Biomedical subjects

Louis C Hampers

Publications and source records attributed to Louis C Hampers.

10 recordsLinked to original sources

PubMed2006

Febrile seizure: measuring adherence to AAP guidelines among community ED physicians.

OBJECTIVE: In 1996, the American Academy of Pediatrics published practice parameters for the acute management of febrile seizure. These guidelines emphasize the typically benign nature of the condition and discourage aggressive neurodiagnostic evaluation. The extent to which these suggestions have been adopted by general emergency medicine practitioners is unknown. We sought to describe recent patterns of the emergency department (ED) evaluation of febrile seizures with respect to these parameters. METHODS: A retrospective review of records of children between 6 month and 6 years of age diagnosed with "febrile seizure" (International Classification of Diseases, Ninth Revision, Clinical Modification 780.31) at 42 community hospital general EDs nationwide was performed. Electronic records of an ED physician billing service from October 2002 to September 2003 were used to identify relevant records. Data had been entered into a proprietary template documentation system, and all charts were reviewed by a professional coder blinded to outcomes of interest. Rates of resource utilization (including lumbar puncture, radiography, hospital admission) were noted. RESULTS: A total of 1029 charts met inclusion criteria. The overall rate of lumbar puncture was 5.2%, and variations were strongly associated with age (8.4% <18 months old vs 3.3% >18 months old). This low rate and age discrimination were consistent with the guidelines of the American Academy of Pediatrics. Although not recommended in the routine evaluation of febrile seizure, computed tomography was part of the evaluation in 11%. The overall rate of admissions or transfers was 12%. CONCLUSIONS: Six years after publication of practice parameters, the use of lumbar puncture in the evaluation of febrile seizure is uncommon and most patients are discharged home. However, the relatively frequent use of head computed tomography is inconsistent with these practice guidelines and merits further investigation.

Child↗

PubMed2005

Correction of factitious hyperkalemia in hemolyzed specimens.

BACKGROUND: Hemolysis in pediatric specimens is common due to difficult blood draws and small-bore intravenous catheters. Values of serum K+ become falsely elevated secondary to release of intracellular contents. If a reliable correction factor existed for this factitious elevation, repeat K+ measurements might be avoided. OBJECTIVE: The aim of the study was to establish a correction factor for factitiously elevated K+, using free plasma hemoglobin (p-Hgb) as a measure of in vitro hemolysis. METHODS: Twenty whole-blood specimens drawn from healthy adults via a 23-gauge needle were divided into 4 aliquots: (1) no manipulation, (2) mechanical hemolysis via a 27-gauge needle, (3) addition of potassium acetate (KAc), and (4) addition of KAc and mechanical hemolysis. KAc was added to mimic potentially significant hyperkalemia. All specimens had standard K+ and p-Hgb measurements performed. RESULTS: Nonhemolyzed and hemolyzed K+ ranged from 3.2 to 8.1 mEq/L and 3.5 to 10.0 mEq/L, respectively. A linear relationship existed between the change in K+ and p-Hgb from the nonhemolyzed to hemolyzed specimens. A correction factor for K+ of 0.00319 (95% confidence interval, 0.00290-0.00349) x p-Hgb was obtained. CONCLUSIONS: A reliable correction factor for factitious hyperkalemia in a clinically relevant range exists. By example, using the above correction factor, one can predict that the delta K+ in a specimen with 500 mg/dL of p-Hgb will be 1.6 mEq/L (range, 1.5-1.7). We suggest that when the lower bound of the predicted delta K+ results in a corrected value within the reference range, a second blood draw is unnecessary.

Adolescent↗

PubMed2005

Performance of a decision rule for radiographs of pediatric knee injuries.

