%0 Journal Article %~ Pubmed %A Hsu, Peter %A Lam, Lawrence T %A Browne, Gary %T The pulmonary index score as a clinical assessment tool for acute childhood asthma. %B Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology %D 2010 %V 105 %N 6 %P 425-9 %@ 1534-4436 %X BACKGROUND: Asthma in the pediatric population imposes a significant burden on the Australian health care system. The lack of a standardized asthma assessment tool is an area that needs to be addressed. OBJECTIVE: To validate the pulmonary index score (PIS) against the National Asthma Council Guidelines (NACG) asthma assessment. METHODS: The project was approved by The Children's Hospital at Westmead Human Research Ethics Committee. Sixty-five patients aged 1 to 12 years with acute asthma were assessed independently using both the PIS and the NACG on presentation to the emergency department. RESULTS: These results indicate that the PIS (1) has high internal consistency (Cronbach ?? = .835); (2) correlates well with the NACG, with significant differences in PIS values across different NACG severity categories; (3) predicts with good sensitivity (85% for nonmild cases and 88% for severe cases) and specificity (75% for nonmild cases and 77% for severe cases) the various categories of asthma severity according to the NACG; and (4) significantly differs between admitted (mean PIS = 8.4) and nonadmitted (mean PIS = 5.0) patients. CONCLUSION: Use of the PIS may provide an objective and standardized approach to the assessment and monitoring of asthma in children. %Z FOR Codes: 111403 %0 Journal Article %~ Pubmed %A Browne, Gary J %A Noaman, Farah %A Lam, Lawrence T %A Soundappan, S V %T The Nature and Characteristics of Abdominal Injuries Sustained During Children's Sports. %B Pediatric emergency care %D 2010 %V %N %P %@ 1535-1815 %X OBJECTIVES:: To increase the evidence base by characterizing various features of pediatric sports-related abdominal injuries. DESIGN:: A review of the trauma database at The Children's Hospital at Westmead was undertaken for all abdominal injuries presenting to the emergency department between 2001 and 2006. SETTING:: The Children's Hospital at Westmead is a tertiary-level pediatric trauma center servicing Sydney's west. It sees approximately 50,000 patients a year. PARTICIPANTS:: Only those injuries occurring during an organized sport were included for analysis. Thirty-three of the original 513 patients were eligible for inclusion. MAIN OUTCOME MEASURES:: The data collected included basic demographics, mechanism of injury, sport injury, time to presentation, length of stay, diagnoses, treatment, and complications. Injury severity scores were assigned retrospectively. RESULTS:: Males sustained more injuries than females. Collisions and falls were the most common modes of injury. Rugby was the most common sport for injury. Most patients presented within 12 hours, and most presented with musculoskeletal injuries. Injury severity was usually mild; treatment, conservative; length of stay, short; and complications, uncommon. When characteristics were compared by sex, males had mostly collision injuries in high-impact/contact sports, with females having more falls in other sports. When characteristics were compared by age, the only statistically significant difference was in the organ injured: older children had more single solid organ injuries, and younger children had more multiple and hollow viscus injuries. CONCLUSIONS:: Sports-related abdominal injuries in children are mostly minor and not as common as other injury mechanisms. Despite this, they can be serious, with early diagnosis often delayed because of their subtle nature. Sports-related abdominal injuries in children require a high index of suspicion in the part of the clinician if they are to be recognized early and managed effectively. %Z FOR Codes: 110305 111403 %0 Journal Article %~ Pubmed %A MacIntyre, C Raina %A Cauchemez, Simon %A Dwyer, Dominic E %A Seale, Holly %A Cheung, Pamela %A Browne, Gary %A Fasher, Michael %A Wood, James %A Gao, Zhanhai %A Booy, Robert %A Ferguson, Neil %T Face mask use and control of respiratory virus transmission in households. %B Emerging Infectious Diseases %D 2009 %V 15 %N 2 %P 233-41 %@ 1080-6059 %X Many countries are stockpiling face masks for use as a nonpharmaceutical intervention to control virus transmission during an influenza pandemic. We conducted a prospective cluster-randomized trial comparing surgical masks, non-fit-tested P2 masks, and no masks in prevention of influenza-like illness (ILI) in households. Mask use adherence was self-reported. During the 2006 and 2007 winter seasons, 286 exposed adults from 143 households who had been exposed to a child with clinical respiratory illness were recruited. We found that adherence to mask use significantly reduced the risk for ILI-associated infection, but <50% of participants wore masks most of the time. We concluded that household use of face masks is associated with low adherence and is ineffective for controlling seasonal respiratory disease. However, during a severe pandemic when use of face masks might be