This technical report explored the feasibility and utility of virtual reality (VR) pediatric resuscitation simulations for pre-hospital providers during their scheduled shifts. To our knowledge, ...neither the pediatric resuscitation VR simulation nor the feasibility of in situ, on-shift training with VR had been previously evaluated in pre-hospital providers. VR headset was available at an urban city fire station for 10 days where a total of 60 pre-hospital providers were scheduled to work. Providers were made aware of the VR module but no formal demonstration was done. There were no facilitators. Participants filled out an anonymous retrospective pre- and post-survey using a five-point Likert scale, rating their confidence from "not confident" to "very confident" in recognizing and managing pediatric emergencies. We found that VR simulation for pediatric resuscitation was a feasible training tool to use in situ as 63% of the providers were able to use it on shift. Furthermore, self-reported confidence increased after the training where responses of "very confident" increased from 20% to 30% for emergency medical technicians and 55% to 63% for paramedics.
Most pediatric emergency care occurs in general emergency departments (GED), where less pediatric experience and lower pediatric emergency readiness may compromise care. Medically vulnerable ...pediatric patients, such as those with chronic, severe, neurologic conditions, are likely to be disproportionately affected by suboptimal care in GEDs; however, little is known about characteristics of their care in either the general or pediatric emergency setting. In this study our objective was to compare the frequency, characteristics, and outcomes of ED visits made by children with chronic neurologic diseases between general and pediatric EDs (PED).
We conducted a retrospective analysis of the 2011-2014 Nationwide Emergency Department Sample (NEDS) for ED visits made by patients 0-21 years with neurologic complex chronic conditions (neuro CCC). We compared patient, hospital, and ED visits characteristics between GEDs and PEDs using descriptive statistics. We assessed outcomes of admission, transfer, critical procedure performance, and mortality using multivariable logistic regression.
There were 387,813 neuro CCC ED visits (0.3% of 0-21-year-old ED visits) in our sample. Care occurred predominantly in GEDs, and visits were associated with a high severity of illness (30.1% highest severity classification score). Compared to GED visits, PED neuro CCC visits were comprised of individuals who were younger, more likely to have comorbid conditions (32.9% vs 21%,
< 0.001), and technology assistance (65.4% vs. 45.9%) but underwent fewer procedures and had lower ED charges ($2,200 vs $1,520,
< 0.001). Visits to PEDs had lower adjusted odds of critical procedures (adjusted odds ratio aOR 0.74, 95% confidence interval CI 0.62-0.87), transfers (aOR 0.14, 95% CI 0.04-0.56), and mortality (aOR 0.38, 95% CI 0.19-0.75) compared to GEDs.
Care for children with neuro CCCs in a pediatric ED is associated with less resource utilization and lower rates of transfer and mortality. Identifying features of PED care for neuro CCCs could lead to lower costs and mortality for this population.
Virtual interviews (VI) are now a permanent part of pediatric emergency medicine (PEM) recruitment, especially given the cost and equity advantages. Yet inability to visit programs in person can ...impact decision-making, leading applicants to apply to more programs. Moreover, the cost advantages of VI may encourage applicants to apply to programs farther away than they might otherwise have been willing or able to travel. This could create unnecessary strain on programs. We conducted this study to determine whether PEM fellowship applicants would apply to a larger number of programs and in different geographic patterns with VI (2020 and 2021) as compared to in-person interviews (2018 and 2019).
We conducted an anonymous national survey of all PEM fellows comparing two cohorts: current fellows who interviewed inperson (applied in 2018/2019) and fellows who underwent VIs in 2020/2021 (current fellows and those recently matched in 2021). The study took place in March-April 2022. Questions focused on geographic considerations during interviews and the match. We used descriptive statistics, chi-square and
-tests for analysis.
Overall response rate was 42% (231/550); 32% (n = 74) interviewed in person and 68% (n = 157) virtually. Fellows applied to a median of 4/6 geographic regions (interquartile range 2, 5). Most applied for fellowship both in the same region as residency (216, 93%) and outside (192, 83%). Only the Pacific region saw a statistically significant increase in applicants during VI (59.9% vs 43.2%,
= 0.02). There was no statistical difference in the number of programs applied to during in-person vs VI (mean difference (95% confidence interval 0.72, -2.8 - 4.2). A majority matched in their preferred state both during VI (60.4%) and in-person interviews (65.7%). The difference was not statistically significant (
= 0.45).
