Decision rules for roentgenography of children with acute ankle injuries

Article Abstract:

The use of x-rays to detect ankle fractures in children may be reduced without missing any fractures by using a new set of decision rules for x-ray. The Ottawa Ankle Rules (OAR), developed by Stiell, state that x-rays are only needed for ankle injuries if there is pain near the malleoli (bony prominences), the ankle is unable to bear weight, or there is bone tenderness at the back or tip of either malleolus. A study of 71 children with ankle injuries found that use of the OAR would have reduced the number of x-rays by 25% without missing any fractures. OAR was found to be 100% sensitive. Reductions in the number of x-rays may reduce costs and the amount of time spent by patients waiting for x-ray results.

Standards, Ankle, Ankle injuries, Fractures (Injuries), Radiography, Medical, Medical radiography

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Role of the primary care provider in expediting care of children with acute appendicitis

Article Abstract:

Contacting the child's doctor may shorten the time between hospital admission and surgery for children with appendicitis. Longer delay between symptom onset and surgery is associated with greater likelihood of a perforated appendix. Parents of 160 children with appendicitis contacted a doctor first and 99 did not. On weekends the average delay between hospital admission and surgery was 5 hours in the physician-contact group and 11 hours in the noncontact group. On weekdays the interval was 12 hours and 14 hours respectively. Thirty-nine percent of the physician-contact group had a perforated appendix versus 54% of the noncontact group.

Care and treatment, Appendicitis

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General pediatricians, pediatric subspecialists, and pediatric primary care

Article Abstract:

Many pediatric subspecialists may be acting as the primary care physician for their patients. About one-third of pediatricians have had some training in a pediatric subspecialty, such as pediatric heart disease. In a survey of 1,145 pediatricians, general pediatricians stated that subspecialists provide only 2% of the primary care in their practice, while subspecialists stated that they provided 32% of the primary care. The 98 subspecialists who provided primary care stated that subspecialists provided 74% of the primary care received by their patients.

Medicine, Pediatricians, Medical specialties

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