Robert G Bolte

University of Utah, Salt Lake City, Utah, United States

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Publications (13)20.16 Total impact

  • Robert G. Bolte, Jeff A. Robison
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    ABSTRACT: Pediatric care providers in the developing world face daunting challenges, often exceeding available resources. This challenge presents an opportunity for constructive involvement in international medicine by pediatric emergency medicine (PEM) physicians. The significant need for providing improved pediatric care worldwide dovetails with a high level of interest in international medicine among medical students, residents, and practicing physicians in the United States and Canada. With its emphasis on acute management and resuscitation, PEM specialists possess a knowledge base and skill set vital to pediatric care in the developing world. Development of collaborative continuing medical education is an important step in the improvement of pediatric emergency care in the developing world. A paradigm of successful program development is discussed based on experiences in Guatemala and Ghana. Future directions in international continuing medical education, including enhanced PEM fellow involvement, are also discussed.
    Clinical Pediatric Emergency Medicine 03/2012; 13(1):25–30. DOI:10.1016/j.cpem.2011.12.003
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    ABSTRACT: Amiodarone is a class 3 antiarrhythmic agent used for a broad range of arrhythmias including adenosine-resistant supraventricular tachycardia, junctional ectopic tachycardia, and ventricular tachycardia. Compared with adults, there are few data on its use in children with arrhythmias resistant to conventional therapy. National and international guidelines for cardiopulmonary resuscitation and emergency cardiovascular care recommend its use for a variety of arrhythmias based on case reports, cohort studies, and extrapolation from adult data. This article will review the historical development, chemical properties, metabolism, indications and contraindications, and adverse effects of amiodarone in infants and children. After completing this CME activity, the reader should be able to utilize amiodarone in the pediatric population for arrhythmias and identify complications associated with its use.
    Pediatric emergency care 05/2010; 26(5):382-9. DOI:10.1097/PEC.0b013e3181ddd2d6 · 0.92 Impact Factor
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    ABSTRACT: Our objective was to describe young children injured through the use of infant carrier car seats, comparing them with children injured through other fall mechanisms. We performed a retrospective chart review of children 18 months or younger with a fall mechanism of injury presenting to the emergency department of a tertiary care level 1 pediatric trauma center from August 2004 to December 2005. The primary outcome measure of the study was to determine the pattern of injuries sustained by infants falling from infant carrier seats. Eight hundred three children were identified. There were 62 patients (7.7%) with infant carrier falls with a mean age of 4.4 months. Of these patients, 87.1% were not buckled into their carriers. Infant carrier-related falls resulted in 22 hospitalizations (35.5%), including 6 pediatric intensive care unit admissions (9.7%). Thirteen patients in the group with infant carrier-related falls sustained intracranial injuries (ICIs; subdural hematoma, 8; epidural hematoma, 3; cerebral contusion, 1; and subarachnoid hemorrhage, 1); 1 patient required a craniotomy. Ten patients had isolated skull fractures, and 11 of the 13 patients with ICIs also had skull fractures. The 62 carrier patients were compared with 741 children with other fall mechanisms. The carrier group had more ICIs (P < 0.001) and hospitalizations (P < 0.001). When carrier injuries were compared with falls down stairs, there were more ICIs (13/62 vs. 2/68, P = 0.002) resulting from carrier injuries. Falls from infant carriers are common, often involve children unbuckled in their car seats, and represent a significant source of morbidity. Injury prevention measures such as education and manufacture labeling may be effective strategies.