greater, pandemic transmission in households could be reduced. %Z FOR Codes: 111706 %0 Journal Article %~ Pubmed %A Mitchell, Rebecca %A Finch, Caroline %A Boufous, Soufiane %A Browne, Gary %T Examination of triage nurse text narratives to identify sports injury cases in emergency department presentations. %B %D 2009 %V 16 %N 3 %P 153-157 %@ 1745-7319 %X Narrative text can be a useful means of identifying injury in routine data collections. An analysis of data from a near real-time emergency department surveillance system (NREDSS) in New South Wales (NSW, Australia) was conducted to determine if sports injuries can be identified from routine narrative text recorded in emergency departments. Around one-third of all emergency department (ED) presentations during 1 September 2003 to 15 February 2007 were identified as injury-related. Narrative text searching of triage nursing assessments using keywords identified between 282 (i.e. football) and 26,944 (i.e. play) potential sports injury presentations depending on the selected sports-related keyword used. Routine narrative text descriptions from triage nurse assessments show promise for the identification of sports injury presentations to EDs. Further work is required regarding in-depth assessment of case detection capabilities and the likelihood of improving the quality of narrative text recorded. %Z FOR Codes: 111709 %0 Journal Article %~ Pubmed %A Marchant, Jeanette %A Cheng, Nicholas %A Lam, Lawrence %A Fahy, Fiona %A Sounndapound, S V %A Cass, Danny %A Browne, Gary %T Bystander basic life support: an important link in the chain of survival for children suffering a drowning or near-drowning episode. %B Medical Journal of Australia %D 2008 %V 188 %N 8 %P 484-485 %@ 0025-729X %X Eight children suffered drowning or near-drowning in Sydney pools over an 11-day period in January 2007. Four received basic life support (BLS) within 5 minutes of immersion and survived with good functional neurological outcomes. The other four were not discovered for >/= 5 minutes and all died. This cluster serves as a reminder that timely effective bystander BLS is crucial to survival and good clinical outcomes in near-drowning episodes. %Z FOR Codes: 110305 %0 Journal Article %~ Pubmed %A Gunja, Naren %A Doyle, Evelyn %A Carpenter, Kevin %A Chan, Olivia %A Gilmore, Simon %A Browne, Gary %A Graudins, Andis %T Gamma-hydroxybutyrate poisoning from toy beads. %B Medical Journal of Australia %D 2007 %V 188 %N 1 %P 54-5 %@ 0025-729X %X A 2-year-old boy and a 10-year-old girl presented to the emergency department with a decreased level of consciousness. The girl had had persistent vomiting and a seizure. Urine metabolic screening tests were positive for gamma-hydroxybutyrate (GHB). Samples from toy beads ingested by both children contained 1,4-butanediol, which is metabolised to GHB in humans. Regulatory authorities were notified, leading to an international recall of the toy beads. %Z FOR Codes: 110101 111705 %0 Journal Article %~ Pubmed %A Browne, G J %A Lam, L T %T Concussive head injury in children and adolescents related to sports and other leisure physical activities. %B British Journal of Sports Medicine %D 2006 %V 40 %N 2 %P 163-8 %@ 1473-0480 %X OBJECTIVE: To compare the characteristics of children and adolescents with concussive head injury (CHI) sustained during organised sports or other leisure physical activity. METHODS: This was a case series study reviewing the medical records retrospectively over a four year period of children 6-16 years presenting to the emergency department with a CHI after participating in sport and/or recreation activity. RESULTS: There were 592 cases of sport and recreation related concussion over the study period (2000-2003). Most of the patients (n = 424, 71.6%) were male, with half (n = 304, 51.4%) being older than 10 years of age. A total of 152 (25.7%) cases of CHI were related to playing sports. Most cases (71.2%) were mild concussion. The cause of injury was a fall (n = 322, 54.4%) or a collision. Nearly a quarter of the children (n = 143, 24.2%) were admitted to hospital, with imaging performed in 134 (22.7%). Most children were treated appropriately and no adverse events were reported. CONCLUSIONS: A severe CHI in a child is six times more likely to have resulted from organised sport than from other leisure physical activities. Outcomes for CHI in children is excellent, although their management places a considerable burden on emergency services. The need for activity restriction and the benefits of this in reducing long term cognitive effects of CHI are uncertain. %Z FOR Codes: 110604 111716 %0 Journal Article %~ Pubmed %A Browne, G J %T Cervical spinal injury in children's community rugby football. %B British Journal of Sports Medicine %D 2006 %V 40 %N 1 %P 68-71 %@ 1473-0480 %X OBJECTIVE: To examine the characteristics of cervical spinal injury (CSI) in school aged children injured in community based rugby football who presented to the emergency department for assessment. METHODS: This is a retrospective descriptive case series study reviewing the medical records of all children younger than 