To describe the current emergency department (ED) wait times and treatment characteristics of children with radial head subluxation (RHS).

We performed a 2-year retrospective medical record review (April 1, 2004, to March 31, 2006) of all children who presented to our tertiary care pediatric ED with a discharge diagnosis of RHS, pulled elbow, dislocated elbow or nursemaid's elbow.

We identified 501 cases of RHS in 427 children over a 2-year period. The mean age was 2.4 years (range 22 d–9.7 yr) and the injury was caused by a pull in 314 (62.8%) cases, a fall in 91 (18.2%) cases and a twist in 20 (4.0%) of the cases. The median time from triage to physician assessment was 1.3 hours, with 112 (23.5%) patients waiting > 2 hours and 33 (6.9%) waiting > 3 hours. The median time from triage to ED discharge was 1.7 hours, with 193 (41.2%) staying > 2 hours, 85 (18.1%) staying > 3 hours and 30 (6.4%) staying > 4 hours. Overall, 490 (99.2%) of these injuries were reduced in the ED: 98 (19.8%) were reduced prior to physician assessment and 309 (89.6%) were reduced on the first attempt. The technique used was pronation in 138 (52.7%), supination in 100 (38.2%), and pronation and supination in 24 (9.2%) cases.

This large cohort indicates that children with RHS often have long ED waits before reduction and discharge. The majority of children with RHS are treated successfully with 1 reduction attempt. The data from this study will be used in planning a prospective study to shorten ED visits for patients with RHS.

To identify the level of consensus among a group of Canadian emergency department (ED) experts on the importance of a set of indicators to document ED overcrowding.

A 2-round Delphi survey was conducted from February 2005 to April 2005, with a multi-disciplinary group of 38 Canadian experts in various aspects of ED operations who rated the relevance of 36 measures and ranked their relative importance as indicators of ED overcrowding.

The response rates for the first and second rounds were 84% and 87%, respectively. The most important indicator identified by the experts was the percentage of the ED occupied by in-patients (mean on a 7-point Likert-type scale 6.53, standard deviation [SD] 0.80). The other 9 indicators, in order of the importance attributed, were the total number of ED patients (mean 6.35, SD 0.75), the total time in the ED (mean 6.16, SD 1.04), the percentage of time that the ED was at or above capacity (mean 6.16, SD 1.08), the overall bed occupancy (mean 6.19, SD 0.93), the time from bed request to bed assignment (mean 6.06, SD 1.08), the time from triage to care (mean 5.84, SD 1.08) the physician satisfaction (mean 5.84, SD 1.22), the time from bed availability to ward transfer (mean 5.53, SD 1.72) and the number of staffed acute care beds (mean 5.53, SD 1.57).

Ten clinically important measures were prioritized by the participants as relevant indicators of ED overcrowding. Indicators derived from consensus techniques have face validity, but their metric properties must be tested to ensure their effectiveness for identifying ED overcrowding in different settings.

Pneumonia is a well-known cause of acute abdominal pain in children. However, the utility of chest radiography in this setting is controversial. We sought to determine the prevalence of pneumonia in children under 12 years of age who had abdominal pain and underwent abdominal radiography when visiting an emergency department (ED). We also aimed to describe the signs and symptoms of children diagnosed with pneumonia in this context.

We conducted a retrospective analysis of electronic data from ED visits to a tertiary care centre by children 12 years of age and under who were seen between June 1, 2001, and June 30, 2003, and who underwent both an abdominal and a chest radiograph during the same visit, or an abdominal x-ray at a first visit as well as a chest x-ray in the 10 days following the initial visit.

Of 1584 visits studied, 30 cases of pneumonia were identified, for a prevalence of 1.89% (95% confidence interval 1.22%–1.56%). If chest radiography had been limited to children who presented with fever, cough and symptoms of an upper respiratory tract infection (URTI), the diagnosis of pneumonia would have been missed in only 2/1584 visits (0.13%).

Children aged 12 years and under presenting to the ED with acute abdominal pain and in whom an abdominal radiograph is requested need only undergo a chest radiograph in the presence of cough, fever or other symptoms of a URTI.

Despite the frequency of acute asthma in the emergency department (ED) and the availability of guidelines, significant practice variation exists. Asthma care maps (ACMs) may standardize treatment. This study examined the use of an ACM to determine its effects on patient management in a regional hospital.

Patients aged 2 to 65 years who presented to the ED with a primary diagnosis of acute asthma were enrolled in a prospective study that took place 5 months before (pre) and 5 months after (post) ACM implementation. Research assistants using a standardized questionnaire abstracted data through direct patient interviews and then followed up at 2 weeks with a standardized telephone interview.

Overall, 71 pre patients and 70 post patients were enrolled. Characteristics in both groups were similar. The care map was used in 100% of the cases during the post period. The mean length of stay in the ED for the pre, compared with the post period, was similar (2 h 14 min v. 2 h 25 min; p = 0.60), as were admission rates (11% v. 9%; p = 0.59). Systemic corticosteroid use was similar (62% v. 57%; p = 0.56); however, the total number of β-agonists (2 v. 4 treatments; p = 0.002) and anticholinergics (1 v. 2 treatments; p < 0.001) administered in the ED was higher during the post period. Prescriptions for oral (73% v. 60%; p = 0.15) and inhaled (78% v. 78%; p = 0.98) corticosteroids at discharge remained the same. Relapse rates at follow-up were unchanged (29% v. 34%; p = 0.52).

This study provides evidence that implementation of an ACM increased acute bronchodilator use; however, prescribing preventive medications did not increase. Further research is required to evaluate other strategies to improve asthma care by emergency physicians.

La pneumonie est une cause bien connue de douleur abdominale aiguë chez les enfants. L'utilité de la radiographie pulmonaire dans ce contexte est toutefois controversée. Nous avons cherché à déterminer la prévalence de la pneumonie chez les enfants de moins de 12 ans qui souffraient de douleur abdominale et ont eu une radiographie abdominale à l'urgence. Nous voulions aussi décrire les signes et les symptômes des enfants chez lesquels on a diagnostiqué une pneumonie dans ce contexte.

Nous avons procédé à une analyse rétrospective des données électroniques tirées des visites effectuées à l'urgence d'un centre de soins tertiaires par des enfants de 12 ans et moins examinés entre le 1er juin 2001 et le 30 juin 2003 et qui ont eu une radiographie abdominale et pulmonaire au cours de la même visite, ou une radiographie abdominale au cours d'une première visite et une radiographie pulmonaire dans les 10 jours suivant la visite initiale.

Sur les 1584 visites étudiées, on a repéré 30 cas de pneumonie, ce qui représente une prévalence de 1,89 % (intervalle de confiance à 95 %, 1,22 %–1,56 %). Si on avait limité la radiographie pulmonaire aux enfants qui avaient de la fière, toussaient et présentaient des symptômes d'infection des voies respiratoires supérieures (IVRS), on aurait raté le diagnostic de pneumonie dans seulement 2 cas sur 1584 (0,13 %).

Les enfants de 12 ans et moins qui se présentent à l'urgence avec une douleur abdominale aiguë et pour lesquels on demande une radiographie abdominale n'ont besoin que d'une radiographie pulmonaire s'ils toussent, ont de la fière ou présentent d'autres symptômes d'IVRS.