BACKGROUND: Inflammatory bowel disease-unclassified (IBD-U) is diagnosed in ∼10% of pediatric and adolescent onset IBD patients. The EUROKIDS registry (2004) initiated by the Porto IBD working group of ESPGHAN prospectively monitors diagnostic workup of newly diagnosed pediatric and adolescent onset IBD patients. We aimed to describe diagnostic workup, phenotype, and change of diagnosis over time in pediatric IBD-U patients. METHODS: Data were collected on children from 52 centers across 20 European countries and Israel, diagnosed with IBD from May 2005 through November 2013. Full endoscopy plus small bowel radiology was considered complete diagnostic workup. Participating centers reporting IBD-U patients were queried in 2014 for follow-up data. RESULTS: IBD-U was the provisional first diagnosis in 265 of 3461 children (7.7%) (91/158 [58%] with pancolitis; 140 [53%] male), diagnosed more frequently under the age of 10 (median age 12.3 years, 89 [34%] under 10 years). Half (48%) had undergone complete diagnostic workup. Lack of small bowel radiology was the prevailing reason for incomplete workup. As a result of reinvestigations (endoscopy in 54%, radiology in 38%) during a median follow-up of 5.7 years (interquartile range, 2.5-7.8), a change in diagnosis from IBD-U to Crohn's disease (12%) or ulcerative colitis (20%) was reported. CONCLUSIONS: Only half of patients reported as IBD-U in EUROKIDS had undergone complete diagnostic workup. Follow-up with reinvestigations resulted in a reduction of IBD-U rate to 5.6%. A diagnosis of IBD-U becomes less likely in case of complete diagnostic workup. Implementation of clear diagnostic criteria will further reduce the rate of IBD-U in the future.

• MeSH
• Diagnostic Errors statistics & numerical data   MeSH
• Child MeSH
• Endoscopy, Gastrointestinal MeSH
• Inflammatory Bowel Diseases classification   diagnosis   epidemiology   MeSH
• Humans MeSH
• Adolescent MeSH
• Registries statistics & numerical data   MeSH
• Retrospective Studies MeSH
• Medical Audit methods   statistics & numerical data   MeSH
• Intestine, Small radiography   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Europe MeSH
• Israel MeSH

ÚVOD: Kontinuální posuzování preventabilního úmrtí je jednou z možností posouzení funkčnosti trauma systému. METODY: V naší práci jsme se zabývali zjišťováním preventabilního úmrtí pacientů transportovaných ze spádového území Traumacentra Hradec Králové v letech 2003-2004. Každé úmrtí bylo revidováno v kategoriích: 1) prevence úrazu, 2) přednemocniční fáze, 3) zajištění na Emergency a nemocniční péče a 4) edukace poskytovatele péče. VÝSLEDKY: V daném období bylo primárně transportováno n=157 pacientů s průměrným ISS 19,7. Celkem n=24 pacientů z tohoto souboru zemřelo (ÆISS 43). Zjistili jsme dvě preventabilní úmrtí. V jednom případě se jednalo o problém se zajištěním dýchacích cest na místě úrazu jako prevence sekundárního mozkového postižení. Ve druhém případě se jednalo o problém s identifikací vnitřního krvácení. ZÁVĚR: Přesné dodržování ATLS protokolu snižuje počet preventabilních úmrtí.

BACKGROUND: Continual evaluation of preventable death is one of choice in evaluation of Trauma system. METHODS: In our paper we have found preventable death in population Triage positive patients primary transported from the scene of injury in rural area in the Trauma Center during the years 2003-2004. Every case of death was reviewed in the categories: 1. injury prevention, 2. prehospital care, 3. ER and hospital care and 4. provider education. RESULTS: There was primary transported n=157 patients (ÆISS 19,7), n=24 of them died (ÆISS 43). We identified as preventable two deaths. There was problem in airway management in the scene of injury as a prevention of secondary brain injury. In cases of unpreventable deaths were found problems with identification of internal bleeding. CONC

• Keywords
• preventabilní úmrtí,
• MeSH
• Time Factors MeSH
• Medical Errors prevention & control   statistics & numerical data   MeSH
• Humans MeSH
• Mortality * MeSH
• Advanced Trauma Life Support Care methods   MeSH
• Cause of Death MeSH
• Wounds and Injuries mortality   prevention & control   therapy   MeSH
• Medical Audit * statistics & numerical data   MeSH
• Injury Severity Score MeSH
• Trauma Centers * standards   organization & administration   MeSH
• Traumatology standards   organization & administration   statistics & numerical data   MeSH
• Accidents MeSH
• Emergency Medical Services organization & administration   statistics & numerical data   MeSH
• Outcome and Process Assessment, Health Care * statistics & numerical data   MeSH
• Health Services Research statistics & numerical data   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

• MeSH
• Cross Infection economics   etiology   mortality   MeSH
• Quality of Health Care economics   organization & administration   MeSH
• Humans MeSH
• Medical Audit economics   statistics & numerical data   MeSH
• Check Tag
• Humans MeSH

Práce přináší modifikovaný pohled na revizní činnost největší zdravotní pojišťovny v roce 2000. Ukazuje, že revizní činnost VZP ČR je stabilizovaná a její parametry odpovídají standardnímu průměru. Neúměrnou benevolenci ukazuji procenta neschválených a nepovolených žádostí SZZ o nestandardní zdravotní péči (vázanou na souhlas revizního lékaře zdravotní pojišťovny). Práce poprvé podrobně analyzuje expertní část revizní činnosti VZP (posuzování). Popisuje personální zajištění realizace revizní činnosti podle jednotlivých typů revizních pracovníků a formy jejich pracovněprávního vztahu k organizaci. Nově přináší i informace o četnosti revizních činností připadajících na jednu Okresní pojišťovnu VZP a její revizní lékaře (revizní pracovníky).

The paper contains a modified view on the revisory activities of the largest health insurance company In 2000. It shows that its revisory activities in the Czech Republic are stabilized and its parameters are consistent with the standard average. Disproport onate benevolence is indicated by the percentage of not approved and not granted applications for non-standard care (pending approval of the Revision medical officers of the health Insurance company. For the first time the expert part of the revisory activities Is analyzed. The authors describe also staff aspects of implementation of revisory activities by different types of workers engaged In the problem and their relationship to the organization. It provides also some new information on tne trequency of revisory activities per District Health Insurance Offices and their Revision medical officers (employees).

• MeSH
• Humans MeSH
• Professional Review Organizations organization & administration   MeSH
• Medical Audit statistics & numerical data   MeSH
• Insurance, Health MeSH
• Check Tag
• Humans MeSH
• Publication type
• Annual Report MeSH