15 years of age who presented to the emergency department at the Children's Hospital at Westmead, Sydney, Australia for assessment of injury to the cervical spine between 2000 and 2003. RESULTS: There were 125 children with CSI; most (97%) were boys of mean age 12.7 years. Injuries occurred throughout the season, with an unexpected peak in June. Neck pain was the main presenting complaint (98%). Neurological symptoms were reported in 43%, half having concussion. Hyperextension of the neck accounted for a third of all cases and was usually the result of a spear tackle. Appropriate treatment of the cervical spine on the field of play before transport to hospital was inconsistently performed. Half of the players with CSI suffered secondary injuries, consisting of concussive head injury, faciomaxillary injury, eye injury, or limb fracture. Admission to hospital was common, with all children admitted undergoing further radiological assessment. Two minor fractures were reported and no permanent neurological disability. Overall, no adverse events were reported and the clinical outcome was good. CONCLUSION: CSI in children playing rugby football is rarely catastrophic although often associated with other injuries. Continued efforts are needed to educate players and referees to prevent injury. %0 Journal Article %~ Pubmed %A Soundappan, S V S %A Holland, A J A %A Browne, G %T Sports-related pneumothorax in children. %B Pediatric emergency care %D 2005 %V 21 %N 4 %P 259-60 %@ 1535-1815 %X Pneumothorax after blunt chest trauma in the absence of rib fractures is uncommon and has only rarely been reported as a result of sporting activity. Presentation may vary from an apparently normal physical examination in the presence of a small pneumothorax to hemodynamic compromise in the presence of a tension pneumothorax. High fitness levels in athletes may result in failure to recognize symptoms and delay diagnosis, potentially increasing morbidity. It is imperative for the emergency physician to exclude pneumothorax in children who present with chest pain after blunt chest trauma from sports injury. We report our experience with and the management of 3 patients with pneumothoraces. %0 Journal Article %~ Pubmed %A Browne, Gary J %A Lam, Lawrence T %A Barker, Ruth A %T The usefulness of a modified adult protocol for the clearance of paediatric cervical spine injury in the emergency department. %B Emergency medicine (Fremantle, W.A.) %D 2003 %V 15 %N 2 %P 133-42 %@ 1035-6851 %X OBJECTIVE: To determine if the use of a modified adult protocol that uses cervical spine imaging on presentation for the assessment of cervical spine injury in children improves clinical outcome. METHODS: This is a case series study on all consecutive trauma patients presenting from April to July 2000 inclusive to the ED of a major paediatric trauma hospital. Children presenting to the ED with potential cervical spine injury (CSI) were identified using standard selection criteria. Patient demographics, mechanism of injury, method and time of presentation, associated injuries, radiological investigation and clinical outcome were recorded. The major outcome measures for this study were: time to clearance of the cervical spine, length of stay in the ED and admission to an in-hospital bed. Data were analysed for compliance to the protocol, this being the standard assessment pathway of cervical spine clearance used by our trauma service. RESULTS: The trauma registry identified 1721 trauma presentations during the 4-month study period; 208 presentations representing 200 children with potential CSI were entered into the study. Males represented 72.5% of the study population, having a mean age of 8.32 years, although 29% were less than 5 years of age. The majority of presentations (69%) occurred outside of normal working hours. In 17.8% of cases the cervical spine was cleared based on clinical assessment alone, half less than 5 years of age. Compliance to the protocol occurred in 78% of presentations. However, when examined by age group, children 5 years of age or above were 1.5 times more likely to comply with the protocol as compared with younger children. Adequate plain imaging was not obtained in 18% of presentations, this group almost exclusively less than 5 years of age. There were no missed injuries and no short or long-term neurological sequelae reported during this study. There were no differences in time to clearance, length of stay and admission rate between compliant and non-compliant groups. CONCLUSIONS: Modified adult protocols for cervical spine clearance offer guidance in managing the majority of children suffering blunt trauma. However, we recommend caution in rigidly applying such protocols, especially to children of young age. %Z FOR Codes: 110305 111403 %0 Journal Article %~ Pubmed %A Frampton, A %A Browne, G J %A Lam, L T %A Cooper, M G %A Lane, L G %T Nurse administered relative analgesia using high concentration nitrous oxide to facilitate minor procedures in children in an emergency department. %B Emergency medicine journal : EMJ %D 2003 %V 20 %N 5 %P 410-3 %@ 1472-0213 %X AIMS: To describe