    Pediatric emergency care 01/2009; 25(2):66-8. DOI:10.1097/PEC.0b013e318196e9dc · 0.92 Impact Factor
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    Roni D Lane, Robert G Bolte
    Pediatric emergency care 02/2007; 23(1):49-56; quiz 57-60. DOI:10.1097/PEC.0b013e31802d4b87 · 0.92 Impact Factor
  • Pediatric Emergency Care 01/2005; 21(1):18-22. DOI:10.1097/01.pec.0000150983.96357.83 · 0.92 Impact Factor
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    ABSTRACT: Freestanding children's hospitals may lack resources, especially surgical manpower, to meet American College of Surgeons trauma center criteria, and may organize trauma care in alternative ways. At a tertiary care children's hospital, attending trauma surgeons and anesthesiologists took out-of-hospital call and directed initial care for only the most severely injured patients, whereas pediatric emergency physicians directed care for patients with less severe injuries. Survival data were analyzed using TRISS methodology. A total of 903 trauma patients were seen by the system during the period 10/1/96-6/30/01. Median Injury Severity Score was 16, and 508 of patients had Injury Severity Score > or =15. There were 83 deaths, 21 unexpected survivors, and 13 unexpected deaths. TRISS analysis showed that z-score was 4.39 and W-statistic was 3.07. Mortality outcome from trauma in a pediatric hospital using this alternative approach to trauma care was significantly better than predicted by TRISS methodology.
    Pediatric emergency care 01/2005; 21(1):18-22. · 0.92 Impact Factor
  • Andrew S Johnson, Robert G Bolte
    Pediatric emergency care 09/2004; 20(8):555-60; quiz 561-3. DOI:10.1097/01.pec.0000136076.60445.3c · 0.92 Impact Factor
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    ABSTRACT: Few studies have addressed the presentation and clinical impact of pediatric pelvic fractures. We sought to describe pediatric blunt trauma patients with pelvic fracture (PF) and to evaluate the sensitivity and specificity of physical examination at presentation for diagnosis. Retrospective analysis of all PF and control (NPF) patients from our pediatric institution over an 8-year period. A total of 174 patients (88 PF, 86 NPF) were included. Median patient age was 8 years (range, 3 months to 18 years), with 54% males. The most common mechanisms of injury for PF patients were automobile-related accidents (75%). There were 140 patients (87%) who were transported by air or ground medical services. At presentation, approximately 16% of PF patients had a Glasgow Coma score of <15, a mean Revised Trauma Score of 7.49, and a median Injury Severity Score (ISS) of 9. Thirty-one PF patients (35%) had an ISS of >15 indicating severe, multiple injuries. Sixty-eight PF patients (77%) had severe isolated injuries (Abbreviated Injury Scale 1990 value of >3); 11% of PF patients required transfusions, and 2% died. Fifteen PF patients (17% ) had no pelvic ring disruption; 39 (43%) had a single pelvic ring fracture, 22 (2%) had two pelvic ring fractures, 2 (2%) had acetabular fractures, and 10 (11%) had a combination of pelvic fractures. An abnormal physical examination of the pelvis was noted in 81 patients with PF (92% sensitivity, 95% confidence interval [CI] = 0.89-0.95), 15 NPF patients had an abnormal examination (79% specificity, 95% CI = 0.74-0.84). The positive predictive value of the pelvis examination was 0.84, and the negative predictive value was 0.89. The most common abnormal pelvis examination finding was pelvic tenderness in 65 PF patients (73%). A total of seven PF patients had a normal examination of the pelvis; four had a depressed level of consciousness (defined as GCS <15), and six patients had a distracting injury. Pediatric blunt trauma patients with pelvic fracture represent a severely injured population but generally have lower transfusion rates and mortality than noted in adult studies. The pelvis examination appears to be sensitive and specific in this retrospective study. However, an altered level of consciousness and/or distracting injuries may affect examination sensitivity and specificity. Based on this retrospective study, we cannot advocate eliminating pelvic radiographs in the severely injured, blunt trauma patient. Prospective studies are recommended.
