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C Walsh-Kelly

Publications and source records attributed to C Walsh-Kelly.

13 recordsLinked to original sources
PubMed2001

Feasibility survey for a study on selective antibiotic management of acute otitis media.

OBJECTIVE: To assess the views of community physicians on management of acute otitis media (AOM) without antibiotics and their willingness to support research on this issue. METHODS: Community physicians who admit to a children's hospital were surveyed using a questionnaire containing questions on current issues in AOM management and their willingness to support research on management of AOM without antibiotics. RESULTS: Fifty-two percent of the surveys were returned. All respondents report concern about antibiotic resistant bacteria. Sixty-three percent treat otitis media with effusion with antibiotics and 68% give prophylactic antibiotics for recurrent otitis media. Thirty-five percent consider management of AOM without antibiotics as a possible alternative management practice. Forty-five percent of the respondents are willing to support research in this practice and 46% need more information. CONCLUSIONS: Surveyed physicians indicate concern about antibiotic resistance and a willingness to support further research on the initial management of acute otitis media without antibiotics.

Acute Disease↗
PubMed2000

Serum neuron-specific enolase as a predictor of intracranial lesions in children with head trauma: a pilot study.

OBJECTIVE: To determine the reliability of serum neuron-specific enolase (NSE) levels in predicting intracranial lesions (ICL) in children with blunt head trauma (HT). METHODS: A prospective pilot study was conducted of patients 0 to 18 years of age presenting to a children's hospital emergency department (ED) between December 1997 and October 1998. Children presenting within 24 hours of injury who required head computed tomography (CT) were eligible. Blood samples were obtained to measure serum NSE level. Data collected included patient demographics, historical information, Glasgow Coma Scale score (GCS), physical examination, head CT results, and outcome. Patients were assigned to one of two groups based on the head CT results (PICL; presence of intracranial lesion, or NICL; no intracranial lesion). Data were analyzed using Student's t-test and chi-square. The 95% confidence interval (95% CI) was calculated when appropriate. A receiver operating characteristic curve was constructed to determine the NSE level that yielded the highest sensitivity and specificity for predicting ICL. RESULTS: Fifty patients were enrolled; 22 (45%) had abnormal head CT. No difference in demographics or mechanism of injury was observed between those with abnormal or normal CT scans. The mean GCS level was 11.9 +/- 4.2 for PICL and 13.9 +/- 2.6 for NICL (p = 0.045; 95% CI = -0.05 to -3.9). The mean NSE level was 26.7 +/- 21.4 for PICL and 17.7 +/- 7.8 for NICL (p = 0.048; 95% CI = 0.1 to 17.9). An NSE level > or = 15.3 ng/mL yielded a sensitivity of 77%, a specificity of 52%, and a negative predictive value of 74%. CONCLUSIONS: These results suggest that serum NSE may be a useful screening tool for predicting ICL in children with blunt head trauma. However, the NSE alone was neither sensitive nor specific in predicting all patients with ICL.

Adolescent↗
PubMed1992

Clinical predictors of bacterial versus aseptic meningitis in childhood.

STUDY OBJECTIVE: To assess the reliability of meningeal signs and other physical findings in predicting bacterial and aseptic meningitis at various ages. DESIGN: Children requiring lumbar puncture were evaluated prospectively for meningeal signs and other physical parameters before lumbar puncture. SETTING: Emergency department of Children's Hospital of Wisconsin. PARTICIPANTS: One hundred seventy-two children, aged 1 week to 17 years, with meningitis (53 bacterial and 119 aseptic). MEASUREMENTS AND MAIN RESULTS: Nuchal rigidity was present in 27% of infants aged 0 to 6 months with bacterial meningitis versus 95% of patients 19 months or older (P = .0001). Three percent of infants 0 to 6 months old with aseptic meningitis had nuchal rigidity versus 79% of patients 19 months or older (P = .0005). Seventy-two percent of infants 12 months of age or younger with bacterial meningitis has at least one positive meningeal sign versus 17% of infants with aseptic meningitis (P = .0001). Eighty-five percent of children older than 12 months with meningitis had at least one positive meningeal sign, 93% with bacterial meningitis, and 82% with aseptic meningitis. CONCLUSION: Despite a lack of meningeal signs, a high index of suspicion for meningitis is essential when evaluating the febrile infant 12 months of age or younger.

Adolescent↗
PubMed1991

Improved speed and accuracy of calculations with a programmable calculator in pediatric emergency scenarios.

Both mathematical and selection errors may occur when ordering drug or fluid therapy in a busy emergency department. In an attempt to improve the speed and accuracy of such calculations, we programmed a hand-held calculator to assist in drug and intravenous fluid therapy dosages and rates for three emergency situations: diabetic ketoacidosis, asthma, and asystole. Performance by 58 subjects at various levels of training was compared when using either the programmable calculator or standard materials and methods. When standard methods were used, an average of 30.6 minutes was needed to complete the three scenarios, with an accuracy of 73%; by contrast, use of programmable calculator resulted in a significant decline in time needed to calculate doses (an average of only 8.5 minutes), with an improved accuracy of 98%. The use of a programmable calculator can result in a significant improvement in both speed and accuracy of drug and fluid selection and dosage and rate calculations, regardless of the level of the subject's medical training.

Age Factors↗
PubMed1989

Prehospital pediatric endotracheal intubation performance review.

