Pediatric Emergency Care Research Networks: A Research Agenda

BackgroundPediatric emergency care research networks have evolved substantially over the past two decades. Some networks are specialized in specific areas (e.g., sedation, simulation) while others study a variety of medical and traumatic conditions. Given the increased collaboration between pediatric emergency research networks, the logical next step is the development of a research priorities agenda to guide global research in emergency medical services for children (EMSC).ObjectivesAn international group of pediatric emergency network research leaders was assembled to develop a list of research priorities for future collaborative endeavors within and between pediatric emergency research networks.MethodsBefore an in‐person meeting, we used a modified Delphi approach to achieve consensus around pediatric emergency research network topic priorities. Further discussions took place on May 15, 2018, in Indianapolis, Indiana, at the Academic Emergency Medicine (AEM) consensus conference “Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps.” Here, a group of 40 organizers and participants met in a 90‐minute “breakout” session to review and further develop the initial priorities.ResultsWe reached consensus on five clinical research priorities that would benefit from collaboration among the existing and future emergency networks focused on EMSC: sepsis, trauma, respiratory conditions, pharmacology of emergency conditions, and mental health emergencies. Furthermore, we identified nonclinical research priorities categorized under the domains of technology, knowledge translation, and organization/administration of pediatric emergency care.ConclusionThe identification of pediatric emergency care network research priorities within the domains of clinical care, technology, knowledge translation and organization/administration of EMSC will facilitate and help focus collaborative research within and among research networks globally. Engagement of essential stakeholders including EMSC researchers, policy makers, patients, and their caregivers will stimulate advances in the delivery of emergency care to children around the globe.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147119/1/acem13656.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147119/2/acem13656_am.pd

Acute Vision Change in a 16-year-old Female

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The Effect of COVID-19 on United States Pediatric Emergency Departments and its Impact on Trainees

  Introduction The purpose of this study was to quantify the effects of the coronavirus disease 2019 (COVID-19) pandemic on pediatric emergency departments (PEDs) across the United States (US), specifically its impact on trainee clinical education as well as patient volume, admission rates, and staffing models. Methods We conducted a cross-sectional study of US PEDs, targeting PED clinical leaders via a web-based REDCap questionnaire.  The survey was sent via 3 national pediatric emergency medicine distribution lists, with several follow-up reminders. Results There were 46 questionnaires included, completed by PED directors from 25 states.  Forty-two sites provided PED volume and admission data for early pandemic (March-July 2020), and a pre-pandemic comparison period (March-July 2019).   Mean PED volume decreased > 32% for each studied month, with a maximum mean reduction of 63.6% (April 2020).  Mean percentage of pediatric admissions over baseline also peaked in April 2020 at 38.5% and remained 16.4% above baseline by July 2020.During the study period, 33 (71.1%) sites had decreased provider staffing at some point.  Only 3 sites (6.7%) reported decreased faculty protected time.  All PEDs reported staffing changes, including decreased mid-level use, increased on-call staff, movement of staff between PED and other units, and added tele-visit shifts.  Twenty-six sites (56.5%) raised their patient age cutoff; median was 25 years (IQR 25-28).Of 44 sites hosting medical trainees, 37 (84,1%) reported a decrease in trainee number or elimination altogether.  Thirty (68.2%) sites had restrictions on patient care provision by trainees:  28 (63.6%) affected medical students, 12 (27.3%) affected residents and 2 (4.5%) impacted fellows.  Fifteen sites (34.1 %) had restrictions on procedures performed by medical students (29.5%), residents (20.5%), or fellows (4.5%). Conclusion This study highlights the marked impact of the COVID-19 pandemic on US PEDs, noting decreased patient volumes, increased admission rates, and alterations in staffing models.  During the early pandemic, educational restrictions for trainees in the PED setting disproportionately affected medical students over residents, with fellow experience largely preserved.  Our findings quantify the magnitude of these impacts on trainee pediatric clinical exposure during this period.&nbsp

Original Research Body Mass Index is a Poor Predictor of Bedside Appendix Ultrasound Success or Accuracy

