In most institutions, the transition from curative to palliative care lacks a comprehensive, coordinated, and evidence-based approach. To learn ways of improving care at the end of life, Contro and colleagues interviewed 44 families with children who had died. Issues regarding communication about treatment or prognosis, preventable oversights in policies, and concern about the pain children suffered were recurring themes. Community hospice programs are frequently poorly prepared to serve pediatric patients. The issues identified should serve to guide the development of pediatric palliative care programs in the future.
While urinary tract infections are the most commonly identified serious bacterial infection in infants with fever younger than 3 months, it is unknown whether urine testing is done in practice in these infants. This prospective study of 573 pediatric practitioners from 219 practices in the American Academy of Pediatrics Pediatric Research in Office Settings research network collected data on 3066 infants 3 months or younger with fever. Urine was tested in 54% of infants, of whom 9.7% had urinary tract infections. Among 807 infants not initially tested or treated, only 2 had subsequent documented urinary tract infections. Selective urine testing with close follow-up was associated with few late urinary tract infections in this study of a large cohort.
A rapid, specific test for a viral infection has the potential to reduce the amount of diagnostic testing and empiric antibiotic usage and decrease hospitalization. This study determined the effect of rapid diagnosis on the clinical management of febrile infants and toddlers in a pediatric emergency department. Patients for whom the test results were available before discharge from the emergency department were less likely to undergo other diagnostic testing and less likely to receive parenteral antibiotics as compared with children for whom the test results were not available until after discharge. The study indicated that rapid viral testing should be explored as a routine emergency department procedure.
This study compared 860 students at age 13 years who had a history of Kawasaki disease, with 308 29 students without a history of disease. While there was no difference in the average height and weight of students in the 2 groups, 10% of adolescents with a history of Kawasaki disease had an abnormal electrocardiogram compared with 3.3% of students with no history. This study provides important information about the long-term consequences of the disease.
Violence-related injury is an important cause of morbidity and mortality for American children. Previous incidence estimates have relied on criminal justice information, surveys, and estimates derived from the experiences of single hospitals. This study sought to establish a city-wide surveillance to measure the incidence of violence-related injury to children. The annual incidence of violence-related injuries that required emergency department care was 52.7 per 10 000 person-years, with 59 emergency department visits and 4 hospitalizations for each violence-related death. The decline in criminal violence and homicide seemed to extend to the much more common minor injuries typically seen in pediatric emergency departments. The incidence of violence-related injuries in Boston, Mass, was 12% lower during each successive year of the 4-year study period.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2002;156(1):5. doi:10.1001/archpedi.156.1.5