Steven Selbst - Academia.edu (original) (raw)
Papers by Steven Selbst
Annals of Emergency Medicine, 1999
Annals of Emergency Medicine, 1999
AAP News, Dec 1, 1995
Medication errors are a significant problem for physicians. Experienced and inexperienced staff, ... more Medication errors are a significant problem for physicians. Experienced and inexperienced staff, including doctors, nurses, pharmacists, administrators, support personnel, patients and other caregivers, can make these mistakes. By producing look-alike and sound-alike drugs, often with similar packaging, drug manufacturers also are involved in medication errors.
Pediatrics in Review, 1986
Appropriate recognition of the likely etiologic basis for chest pains in children and adolescents... more Appropriate recognition of the likely etiologic basis for chest pains in children and adolescents (Recent Advances, 86/87).
Clinical Pediatric Emergency Medicine, 2003
EDIATRIC EMERGENCY medicine is a high risk specialty. Surveys of the American Academy of Pediatri... more EDIATRIC EMERGENCY medicine is a high risk specialty. Surveys of the American Academy of Pediatrics membership have shown that one third of pediatricians have been named in a malpractice suit, and many of those cases involved acutely ill or injured children. 1 Although all physicians have significant legal liability, medical malpractice cases involve the emergency department (ED) in a disproportionate number of cases. In one study of 262 pediatric cases alleging malpractice, the ED accounted for 45% of hospital-related cases. 2 Physicians are involved in 88% of ED claims, and nurses account for 7% as the principle participants. 3 Pre-hospital care providers are less likely to be sued for malpractice; however, they are not invulnerable. Most lawsuits against physicians are dropped or settled out of court. 4 Only about 10% actually reach a jury verdict. However, the strain of a lawsuit is still quite burdensome for all involved. It can result in significant emotional stress as well as a loss of time and money. Even if the case does not go to trial, it can still prove quite expensive. Malpractice suits may be an unpleasant and undeniable part of emergency medicine. However, they are not inevitable. Like other pediatric diseases and childhood injuries, some malpractice suits are predictable and preventable. If we begin to understand the etiology, epidemiology, and pathology of malpractice suits, we can take steps to avert them. 5
Academic Emergency Medicine, 2015
Objectives: Changes in health care delivery and graduate medical education have important consequ... more Objectives: Changes in health care delivery and graduate medical education have important consequences for the workforce in pediatric emergency medicine (PEM). This study compared career preparation and potential attrition of the PEM workforce with the prior assessment from 1998. Methods: An e-mail survey was sent to members of the American Academy of Pediatrics (AAP) Section on EM and to non-AAP members board certified in PEM. Information on demographics, practice characteristics and professional activities, career preparation, future plans, and burnout (using two validated screening questions) was analyzed using standard descriptive statistics.
Archivos De Pediatria Del Uruguay, Nov 1, 2001
La intoxicación por plomo es un importante problema ambiental en EE.UU. y en el mundo. Si bien en... more La intoxicación por plomo es un importante problema ambiental en EE.UU. y en el mundo. Si bien en la década pasada declinó el nivel promedio de plomo en sangre, el envenenamiento es aún una amenaza para los niños. En el año 2001 se reportó en EE.UU. la primera muerte debida a esta intoxicación en muchos años. Otros miles están afectados por esta enfermedad.
Pediatric Sedation Outside of the Operating Room, 2011
Current Problems in Pediatrics, 1990
Although the principles of emergency care may be relatively easy to state, it is their promulgati... more Although the principles of emergency care may be relatively easy to state, it is their promulgation that is so difficult. The development of EMS-C is the challenge. How do we take these principles of preserving children's lives and translate them into services for everyone who needs them? How do we organize a large, diverse health care system which will be responsive to this group of patients in need? How do we prioritize pediatric emergency care among the many other funding needs, both medical and nonmedical? The answer lies with the initiative and advocacy of each of us as child advocates. Providing all the aforementioned elements of the EMS-C will save children's lives. These are lives which are usually responsive to therapy, uncomplicated by interlocking disease states, and filled with potential for future achievement. The challenge is ours.
