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Biomedical subjects

J R Avner

Publications and source records attributed to J R Avner.

10 recordsLinked to original sources
PubMed1992

Lacerations involving glass. The role of routine roentgenograms.

OBJECTIVE: To determine, when evaluating a laceration caused by glass, whether seeing that the bottom of the wound is free of glass eliminates the possibility that glass is present in the wound. RESEARCH DESIGN: Prospective patient series. SETTING: Two pediatric emergency departments. PARTICIPANTS: 226 children with lacerations due to glass occurring in a period of 21 months. SELECTION PROCEDURES: Consecutive sample. INTERVENTIONS: Before obtaining a roentgenogram, the triage nurse or the managing physician visually inspected each wound and recorded whether the bottom of the wound was seen, if glass was seen in the wound, and the length and depth of the wound. Further treatment of the wound was at the discretion of the managing physician. MEASUREMENTS/MAIN RESULTS: Glass was seen in the wounds of 10 children on initial inspection. Of the remaining 216 injuries, glass was contained in 12 (21.4%) of the 56 lacerations when the bottom of the wound was not visualized, and in 11 (6.9%) of the 160 lacerations when the bottom of the wound was visualized. There was a significant association between the depth of the wound and an inability to see the bottom of the wound, and deeper wounds were significantly more likely to contain glass. All but one of the lacerations containing glass had a depth of at least 0.5 cm. CONCLUSIONS: In the population studied, seeing that the bottom of the laceration was free of glass reduced, but did not eliminate, the possibility that glass was present in the wound. In addition, superficial lacerations (less than 0.5 cm) rarely contained undetected glass fragments. We recommended that further investigation concerning the mechanism of injury, the depth of the wound, and the type of glass involved is needed before physicians abandon routine roentgenography for lacerations due to glass.

Child↗
PubMed1992

Follow-up of patients with occult bacteremia in pediatric emergency departments.

Blood cultures are frequently obtained in pediatric emergency departments (EDs) from febrile young children at risk for bacteremia and subsequent development of serious bacterial infections. This study of 105 children with occult bacteremia treated in two large urban pediatric EDs describes the follow-up of these patients and the impact that positive blood culture results have on the detection of serious illness. Seventy-seven percent of patients had a follow-up visit in the ED, 8% had follow-up by telephone alone, and 15% were not contacted. Of the patients who returned to the ED, 49% did so because they were notified of the positive blood culture result. The mean time interval for these patients from registration at the initial visit to report of positive blood culture result was 30.0 hours and, from registration at the initial visit to follow-up visit, was 42.7 hours. Thirty-seven percent of those who returned did so because a follow-up visit was scheduled at the initial encounter, and 13% returned because of persistent illness. Ten children (9.6%), five of whom had been notified of the positive blood culture, returned with serious illnesses. Patients whose diagnosis of serious illness was facilitated by blood culture results had shorter delay in identifying cultures as positive than did patients notified of positive results who did not develop serious illness (16.2 vs 31.6 hours; P < 0.05). The delay in follow-up of children with occult bacteremia limits the usefulness of blood cultures in the early detection of serious illness.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteremia↗
PubMed1991

Daddy, MD.

Explore the source record for details and available documents.

Attitude of Health Personnel↗
PubMed1991

Dog bites in urban children.

As a result of a perceived increase in pit bull injuries, all children who presented to The Children's Hospital of Philadelphia during 1989 for evaluation of dog bite injuries were prospectively studied. Epidemiologic information was collected from parents, either at the time of visit or by phone on the following day. A total of 168 children were enrolled; the mean age was 8 years. Males outnumbered females 1.5:1. Most (61%) injuries occurred in or around the home and involved dogs known to the patient (77%). Types of injuries included abrasions (33%), punctures (29%), and lacerations (38%). Thirteen bites had associated complications; nine developed infection. Twelve (7%) children required admission to the hospital. More than 12 different purebreeds or cross-breeds were identified as perpetrators, including German shepherds (n = 35), pit bulls (n = 33), rottweilers (n = 9), and Dobermans (n = 7). Most (54%) animals were contained (ie, leashed, fenced, in-house) at the time of injury. Fewer (46%) were provoked prior to biting. Significantly more pit bull injuries (94% vs 43%, P less than .001) were the consequence of unprovoked attacks and involved freely roaming animals (67% vs 41%, P less than .01). Children aged 5 or younger were more likely to provoke animals prior to injury than were older children (69% vs 36%, P less than .001). It is recommended that families with young children be the target of pet safety education and that measures be sought that would lead to early identification of a potentially dangerous dog and restrict ownership.

Age Factors↗
PubMed1990

Acquired methemoglobinemia. The relationship of cause to course of illness.

To better characterize methemoglobinemia in children, we reviewed the charts of 17 patients who were admitted to a children's hospital over the last 10 years. Two distinct groups were identified: (1) The endogenous group (n = 9) included patients with methemoglobinemia associated with an intercurrent illness. (2) The exogenous group (n = 8) included patients with methemoglobinemia secondary to drug exposure. Despite similar initial methemoglobin levels in the endogenous (mean, 29%) and exogenous (mean, 28%) groups, children in the endogenous group had more acidosis (serum bicarbonate levels of 5.9 vs 19.1 mmol/L and arterial pH of 7.01 vs 7.35). All the children in the exogenous group with methemoglobinemia secondary to an accidental ingestion stayed only 1 day in the hospital, while children in the endogenous group were admitted for an average of 19 days. Children with methemoglobinemia secondary to a drug exposure have a more benign illness with a shorter duration than children with methemoglobinemia associated with an intercurrent illness. It appears that the absolute level of methemoglobin is not as important as the underlying cause in determining both the course and severity of illness.

Bicarbonates↗
PubMed1990

Failure of infant observation scales in detecting serious illness in febrile, 4- to 8-week-old infants.

All infants aged 29 to 56 days with rectal temperatures in excess of 38.2 degrees C who presented to the Emergency Department of The Children's Hospital of Philadelphia from July 1987 through July 1988 were studied. Each infant was scored (1 to 5) on each of the six items in the Yale Observation Scale by an Emergency Department attending physician before history and physical examination. Individual scores were then added to yield a total score for each patient. An observation score of 10 or less was indicative of a generally well-appearing child, and a score of 16 or more represented an ill-appearing child. Of 126 infants enrolled, 37 (29%) had serious illness; 12 (9.5%) had culture-proven bacterial disease. Of all infants with an observation score less than or equal to 10 (n = 91), 22% had serious illness, and of all infants with an observation score greater than or equal to 16 (n = 20), only 45% had serious illness. The findings suggest that even in experienced hands, the Yale Observation Scale alone does not provide sufficient data to identify serious illness in febrile, 1- to 2-month-old infants.

Bacterial Infections↗