the mean increase in circumference from post-fracture swelling was 9.6 +/- 7.1%, using the uninjured extremity as the control. The abuse group had a lesser increase in circumference compared to the nonintentional group, even after adjusting for injury age (3.8 +/- 3.6% vs 11.2 +/- 7.0%, P < 0.006). We concluded that patients with long bone fractures had a mean swelling of 9.6 +/- 7.1% at presentation. Injuries induced by A/N present with less swelling than similar injuries sustained nonintentionally, and we speculate that this difference indicates that the history and/or time of injury may not be reliable.
View details for Web of Science ID A1995RP90600004
View details for PubMedID 8532564
Abstract
The objectives of this study were to determine reasons for leaving a pediatric emergency department before physician evaluation, any adverse outcomes of those leaving, and to assess whether the presence of an ombudsman altered the pattern. This was a prospective follow-up study of all patients who left the pediatric emergency department of the Children's Hospital of Michigan before physician evaluation between October 24, 1991 and January 30, 1992. Information was obtained from medical records and a telephone questionnaire with the parent or guardian one week later. A control group of patients (n = 150) evaluated in the same period were randomly selected for comparison and matched for triage acuity score, shift, and weekday/weekend visit. Five hundred and twelve patients left during this period. Contact was made with 82% (419). Forty-three percent of patients left only because of a long wait, and an additional 19% included a long wait as one of the reasons for leaving. There was a significantly longer waiting time for walk-outs compared with controls (188 +/- 76.4 vs 93.6 +/- 64.9 minutes, P < 0.0001). Of the 419 patients followed, 256 (61%) were seen by a physician within seven days, and seven (1.7%) were hospitalized. Three hundred one (72%) were reported to be well; 108 (26%) were better. No deaths occurred. Hospitalization rates were significantly lower for patients who left compared with patients who stayed over the same period of time (7/419 vs 1931/16,990, P < 0.0001). The presence of an ombudsman was associated with an increase in walk-outs.(ABSTRACT TRUNCATED AT 250 WORDS)
View details for Web of Science ID A1994NG67100004
View details for PubMedID 8029114