Pediatric emergency care, 2009
Pediatric Emergency Care, 1985
Pediatrics, 1997
Background. Approximately 32 000 nonpowder firearm injuries are reported annually with more than ... more Background. Approximately 32 000 nonpowder firearm injuries are reported annually with more than 60% occurring in the pediatric population. Case reports of serious and fatal injuries have been described; however, no large inclusive series have been published. We reviewed an 11-year experience of an urban pediatric emergency department to evaluate the circumstances, spectrum of injuries, and outcomes attributable to nonpowder firearms. Methods. A retrospective, descriptive case series of all children 18 years of age or younger evaluated at an urban children's hospital from January 1983 through December 1994 were eligible for study. Patients were identified using a computerized database, the National Electronic Injury Surveillance System, and the trauma registry in the department of surgery. Medical records were reviewed to collect demographic information, circumstances of injury, anatomic site and type of injury, treatment, and outcomes for nonpowder firearm injuries. Results. On...
Pediatrics, 2012
Pediatric observation units (OUs) are hospital areas used to provide medical evaluation and/or ma... more Pediatric observation units (OUs) are hospital areas used to provide medical evaluation and/or management for health-related conditions in children, typically for a well-defined, brief period. Pediatric OUs represent an emerging alternative site of care for selected groups of children who historically may have received their treatment in an ambulatory setting, emergency department, or hospital-based inpatient unit. This clinical report provides an overview of pediatric OUs, including the definitions and operating characteristics of different types of OUs, quality considerations and coding for observation services, and the effect of OUs on inpatient hospital utilization.
PEDIATRICS, 2000
Objective. Factors that contribute to adverse sedation events in children undergoing procedures w... more Objective. Factors that contribute to adverse sedation events in children undergoing procedures were examined using the technique of critical incident analysis. Methodology. We developed a database that consists of descriptions of adverse sedation events derived from the Food and Drug Administration's adverse drug event reporting system, from the US Pharmacopeia, and from a survey of pediatric specialists. One hundred eighteen reports were reviewed for factors that may have contributed to the adverse sedation event. The outcome, ranging in severity from death to no harm, was noted. Individual reports were first examined separately by 4 physicians trained in pediatric anesthesiology, pediatric critical care medicine, or pediatric emergency medicine. Only reports for which all 4 reviewers agreed on the contributing factors and outcome were included in the final analysis. Results. Of the 95 incidents with consensus agreement on the contributing factors, 51 resulted in death, 9 in permanent neurologic injury, 21 in prolonged hospitalization without injury, and in 14 there was no harm. Patients receiving sedation in nonhospital-based settings compared with hospital-based settings were older and healthier. The venue of sedation was not associated with the incidence of presenting respiratory events (eg, desaturation, apnea, laryngospasm, ϳ80% in each venue) but more cardiac arrests occurred as the second (53.6% vs 14%) and third events (25% vs 7%) in nonhospital-based facilities. Inadequate resuscitation was rated as being a determinant of adverse outcome more frequently in nonhospital-based events (57.1% vs 2.3%). Death and permanent neurologic injury occurred more frequently in nonhospital-based facilities (92.8% vs 37.2%). Successful outcome (prolonged hospitalization without injury or no harm) was associated with the use of pulse oximetry compared with a lack of any documented monitoring that was associated with unsuccessful outcome (death or per-From the
Pediatrics, 2012
Control of pain and stress for children is a vital component of emergency medical care. Timely ad... more Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a child’s and family’s reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction.
