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Biomedical subjects

S M Selbst

Publications and source records attributed to S M Selbst.

At least 73 records · Page 4Linked to original sources
PubMed1990

Lacerations in urban children. A prospective 12-January study.

We prospectively investigated the epidemiologic characteristics of all lacerations (N = 2834) repaired at the Children's Hospital of Philadelphia (Pa) during 1987 and identified common hazards and possible avenues of intervention. Two-year-old children incurred most injuries; males outnumbered females 2:1. Almost two thirds (61.8%) of all lacerations occurred from May through September, and 62.2% between 3 and 9 PM. Most injuries occurred indoors (47.0%), on the sidewalk or street (22.5%), or in the residential yard (13.0%). Injuries usually occurred during play (42.3%) or daily activity (32.1%); 1247 (44.0%) involved some sort of fall. Vectors most frequently causing injury were broken glass bottles (15.0%), wooden furniture (12.0%), and asphalt or concrete (11.0%). Broken glass bottles also most frequently inflicted injuries resulting in functional impairment (0.2%), hospitalization (0.9%), or both. Complications were seen in 8% of all lacerations. Our data confirm the importance of injury-prevention strategies aimed at reduction of discarded glass objects (ie, recycling legislation), improved furniture design, and improved municipal services (ie, street repair).

Adolescent↗
PubMed1990

Bunk bed injuries.

Bunk beds are commonly used in American households, yet to our knowledge, no studies have been done to determine if they are safe. We prospectively studied the incidence, epidemiology, and outcome of injuries related to bunk beds. We interviewed all patients with such injuries who presented to the emergency department between February 1987 and February 1988. A control group of children who use bunk beds but who came to the emergency department for another reason were also interviewed. There were 68 injured children and 54 controls during the 1-year study period. There were 47 injured children (70% of this group) and 26 control children (48% of this group) younger than 6 years, which is below the age recommended by the Consumer Product Safety Commission for bunk bed use. Carpeted floors were significantly more common in the control group, 67% (36 children) vs 42% (26 children). Injuries occurred most often when the child fell from the top bed (38 children [58%]), fell off the ladder (7 children [11%]), or fell off the bottom bed (8 children [12%]). Injuries occurred during sleep (19 children [29%]), getting in or out of the bunk bed (13 children [20%]), or playing in or near the beds (28 children [43%]). Of those injured while asleep, 13 of 19 children were younger than 6 years. Head injuries accounted for half the trauma (35 children [52%]), and extremities were involved in 16 patients [24%]. The most common injuries were lacerations (27 children [40%]) and contusions (19 children [28%]), but 8 children (12%) had concussions and 7 children (10%) had fractures. Six children (9%) required admission to the hospital. Head and face injuries were significantly more likely if the top bed had no side rails. These data suggest injuries could be prevented if side rails were mandatory for all top beds, young children were not permitted to sleep in bunk beds, and all children were encouraged not to use the beds for play.

Accident Prevention↗
PubMed1990

Indigent children who are denied care in the emergency department.

We conducted a six-month prospective study of the diagnoses and outcomes of 588 children who were denied care in our emergency department under a new primary-care case management health system for 100,000 indigent patients. The mean patient age was 4.7 years (39% were less than 2 years old). The most common presenting complaints were colds, earaches, rash, vomiting, and diarrhea. Nine percent of children presented for trauma, and 10% had fever of more than 38.2 C. Follow-up was available from the primary care physician for 388 children (66%). Of the 60% of patients who kept their arranged appointment, 42% received antibiotics, 3% were referred for further evaluation, and two children were hospitalized. Follow-up was available from the parents for 125 children (21%). No follow-up information of any kind was available for 111 children (19%), and no follow-up regarding the health of the child was available for 265 children (45%). This last group included 10% with a chief complaint of trauma and 6% with temperature of more than 39 C. Forty-nine percent of patients in this group were less than 2 years old.

Appointments and Schedules↗
PubMed1990

Analgesic use in the emergency department.

