Pediatric emergency care最新文献

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Point-of-Care Ultrasound of a Pediatric Mediastinal Mass: A Case Report.
IF 1.2 4区 医学
Pediatric emergency care Pub Date : 2025-01-23 DOI: 10.1097/PEC.0000000000003329
Phoebe Greenwald, Joni E Rabiner
{"title":"Point-of-Care Ultrasound of a Pediatric Mediastinal Mass: A Case Report.","authors":"Phoebe Greenwald, Joni E Rabiner","doi":"10.1097/PEC.0000000000003329","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003329","url":null,"abstract":"<p><strong>Abstract: </strong>Point-of-care ultrasound may be used for identification of thoracic pathology, including mediastinal masses. In this case report, we describe the case of an otherwise healthy 17-year-old boy who presented with generalized pruritis. Point-of-care ultrasound was useful in identifying a complex cystic and solid mediastinal mass extending into the thoracic cavities as well as an associated pericardial effusion.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143041045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Does Virtual Interviewing Provide the Information for a Satisfactory Rank Decision?: A Perspective From the Pediatric Emergency Medicine Fellowship Interviews. 虚拟面试是否为一个满意的等级决定提供了信息?来自儿科急诊医学奖学金访谈的观点。
IF 1.2 4区 医学
Pediatric emergency care Pub Date : 2025-01-22 DOI: 10.1097/PEC.0000000000003307
Simi Gotewal, Sing-Yi Feng, Bharati Beatrix Chandra Bansal, Jo-Ann Nesiama
{"title":"Does Virtual Interviewing Provide the Information for a Satisfactory Rank Decision?: A Perspective From the Pediatric Emergency Medicine Fellowship Interviews.","authors":"Simi Gotewal, Sing-Yi Feng, Bharati Beatrix Chandra Bansal, Jo-Ann Nesiama","doi":"10.1097/PEC.0000000000003307","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003307","url":null,"abstract":"<p><strong>Objective: </strong>The primary aim of this study was to determine whether current fellows and program directors in pediatric emergency medicine (PEM) were satisfied with virtual interviewing (VI) in terms of their respective matches. The secondary goal was to assess areas in which the virtual interview process could be improved.</p><p><strong>Methods: </strong>After institutional review was obtained, fellow surveys were piloted to non-PEM fellows to solicit feedback. Surveys were distributed via the PEM Survey committee from September 18, 2023, to November 13, 2023. There were 2 separate surveys: one for PEM program directors (PDs) and another for PEM fellows. The first survey targeted PEM fellows who matched in interview cycles from 2020 to 2022; it evaluated VI accuracy in representing program attributes and assessed the effectiveness of specific interview components. The second survey was for PEM PDs and explored the types of interview components employed and the evolution of the VI process. Both surveys gauged overall satisfaction with the VI process regarding their matches and preference for interview modality (VI vs in-person vs hybrid).</p><p><strong>Results: </strong>A response rate of 25% (n = 56) from fellows and 44% (n = 40) from PDs were obtained. Three-quarters (75%) of fellows were satisfied or highly satisfied with the information obtained via the virtual interview in terms of being able to accurately assess their program. PD satisfaction trended upward from 2020 to 2022 regarding virtual interviewing. Sixty-four percent of fellows, compared to 72% of PDs believed that their in-person experience aligned well or very well with the perception they obtained via virtual interviewing.</p><p><strong>Conclusions: </strong>Despite high satisfaction rates with the VI regarding matches and strong alignment of perception obtained via VI with in-person assessment during fellowship, both PDs and fellows continue to prefer a form of hybrid interviews. Our study provides valuable insights for guiding recommendations in future implementations of VI.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pharmacotherapy for Agitation Management in a Pediatric Emergency Department. 小儿急诊科躁动管理的药物治疗
IF 1.2 4区 医学
Pediatric emergency care Pub Date : 2025-01-22 DOI: 10.1097/PEC.0000000000003320
Kelsey Brasel, Elizabeth LaScala, Erin Weeda, Christine Rarrick
{"title":"Pharmacotherapy for Agitation Management in a Pediatric Emergency Department.","authors":"Kelsey Brasel, Elizabeth LaScala, Erin Weeda, Christine Rarrick","doi":"10.1097/PEC.0000000000003320","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003320","url":null,"abstract":"<p><strong>Objectives: </strong>In the treatment of agitation in a pediatric emergency department (PED), it is common to use once or as needed (PRN) medications when nonpharmacological management options have failed. Currently, there is limited available evidence on the treatment of pediatric agitation. The objective of this analysis was to characterize the prescribing practices of once or PRN medications for the treatment of agitation in a PED at an academic medical center.