    Pediatric Emergency Care 03/2001; 17(1):15-8. DOI:10.1097/00006565-200102000-00004 · 0.92 Impact Factor
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    ABSTRACT: The purpose of this study was to determine the applicability of two accepted outpatient management protocols for the febrile infant 1-2 months of age (Boston and Philadelphia protocols) in febrile infants 1-28 days of age. We retrospectively reviewed charts of patients 1-28 days of age with a temperature greater than or equal to 38.0 degrees C. Criteria from each of the above-cited management protocols were applied to the patients to determine their applicability in screening for serious bacterial infection (SBI). An SBI was defined as bacterial growth in cultures from blood, urine, cerebrospinal fluid (CSF), stool, or any aspirated fluid. Overall, 372 febrile infants were included in the study. Ages ranged from 1 to 28 days of age. The mean age was 15 days. SBI occurred in 45 patients (12%). The mean age of the patients with an SBI was 13 days. Thirty-two infants (8.6%) had a urinary tract infection; 12 (3.2%), bacteremia; five (1.3%), bacterial meningitis; three (0.8%), cellulitis; one (0.3%), septic arthritis; one (0.3%), bacterial gastroenteritis; and one (0.3%), pneumonia. Ten infants had more than one SBI. Of 372 patients, 231 (62%) met the Boston's laboratory low-risk criteria; eight (3.5%) would have been sent home with an SBI with these criteria. Philadelphia's laboratory low-risk criteria would have been met by 186 patients (50%); six (3.2%) would have been sent home with an SBI with these criteria. The negative predictive value of both the Boston and Philadelphia protocols for excluding an SBI was 97%. We conclude that current management protocols for febrile infants 1-2 months of age when applied to febrile infants 1 to 28 days of age would allow 3% of febrile infants less than 28 days of age to be sent home with an SBI. Current guidelines recommending admitting all febrile infants less than 28 days of age should be followed until the outcome of those 3% of febrile infants with an SBI treated as outpatients can be determined.
    Clinical Pediatrics 03/2000; 39(2):81-8. DOI:10.1177/000992280003900202 · 1.26 Impact Factor
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    ABSTRACT: Delay in the provision of definitive care for critically injured children may adversely effect outcome. We sought to speed care in the emergency department (ED) for trauma victims by organizing a formal trauma response system. A case-control study of severely injured children, comparing those who received treatment before and after the creation of a formal trauma response team. A tertiary pediatric referral hospital that is a locally designated pediatric trauma center, and also receives trauma victims from a geographically large area of the Western United States. Pediatric trauma victims identified as critically injured (designated as "trauma one") and treated by a hospital trauma response team during the first year of its existence. Control patients were matched with subjects by probability of survival scores, and were chosen from pediatric trauma victims treated at the same hospital during the year preceding the creation of the trauma team. A trauma response team was organized to respond to pediatric trauma victims seen in the ED. The decision to activate the trauma team (designation of patient as "trauma one") is made by the pediatric emergency medicine (PEM) physician before patient arrival in the ED, based on data received from prehospital care providers. Activation results in the notification and immediate travel to the ED of a pediatric surgeon, neurosurgeon, emergency physician, intensivist, pharmacist, radiology technician, phlebotomist, and intensive care unit nurse, and mobilization of an operating room team. Most trauma one patients arrived by helicopter directly from accident scenes. Data recorded included identifying information, diagnosis, time to head computerized tomography, time required for ED treatment, admission Revised Trauma Score, discharge Injury Severity Score, surgical procedures performed, and mortality outcome. Trauma Injury Severity Score methodology was used to calculate the probability of survival and mortality compared with the reference patients of the Major Trauma Outcome Study, by calculation of z score. Patients treated in the ED after trauma team initiation had statistically shorter times from arrival to computerized tomography scanning (27 +/- 2 vs 21 +/- 4 minutes), operating room (63 +/- 16 vs 623 +/- 27 minutes) and total time in the ED (85 +/- 8 vs 821 +/- 9 minutes). Calculation of z score showed that survival for the control group was not different from the reference population (z = -0.8068), although survival for trauma-one patients was significantly better than the reference population (z = 2.102). Before creation of the trauma team, relevant specialists were individually called to the ED for patient evaluation. When a formal trauma response team was organized, time required for ED treatment of severe trauma was decreased, and survival was better than predicted compared with the reference Major Trauma Outcome Study population.