the experience of using high concentration nitrous oxide (N(2)O) relative analgesia administered by nursing staff in children undergoing minor procedures in the emergency department (ED) and to demonstrate its safety. METHOD: Data were collected over a 12 month period for all procedures in the ED performed under nurse administered N(2)O sedation. All children greater than 12 months of age requiring a minor procedure who had no contraindication to the use of N(2)O were considered for sedation by this method. The primary outcome measure was the incidence of a major complication namely respiratory distress or hypoxia during the procedure. Secondary outcome measures were minor complications and the maximum concentration of N(2)O used. RESULTS: Data were collected for a total of 224 episodes of nurse administered N(2)O sedation over a 12 month period. In 73.2% of children no complications were recorded. One major complication was recorded (respiratory distress) and the most common minor complication was mask intolerance in 17%. The mean maximum concentration of N(2)O used was 60.2%. CONCLUSIONS: N(2)O is a safe analgesic in children over the age of 1 year undergoing painful or stressful procedures in the ED. It may safely be administered in concentrations of up to 70% by nursing staff after appropriate training. %Z FOR Codes: 110305 111403 %0 Journal Article %~ Pubmed %A Phin, S J %A McCaskill, M E %A Browne, G J %A Lam, L T %T Clinical pathway using rapid rehydration for children with gastroenteritis. %B Journal of Paediatrics and Child Health %D 2003 %V 39 %N 5 %P 343-8 %@ 1034-4810 %X OBJECTIVE: To determine in the Emergency Department (ED) the efficacy of a clinical pathway using rapid rehydration for children moderately dehydrated as a result of acute gastroenteritis. METHODS: This was a prospective study using historical controls, set in the ED of the Children's Hospital at Westmead, NSW, Australia. Subjects were aged from 6 months to 16 years presenting with vomiting and diarrhoea for <48 h who were mildly or moderately dehydrated. The intervention was a clinical pathway involving rapid rehydration using N/2 saline + 2.5% dextrose intravenously at 20 mL/kg per h for 2 h, or Gastrolyte R (Aventis Pharma, Lane Cove, NSW, Australia) via nasogastric tube at the same rate. There were 145 children in the prospective intervention group and 170 in the historical control group. The outcome measures were admission rate, percentage of patients discharged from the ED in 8 h or less, rate of re-presentations within 48 h requiring admission, and rate of procedures with intravenous cannula or nasogastric tube. RESULTS: In the moderately dehydrated children, significant reductions were observed in the admission rate and the number discharged in 8 h or less in the intervention group compared with the control group, with no significant difference in the rate of re-presentation and the rate of procedures. In the moderately dehydrated children in the intervention group, the admission rate was 29 of 52 (55.8%) compared with the controls 26 of 27 (96.3%) (P < 0.001) and the number discharged in 8 h or less was 23 of 52 (44.2%) compared with 1 of 27 (3.7%) in the controls (P < 0.01). CONCLUSION: The clinical pathway utilizing rapid rehydration in children moderately dehydrated from gastroenteritis is effective in reducing admission rates and lengths of stay in the ED. %Z FOR Codes: 111403 110307 %0 Journal Article %~ Pubmed %A Chu, Robert S %A Browne, Gary J %A Lam, Lawrence T %T Traction splinting of femoral shaft fractures in a paediatric emergency department: time is of the essence? %B Emergency medicine (Fremantle, W.A.) %D 2003 %V 15 %N 5-6 %P 447-52 %@ 1035-6851 %X OBJECTIVE: To describe the use of traction splinting in children with femoral shaft fracture and to determine if timing of traction splinting application effects outcome. METHODS: A retrospective descriptive study conducted over a five and a half year period (1 January 1996 to 1 July 2001) on children presenting with femoral shaft fracture to a Paediatric trauma centre. Data were collected on all children with a radiological diagnosis of fracture to the femoral shaft. Evidence for hypovolaemic shock and neurovascular compromise was sought. The administration of parenteral analgesia and whether a validated pain scale was employed to monitor pain relief was documented. The use of traction splint or other leg splint device before arrival in the ED and subsequent changes to splinting in hospital were noted. Times to perform radiographic examination and femoral nerve block were also recorded. RESULTS: Ninety-five (95) patients met the study inclusion criteria with 66.3% having some form of immobilization and 70% administered parenteral analgesia in the pre-hospital setting. In only 7.3% of patients was a Thomas splint traction applied within 2 h of arrival. Adverse clinical outcome was not reported in any patient regardless of time to application of Thomas splint traction. The application of Thomas splint traction in the ED resulted in a significant delay in the performance of diagnostic radiographs and femoral