Pediatric Emergency Care, 1996
Pediatric Clinics of North America, 2009
Chest pain is a relatively common complaint among pediatric patients and presents a diagnostic ch... more Chest pain is a relatively common complaint among pediatric patients and presents a diagnostic challenge that is associated with significant emotional as well as monetary costs. Patients as well as their families are often concerned about life-threatening causes for the chest pain, although these are rarely identified. There are numerous etiologies for pediatric chest pain and Box 1 lists the differential diagnosis of chest pain in children. The clinician's primary goal in evaluating the pain, whether it is in a primary care office, cardiology clinic, or the emergency department (ED) setting, is to identify the serious causes and rule out other organic pathology. Similarly, chest wall deformity can also be of great concern to patients and their families. The goal in evaluation and treatment of patients with chest wall deformity should be to maximize lung growth and function as a child grows and to minimize related psychologic problems. Table 1 describes the levels of evidence for studies discussed in this paper. CHEST PAIN The frequency of pediatric chest pain among different EDs has been shown to be anywhere between 0.3% (Level of evidence [LOE] 2, Table 1) 1 and 0.6% of all visits (LOE 2). 2,3 In an earlier study (LOE 2), 4 the occurrence rate of chest pain in the ED, cardiac clinic, and primary care physician's office in one hospital was found to be 0.288%. One of these studies (LOE 2), 1 while finding very few ''serious'' causes of chest pain, noted that almost 90% of patients considered the pain to be at least ''moderate or severe'' in intensity; at least half of the patients interviewed by a psychiatrist in another study were worried about the pain being related to their ''heart'' (LOE 2). 4 Given the perceived severity of pain and the surrounding anxiety about heart problems and presumably other life-threatening problems, it would be useful to have an evidence-based guide for chest pain that allowed efficient identification of
Clinical Pediatrics, 1990
During a 1-year period, 407 children with chest pain were seen in the Emergency Department of Chi... more During a 1-year period, 407 children with chest pain were seen in the Emergency Department of Children's Hospital of Philadelphia. Analysis of the clinical data of these children was reported previously. The authors successfully followed 149 of these children for 6 months or more, and 51 for 2 years or more. These patients returned for an average of 3.4 visits during the follow-up period. Thirty-four percent of the initial diagnoses were altered. Usually, during the follow-up period, the authors concluded that chest pain resulted from nonorganic causes. A new organic etiology was uncovered in only 12 of 149 cases. Only 1 child was found to have a heart abnormality (mitral valve prolapse), and 3 were found to have asthma. Chest pain did not resolve during the follow-up period in 43 percent of those followed. Children with chest pain should have follow-up care because of the persistence of symptoms, but serious disease is unlikely to be found over time.
Clinical Pediatrics, 2001
Annals of Emergency Medicine, 1999
Annals of Emergency Medicine, 1999
AAP News, Dec 1, 1995
Medication errors are a significant problem for physicians. Experienced and inexperienced staff, ... more Medication errors are a significant problem for physicians. Experienced and inexperienced staff, including doctors, nurses, pharmacists, administrators, support personnel, patients and other caregivers, can make these mistakes. By producing look-alike and sound-alike drugs, often with similar packaging, drug manufacturers also are involved in medication errors.
Pediatrics in Review, 1986
Appropriate recognition of the likely etiologic basis for chest pains in children and adolescents... more Appropriate recognition of the likely etiologic basis for chest pains in children and adolescents (Recent Advances, 86/87).
Clinical Pediatric Emergency Medicine, 2003
EDIATRIC EMERGENCY medicine is a high risk specialty. Surveys of the American Academy of Pediatri... more EDIATRIC EMERGENCY medicine is a high risk specialty. Surveys of the American Academy of Pediatrics membership have shown that one third of pediatricians have been named in a malpractice suit, and many of those cases involved acutely ill or injured children. 1 Although all physicians have significant legal liability, medical malpractice cases involve the emergency department (ED) in a disproportionate number of cases. In one study of 262 pediatric cases alleging malpractice, the ED accounted for 45% of hospital-related cases. 2 Physicians are involved in 88% of ED claims, and nurses account for 7% as the principle participants. 3 Pre-hospital care providers are less likely to be sued for malpractice; however, they are not invulnerable. Most lawsuits against physicians are dropped or settled out of court. 4 Only about 10% actually reach a jury verdict. However, the strain of a lawsuit is still quite burdensome for all involved. It can result in significant emotional stress as well as a loss of time and money. Even if the case does not go to trial, it can still prove quite expensive. Malpractice suits may be an unpleasant and undeniable part of emergency medicine. However, they are not inevitable. Like other pediatric diseases and childhood injuries, some malpractice suits are predictable and preventable. If we begin to understand the etiology, epidemiology, and pathology of malpractice suits, we can take steps to avert them. 5
Academic Emergency Medicine, 2015
Objectives: Changes in health care delivery and graduate medical education have important consequ... more Objectives: Changes in health care delivery and graduate medical education have important consequences for the workforce in pediatric emergency medicine (PEM). This study compared career preparation and potential attrition of the PEM workforce with the prior assessment from 1998. Methods: An e-mail survey was sent to members of the American Academy of Pediatrics (AAP) Section on EM and to non-AAP members board certified in PEM. Information on demographics, practice characteristics and professional activities, career preparation, future plans, and burnout (using two validated screening questions) was analyzed using standard descriptive statistics.