Although decision rules for radiographs of pediatric knee injuries have been suggested from retrospective studies, prospective evaluations of such rules have been limited. We sought to prospectively assess the performance of a rule in children presenting with acute knee injuries. Eligible participants were children aged 3-18 years with an acute knee injury. The settings for the study were a tertiary pediatric emergency department (ED), a community hospital ED, and a pediatric urgent care center. All of the participants received standard knee radiographs. Before radiography, each patient was assessed by a pediatrician or pediatric emergency physician for presence of the following: 1) inability to bear weight, 2) inability to flex the knee to 90( degrees ), 3) presence of bony tenderness. The radiographs were interpreted by a radiologist blinded to the study; those with findings reported as consistent with acute fracture were considered positive. A total of 146 patients were enrolled (65% male, mean age 11.6 years). Of these, 15 (10.3%) had a fracture on their radiograph, 6 of which were related to trampoline use. Seventy-seven (53%) were negative for criterion 1 (i.e., able to bear weight immediately after the accident and in the ED), none (0%) of whom had fractures. The negative predictive value of this criterion was 1.0 (95% CI 0.94-1.0). The positive predictive value was 0.22 (95% CI 0.13-0.34). The sensitivity was 1.0 (95% CI 0.82-1.0). The specificity was 0.59 (95% CI 0.50-0.67). Three patients negative for criterion 3 were found to have fractures. The proximal tibia was the most common fracture site (47%). In conclusion, assessment of the ability to bear weight would have decreased the use of radiography by 53% without missing any fractures in our study population. No additional value to the rule was found by adding assessment of the ability to flex the knee or bony tenderness.

Adolescent↗

PubMed2004

Cecal retention of a swallowed penny mimicking appendicitis in a healthy 2 year old.

Toddlers commonly ingest coins. Studies of the evaluation and management of such ingestions have focused on the risk of complications from impaction in the esophagus. It is commonly assumed that coins that have passed through the esophagus present little or no risk for distal complications. We present the first report of cecal retention of a penny in a previously healthy 2 year old, ultimately resulting in surgical intervention.

Abdominal Pain↗

PubMed2003

Physician variation in test ordering in the management of gastroenteritis in children.

OBJECTIVES: To describe the variation among physicians in test ordering when caring for children with gastroenteritis and to explore the effect of hospital charge information on such variation. DESIGN: Prospective, nonmasked, observational study and controlled trial of price information. SETTING: Urban, university-affiliated pediatric emergency department. PARTICIPANTS: Pediatric emergency medicine faculty (n = 10) and fellows (n = 5). METHODS: Test-ordering practices were reviewed during 3 periods: control, intervention, and washout. During the intervention period, test charge information was placed on patients' emergency department records. Telephone contact with families was initiated 7 days after care. RESULTS: We included 3198 visits. Individual physician mean test charges varied more than 2-fold during the control period (mean, 127 US dollars; range, 82 US dollars-185 US dollars). Based on their test charges (control period), physicians were assigned to the "high" (n = 8) or "low" (n = 7) test user group. Differences in mean charges in high vs low test users during the control period (144 US dollars vs 112 US dollars) persisted in the intervention period (80 US dollars vs 52 US dollars; Mann-Whitney P =.01), as did rates of intravenous fluid use (20% vs 14% in both periods). Among the lowest-acuity patients, low test users exhibited greater price sensitivity (vs high users). Patients treated by low test users did not differ in improved condition (82% vs 86%) or family satisfaction (93% vs 92%); they had more unscheduled follow-up (25% vs 17%; P<.01), but were no more often admitted (5% vs 3%; P =.11). CONCLUSIONS: Physicians varied in resource use when treating children with gastroenteritis. High and low test users were sensitive to price information. This intervention did not seem to compromise patient outcome.

Child↗

PubMed2003

The truth about language barriers: one residency program's experience.