nerve block. CONCLUSIONS: The timing of traction splinting is not associated with poor outcome in isolated paediatric femoral shaft fracture provided effective analgesia has been administered in a timely fashion. %Z FOR Codes: 110305 111403 %0 Journal Article %~ Pubmed %A Habashy, Doaa %A Lam, Lawrence T %A Browne, Gary J %T The administration of beta2-agonists for paediatric asthma and its adverse reaction in Australian and New Zealand emergency departments: a cross-sectional survey. %B European journal of emergency medicine : official journal of the European Society for Emergency Medicine %D 2003 %V 10 %N 3 %P 219-24 %@ 0969-9546 %X AIM: To determine the current use of beta2-agonists, in particular salbutamol, for the management of acute asthma in children in emergency departments throughout Australia and New Zealand. METHODS: A cross-sectional survey using a questionnaire that sought to determine the current use of salbutamol and any adverse drug reactions in paediatric emergency departments. RESULTS: Out of 37 hospitals eligible as paediatric emergency departments, 33 (89.1%) responded to the survey, 54.5% having guidelines for the management of acute asthma. Of the paediatric emergency departments surveyed, 45.5% used metered-dose inhaler spacer combination in the treatment of mild to moderate asthma. All paediatric emergency departments used nebulized salbutamol for acute severe asthma. In addition, 85% of paediatric emergency departments used continuous-infusion intravenous salbutamol in unresponsive patients, 63.6% administering a single-dose intravenous salbutamol bolus before commencing the infusion. District paediatric emergency departments were more likely to treat with continuous-infusion intravenous salbutamol outside of the intensive care unit. Clinical unresponsiveness to inhaled salbutamol and clinical improvement were the reported criteria in all paediatric emergency departments for the use and cessation of intravenous salbutamol. Adverse drug reactions were common: tremor (90%), hypokalaemia (45.5%) and supraventricular tachycardia (21%), particularly if continuous-infusion intravenous salbutamol administered. Eight deaths from asthma were reported, none being related to adverse drug reactions. CONCLUSION: We report a wide variation of salbutamol use in paediatric emergency departments and a high prevalence of type A adverse drug reactions when continuous-infusion intravenous salbutamol therapy was administered. More evidence is needed on the clinical significance of the adverse effects reported in this study and optimal doses for the safe use of continuous-infusion intravenous salbutamol therapy in paediatric emergency departments. %Z FOR Codes: 110305 %0 Journal Article %~ Pubmed %A Chu, Robert S L %A Browne, Gary J %A Cheng, Nicholas G %A Lam, Lawrence T %T Femoral nerve block for femoral shaft fractures in a paediatric Emergency Department: can it be done better? %B European journal of emergency medicine : official journal of the European Society for Emergency Medicine %D 2003 %V 10 %N 4 %P 258-63 %@ 0969-9546 %X BACKGROUND: The relatively simple technique of administering a femoral nerve block is known to be quick, safe and effective in providing prolonged analgesia to children with femoral shaft fracture. Although medical literature supports its use in the emergency setting, no studies have been conducted on how this is undertaken in practice. OBJECTIVE: The aim of this study is to describe the practice of femoral nerve block in previously well children who present to our Emergency Department with femoral shaft fracture. SETTING: This study was conducted at the Emergency Department of a tertiary paediatric hospital in Sydney, Australia. METHODS: A retrospective descriptive study was conducted by gathering data on all patients presenting to the Emergency Department between 1 January 1996 and 1 July 2001 with traumatic fracture to the femoral shaft. Whether femoral nerve block had been performed in the emergency setting; the time taken for femoral nerve block to be performed; the type of local anaesthetic used; the dose of local anaesthetic administered, and the level of training and area of expertise of doctors performing the femoral nerve block were determined from the clinical records. One-way analysis of variance and Student's t-tests were conducted to compare the average dosages of local anaesthetic used by the different medical sub-specialities involved. Student's t-tests were applied to analyse the time differences for performing femoral nerve block between emergency- and non-emergency-based medical staff. RESULTS: The majority (111) of the 117 patients who met the inclusion criteria for the study had isolated femoral shaft fractures (94.9%). Femoral nerve blocks were performed in 97 of our study patients (82.9%). No correlation was found between the age of the child and the time taken for a femoral nerve block. In 76 cases in which a femoral nerve block was given (64.9%), a member of staff external to the Emergency Department performed the procedure. The average time taken for a femoral nerve block to be performed for