The relief of pain is one of the most common reasons for seeking care in an emergency department. We conducted a retrospective chart review to see whether children received analgesic treatment similar to that of adults with the same acute, painful conditions. Charts of 112 pediatric patients from the Children's Hospital of Philadelphia ED and 156 patients from the Medical College of Pennsylvania ED were reviewed. Patient ages ranged from a few months to 97 years. All patients had acute pain due to sickle cell crises (20%), lower-extremity fractures (31%), or second- or third-degree burns (49%). Hospitalization was required in 15% of cases. In the ED, 60% of patients with painful conditions received no pain medication at all. When medications were given, they were usually narcotics. Children (aged 19 years or younger) were much less likely to receive pain medications than adults (P = .001). Those less than 2 years old received analgesics less often than older children (P less than .01). Senior citizens (aged 65 years or older) received analgesics as often as other adults. On discharge from the ED, 55% of all patients had no pain medications prescribed; and children were less likely than adults to receive analgesics at discharge (P less than .001). Pediatricians and emergency physicians are reluctant to use analgesics for children in pain. The data suggest that these physicians need additional education about management of acute pain.

Adolescent↗
PubMed1990

Chest pain in children. Follow-up of patients previously reported.

During a 1-year period, 407 children with chest pain were seen in the Emergency Department of Children's Hospital of Philadelphia. Analysis of the clinical data of these children was reported previously. The authors successfully followed 149 of these children for 6 months or more, and 51 for 2 years or more. These patients returned for an average of 3.4 visits during the follow-up period. Thirty-four percent of the initial diagnoses were altered. Usually, during the follow-up period, the authors concluded that chest pain resulted from nonorganic causes. A new organic etiology was uncovered in only 12 of 149 cases. Only 1 child was found to have a heart abnormality (mitral valve prolapse), and 3 were found to have asthma. Chest pain did not resolve during the follow-up period in 43 percent of those followed. Children with chest pain should have follow-up care because of the persistence of symptoms, but serious disease is unlikely to be found over time.

Adolescent↗
PubMed1990

Chest pain in children.

Although chest pain in children is usually not due to serious organic pathology, its association with heart disease is a source of concern for patients and their families. Most cases of pediatric chest pain are of unknown etiology. Common diagnoses include musculoskeletal disorders, cough, costochondritis, psychogenic disturbance and asthma. A thorough history and a careful physical examination will determine the diagnosis in most children.

Bone Diseases↗
PubMed1989

The treatment of pain in the emergency department.

Our approach to the management of fear and pain in the pediatric emergency department is presented. Tricks to attempt the gaining of rapport with frightened children in pain are noted, with emphasis on a developmental approach. The use of analgesic medications, local anesthetics, ketamine, and nitrous oxide as appropriate to emergency situations is outlined. Lastly, the guidelines of the American Academy of Pediatrics for outpatient sedation are reviewed.

Analgesics↗
PubMed1989

Managing pain in the pediatric emergency department.

In summary, it is common to encounter children in pain in the pediatric ED. It is often impossible to avoid inflicting pain on some children in the ED. The proper management of this pain is thus essential. This management should be accomplished with a variety of narcotic and nonnarcotic analgesics, as well as local and topical anesthetics. Other agents such as nitrous oxide, and techniques such as hypnosis and transcutaneous nerve stimulation, have a more limited role in pain management. Gentle restraint and reassurance are of paramount importance.

Child↗
PubMed1988

Medical/legal issues in prehospital pediatric emergency care.

In summary, paramedics face many hazards in delivering emergency care to children in the field. They must be aware of many legal issues in order to avoid litigation proceedings. They must know when to deliver care and when to withhold it, and they must, of course, know how to properly administer care to children. Better training and more pediatric equipment will certainly help reduce problems here. Finally, paramedics must carefully document their actions.

Allied Health Personnel↗
PubMed1988

Vulvar hemangioma simulating child abuse.