</p><p><strong>Methods: </strong>This was a retrospective chart review of all encounters in which a patient was administered once or PRN medications for agitation treatment in the PED from July 1, 2021, to June 30, 2022. Once or PRN medications were defined as any medication in the antipsychotic, benzodiazepine, and barbiturate classes along with diphenhydramine, clonidine, ketamine, and guanfacine. The primary outcome was to describe the prescribing patterns of the most utilized agents for the treatment of agitation in the PED. Secondary outcomes were to assess effectiveness and safety of the agents utilized.</p><p><strong>Results: </strong>We reviewed 109 patient encounters in which a once or PRN medication was used for agitation treatment. The most common initial regimens were benzodiazepine monotherapy (n = 47; 43%), antipsychotic monotherapy (n = 23; 21%), and concurrent use of an antipsychotic, benzodiazepine, and diphenhydramine (n = 16; 15%). Patients required another administration of a once or PRN medication within 5 to 120 minutes of initial administration 11% (n = 12) of the time. No patients required rapid sequence intubation and one patient (0.9%) needed treatment for extrapyramidal symptoms.</p><p><strong>Conclusions: </strong>Results indicate that there is not a standard regimen choice in the treatment of agitation in the PED; however, benzodiazepine monotherapy was used most frequently. Few adverse events occurred. Further research is needed to identify the optimal regimen choice for patients presenting with agitation in a PED.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Procedural Entrustment Alignment Between Pediatric Residents and Their Preceptors in the Pediatric Emergency Department. 儿科急诊科住院医师与指导医师程序委托的一致性。
IF 1.2 4区 医学
Pediatric emergency care Pub Date : 2025-01-22 DOI: 10.1097/PEC.0000000000003330
Michael P Goldman, Martin D Slade, Katherine Gielissen, Alexander W Hirsch, Elizabeth A Prabhu, Dana W Dunne, Marc A Auerbach
{"title":"Procedural Entrustment Alignment Between Pediatric Residents and Their Preceptors in the Pediatric Emergency Department.","authors":"Michael P Goldman, Martin D Slade, Katherine Gielissen, Alexander W Hirsch, Elizabeth A Prabhu, Dana W Dunne, Marc A Auerbach","doi":"10.1097/PEC.0000000000003330","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003330","url":null,"abstract":"<p><strong>Objective: </strong>Entrustment describes the balance of supervision and autonomy between resident and preceptor to complete doctoring tasks like procedures. Entrustment alignment between resident and preceptor facilitates safe, successful outcomes, and promotes learning. Study objectives describe procedural entrustment alignment between senior pediatric residents and their preceptors and report the impact of a simulation-based formative assessment (SFA) on entrustment alignment.</p><p><strong>Methods: </strong>This prospective observational study enrolled a convenience sample of senior pediatric residents in 2023. The SFA was videoed, consisted of obtaining informed consent and performing simulated procedures (laceration [LAC] and lumbar puncture [LP]). Residents self-assessed their entrustability pre/post-SFA. A PEM preceptor panel individually rated videos of the residents. PEM panel's scores were compared to residents' scores on both an 8-point scale and the dichotomized variable of needing \"in versus out\" of the room entrustment.</p><p><strong>Results: </strong>Twenty-four residents' SFAs were rated by 9 panelists. Before the SFA, entrustment alignments on the 8-point scale were as follows: resident LAC 4.08 vs PEM panel 4.97 (P < 0.001), and resident LP 4.75 vs PEM panel 5.31 (P = 0.15). After the SFA, entrustment alignments were as follows: resident LAC 5.21 vs PEM panel 4.97 (P = 0.32), and resident LP 5.54 vs PEM panel 5.31 (P = 0.52). The dichotomized analyses revealed improved alignment post-SFA: LAC-pre-kappa = 0.03 vs LAC-post 0.46, and LP-pre-kappa = (-0.03) vs LP-post = 0.24.</p><p><strong>Conclusions: </strong>Our findings indicate senior pediatric residents desire less entrustment (more supervision) for procedures but better align with preceptors after an SFA. This work offers insight into procedural entrustment decision making and the potential of SFA's to facilitate procedural learning.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A National Survey of Caregiver Needs and Experiences When Attending the Emergency Department. 急诊护理人员需求和经验的全国调查
IF 1.2 4区 医学
Pediatric emergency care Pub Date : 2025-01-09 DOI: 10.1097/PEC.0000000000003327
Samina Ali, Asa Rahimi, Manasi Rajagopal, Keon Ma, Maryna Yaskina, Paul Clerc, Antonia Stang, Darcy Beer, Naveen Poonai, April Kam, Tania Principi, Katie Gardner, Bruce Wright, Amy Plint, Serge Gouin, Kurt Schreiner, Shannon D Scott
