Ambulatory Child Health最新文献

Objectives The goal of this study was to assess (i) whether preschool children enrolled in a hospital-based, Medicaid managed care practice had received recommended preventive screenings, including blood lead, hematocrit and tuberculosis testing, and (ii) the prevalence of positive results in these screens.

Design and methods All children between 12 and 35 months of age who had been continuously enrolled in the practice for the last 6 months of 1996 were included in the study, regardless of their visit frequency. Medical records were reviewed for the study children. The dates and results of all blood lead, hematocrit and tuberculosis tests were abstracted.

Results Eight hundred and twelve children met the study inclusion criteria. All but two of these children had a hospital medical record available for review. Six hundred and ninety of the 812 children (85.0%) had a documented blood lead test. Of those screened, more than one-quarter (190 of 690; 27.5%) had at least one result ≥ 10 μg/dL. A hematocrit result was documented for 742 of the study children (91.4%), and 377 of these children (50.8%) were anemic on at least one test (defined as a hematocrit two standard deviations below published norms). Two-thirds of study children (536) had documentation of a tuberculosis screen being performed, with two-thirds of these having a documented reading. None of the 342 children with a documented tuberclin skin test reading had a positive test.

Conclusions Screening rates were relatively high in this study group, especially when one considers that the denominator for screening rates was based on enrollment in the practice, regardless of whether or not the child had been seen. The results of these screening tests provide evidence for the high burden of lead poisoning and anemia in this low-income population.

Implications for practice This study demonstrates that it is feasible to carry out assessments based

on defined primary care responsibilities, allowing for a more population-based approach to health care in hospital-based clinics.

Objective To determine whether demographic, historical and clinical information available at the time of presentation to the pediatric emergency department (ED) can be used to predict which children with acute asthma are likely to require extended treatment (>5 hours in ED or hospital admission).

Design Concurrent cohort study.

Setting and sample Inner-city, university-based pediatric ED. Subjects were 1–18 years old (n = 181) receiving standardized asthma therapy with frequent beta-agonists and corticosteroids.

Measurement Upon ED presentation, demographic information, asthma history and seven clinical variables were assessed. Bivariate analysis and multivariable logistic regression were used to identify significant predictors of extended treatment. Positive predictive values (PPVs) for individual and combined variables were calculated.

Results Overall, 30% (54 of 181) subjects required extended treatment; 8% (15 of 181) required treatment in the ED > 5 hours and 22% (39 of 181) were admitted. All but one of the asthma severity score items were significantly associated with prolonged treatment (suprasternal indrawing, P = 0.07; all others, P < 0.05). When these items were combined into the asthma scores from which they were originally derived, PPVs for extended treatment were only 45 and 50%, respectively. These PPVs for extended treatment were no better than those for individual items, which ranged between 36 and 50%. Demographic information and prior asthma history were not associated with extended treatment.

Conclusions/implications for practice Although individual asthma severity score items and asthma severity scores assessed at ED presentation were associated with extended treatment, no variable, alone or in combination, had a clinically useful PPV. Decisions regarding observation unit admission for pediatric asthmatics should not solely be based on initial clinical assessment.