While more PEM fellowship applicants applied outside the geographic area where their residency was and to the Pacific region, there was no overall increase in the number of programs or geographic areas PEM applicants applied to during VI as compared to in-person interview seasons. As this was the first two years of VI, ongoing data collection will further identify trends and the impactof VI.
PURPOSETo investigate the validity and reliability of the Turkish version of the Ottawa Sitting Scale (OSS-T) in patients with acute stroke. MATERIALS AND METHODSThe Berg Balance Scale (BBS) and ...Trunk Impairment Scale (TIS) were used to determine the validity of the OSS-T. The OSS-T was re-applied by the same rater after an interval of 7 days to determine the reliability. To test inter-rater reliability, the evaluation was repeated by a second rater 1 day after the first evaluation. Reliability was quantified using intraclass correlation coefficients (ICC), and validity was assessed by correlating the OSS-T scores with the results of the other measures. RESULTSThe ICC of the total OSS-T score for inter-rater reliability was 0.996 and for intra-rater reliability, it was 0.951. The Cronbach's α coefficient used to determine internal consistency was 0.980, which indicates excellent reliability. A strong positive correlation was found between OSS-T and TIS (rho = 0.861, p < 0.001), and between OSS-T and BBS (rho = 0.875, p < 0.001). An evident 2-factor structure was shown by the results of the factor analysis. CONCLUSIONSThe results of this study indicated that the OSS-T has strong measurement properties, making it a valid and reliable tool for research and clinical practice in patients with acute stroke.IMPLICATIONS FOR REHABILITATIONIndependent sitting function is an important indicator of functional recovery and discharge from hospital.Unlike other sitting balance tools, the Ottawa Sitting Scale can even categorize patients with low balance reserve by applying all the items with and without foot support.The Turkish version of the Ottawa Sitting Scale is a valid and reliable tool to evaluate sitting balance in patients with acute stroke.
Purpose. Work-related musculoskeletal disorders (WMSDs) are increasing due to overuse of desktop computers. This investigation examined musculoskeletal pain in office workers. Methods. ...Sociodemographic factors were recorded for 362 participants (female, 50.8%; male, 49.2%; mean age 37.35 ± 8.43 years). Participants were questioned for their daily working time, computer usage time and years, whether musculoskeletal pain was related to their job and whether pain disturbed their activities of daily living (ADLs). Working postures were observed and pain severity was evaluated by visual analog scale. Results. Participants more frequently had upper back pain (69.6%), neck pain (65.2%) and lower back pain (LBP) (64.1%) during the last 12 months; 60.5% of participants reported pain after they started work. LBP (32.9%), back pain (28.2%) and neck pain (22.9%) restricted participants' daily life. We found positive correlations between daily computer use and neck/upper back, and LBP. Conclusions. The most painful areas of participants using desktop computers were the upper back, neck, lower back and shoulder, and the pain in these regions affected ADLs negatively. This pain mostly occurred after the current job and these individuals experience more intense pain. Ergonomic approaches could reduce WMSDs and make workers more independent in ADLs and prevent chronicity.
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Submersion injury or drowning is a leading preventable cause of pediatric mortality and morbidity. Submersion injuries are often accompanied by hypothermia and asphyxia that can lead to inadequate ...oxygen delivery to tissues and subsequent cardiac arrhythmias.
This simulation-based curriculum involves the identification and management of a submersion injury in a 4-year-old boy who was rescued from a cold-water submersion. The simulated patient is apneic, pulseless, bradycardic, and hypothermic; he is being bag-mask ventilated on arrival without intravenous access. He ultimately develops ventricular fibrillation. Providers must recognize the degree of submersion injury, initiate early airway protection, adequately address circulation, and be alert to developing hypothermia and cardiac arrhythmias to prevent further decompensation. This scenario can be modified based on trainee level (pediatric residents vs. pediatric emergency medicine fellows).
A total of 22 trainees (PGY 1-PGY 6 pediatric residents and pediatric emergency medicine fellows) participated in this simulation curriculum on separate occasions and rated it as an overall positive learning experience. The curriculum's goal is to provide learners with an opportunity to manage life-threatening pediatric submersion injuries, where the correct steps need to be taken in a limited period of time.
We have provided preparatory materials to help instructors set up, run, and debrief the scenario in a standardized fashion. The debriefing tools allow for adaptation depending on learners' needs and individual experiences during the simulated scenario. Also included are supporting educational materials and a learner feedback form that can be used to evaluate the session.
