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Kenneth Yen

Publications and source records attributed to Kenneth Yen.

8 recordsLinked to original sources
PubMed2006

The kappa statistic was representative of empirically observed inter-rater agreement for physical findings.

BACKGROUND AND OBJECTIVE: To determine empirically chance agreement between different clinicians evaluating physical examination findings in children with acute abdominal pain. MATERIALS AND METHODS: Cross-sectional study of children age 3 to 18 years treated in a pediatric emergency department for acute abdominal pain. Three different examiners were provided the same historic information and asked to predict, independently and prior to examining the patient, the presence or absence of seven different clinical findings. Agreement between pairs of observers on these predicted findings was determined, and was defined as observed chance agreement. Actual examination findings were also recorded, and expected agreement due to chance was determined from the kappa statistic calculation. RESULTS: There were 68 pair of observations between two pediatric examiners, and 46 pair between pediatric and surgical examiners. Observed and expected chance agreement were very similar for six of the seven clinical findings. Agreement beyond chance for the actual exam findings was generally poor, with kappa less than 0.5 for all but one finding. CONCLUSIONS: Expected chance agreement, as calculated from the kappa statistic, is a reasonable reflection of empirically observed chance agreement between clinicians.

Abdominal Pain↗
PubMed2006

Vomiting of liquid corticosteroids in children with asthma.

BACKGROUND: Oral corticosteroids are an essential part of the management of children with acute asthma exacerbations. Vomiting is a frequently cited problem attributed to oral corticosteroids. A new formulation of prednisolone, Orapred, claims to have improved palatability that may decrease the incidence of vomiting. OBJECTIVE: To compare the incidence of vomiting and taste between patients who are given the generic preparation of prednisolone with those given Orapred. DESIGN/METHODS: A randomized, double blind clinical trial was conducted at a tertiary care children s hospital emergency department. Children age 2 to 10 years presenting with acute asthma exacerbation were eligible. Patients with allergy to prednisolone, corticosteroid use within 2 weeks, history of vomiting in the last 24 hours, requirement for vascular access, and preference for other forms of corticosteroid were excluded. Enrolled patients were randomized and given either generic prednisolone (15 mg/5 ml) or Orapred (15 mg/5 ml). In children 6 years or older, a taste score was obtained using a 5 point hedonic face scale (1 = bad to 5 = great). After the administration, patients were observed for 30 minutes for vomiting. The Mann-Whitney U test was used to compare the median taste score between the two study groups. Relative risk (RR) of vomiting was calculated. Other confidence intervals were calculated when appropriate. RESULTS: During the study period, 211 eligible children were enrolled, of whom 23 were excluded. Of the remaining 188 subjects, 96 received generic prednisolone and 92 received Orapred. All baseline characteristics were similar in both groups. In the generic prednisolone group, 17 (17.7%) children vomited compared with 5 (5.4%) in the Orapred group (RR = 3.26, 95% CI, 1.25, 8.47). Taste scores were obtained from 18 children in the generic prednisolone group and from 19 children in the Orapred group. The median taste score was 2 for the generic prednisolone group and 4 for the Orapred group (Delta = -2.0, 95% CI, -3.0, -1.0) (P = 0.0001). CONCLUSIONS: In our study population, Orapred was associated with a significant less incidence of vomiting and better taste score compared to the generic prednisolone.

Acute Disease↗
PubMed2005

Interexaminer reliability in physical examination of pediatric patients with abdominal pain.

