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Biomedical subjects

S M Selbst

Publications and source records attributed to S M Selbst.

At least 19 recordsLinked to original sources
PubMed1992

The pediatrician as expert witness. Participation and reaction to this activity.

Little is known about the qualifications and motives of pediatricians who provide expert witness testimony. Pediatricians in Pennsylvania were surveyed anonymously to learn more about this practice. Two hundred fifty-five (49%) of 520 pediatricians responded, and 126 of these physicians had provided expert testimony at some time. Fully affiliated medical school faculty members were more likely to act as expert witnesses than were other pediatricians. Seventy-seven (61%) did so to defend a fellow physician. Only eight (6%) were listed with an organization that provides expert witnesses. Pediatricians were selective about their involvement as expert witnesses, and 96 (76%) had refused to give testimony at some time. Most were paid an hourly rate, which was in keeping with charges for medical consultation or lecturing. More than 80% of respondents were unhappy with the present system of procuring expert witnesses.

Malpractice↗
PubMed1992

Cephalexin and penicillin in the treatment of group A beta-hemolytic streptococcal throat infections.

OBJECTIVE: To determine whether cephalexin or penicillin is more effective in the treatment of group A beta-hemolytic streptococcal tonsillopharyngitis in children. DESIGN: Randomized, double-blind, crossover study conducted from 1981 to 1984. SETTING: Seven pediatric practices in the United States, including private offices and pediatric clinics. PARTICIPANTS: Of the 654 patients, 525 children and adolescents with clinical evidence of tonsillitis or pharyngitis and throat cultures positive for group A beta-hemolytic streptococcal infection were evaluable. Eighty percent of patients completed the study; none were withdrawn because of adverse reaction. SELECTION CRITERIA: Children and adolescents who had acute illness suggestive of group A beta-hemolytic streptococcal infection were enrolled in the study. Treatment was continued if the throat culture was positive for group A beta-hemolytic streptococcal infection. INTERVENTIONS: Four doses of cephalexin and penicillin (27 mg/kg per day) were prescribed to be taken on an empty stomach for 10 days. MEASUREMENTS/MAIN RESULTS: Symptomatic clinical failure occurred in 8% of penicillin-treated patients and in 3% of cephalexin-treated patients. Bacteriologic failure rates were 11% in the penicillin treatment group and 7% in the cephalexin treatment group. The combined treatment failure rate of clinical relapse plus asymptomatic bacteriologic failure was 19% in the penicillin treatment group and 10% in the cephalexin treatment group. Paired antistreptolysin-O titer increased significantly in 62.3% of penicillin-treated patients and in 64.2% of cephalexin-treated patients. Similarly, anti-DNase B titers rose 52.2% in penicillin-treated patients and 52.4% in cephalexin-treated patients. CONCLUSION: Cephalexin is a more effective drug than penicillin in the treatment of group A beta-hemolytic streptococcal throat infection in children.

Adolescent↗
PubMed1992

Interfacing with police in the pediatric emergency department.

In summary, ED staff and local police departments should make a concerted effort to work together. The ED director should develop management protocols in conjunction with local police chiefs to plan strategies in advance. It is helpful to provide "orientation sessions," so that each group of professionals knows what to expect of the other. It may also be helpful to arrange tours of the ED so that police know where to go when they are called to the ED. All of these efforts should foster better care of children in the ED and will reduce tensions between the dedicated groups who work with such children.

Adolescent↗
PubMed1992

Blood lead levels in children with foreign bodies.

To determine the risk of increased blood lead levels in children with aural, nasal, or gastrointestinal foreign bodies, the authors prospectively obtained venous blood lead and erythrocyte protoporphyrin levels from 40 study patients and two control groups without foreign bodies (65 patients presenting to a medical clinic and 40 patients presenting to an emergency department). A questionnaire was used to assess environmental and behavioral risk factors for lead poisoning in the three groups. Mean blood lead level was higher in children with foreign bodies (P less than .001), and they were more likely to have a venous blood lead value of more than 1.2 mumol/L (25 micrograms/dL, P less than .01) than patients in either control group. Seventy-eight percent of study patients had no prior lead screening by parent's report vs 64% of emergency department control subjects and 55% of medical clinic control subjects. Control patients in the emergency department had the same incidence of elevated blood lead values as patients enrolled from the medical clinic (6%). No differences in environmental risk factors were found among the three groups. Study patients more often had a history of pica or ingestion of a poison than control patients from the medical clinic. Inner-city children with foreign bodies have increased lead exposure and may have an increased risk for lead poisoning. In areas of high prevalence of lead poisoning, children with foreign bodies should be screened for lead poisoning in the emergency department. General lead screening in the emergency department may be justified for high-risk, inner-city populations.

Child, Preschool↗
PubMed1991

Factors affecting outcome in meningococcal infections.

A prognostic score for evaluating meningococcal infections in patients consists of the following five features that indicate a poor prognosis: onset of petechiae within 12 hours of presentation; shock; normal or low peripheral leukocyte count; normal or low erythrocyte sedimentation rate; and absence of meningitis. Based on our experience and some published data, we suspected that the score may no longer be reliable. We reviewed the charts of 73 children with meningococcal infection from December 19, 1979 to December 19, 1987 and applied the prognostic score mentioned previously. Our findings indicate that although a low score is generally associated with a good outcome, a higher score is less predictive of poor outcome than previously suggested. A rash with petechiae or purpura, the presence of shock, and a normal or low peripheral leukocyte count continue to be predictors of poor outcome. Erythrocyte sedimentation rate was not evaluated owing to a limited amount of data. The absence of meningitis did not correlate with a worse outcome in our patients. Most patients who died had evidence of meningeal involvement at the time of presentation. Instead, altered mental status at presentation, particularly obtundation or coma, was an ominous sign. We conclude that absence of meningitis is not a good predictor of outcome, as was previously thought. Altered mental status at the time of presentation may prove to be a stronger indicator of poor outcome.

Humans↗
PubMed1990

Three-wheeled vehicle injuries in children.

Injuries associated with nonmotorized three-wheeled vehicles were prospectively evaluated through a standard questionnaire during the summer months at the emergency department of the Children's Hospital of Philadelphia, Pa. Forty-four children, including 32 boys, with a mean age of 3.77 years, reported such injuries. Most fell (36.4%), but a second vehicle was often involved. Most children (33 of 44) were on low-slung Big Wheels. Head, neck, and dental injuries accounted for the majority. Most injuries were not serious. Two patients were admitted; both had fractures, one of them had a concussion. Data from the US Consumer Product Safety Commission corroborate the epidemiology of these injuries. Recommendations of safety precautions with non-motorized three-wheeled vehicles are reviewed.

Accidents↗
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↗