Book and media review Caglar, Derya, MD; (Tony) Woodward, George A., MD, MBA
Annals of emergency medicine,
12/2009, Volume:
54, Issue:
6
Journal Article
Peer reviewed
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The COVID-19 pandemic resulted in training programs restructuring their curricula. Fellowship programs are required to monitor each fellow’s training progress through a combination of formal ...evaluations, competency tracking, and measures of knowledge acquisition. The American Board of Pediatrics administers subspecialty in-training examinations (SITE) to pediatric fellowship trainees annually and board certification exams at the completion of the fellowship. The objective of this study was to compare SITE scores and certification exam passing rates before and during the pandemic.
In this retrospective observational study, we collected summative data on SITE scores and certification exam passing rates for all pediatric subspecialties from 2018 to 2022. Trends over time were assessed using analysis of variance (ANOVA) analysis to test for trends across years within one group and t-test analysis to compare groups before and during the pandemic.
Data were obtained from 14 pediatric subspecialties. Comparing prepandemic to pandemic scores, Infectious Diseases, Cardiology, and Critical Care Medicine saw statistically significant decreases in SITE scores. Conversely, Child Abuse and Emergency Medicine saw increases in SITE scores. Emergency Medicine saw a statistically significant increase in certification exam passing rates, while Gastroenterology and Pulmonology saw decreases in exam passing rates.
The COVID-19 pandemic resulted in restructuring didactics and clinical care based on the needs of the hospital. There were also societal changes affecting patients and trainees. Subspecialty programs with declining scores and certification exam passing rates may need to assess their educational and clinical programs and adapt to the needs of trainees’ learning edges.
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OBJECTIVESAcute osteomyelitis is a challenging diagnosis to make in the pediatric emergency department (ED), in part because of variability in its presentation. There are limited data detailing the ...presenting features of pediatric osteomyelitis, factors that are essential to understand to inform diagnostic decision making. We sought to describe relevant clinical data that contributed to the diagnosis of acute osteomyelitis in children presenting to a pediatric ED.
METHODSThis was a 10-year retrospective cohort study of patients 18 years or younger diagnosed with acute osteomyelitis in the ED of a large tertiary care childrenʼs hospital. Collected data included demographics, clinical history, patient-reported symptoms, vital signs, physical examination findings, and results of basic laboratory, microbiologic, and imaging studies. Descriptive statistics were used to summarize key findings.
RESULTSTwo hundred eleven cases of acute osteomyelitis were identified during the study period. The median age was 8.4 years, with 61.1% male. One hundred twenty-seven patients (60.2%) presented to care more than once before being diagnosed. Common symptoms included pain (94.3%), functional limitation (83.9%), and fever (76.3%). Common examination findings included functional limitation (78.2%), focal tenderness (73.5%), and swelling (52.1%). One hundred seventeen patients (55.5%) were febrile during their ED evaluation. Elevated C-reactive protein (>0.8 mg/dL, 92.9%) and erythrocyte sedimentation rate (>10 mm/h, 94.3%) were the most sensitive laboratory markers.
CONCLUSIONSFever may be absent in up to a quarter of pediatric patients with acute osteomyelitis. Although highly sensitive, inflammatory marker elevations were more modest than those reported previously in cases of pediatric septic arthritis.
Patients with limited English proficiency (LEP) experience worse health care outcomes compared to English proficient (EP) patients, and professional interpretation is underutilized in clinical ...settings. The objectives of this study were to describe patterns of interpreter use in a pediatric emergency department (ED), to determine factors associated with its use, and to examine differences in outcomes between EP families and those with LEP.
ED encounters for LEP and EP patients were reviewed in a retrospective cohort study design over a 15 month period. Generalized estimating equations were used to compare patient encounters and factors associated with interpreter use.
Interpreter use for families who preferred a non-English language was 45.4%. Use of interpretation was less likely during busier times of day (odds ratio OR 0.85, confidence interval CI 0.78–0.93), with a lower triage acuity (OR 0.66, CI 0.62–0.70), and with each increasing year of patient age (OR 0.97, CI 0.96–0.98). LEP patients who did not receive interpretation were less likely to be admitted than EP patients (OR 0.69, 0.62–0.78). Patients of LEP families, with or without interpretation, were more likely to be transferred to the ICU within 24 hours of admission than patients of EP families (OR 1.76, 1.07–2.90; 1.85, 1.08–3.18) suggesting that an aspect of clinical severity may have been missed in the ED.
Professional interpretation is currently underutilized in this ED for patients with LEP, and important differences in outcomes exist between LEP and EP patients. Factors associated with interpreter use will inform ongoing improvement efforts.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, VSZLJ, ZAGLJ, ZRSKP
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