This large multicenter study validates the Bacterial Meningitis Score prediction rule in the era of conjugate pneumococcal vaccine as an accurate decision support tool. The risk of bacterial meningitis is very low (0.1%) in patients with none of the criteria. The Bacterial Meningitis Score may be helpful to guide clinical decision making for the management of children presenting to emergency departments with CSF pleocytosis.

In patients with bacterial meningitis, antibiotic pretreatment is associated with higher cerebrospinal fluid glucose levels and lower cerebrospinal fluid protein levels, although pretreatment does not modify cerebrospinal fluid white blood cell count or absolute neutrophil count results.

An asymptotic solution is presented for the diffraction by a resistive strip which is useful in the simulation of thin dielectric layers. Up to third-order diffraction terms are derived which include the surface wave field effects in a uniform manner. Extensions to the case of conductive and impedance strips are also given in Appendix C. The derivation of the higher order terms is based on the extended spectral ray method. New first-order diffraction coefficients for the impedance, resistive and conductive half planes are also presented. The last are uniform everywhere, including the surface wave field boundaries.

Objectives To describe the culture results of cutaneous infections affecting otherwise healthy children presenting to two pediatric emergency departments (EDs) in the southeastern United States and southern California. Methods Medical records of 920 children who presented to the pediatric EDs with skin infections and abscesses (International Classification of Diseases, Ninth Revision codes 680.0–686.9) during 2003 were reviewed. Chronically ill children with previously described risk factors for community‐associated methicillin‐resistant Staphylococcus aureus (CA‐MRSA) were excluded. Data abstracted included the type of infection; the site of infection; and, if a culture was obtained, the organism grown, along with their corresponding sensitivities. Results Of the 270 children who had bacterial cultures obtained, 60 (22%) were CA‐MRSA–positive cultures, most cultured from abscesses (80%). Of all abscesses cultured, CA‐MRSA grew in more than half (53%). All CA‐MRSA isolates tested were sensitive to vancomycin, trimethoprim‐sulfamethoxazole, rifampin, and gentamicin. One isolate at each center was resistant to clindamycin. The sensitivities at both institutions were similar. Conclusions The authors conclude that CA‐MRSA is responsible for most abscesses and that the pattern of CA‐MRSA infections in these geographically distant pediatric EDs is similar. These data suggest that optimal diagnostic and management strategies for CA‐MRSA will likely be widely applicable if results from a larger, more collaborative study yield similar findings.

The unique characteristics of the pediatric population expose them to errors in the emergency department (ED) with few standard practices for the safety of care. Young children and high-acuity patients are at increased risk of adverse events both in the prehospital and ED settings. We provide an overview of the problems and possible solutions to the threats to pediatric patient safety in the ED. Endorsing a culture of safety and training to work in a team are discussed. Medication errors can be reduced by using organizational systems, and manufacturing and regulatory systems, by educating health care providers, and by providing caregivers tools to monitor prescribing. The consensus is that a safe environment with a high quality of care will reduce morbidity and mortality in ED pediatric patients.