An infant with a vulvar hemangioma that had undergone extensive ulcerative changes was initially diagnosed as having a perineal burn secondary to child abuse. Although genital burns are a well-recognized manifestation of child abuse, knowledge of the natural course of untreated hemangiomas and the uncommon complication of ulceration as well as familiarity with the characteristic patterns of abusive burn injuries may allow the physician to avoid making this misdiagnosis. The confusion in diagnosis led to an extensive social service investigation that, in this case, had a positive outcome for the mother's ability to cope. There exists, however, the possibility of iatrogenic-induced emotional stress if child abuse is misdiagnosed.

Burns↗
PubMed1988

Thermal epiglottitis after swallowing hot beverages.

Two young children who sustained thermal injuries to the epiglottis (or "thermal epiglottitis") after swallowing hot beverages are reported. Findings, clinically and radiologically, in both children were similar to acute infectious epiglottitis. Children with these injuries are at risk for significant upper airway obstruction which may progress for several hours. Children in whom thermal epiglottitis is suspected should be approached with the same caution and preparedness for emergency airway management and pediatric intensive care afforded those with acute infectious epiglottitis.

Beverages↗
PubMed1988

Pediatric chest pain: a prospective study.

Previous studies of childhood chest pain have been retrospective or considered only limited age groups or referred patients. In this study, all children who were admitted to the emergency department with chest pain were evaluated prospectively. Patients with ill-defined chest pain had ECGs and echocardiograms performed. A total of 407 children were evaluated. The most common causes of the pain were idiopathic (21%) and musculoskeletal (15%). Cardiac problems were found in 4%. Chest pain was acute (of less than 48 hours' duration) in 43% and chronic (of greater than 6 months' duration) in 7%. Pain caused 30% of children to stay out of school and 31% to awaken from sleep. Chest wall tenderness was the most common abnormality. ECGs were obtained in 47%; results of 31/191 were abnormal but only 4/191 ECG abnormalities were related to the diagnosis. Echocardiograms were obtained in 34%; results of 17/139 were abnormal (12/139 showed mitral valve prolapse). Young children are more likely to have cardiorespiratory problems; children older than 12 years of age are more likely to have psychogenic pain. The description and location of the pain and the patient's sex are not related to the diagnosis. Nonorganic disease is related to a family history of heart disease or chest pain or having chronic pain. Organic disease is related to pain of acute onset, abnormal physical examination results, pain that awakens the child from sleep, and the presence of fever. Laboratory tests are rarely helpful in evaluating children with chest pain. Chest pain in children is usually benign. Psychogenic pain and idiopathic pain are less common than previously believed.

Acute Disease↗
PubMed1987

Bicycle-related injuries.

To obtain epidemiologic data and information on the probable causes and severity of bicycle-related injuries, we interviewed all patients with such trauma. Between April 1 and Oct 1, 1983, 520 children presented to the Emergency Department of The Children's Hospital of Philadelphia with trauma related to two-wheeled nonmotorized bicycles. The ages of the patients ranged from 1 to 18 years (mean, 8.7 years), and most (72%) were males. Most accidents (84%) occurred less than five blocks from home, and 49% occurred in the street. Thirty-six percent of the patients admitted to stunt riding or going too fast when the accident occurred, and 36% claimed there was a problem with the surface on which they were riding. The accidents occurred when a patient lost control of the bike (45%), a patient on a bicycle was hit by a car (17%), or a pedestrian was hit by a bicyclist (10%). Only three patients were wearing protective equipment at the time of the accident. Most (54%) had received no specific safety instructions about bicycling. The extremities were injured in 53% of the accidents, but head and neck injuries accounted for 31%. Six percent required hospital admission. Males and children over 12 years of age were more likely to have multiple injuries. Accidents that occurred in the street or involved cars were associated with a greater number of serious and multiple injuries. The infrequent use of protective equipment and minimal safety instructions received by the patients in this study suggest that many bicycle-related injuries are preventable. Education of parents and children is recommended to improve bicycle safety.

Accident Prevention↗