    PEDIATRICS 02/1999; 103(1):20-4. DOI:10.1542/peds.103.1.20 · 5.30 Impact Factor
  • HA Kadish, R G Bolte
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    ABSTRACT: To compare historical features, physical examination findings, and testicular color Doppler ultrasound in pediatric patients with epididymitis, testicular torsion, and torsion of appendix testis. A retrospective review of patients with the diagnosis of epididymitis, testicular torsion, or torsion of appendix testis. Ninety patients were included in the study (64 with epididymitis, 13 with testicular torsion, and 13 with torsion of appendix testis). Historical features did not differ among groups except for duration of symptoms. Of 13 patients with testicular torsion all had a tender testicle and an absent cremasteric reflex. When compared with the testicular torsion group, fewer patients with epididymitis had a tender testicle (69%) or an absent cremasteric reflex (14%). 62 (97%) patients with epididymitis had a tender epididymis and 43 (67%) had scrotal erythema/edema. By comparison, 3 (23%) and 5 (38%) patients with testicular torsion had a tender epididymis or scrotal erythema/edema, respectively. Doppler ultrasound showed decreased or absent blood flow in 8 patients, 7 of whom were diagnosed with testicular torsion. Ten out of 13 patients with testicular torsion had a salvageable testicle at the time of surgery. The physical examination is helpful in distinguishing among epididymitis, testicular torsion, and torsion of appendix testis. Patients presenting with a tender testicle and an absent cremasteric reflex were more likely to have a testicular torsion rather than epididymitis or torsion of appendix testis. An absent cremasteric reflex was the most sensitive physical finding for diagnosing testicular torsion. Color Doppler ultrasound is a useful adjunct in the evaluation of the acute scrotum when physical findings are equivocal.
    Pediatrics 08/1998; 102(1 Pt 1):73-6. DOI:10.1542/peds.102.1.73 · 5.30 Impact Factor
  • Pediatric Emergency Care 07/1998; 14(3):237-45. DOI:10.1097/00006565-199806000-00019 · 0.92 Impact Factor
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    ABSTRACT: To evaluate the effectiveness of a pediatric trauma course taught in a developing country. A pediatric trauma course was designed with didactic presentations and reinforced with small group case discussions. Subjects included a general trauma overview, head trauma, airway/chest trauma, cervical spine trauma, abdominal trauma, shock, burns, and orthopedic injuries. Evaluation consisted of a pre- and post-course test and questionnaire assessing the participants' knowledge and level of comfort in managing trauma. Nine months after the course, the participants were evaluated with the same post-course test. Also a questionnaire was given to physician and nurse co-workers from the participating institutions, who themselves had not participated in the course, to assess the perceptual and attitudinal impact of the pediatric trauma course. Guatemala City, Guatemala. Forty-three physicians from Central America. Initial and nine-month post-test scores showed uniform improvement (P value < 0.05) when compared to pretest results using the Wilcoxon signed-ranks test. Analysis of the pre- and post-course questionnaires indicated that all participants felt more comfortable (scale 1 to 5) after the course managing pediatric trauma patients. All participants "strongly agreed" the course provided information that would improve their management of the pediatric trauma victim. Nine months after the course, 100% of their medical co-workers perceived physicians who participated in the pediatric trauma course to have better resuscitative skills, and 92% perceived these physicians to have a higher level of confidence. This course, when presented to physicians in a developing country, appears to be effective in improving their knowledge base regarding pediatric trauma and increasing their comfort level in managing major pediatric trauma.
    Pediatric Emergency Care 12/1996; 12(6):407-10. DOI:10.1097/00006565-199612000-00005 · 0.92 Impact Factor