Page 19 - Delaware Medical Journal - October 2016
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SCIENTIFIC ARTICLE
investigation is judged to be warranted, it is intensive. In addition to brain imaging, it may include some or all of the following: a careful history and physical examination by a trained pediatrician, a social work evaluation of the family and the home, a radiographic skeletal survey, and a dilated funduscopic examination. Clinical abuse investigations can be performed only at the children’s medical center. Transfer of a child for an abuse investigation is not an emergency, however, and deliberate decisions can be made in consultation
with specialists at the children’s center facilitated as needed by telemedicine and remote review of imaging.
Our study suggests that there may be ways to provide medically
System with fewer admissions and fewer interhospital transfers,
but it has obvious limitations. Beyond GCS and ISS there were diagnoses of child abuse, but children who required admission the impact of necessary investigations of the possibility of child
as workers in the system, we did not view the ICD-9 diagnostic to support detailed analysis, and the listings of procedures were capped at 6 codes per registration. The terms “substantive” and “non-substantive” were adopted to try to avoid the appearance of judgments regarding medical necessity, which were impossible and
of these terms in relation to other concepts of value in medical evaluating trends over time.
Professional education and technological adjuncts such as telemedicine and interhospital transmission of imaging studies are tools that might be employed to effect the changes that we propose, but further work is needed to explore professional, institutional, and economic factors and patient preferences that shape current practices.
CONTRIBUTING AUTHORS
■ JOSEPH PIATT, MD, FAAP is Head of the Division of Neurosurgery at Nemours Neuroscience Center at Nemours/AI duPont Hospital for Children in Wilmington, Del.
■ DIANE HOCHSTUHL, MSN, RN, NP-C is Director of Trauma and Critical Care Transport Programs at Nemours/AI duPont for Children in Wilmington, Del.
■ STEPHEN MURPHY, MD, FAAP is Director of Trauma Program at Nemours/AI duPont Hospital for Children in Wilmington, Del.
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