OBJECTIVE: To describe perceptions of how a lack of house staff Spanish proficiency adversely affects communication with Spanish-speaking families with limited English proficiency (LEP). METHODS: An anonymous, structured questionnaire was administered to the house staff an of urban, university-affiliated children's hospital that serves a population in which 10%-20% have LEP. RESULTS: Ninety-four percent (59 of 63) completed the questionnaire. Sixty-eight percent (40 of 59) reported that they spoke little or no Spanish (although 36 of 40 expressed a desire to learn Spanish). Fifty-three percent (21 of 40) of these nonproficient residents reported that they used their inadequate language skills in the care of patients "often" or "every day." Many of these residents believed that LEP families under their care "never" or only "sometimes" understood their child's diagnosis (21 of 40), medications (11 of 40), discharge instructions (17 of 40), or follow-up plan (16 of 40). Eighty percent (32 of 40) admitted to avoiding communication with such families. Although all (40 of 40) agreed that hospital interpreters were effective, 30 of 40 nonproficient residents reported use of hospital interpreters "never" or only "sometimes." Fifty-three percent (21 of 40) of these nonproficient residents reported calling on their proficient colleagues "often" or "every day" for assistance. Thirty-two percent (19 of 59) of residents described themselves as "fluent" or "proficient" in Spanish. Fifty-eight percent (11 of 19) reported that they were asked to interpret for fellow residents "often" or "every day." Proficient residents estimated that they spent a mean of 2.3 hours per week interpreting for other residents. CONCLUSIONS: Despite a perception that they are providing suboptimal communication, nonproficient residents rarely use professional interpreters. Instead, they tend to rely on their own inadequate language skills, impose on their proficient colleagues, or avoid communication with Spanish-speaking families with LEP.

Adolescent↗

PubMed2002

Professional interpreters and bilingual physicians in a pediatric emergency department: effect on resource utilization.

OBJECTIVE: To determine the impact of interpreters and bilingual physicians on emergency department (ED) resource utilization. DESIGN: Cohorts defined by language concordance and interpreter use were prospectively studied preceding and following the availability of dedicated, professional medical interpreters. SETTING: Pediatric ED in Chicago, Ill. PARTICIPANTS: We examined 4146 visits of children (aged 2 months to 10 years) with a presenting temperature of 38.5 degrees C or higher or a complaint of vomiting or diarrhea; 550 families did not speak English. In 170 cases, the treating physician was bilingual. In 239, a professional interpreter was used. In the remaining 141, a professional medical interpreter was unavailable. MAIN OUTCOME MEASURES: Incidence and costs of diagnostic testing, admission rate, use of intravenous hydration, and length of ED visit. RESULTS: Regression models incorporated clinical and demographic factors. Compared with the English-speaking cohort, non-English-speaking cases with bilingual physicians had similar rates of resource utilization. Cases with an interpreter showed no difference in test costs, were least likely to be tested (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.56-0.97), more likely to be admitted (OR, 1.7; 95% CI, 1.1-2.8), and no more likely to receive intravenous fluids, but had longer lengths of visit (+16 minutes; 95% CI, 6.2-26 minutes). The barrier cohort without a professional interpreter had a higher incidence (OR, 1.5; 95% CI, 1.04-2.2) and cost (+$5.78; 95% CI, $0.24-$11.21) for testing and was most likely to be admitted (OR, 2.6; 95% CI, 1.4-4.5) and to receive intravenous hydration (OR, 2.2; 95% CI, 1.2-4.3), but showed no difference in length of visit. CONCLUSION: Decision making was most cautious and expensive when non-English-speaking cases were treated in the absence of a bilingual physician or professional interpreter.

Chicago↗

PubMed2002

Teaching Spanish to pediatric emergency physicians: effects on patient satisfaction.

BACKGROUND: Language barriers are known to negatively affect patient satisfaction. OBJECTIVE: To determine whether a course of instruction in medical Spanish for pediatric emergency department (ED) physicians is associated with an increase in satisfaction for Spanish-speaking-only families. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION: Nine pediatric ED physicians completed a 10-week medical Spanish course. Mock clinical scenarios and testing were used to establish an improvement in each physician's ability to communicate with Spanish-speaking-only families. Before (preintervention period) and after (postintervention period) the course, Spanish-speaking-only families cared for by these physicians completed satisfaction questionnaires. Professional interpreters were equally available during both the preintervention and postintervention periods. MAIN OUTCOME MEASURES: Responses to patient family satisfaction questionnaires. RESULTS: A total of 143 Spanish-speaking-only families completed satisfaction questionnaires. Preintervention (n = 85) and postintervention (n = 58) cohorts did not differ significantly in age, vital signs, length of ED visit, discharge diagnosis, or self-reported English proficiency. Physicians used a professional interpreter less often in the postintervention period (odds ratio [OR], 0.34; 95% confidence interval [CI], 0.16-0.71). Postintervention families were significantly more likely to strongly agree that "the physician was concerned about my child" (OR, 2.1; 95% CI, 1.0-4.2), "made me feel comfortable" (OR, 2.6; 95% CI, 1.1-4.4), "was respectful" (OR, 3.0; 95% CI, 1.4-6.5), and "listened to what I said" (OR, 2.9; 95% CI, 1.4-5.9). CONCLUSIONS: A 10-week medical Spanish course for pediatric ED physicians was associated with decreased interpreter use and increased family satisfaction.