Archivos De Pediatria Del Uruguay, Nov 1, 2001
La intoxicación por plomo es un importante problema ambiental en EE.UU. y en el mundo. Si bien en... more La intoxicación por plomo es un importante problema ambiental en EE.UU. y en el mundo. Si bien en la década pasada declinó el nivel promedio de plomo en sangre, el envenenamiento es aún una amenaza para los niños. En el año 2001 se reportó en EE.UU. la primera muerte debida a esta intoxicación en muchos años. Otros miles están afectados por esta enfermedad.
Pediatric Sedation Outside of the Operating Room, 2011
Current Problems in Pediatrics, 1990
Although the principles of emergency care may be relatively easy to state, it is their promulgati... more Although the principles of emergency care may be relatively easy to state, it is their promulgation that is so difficult. The development of EMS-C is the challenge. How do we take these principles of preserving children's lives and translate them into services for everyone who needs them? How do we organize a large, diverse health care system which will be responsive to this group of patients in need? How do we prioritize pediatric emergency care among the many other funding needs, both medical and nonmedical? The answer lies with the initiative and advocacy of each of us as child advocates. Providing all the aforementioned elements of the EMS-C will save children's lives. These are lives which are usually responsive to therapy, uncomplicated by interlocking disease states, and filled with potential for future achievement. The challenge is ours.
Pediatric emergency care, 2009
Pediatric Emergency Care, 1985
Pediatrics, 1997
Background. Approximately 32 000 nonpowder firearm injuries are reported annually with more than ... more Background. Approximately 32 000 nonpowder firearm injuries are reported annually with more than 60% occurring in the pediatric population. Case reports of serious and fatal injuries have been described; however, no large inclusive series have been published. We reviewed an 11-year experience of an urban pediatric emergency department to evaluate the circumstances, spectrum of injuries, and outcomes attributable to nonpowder firearms. Methods. A retrospective, descriptive case series of all children 18 years of age or younger evaluated at an urban children's hospital from January 1983 through December 1994 were eligible for study. Patients were identified using a computerized database, the National Electronic Injury Surveillance System, and the trauma registry in the department of surgery. Medical records were reviewed to collect demographic information, circumstances of injury, anatomic site and type of injury, treatment, and outcomes for nonpowder firearm injuries. Results. On...
Pediatrics, 2012
Pediatric observation units (OUs) are hospital areas used to provide medical evaluation and/or ma... more Pediatric observation units (OUs) are hospital areas used to provide medical evaluation and/or management for health-related conditions in children, typically for a well-defined, brief period. Pediatric OUs represent an emerging alternative site of care for selected groups of children who historically may have received their treatment in an ambulatory setting, emergency department, or hospital-based inpatient unit. This clinical report provides an overview of pediatric OUs, including the definitions and operating characteristics of different types of OUs, quality considerations and coding for observation services, and the effect of OUs on inpatient hospital utilization.