non-Emergency Department medical staff was significantly longer than for Emergency Department medical staff. In only 37 cases (31.9%), was a femoral nerve block administered within an hour of the time of triage. Doses used by non-anaesthetists were lower than those used by anaesthetists. CONCLUSION: There is unnecessary delay in carrying out this procedure for children with fractures to the femoral shaft. A significant degree of reliance on staff external to the Emergency Department was reported. This paper supports increased training and supervision to promote the more widespread and prompt use of femoral nerve blocks as an important standard of care for the Emergency Department. %Z FOR Codes: 110305 111403 %0 Journal Article %~ Pubmed %A Chu, Robert S %A Browne, Gary J %A Lam, Lawrence T %T Are children with femoral fracture haemodynamically unstable? %B Emergency medicine (Fremantle, W.A.) %D 2003 %V 15 %N 5-6 %P 453-8 %@ 1035-6851 %X OBJECTIVE: To assess the occurrence of hypovolaemic shock in children who have sustained traumatic femoral fracture. METHODS: A retrospective descriptive study was performed on a cohort of children with traumatic femoral fracture presenting over a five and a half year period from 1 January 1996 to 1 July 2001. Selected parameters for analysis included administration of a fluid bolus, as well as all available vital signs within 4 h following injury relating to pulse, systolic blood pressure, respiratory rate, skin capillary refill time and mental status. Fluid and blood transfusion records were examined, as was the need for intraosseous access. Initial haemoglobin and haematocrit results were also obtained. RESULTS: There was no evidence for haemodynamic instability in the 100 patients who met the selection criteria when compared with internationally accepted normal vital sign parameters. No significant difference was found in the initial vital signs between patients who received fluid bolus and those that didn't. No patient needed intraosseous access or fluid resuscitation. One patient received blood transfusion without evidence of haemodynamic instability. Haemoglobin and haematocrit values were not significantly decreased. Ninety-two percent of patients in this study had isolated femoral fracture. CONCLUSIONS: No evidence for haemodynamic instability was found in a cohort of children with traumatic femoral fracture. %Z FOR Codes: 111403 110305 %0 Journal Article %~ Pubmed %A Chin, R %A Browne, G J %A Lam, L T %A McCaskill, M E %A Fasher, B %A Hort, J %T Effectiveness of a croup clinical pathway in the management of children with croup presenting to an emergency department. %B Journal of Paediatrics and Child Health %D 2002 %V 38 %N 4 %P 382-7 %@ 1034-4810 %X OBJECTIVE: The aim of this study was to evaluate the safety and effectiveness of a clinical pathway for croup in an emergency department (ED). METHODOLOGY: This before-and-after intervention study on all consecutive children aged 6 months to 10 years who presented to our ED with moderate/severe croup was conducted over a 6-month period. Children with a clinical croup score (CSS) of 2 or more and resting stridor were considered eligible for entry into the study. Children were treated with either oral dexamethasone, or a combination of oral dexamethasone suspension and nebulized adrenaline. Children were clinically assessed, observed in the emergency short-stay ward and discharged or admitted according to the clinical pathway. The following outcomes were measured: admission rates, hospital re-presentation, length of stay, and adverse clinical events. Children in the post-intervention group were followed up by telephone within 48 h of discharge. RESULTS: There were 157 patients recruited in the pre-intervention group and 110 in the post-intervention group. Significant reductions were reported in the length of stay (18.9 h compared with 5.2 h), hospital admission (52.9% compared with 18.0%) and intensive care admission (10.2% compared with 0.0%) after the introduction of the croup clinical pathway. No children in the study experienced an adverse clinical event. Follow-up interviews of parents indicated that the new treatment strategy was well received. CONCLUSION: The use of the croup clinical pathway in the ED is safe and effective in guiding consistent management, resulting in reduced admission rates, earlier discharge home, and no reported adverse events. %0 Journal Article %~ Pubmed %A Browne, Gary %A Lam, Lawrence %T Single-dose intravenous salbutamol bolus for managing children with acute severe asthma in the emergency department:Reanalysis of data. %B Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies %D 2002 %V 3 %N 2 %P 117-123 %@ 1529-7535 %X OBJECTIVE: To reanalyze data from two previous studies to provide stronger evidence of benefit for early use of single-dose intravenous bolus salbutamol in children with acute severe exacerbations of asthma. Methods: Randomized, double-blind, placebo-controlled trial of 84 children with acute severe asthma who presented to the emergency department of the Children's Hospital at Westmead. After clinical evaluation, patients