Pediatric prehospital care was reviewed over a one-year period to determine success rate, causes of unsuccessful attempts, and complications of performing endotracheal intubation. The Milwaukee County Emergency Medicine Technician-Paramedics (EMT-Ps) responded to 1467 pediatric (less than 19 years of age) patient calls. This accounted for 11% of the patients who received EMT-P care during the study period. Of the 63 patients requiring pediatric endotracheal intubation, 49 (78%) were successfully intubated. Of the 42 pulseless nonbreathing (PNB) patients, 39 (93%) were successfully Of the 21 patients judged to be in impending respiratory failure, 10 (48%) were successfully intubated. Common difficulties in intubating the PNB patient included inability to visualize the glottis and cords secondary to mucus and/or vomitus, use of inappropriately small endotracheal tubes, and accidental extubation during transport. Difficulties in intubating impending respiratory failure patients included patient resistance and seizure activity. We recommend that the EMT-P training curriculum include a review of these difficulties and that prehospital pediatric endotracheal intubation performance be monitored and reviewed with the EMT-Ps.

Adolescent↗
PubMed1989

Naphthalene-induced hemolysis in a black female toddler deficient in glucose-6-phosphate dehydrogenase.

Hemolysis following accidental ingestion of naphthalene in black females deficient in glucose-6-phosphate dehydrogenase (G-6-PD) has not been previously reported. A 20-month-old black female is presented and the literature reviewed. Although G-6-PD deficiency is X-linked, health care providers must be aware that hemolysis may occur in females who are deficient in G-6-PD after exposure to naphthalene.

Anemia, Hemolytic↗
PubMed1988

Pediatric intraosseous infusions: impact on vascular access time.

A 1-year retrospective chart review was performed to evaluate the effect of intraosseous infusions (IO) on the time required to establish vascular access in pediatric patients requiring immediate vascular access for resuscitation. Eighty-one patients were identified, including 29 pulseless and non-breathing and 52 noncardiopulmonary arrest children, who required intravenous fluids or medication for resuscitation. Comparing the results with a previous review, the IO method effectively reduced the time needed to establish vascular access in the arrested group when standard techniques failed, particularly in the child less than 2 years old. The IO method was not used effectively in the non-arrest group, as evidenced by a significantly greater mean time required to establish vascular access. There were no significant complications related to the IO procedure. Nine (50%) of the patients receiving IO fluids or medication had clinical and/or laboratory evidence that these substances reached the central circulation. Early use of IO infusion in the resuscitation is recommended for not only the arrested patient, but also the critical nonarrested patient requiring immediate vascular access.

Bone Marrow↗
PubMed1988

Pediatric sexual abuse management in a sample of children's hospitals.

Medical directors of pediatric emergency departments were surveyed by mail to determine the present role of their pediatric hospitals in general, and emergency departments in particular, in the evaluation and management of pediatric sexual assault and abuse. Seventy-four percent of the responses were from communities with an estimated yearly incidence of sexual abuse cases greater than 500. Sixty-eight percent of the communities had a designated pediatric sexual assault center. Thirty-two percent were affiliated with adult facilities and 68% with pediatric facilities. Of those hospitals responding, initial evaluation was most often performed in the emergency department in 77%. Most initial evaluations were performed by resident (PL-2 or above) level physicians (59%). The availability of non-physician professionals, eg, social workers, was felt to be always or usually adequate in 57% and occasionally, rarely, or never adequate in 43%. Estimated physician time required for evaluations averaged less than 60 minutes in 52%, 60 to 90 minutes in 32%, and greater than 90 minutes in 16%. Other patients were felt to be always or frequently compromised in 34% and occasionally compromised in another 44%. The directors rated the abilities of their respective departments to evaluate and manage these patients as excellent in 33%, good in 33%, adequate in 29%, and inadequate in 4%.

Adolescent↗
PubMed1987

Electric mixer-inflicted scalp injury: a case report and review of CPSC data.

Electric mixers present a major risk for childhood injuries. Scalp injury, although rarely encountered, results from hair entanglement in the mixer blades. Potential for serious injury and disfigurement exists. The US Consumer Product Safety Commission data indicate that most injuries inflicted by electric mixers are either minor electrical shock or traumatized fingers and hands. Constant observation is mandatory when operating an electric mixer in the presence of children.

Accidents, Home↗
PubMed1986

Pediatric emergency departments.

Pediatric emergency departments were surveyed by mail to determine the following patient and physician characteristics: census, triage classification, and staffing characteristics. The average number of patient visits per department per year was 44,615 (SD +/- 15,650). Of these, the mean percentage triaged as emergent, urgent, and nonurgent was 14.6 (SD +/- 13.4%), 35.4 (SD +/- 13.1%), and 52.2 (SD +/- 8.7%), respectively. The average number of full-time attending physicians per department was five. Fifty-nine (91%) of the physicians were pediatric board certified, and five (7.6%) were emergency medicine board certified. Academic standing, salaries, clinical research requirements, teaching responsibilities, and average patient care hours were also reviewed. From these data, suggestions for the management of patient care, teaching, and clinical research are presented.

Child↗
PubMed1986

Dysphonia: an unusual presentation of spontaneous pneumomediastinum.

Spontaneous pneumomediastinum, an unusual entity in children, is rarely associated with dysphonia. Muffling of the voice is more commonly associated with such pediatric illnesses as retropharyngeal or peritonsillar abscesses and epiglottitis. We report a 14-year-old female with spontaneous pneumomediastinum who presented to the emergency department with dysphonia as the primary complaint. Pneumomediastinum should be included in the differential diagnosis of dysphonia.

Adolescent↗