Estimating the weight of ethnically diverse children attending an Australian emergency department: a prospective, blinded, comparison of age-based and length-based tools including Mercy, PAWPER and Broselow

Objective To prospectively compare the actual weights of Australian children in an ethnically diverse metropolitan setting with the predicted weights using the Paediatric Advanced Weight Prediction in the Emergency Room (PAWPER) tape, Broselow tape, Mercy system and calculated weights using the updated Advanced Paediatric Life Support (APLS), Luscombe and Owens and Best Guess formulae. Methods A prospective, cross-sectional, observational, blinded, convenience study conducted at the Children’s Hospital at Westmead Paediatric Emergency Department in Sydney, Australia. Comparisons were made using Bland-Altman plots, mean difference, limits of agreement and estimated weight within 10% and 20% of actual weight. Results 199 patients were enrolled in the study with a mean actual weight of 27.2 kg (SD 17.2). Length-based tools, with or without body habitus adjustment, performed better than age-based formulae. When measuring estimated weight within 10% of actual weight, PAWPER performed best with 73%, followed by Mercy (69%), PAWPER with no adjustment (62%), Broselow (60%), Best Guess (47%), Luscombe and Owens (41%) and revised APLS (40%). Mean difference was similar across all methods ranging from 0.4 kg (0.0, 0.9) for Mercy to −2.2 kg (−3.5, −0.9) for revised APLS. Limits of agreement were narrower for the lengthbased tools (−5.9, 6.8 Mercy; −8.3, 5.6 Broselow; −9.0, 7.1 PAWPER adjusted; −12.1, 9.2 PAWPER unadjusted) than the age-based formulae (−18.6, 17.4 Best Guess; −19.4, 15.1 revised APLS, −21.8, 17.7 Luscombe and Owens). Conclusion In an ethnically diverse population, lengthbased methods with or without body habitus modification are superior to age-based methods for predicting actual body weight. Body habitus modifications increase the accuracy and precision slightly

Realism in paediatric emergency simulations: A prospective comparison of in situ, low fidelity and centre-based, high fidelity scenarios

Objective To measure scenario participant and faculty self‐reported realism, engagement and learning for the low fidelity, in situ simulations and compare this to high fidelity, centre‐based simulations. Methods A prospective survey of scenario participants and faculty completing in situ and centre‐based paediatric simulations. Results There were 382 responses, 276 from scenario participants and 106 from faculty with 241 responses from in situ and 141 from centre‐based simulations. Scenario participant responses showed significantly higher ratings for the centre‐based simulations for respiratory rate (P = 0.007), pulse (P = 0.036), breath sounds (P = 0.002), heart sounds (P < 0.001) and patient noises (P < 0.001). There was a significant difference in overall rating of the scenario reality by scenario participants in favour of the centre‐based simulations (P = 0.005); however, there was no significant difference when rating participant engagement (P = 0.11) and participant learning (P = 0.77). With the centre‐based scenarios, nurses rated the reality of the respiratory rate (P < 0.001), blood pressure (P = 0.016) and abdominal signs (P = 0.003) significantly higher than doctors. Nurses rated the overall reality higher than doctors for the centre simulations (96.8% vs 84.2% rated as realistic, P = 0.041), which was not demonstrated in the in situ scenarios (76.2% vs 73.5%, P = 0.65). Conclusion Some aspects of in situ simulations may be less ‘real’ than centre‐based simulations, but there was no significant difference in self‐reported engagement or learning by scenario participants. Low fidelity, in situ simulation provides adequate realism for engagement and learning

Improving the quality of care for children with wheeze: The use of electronic asthma action plans and electronic pre-school wheeze action plans

Aim: To measure the long-term improvement in the documented provision of an asthma action plan (AAP) to children with asthma and wheeze discharged from the Emergency Department following the introduction of the electronic AAP (eAAP) and to determine the need for an electronic pre-school wheeze action plan in our population. Methods: A retrospective case note review, from July 2014 to June 2015, of all patients over 12 months old discharged from the Emergency Department or Emergency Medical Unit, with a discharge diagnosis of either asthma or wheeze. The primary outcome was the documentation of an AAP, either recorded electronically as an eAAP or a report of an AAP as part of the patient medical record. Results: Two thousand three hundred and forty-two patients were included in the study, 926 with asthma and 1416 with wheeze. The median age was 3.3 years (interquartile range (IQR) 3.5, range 1–15.9 years). The median age of the children with asthma was 5.3 years (IQR 4.6) and of the children with wheeze was 2.5 years (IQR 2.0).Overall, 1683 (71.9%) children had a documented AAP, with a significant difference between those with a discharge diagnosis of asthma (85.9%) compared with wheeze (62.9%), P  <  0.001. These results justified the design of the electronic pre-school wheeze action plan. Conclusions: The integration of an eAAP into the Emergency Department has resulted in a sustained improvement in the documented provision of an AAP to children with a discharge diagnosis of asthma. Children with a discharge diagnosis of wheeze are significantly less likely to receive an action plan