2323 Race St Apt 208
Philadelphia PA 19103
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: MD433835
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Use of a Dedicated, Non-Physician Led Mental Health Team to Reduce Pediatric Emergency Department Lengths of Stay. - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
Mental health (MH) disorders are common in children, with an estimated 13-20% of children in the United States experiencing a mental disorder in a given year.(1-5) They also are increasing, with a reported 24% increase in inpatient MH and substance abuse admissions among children from 2007-2010,(6) and an 80% increase in hospital stays for children with mood disorders from 1997-2010.(7) Despite this increasing prevalence, psychiatric services for children in many parts of the country are limited,(8) leaving many with unmet psychiatric care needs.(9) Nationally, pediatric ED visits for MH issues increased by over 20% between 2001 and 2010.(10) Pediatric emergency departments (PEDs) have also seen high volumes of patients presenting with psychiatric crises, with 3.3% of PED visits related to MH issues in one multi-center study.(11) Patients with primary MH complaints have significantly longer lengths of stay (LOS) and higher admission rates than patients with medical complaints, creating disproportionately greater service demands on EDs.(11, 12) This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.
Variation in the use of procedural sedation for incision and drainage of skin and soft tissue infection in pediatric emergency departments. - Hospital pediatrics
Little is known about procedural sedation use for anxiety and pain associated with skin and soft tissue infections (SSTIs) requiring incision and drainage (I&D). Our objectives were therefore (1) to characterize the use of procedural sedation use for SSTI I&D procedures in pediatric emergency departments (EDs), (2) to compare the frequency of procedural sedation for I&D across hospitals, and (3) to determine factors associated with use of procedural sedation for I&D.We performed a retrospective cohort study of pediatric EDs contributing to the Pediatric Health Information Systems database in 2010. Cases were identified by primary International Classification of Diseases, 9th revision, Clinical Modification procedure codes for I&D. We used descriptive statistics to describe procedural sedation use across hospitals and logistic generalized linear mixed models to identify factors associated with use of procedural sedation.There were 6322 I&D procedures, and procedural sedation was used in 24% of cases. Hospital-level use of procedural sedation varied widely, with a range of 2% to 94% (median 17%). Procedural sedation use was positively associated with sensitive body site, female gender, and employer-based insurance, and negatively associated with African American race and increasing age. Estimates of hospital-level use of procedural sedation for a referent case eliminating demographic differences exhibit similar variability with a range of 5% to 97% (median 34%).Use of procedural sedation for SSTI I&D varies widely across pediatric EDs, and the majority of variation is independent of demographic differences. Additional work is needed to understand decision-making and to standardize delivery of procedural sedation in children requiring I&D.Copyright Â© 2015 by the American Academy of Pediatrics.
Factors associated with the use of procedural sedation during incision and drainage procedures at a children's hospital. - The American journal of emergency medicine
The incidence of skin and soft tissue infections requiring incision and drainage has increased. Little evidence exists about the use of procedural sedation (PS) for these procedures in children. Our objective was to determine factors associated with the use of PS during incision and drainage procedures at a tertiary children's hospital.This was a nested cohort study that combined a retrospective medical record review with prospectively collected data for children 2 months to 18 years old who had an incision and drainage procedure performed at a children's hospital over a 1-year period. Procedural sedation was defined as the use of pharmacologic agents to alter patient consciousness. Patient, lesion (eg, size and induration), provider (eg, years of experience), and emergency department (eg, patient volume and wait time) factors were analyzed. Emergency department physicians were divided into tertiles by frequency of sedation (high/medium/low) to assess provider practice variation. Ï‡(2) Analysis and multivariable logistic regression were used to identify factors associated with PS use.Of the 215 enrolled patients, 95 (44.2%) received PS. Ninety (94.7%) of 95 sedated patients received ketamine as their primary sedation agent. On univariate analysis, emergency department volume, wait time, duration of illness, and provider experience were not associated with PS use. With multivariable regression, patient age, abscess size, and provider frequency of sedation were all independently associated with the decision to sedate.Patient age and abscess size are independent predictors of the use of PS for incision and drainage procedures. Provider practice patterns are also independently associated with PS use.Copyright Â© 2013 Elsevier Inc. All rights reserved.
Cataracts as the initial manifestation of type 1 diabetes mellitus. - Pediatric emergency care
A 13-year-old girl presented with the gradual onset of bilateral visual changes. She was initially diagnosed with idiopathic cataracts, but a medical evaluation revealed new-onset type 1 diabetes mellitus with ketosis. The patient was hospitalized and started on a regimen of insulin before discharge and eventual surgical correction of her cataracts. Cataracts are an uncommon initial manifestation of new-onset type 1 diabetes, occasionally in the absence of other more classic symptoms of diabetes. Pediatric patients presenting with bilateral cataracts should be evaluated for a underlying etiology of their cataracts before being referred for surgical correction.
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2323 Race St Apt 208 Philadelphia, PA 19103
255 S 17Th St Suite 2810
1714 Locust St Suite 2
1810 Rittenhouse Sq Suite 1801
255 S 17Th St Suite 606
1608 Walnut St Suite 602 Box 75