Introduction: The objective of this study was to determine whether there is a relationship between body mass index (BMI) and success or accuracy rate of beside ultrasound (BUS) for the diagnosis of appendicitis. Methods: Patients four years of age and older presenting to the emergency department with suspected appendicitis were eligible. Enrollment was by convenience sampling. After informed consent, BUS was performed by trained emergency physicians who had undergone a minimum of one-hour didactic training on the use of BUS to diagnose appendicitis. We ascertained subject outcomes by a combination of medical record review and telephone follow up. Calculated BMI for adults and children were divided into four categories (underweight, normal, overweight, obese) according to Centers for Disease Control and Prevention classifications. Results: A total of 125 subjects consented for the study, and 116 of them had adequate image data for final analysis. Seventy (60%) of the subjects were children. Prevalence of appendicitis was 39%. Fifty-two (45%) of the BUS studies were diagnostic (successful). Overall accuracy rate was 75%. Analysis by chi-square test or Mann-Whitney U test did not find any significant correlation between BMI category and BUS success. Similarly, there was no significant correlation between BMI category and BUS accuracy. The same conclusion was reached when children and adults were analyzed separately, or when subjects were dichotomized into underweight/ normal and overweight/ obese categories. Conclusion: BMI category alone is a poor predictor of appendix BUS success or accuracy. [West J Emerg Med. 2016;17(4)454-459.

Bedside Ultrasonography as an Adjunct to Routine Evaluation of Acute Appendicitis in the Emergency Department

Introduction: Appendicitis is a common condition presenting to the emergency department (ED). Increasingly emergency physicians (EP) are using bedside ultrasound (BUS) as an adjunct diagnostic tool. Our objective is to investigate the test characteristics of BUS for the diagnosis of appendicitis and identify components of routine ED workup and BUS associated with the presence of appendicitis.Methods: Patients four years of age and older presenting to the ED with suspected appendicitis were eligible for enrollment. After informed consent was obtained, BUS was performed on the subjects by trained EPs who had undergone a minimum of one-hour didactic training on the use of BUS to diagnose appendicitis.They then recorded elements of clinical history, physical examination, white blood cell count (WBC) with polymophonuclear percentage (PMN), and BUS findings on a data form. We ascertained subject outcomes by a combination of medical record review and telephone follow-up.Results: A total of 125 subjects consented for the study, and 116 had adequate image data for final analysis. Prevalence of appendicitis was 40%. Mean age of the subjects was 20.2 years, and 51% were male. BUS was 100% sensitive (95% CI 87-100%) and 32% specific (95% CI 14-57%) for detection of appendicitis, with a positive predictive value of 72% (95% CI 56-84%), and a negative predictive value of 100% (95% CI 52-100%).  Assuming all non-diagnostic studies were negative would yield a sensitivity of 72% and specificity of 81%. Subjects with appendicitis had a significantly higher occurrence of anorexia, nausea, vomiting, and a higher WBC and PMN count when compared to those without appendicitis. Their BUS studies were significantly more likely to result in visualization of the appendix, appendix diameter >6mm, appendix wall thickness >2mm, periappendiceal fluid, visualization of the appendix tip, and sonographic Mcburney’s sign (p<0.05). In subjects with diagnostic BUS studies, WBC, PMN, visualization of appendix, appendix diameter >6mm, appendix wall thickness >2mm, periappendiceal fluid were found to be predictors of appendicitis on logistic regression.Conclusion: BUS is moderately useful for appendicitis diagnosis. We also identified several components in routine ED workup and BUS that are associated with appendicitis generating hypothesis for future studies. [West J Emerg Med. 2014;15(7):-0.

Use of antitussive medications in acute cough in young children

Acute cough, a common complaint in young children, is often the result of a viral upper respiratory infection. Cough and cold remedies generate billions of dollars in annual sales in the United States, despite a lack of evidence of their efficacy and multiple warnings by the US Food and Drug Administration. The current article begins with the best available evidence for common over-the-counter (OTC) and prescription antitussive remedies in children. The article concludes with a discussion of the pros and cons for the use of antitussives in children with cough. In general, OTC antitussive medications should not be routinely used in children under 2 years of age. In certain cases, antitussives with minimal adverse profile and some evidence of benefit may be recommended after informed counseling