Adult↗

PubMed2002

Practice variation in the emergency management of croup.

OBJECTIVE: To explore the effect of physician training background on the emergency management of croup. METHODS: Two community hospitals with a general emergency department (ED) staffed by board-certified emergency medicine (EM) practitioners were the setting for this study. At both sites, pediatricians (PED) or pediatric emergency medicine specialists (PEM) managed acute pediatric visits during evening and weekend hours. Retrospective patient cohorts (6 months to 6 years) with a primary discharge diagnosis of croup were identified from a 1-year period. Data abstraction was performed by a registered nurse who was blinded to the study hypothesis. RESULTS: There were 229, 92, and 209 patients in the PED, PEM, and EM cohorts, respectively, reflecting the practice of 69 physicians (19 PED, 12 PEM, and 38 EM). The groups had similar rates of admission and prescription of steroids at discharge. In regression models that incorporated all recorded clinical variables, EM patients were more likely to have received a chest radiograph (odds ratio [OR]: 6.6; 95% confidence interval [CI]: 3.1--14), racemic epinephrine (OR: 6.5; 95% CI: 3.1--14), albuterol in the ED (OR: 3.0; 95% CI: 1.4--6.4), and parenteral steroids (OR: 3.6; 95% CI: 2.1--6.3) and were less likely to have received oral steroids (OR: 0.41; 95% CI: 0.26--0.64). For the EM cohort, adjusted mean length of ED visit was 40 minutes longer (95% CI: 6.8--72) and mean direct costs were $90 higher (95% CI: $27--$153). Regression models comparing the PEM and PED cohorts revealed no significant management differences. CONCLUSION: Compared with physicians with a pediatric background, rates of resource utilization were higher for EM-trained physicians who managed uncomplicated cases of croup.

Child↗

PubMed2002

Regional after-hours urgent care provided by a tertiary children's hospital.

BACKGROUND: Ambulatory presentation to a tertiary pediatric emergency department (ED) is not convenient for many families. Yet many primary care pediatricians (PCPs) desire after-hours urgent care for their patients as an alternative to extended office hours or care by general emergency medicine providers at community hospitals. OBJECTIVE: To describe a regional, community-based pediatric urgent care network (PUCN). METHODS: The PUCN consists of 4 models: 1) pediatric emergency medicine faculty in a community hospital ED; 2) general pediatricians in a community hospital ED; 3) general pediatricians in a freestanding urgent care center; and 4) general pediatricians in a community hospital-based urgent care center. Physician staffing at all 4 sites is managed by our tertiary children's hospital. Billing records were reviewed and a questionnaire was mailed to 55 PCP practices in our metro area. RESULTS: Year 2001 visits totaled 37 143. Minor trauma, ear complaints, and viral illnesses accounted for 70% of visits. Current Procedural Terminology codes for visits, reflecting complexity levels 1, 2, 3, 4, and 5 were billed at the following frequency: 1%, 35%, 44%, 17% and 3%, respectively. A total of 2.2% of visits required admission or transfer. Mean collection rates ranged from 37% to 68% across the 4 sites. Break-even average hourly patient volumes ranged from 1.1 (site 4) to 1.9 (sites 1 and 3). A total of 110 PCPs, representing all 55 practices, responded to the questionnaire: 81% reported their patients used the PUCN often, 85% felt that communication between the PUCN and their practice was good, and 99% reported overall satisfaction with the network. CONCLUSIONS: The PUCN effectively addresses the needs of regional PCPs; however, the cost-effectiveness of such a program depends on billing practices, local collection rates, and site-specific staffing patterns.

After-Hours Care↗