who had severe asthma were given high-dose inhaled salbutamol and had an intravenous cannula inserted. Additional treatment consisted of intravenous methylprednisolone (1 mg/kg), oxygen (6 L/min via mask if Sao(2) was <93%). Patients were then randomized to receive an intravenous infusion of either 15 &mgr;g/kg salbutamol or saline, with clinical progress assessed hourly for 2 hrs. All patients were admitted to the hospital and clinically monitored for the proceeding 2-24 hrs, with inhaled salbutamol treatment administered in accord with the hospital's protocol. RESULTS: The intravenous salbutamol group (n = 50) demonstrated earlier clinical improvement, with earlier reduction in oxygen therapy and reduced need for ongoing inhaled salbutamol therapy by the end of phase 1 compared with the control group (n = 34). Patients in the intravenous salbutamol group were ready for discharge from the emergency department 3.7 hrs earlier than those in the control group and were ready for discharge from the hospital 9.7 hrs earlier than controls. No significant side effects were found in either group. CONCLUSION: A single-dose intravenous salbutamol bolus of 15 &mgr;g/kg administered over 10 mins in the initial treatment of children with acute severe asthma in the emergency department has the potential to shorten the duration of severe attacks and reduce overall requirements for inhaled salbutamol maintenance. %0 Journal Article %~ Pubmed %A Browne, Gary J %A Lam, Lawrence T %T Isolated extradural hematoma in children presenting to an emergency department in Australia. %B Pediatric emergency care %D 2002 %V 18 %N 2 %P 86-90 %@ 0749-5161 %X BACKGROUND: Isolated extradural hematoma (EDH) is becoming more frequently recognized in emergency departments (EDs) in children. We describe the natural history of children with isolated EDH presenting to a large Children's Hospital ED. METHODS: This is a descriptive case series study using a retrospective review of the medical records of children presenting to the ED with a diagnosis of isolated EDH over 8 years. Comparison was made with children having other injuries in addition to EDH. The cause, nature of injury, presentations to hospital, management, outcome, and any association with nonaccidental injuries (NAI) were analyzed. RESULTS: Of the 35 cases with a final diagnosis of isolated EDH initially presenting to the ED, 70% were over 3 years of age (mean 6.6 years), and 60% were boys. A fall of less than half a meter was the cause of isolated EDH in 51.4% of patients. The remaining cases resulted from a fall from a height greater than half a meter (17.1%), a motor vehicle accident (11.4%), being hit by an object (8.6%), a bicycle accident (5.7%), and a skateboard accident (5.7%). Children younger than 3 years presented within 24 hours of injury in 70% of cases, compared with 65% of older children. In 95% of cases, presentation was nonspecific, suggesting a medical rather than a surgical problem. This resulted in a delay in seeking emergency care and a delay in final diagnosis for these patients. Surgical drainage was required in 68.6% of cases, with older children being more likely to be managed conservatively. In 23.4% of cases, minor residual neurologic deficit occurred; there were no cases of serious long-term problems. There were no cases of NAI in the children studied. CONCLUSION: This report highlights falls as a common cause of isolated EDH in children. Delay in presentation for clinical assessment is common, because many children have nonspecific presentation that is suggestive of a medical problem. No cases of NAI were reported in this study. %0 Journal Article %A Browne, GJ %A Trieu, L %A Van Asperen, PP %T Randomized, double-blind, placebo-controlled trial of intravenous salbutamol and nebulized ipratropium bromide in early management of severe acute asthma in children presenting to an emergency department %B Critical Care Medicine %D 2002 %C 530 Walnut St, Philadelphia, Pa, 19106-3621 %I Lippincott Williams & Wilkins %V 30 %N %P 448-453 %@ 0090-3493 %X %0 Journal Article %~ Pubmed %A Holland, A J A %A Kirby, R %A Browne, G J %A Ross, F I %A Cass, D T %T Penetrating injuries in children: is there a message? %B Journal of Paediatrics and Child Health %D 2002 %V 38 %N 5 %P 487-91 %@ 1034-4810 %X OBJECTIVES: To determine the frequency, management and outcome of penetrating trauma in children. METHODS: A retrospective review of penetrating injuries in children under 16 years of age admitted to the Children's Hospital at Westmead (CHW), and deaths reported to the New South Wales Paediatric Trauma Death (NPTD) Registry, from January 1988 to December 2000. Patient details, circumstances of trauma, injuries identified, management and outcome were recorded. RESULTS: Thirty-four children were admitted to the CHW with penetrating injuries during the 13-year period. This represented 0.2% of all trauma admissions, but 3% of those children with major trauma. The injury typically involved a male, school-age child that fell onto a sharp object or was assaulted with a knife or firearm by a parent or person known to them. Twenty-five