Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Objectives: Pediatric emergency department (PED) patients often present with non-urgent complaints. We attempted to estimate the perceived degree of urgency of the visit and to identify reasons for seeking non-urgent care in the PED by patients and parents. Methods: A prospective survey was completed by parents (for children 17 and younger) and patients (18-21) presenting to a suburban academic PED that sees approximately 15,000 patients per year. A convenience sample of participants was enrolled. Results: Three hundred and five of 334 surveys were completed (91% response rate) over a 3-month period. Twenty-four percent of the chief complaints were perceived by those surveyed as emergent or possibly life-threatening, 23% were felt to be very urgent, and 52% were deemed somewhat urgent or minor. Twenty-five percent of those with minor or somewhat urgent complaints arrived by ambulance. Weekend visits and minority race correlated with a lower degree of perceived urgency. Overall, 79% of those surveyed identified a primary care provider (PCP) for themselves or their child. Of those, 54% had attempted to contact the PCP prior to coming to the PED. Six percent of those who attempted to reach their primary care providers were able to contact them and 52% were told to come to the PED. Conclusions: More than half of patients and parents presenting to the PED believed they had minor or somewhat urgent complaints. While the majority of patients have a regular provider, limited access to timely primary care and convenience may make the PED a more attractive care option than primary care for many parents and patients.

Cryptorchidism, or maldescended testis, is a common problem encountered in pediatric age groups. Despite more than 100 years of research, many aspects of cryptorchidism are not well defined and remain controversial. However, cryptorchidism clearly has deleterious effects on the testis over time. Among the problems associated with an undescended testis are an increased risk for testicular tumor development and a propensity for torsion. In cases of bilateral undescended testis, infertility is a concern. Torsed intraabdominal testis is rarely considered in the differential of acute appendicitis, probably because of a failure to examine the external genitalia as part of the abdominal examination. Most patients with an undescended testis, especially adults, are aware of the absence of the testis within the scrotal sac. The purpose of this report is to highlight a case of torsed abdominal testis which presented with features of acute appendicitis in a 32 year old man who was unaware of the absence of the right testis within the right hemiscrotum.

As several highly publicized traffic collisions occurred in 2003 and 2004, the nation began to give more attention to the issue of older drivers. After several older-driver collisions, California, Minnesota, Wisconsin, and Massachusetts examined their license renewal and driver testing policies for both the young and old. We describe these major traffic incidents and discuss their impact on the political, medical, and social forums.