The diagnosis of thoracic aortic dissection by noninvasive imaging procedures: Nienaber CA, von Kodolitsch Y, Nicolas V, et al N Engl J Med 328:1–9 Jan 1993
✍ Scribed by Bryan D Goldberg
- Publisher
- Elsevier Science
- Year
- 1993
- Tongue
- English
- Weight
- 223 KB
- Volume
- 22
- Category
- Article
- ISSN
- 1097-6760
No coin nor oath required. For personal study only.
✦ Synopsis
This prospective study evaluates outcomes in pediatric foreign body ingestions relative to the site of initial health care contact. The authors challenge current recommendations for management that are based on studies that included only children seen in hospital settings. This study enrolled 244 children through three sources: selfreferred to pediatric emergency department, referred to pediatric ED after initial evaluation elsewhere, and patients reporting ingestions to private pediatricians. As seen in previous studies, coins were the most common item ingested; however, in contrast to other studies, the subjects in this study had a low incidence of developmental abnormalities or esophageal disease. Complications occurred at much higher rates in patients referred after evaluation elsewhere (63%) than in the self-referred patients (13%) 'or those reporting to private pediatricians (7%). Similarly, procedures were required more often for those patients initially evaluated elsewhere (67%) than for those selfreferred to EDs (16%) or reporting to private pediatricians (7%). The authors suggest additional studies to establish management guidelines for asymptomatic foreign body ingestions. They further recommend using studies that include nonhospital patients for establishing standards of care because hospital-based studies may reflect higher rates of procedures and complications.