children (75%) required operative intervention for their injuries and 14 survivors (42%) suffered long-term morbidity. Thirty children were reported to the NPTD Registry over the same interval, accounting for 2.3% of all trauma deaths in New South Wales. Of these, a significant minority was injured by falls from a mower or a tractor towing a machine with blades. CONCLUSIONS: Penetrating injuries are uncommon, but cause serious injury in children. There are two clear groups: (i) those dead at the scene or moribund on arrival, in whom prevention must be the main aim; and (ii) those with stable vital signs. Penetrating wounds should be explored in the operating theatre to exclude major injury. Young children should not ride on mowers or tractors. %Z FOR Codes: 111403 %0 Journal Article %~ Pubmed %A Browne, G J %A Giles, H %A McCaskill, M E %A Fasher, B J %A Lam, L T %T The benefits of using clinical pathways for managing acute paediatric illness in an emergency department. %B Journal of quality in clinical practice %D 2001 %V 21 %N 3 %P 50-5 %@ 1320-5455 %X The aim of this study was to provide an evaluation of the overall effectiveness of using a number of clinical pathways in treating common acute paediatric conditions in an emergency department. This was a before and after study conducted on the effectiveness of three clinical pathways (gastroenteritis, asthma, and croup) in the emergency department of the Children's Hospital at Westmead, conducted over two separate yearly periods January to December 1996 and January to December 1999 representing before and after the introduction of clinical pathways in the emergency department. The main outcomes of the effectiveness of the pathways, namely admission to an in-patient bed, length of hospital stay and re-presentation after discharge from the ED were compared. Other outcomes of interest such as parental satisfaction and patient waiting times were also presented. Any deviation from a key clinical pathway process was reported. A total of 2854 children were managed by a clinical pathway compared to 2680 children managed before clinical pathways were introduced. The admission rate was reduced by threefold (9.1% compared to 23.6%) with a twofold reduction in length of hospital stay (32.7 h compared to 17.5 h). In 3.6% of children using a clinical pathway an unscheduled medical visit or re-presentation to the emergency department occurred after discharge, compared to 4.9% before the use of clinical pathways. No adverse events were reported in these children. In 76 cases deviation from a clinical pathway process was reported. High parental satisfaction was reported for clinical pathways throughout the study. Clinical pathways in this emergency department allowed rapid stabilisation of children, reducing admission rate, with a shortened length of hospital stay and few patients re-presenting after discharge and were well accepted by parents. %0 Journal Article %~ Pubmed %A Browne, G J %A McCaskill, M E %A Giles, H %A Lam, L T %A Fasher, B J %A Exley, B %T Paediatric walk-out patients: characteristics and outcomes. %B Journal of Paediatrics and Child Health %D 2001 %V 37 %N 3 %P 235-9 %@ 1034-4810 %X OBJECTIVE: To investigate the characteristics and outcomes of patients who walked out from a tertiary children's hospital emergency department (ED) without seeing a medical officer. METHODS: A prospective study of patients who walked-out from the ED of a children's hospital, without seeing a medical officer. Information collected at triage included demographics, presenting problems, time of arrival, time of departure and reason for leaving. Charts were reviewed and those at high risk of serious illness or adverse outcome were contacted by telephone within 24 h. Further information collected during follow up included outcome, such as adverse events and admission to hospital. Data were analysed by comparing the walk-out and non-walk-out groups with regard to demographic variables, presenting problems and outcomes. RESULTS: Over a 29 week period, 1037 (5.5%) patients walked out from the ED of the hospital without seeing a medical officer. Comparisons between the walk-out and non-walk-out patients indicated no differences in terms of demographics. However, significant differences were found between the triage categories, presenting problems and arrival time. Of these, 829 (79.9%) were followed up by telephone. This revealed the predominant presenting problem was non-urgent and infectious in nature and no adverse events occurred. The admission rate for walk-out patients (1.5%) was significantly lower in comparison with the non-walk-out group (6.9%; odds ratio 0.2; 95% confidence interval 0.1-0.3). Walk-out patients who were eventually hospitalized had a shorter mean length of stay than non-walk-out patients (20.4 vs 34.8 h, respectively; t = 17.78, P < 0.0001). CONCLUSIONS: Medical resources are limited and, therefore, some extended waiting in the ED is necessary. Paediatric patients who walk-out of the ED without seeing a medical officer have simple illnesses that resolve without medical intervention or adverse events.