OBJECTIVE: To test the interexaminer reliability of abdominal examinations performed by pediatric emergency medicine physicians and surgeons in an emergency department. METHODS: A prospective cross-sectional study in which 3 different types of physicians (pediatric emergency department residents, pediatric emergency department attending physicians, and pediatric surgeons in training) independently examined a convenience sample of children (aged 3-19 years) with initial complaint of abdominal pain. The interexaminer reliability of 6 components of the abdominal examination (the presence or absence of abdominal distension, abdominal tenderness to percussion, abdominal tenderness to palpation, abdominal guarding, rebound tenderness, and bowel sounds) and the clinical diagnosis of peritonitis was tested. RESULTS: Sixty-eight patients were examined by pediatric emergency department residents and pediatric emergency department attending physicians. All 3 physician types examined 46 of these 68 patients. When comparing residents and attending physicians, the components of the abdominal examination showed less than moderate chance-adjusted agreement (kappa range, -0.04 to 0.38). When comparing attending physicians and surgeons, the presence of rebound tenderness showed moderate agreement (kappa = 0.54). The rest of the components demonstrated less than moderate chance-adjusted agreement (kappa range, -0.04 to 0.34). CONCLUSIONS: The components of the abdominal examination are poorly reliable between physician types. Only the "rebound tenderness" component of the abdominal examination shows moderate agreement between the pediatric emergency department attending physicians and the surgeon. No component of the abdominal examination appears to be consistently reliable. Interexaminer agreement must be considered when developing management strategies for acute abdomen. Interventions to improve reliability should be developed.

Abdominal Pain↗
PubMed2005

The effect of in-room registration on emergency department length of stay.

STUDY OBJECTIVE: Length of stay is a measure of efficiency of delivery of care and is an important determinant of patient satisfaction in a pediatric emergency department (ED). Although length of stay is affected by many unmodifiable factors, changes in care processes may lead to improvements in throughput. Evaluating the success of such changes, however, requires an understanding of the effect of other determinants. We determine the factors associated with ED length of stay and estimate the effect of an in-room registration process on throughput time. METHODS: This was a before-and-after study at an academic pediatric ED with annual census of 45,000 visits. The study period was January 2, 2000, through December 31, 2003. In June 2003, an in-room registration process was initiated so that patients were placed directly into a room after triage, and the registration process was completed after physician evaluation. Weekly data were obtained on average length of stay and the following possible confounders: average daily ED census, hospital admissions from the ED, hospital occupancy rate, hours of physician staffing, and month of the year. An autoregressive integrated moving-average time series model was used to determine the effect of each variable on length of stay. RESULTS: Data were obtained for 209 weekly intervals during the study period; average length of stay ranged from 2.2 to 3.8 hours. All factors were highly associated with length of stay except for the number of hours of physician staffing (P =.71). The presence of in-room registration led to an estimated average decrease in length of stay of 15.0 minutes (95% confidence interval 6.3 to 33.4 minutes), or 9.3%. CONCLUSION: In-room registration leads to a statistically significant and practically meaningful improvement in total length of stay in the pediatric ED. Throughput time can be largely explained by a limited number of factors; our predictive model may facilitate the evaluation of other interventions.

Emergency Service, Hospital↗
PubMed2003

Effect of ethnicity and race on the use of pain medications in children with long bone fractures in the emergency department.

STUDY OBJECTIVES: We characterize the use of analgesics among children of different race and ethnicity who had isolated long bone fractures that were treated in emergency departments (EDs) across the United States. METHODS: According to ED survey data from the National Hospital Ambulatory Medical Care Survey for 1992 through 1998, patients younger than 19 years and visiting EDs with isolated long bone fractures were identified by International Classification of Diseases, Ninth Revision codes. Analgesic-prescribing rates were examined for children of different racial and ethnic groups. Multivariate logistic regression was used to determine the independent effect of race and ethnicity on analgesic use and on opioid use while other potential confounders were controlled. RESULTS: One thousand thirty records representing approximately 3.9 million children were identified. Seven hundred ninety-two records were of non-Hispanic white patients, 111 were of black patients, and 127 were of Hispanic white patients. No significant difference was noted among the different racial and ethnic groups for receipt of analgesic medications or of opioid analgesic medications. Children with long bone fractures who visited the ED in the South (adjusted odds ratio [OR] 1.91; 95% confidence interval [CI] 1.19 to 3.09) and the West (adjusted OR 1.78; 95% CI 1.07 to 2.96) received opioid analgesic medications more often than children in the Northeast. Children in the South also received any analgesics more often (adjusted OR 1.61; 95% CI 1.01 to 2.56). CONCLUSION: No difference in analgesic prescription or opioid analgesic prescription was found between black and Hispanic children compared with non-Hispanic white children with long bone fractures in EDs. There are, however, previously unreported regional differences in analgesic administration.

Adolescent↗