PEDIATRICS, 2000
Objective. Factors that contribute to adverse sedation events in children undergoing procedures w... more Objective. Factors that contribute to adverse sedation events in children undergoing procedures were examined using the technique of critical incident analysis. Methodology. We developed a database that consists of descriptions of adverse sedation events derived from the Food and Drug Administration's adverse drug event reporting system, from the US Pharmacopeia, and from a survey of pediatric specialists. One hundred eighteen reports were reviewed for factors that may have contributed to the adverse sedation event. The outcome, ranging in severity from death to no harm, was noted. Individual reports were first examined separately by 4 physicians trained in pediatric anesthesiology, pediatric critical care medicine, or pediatric emergency medicine. Only reports for which all 4 reviewers agreed on the contributing factors and outcome were included in the final analysis. Results. Of the 95 incidents with consensus agreement on the contributing factors, 51 resulted in death, 9 in permanent neurologic injury, 21 in prolonged hospitalization without injury, and in 14 there was no harm. Patients receiving sedation in nonhospital-based settings compared with hospital-based settings were older and healthier. The venue of sedation was not associated with the incidence of presenting respiratory events (eg, desaturation, apnea, laryngospasm, ϳ80% in each venue) but more cardiac arrests occurred as the second (53.6% vs 14%) and third events (25% vs 7%) in nonhospital-based facilities. Inadequate resuscitation was rated as being a determinant of adverse outcome more frequently in nonhospital-based events (57.1% vs 2.3%). Death and permanent neurologic injury occurred more frequently in nonhospital-based facilities (92.8% vs 37.2%). Successful outcome (prolonged hospitalization without injury or no harm) was associated with the use of pulse oximetry compared with a lack of any documented monitoring that was associated with unsuccessful outcome (death or per-From the
Pediatrics, 2012
Control of pain and stress for children is a vital component of emergency medical care. Timely ad... more Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a child’s and family’s reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction.
Pediatric Emergency Care, 1996
Pediatric Clinics of North America, 2009
Chest pain is a relatively common complaint among pediatric patients and presents a diagnostic ch... more Chest pain is a relatively common complaint among pediatric patients and presents a diagnostic challenge that is associated with significant emotional as well as monetary costs. Patients as well as their families are often concerned about life-threatening causes for the chest pain, although these are rarely identified. There are numerous etiologies for pediatric chest pain and Box 1 lists the differential diagnosis of chest pain in children. The clinician's primary goal in evaluating the pain, whether it is in a primary care office, cardiology clinic, or the emergency department (ED) setting, is to identify the serious causes and rule out other organic pathology. Similarly, chest wall deformity can also be of great concern to patients and their families. The goal in evaluation and treatment of patients with chest wall deformity should be to maximize lung growth and function as a child grows and to minimize related psychologic problems. Table 1 describes the levels of evidence for studies discussed in this paper. CHEST PAIN The frequency of pediatric chest pain among different EDs has been shown to be anywhere between 0.3% (Level of evidence [LOE] 2, Table 1) 1 and 0.6% of all visits (LOE 2). 2,3 In an earlier study (LOE 2), 4 the occurrence rate of chest pain in the ED, cardiac clinic, and primary care physician's office in one hospital was found to be 0.288%. One of these studies (LOE 2), 1 while finding very few ''serious'' causes of chest pain, noted that almost 90% of patients considered the pain to be at least ''moderate or severe'' in intensity; at least half of the patients interviewed by a psychiatrist in another study were worried about the pain being related to their ''heart'' (LOE 2). 4 Given the perceived severity of pain and the surrounding anxiety about heart problems and presumably other life-threatening problems, it would be useful to have an evidence-based guide for chest pain that allowed efficient identification of
Clinical Pediatrics, 1990
During a 1-year period, 407 children with chest pain were seen in the Emergency Department of Chi... more During a 1-year period, 407 children with chest pain were seen in the Emergency Department of Children's Hospital of Philadelphia. Analysis of the clinical data of these children was reported previously. The authors successfully followed 149 of these children for 6 months or more, and 51 for 2 years or more. These patients returned for an average of 3.4 visits during the follow-up period. Thirty-four percent of the initial diagnoses were altered. Usually, during the follow-up period, the authors concluded that chest pain resulted from nonorganic causes. A new organic etiology was uncovered in only 12 of 149 cases. Only 1 child was found to have a heart abnormality (mitral valve prolapse), and 3 were found to have asthma. Chest pain did not resolve during the follow-up period in 43 percent of those followed. Children with chest pain should have follow-up care because of the persistence of symptoms, but serious disease is unlikely to be found over time.
Clinical Pediatrics, 2001