{"title":"A National Survey of Caregiver Needs and Experiences When Attending the Emergency Department.","authors":"Samina Ali, Asa Rahimi, Manasi Rajagopal, Keon Ma, Maryna Yaskina, Paul Clerc, Antonia Stang, Darcy Beer, Naveen Poonai, April Kam, Tania Principi, Katie Gardner, Bruce Wright, Amy Plint, Serge Gouin, Kurt Schreiner, Shannon D Scott","doi":"10.1097/PEC.0000000000003327","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003327","url":null,"abstract":"<p><strong>Objectives: </strong>Despite being a frequent entry point of care, it remains unknown if families' needs are being met across pediatric emergency departments (PEDs). Study objectives were to describe caregivers' perceived overall PED experience and needs and to what extent these needs were met.</p><p><strong>Methods: </strong>This descriptive, cross-sectional survey with medical record review was conducted in 10 Canadian PEDs. Caregivers completed electronic surveys in the PED and within 7 days postvisit. The primary outcome was the degree to which caregivers' overall needs were met in the PED.</p><p><strong>Results: </strong>A total of 2005 caregivers participated; mean age was 37.8 (standard deviation 7.7) years and 74.3% (1462/1969) were mothers. Mean child age was 5.9 (standard deviation 5.1) years; 51.9% (1040/2003) were male. The median [interquartile range (IQR)] length of stay was 3.9 (2.6-6.1) hours. A total of 22.1% (322/1454) of caregivers reported that their overall needs were not adequately met (Likert scale 1-3/5). The top unmet needs during a PED visit were prompt medical care [20.3% (194/955)], access to practical items [16.8% (160/955)], and effective communication surrounding care [8.7% (83/955)]. Caregiver needs being met were associated with their child's needs being met [odds ratio (OR) 21.2 (13.1-34.2)], child's pain being well managed [OR 3.7 (2.4-5.6)], and satisfaction with overall length of stay [OR 2.6 (1.8-3.8)].</p><p><strong>Conclusions: </strong>Almost one fourth of caregivers report their overall needs were not fully met. Improving the quality of PED experience through better communication (ie, wait time delays, medical updates) and earlier pain care initiation may improve family experiences while policymakers work nationally to address lengthy wait times.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Qualitative Assessment of Barriers, Facilitators, and Outcomes in a Simulation-Based Collaborative Quality Improvement Program: The ImPACTS Project. 基于模拟的协作质量改进计划中障碍、促进因素和结果的定性评估:影响项目。
IF 1.2 4区 医学
Pediatric emergency care Pub Date : 2025-01-09 DOI: 10.1097/PEC.0000000000003321
Michelle J Alletag, Shruti Kant, Wendy L Van Ittersum, Theresa A Walls, Erin E Montgomery, Hannah L Anderson, Mark S Mannenbach, Marc A Auerbach
{"title":"A Qualitative Assessment of Barriers, Facilitators, and Outcomes in a Simulation-Based Collaborative Quality Improvement Program: The ImPACTS Project.","authors":"Michelle J Alletag, Shruti Kant, Wendy L Van Ittersum, Theresa A Walls, Erin E Montgomery, Hannah L Anderson, Mark S Mannenbach, Marc A Auerbach","doi":"10.1097/PEC.0000000000003321","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003321","url":null,"abstract":"<p><strong>Objectives: </strong>ImPACTS (Improving Acute Care Through Simulation) is a collaborative simulation-based program partnering pediatric specialty centers (\"hubs\") with general emergency departments (GEDs) to improve pediatric acute care. Objective measurements of ImPACTS, such as evaluating Pediatric Readiness Score (PRS) and simulation-based outcome improvements, have been reported previously. Barriers to and facilitators of program involvement and the downstream effects of the program have not been previously described. This study explores these aspects and key drivers for successful collaboration.</p><p><strong>Methods: </strong>The authors performed open coding of semistructured interviews of hub team members and pediatric emergency care coordinators (PECCs) from community GED \"spokes.\" We then identified and explored themes within the categories of barriers to, facilitators of, and barrier mitigation strategies for successful partnerships from the perspectives of both groups.</p><p><strong>Results: </strong>Analysis generated 4 dominant themes: buy-in, communication, personnel, and logistics. Engagement, institutional support, and buy-in of site leaders and individual participants were crucial to successful implementation, without which the programs were not completed or never started. Hubs benefited from project involvement via increased local engagement in pediatric readiness, organizational support, and further buy-in from institutional leadership, allowing for the future continuation of ImPACTS and similar programs. Benefits experienced by GEDs impacted education, pediatric readiness, and clinical and financial partnerships across institutions. Additionally, spoke interviewees cited downstream effects of participation, including increased collaboration and improved relationships with hub sites as being the most impactful.</p><p><strong>Conclusion: </strong>Understanding the key drivers of all collaborators is instrumental in successfully implementing large-scale educational and quality initiatives like the ImPACTS program.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Postintubation Sedation of Pediatric Patients in the Emergency Department: A Systematic Review and Meta-Analysis. 急诊儿科患者插管后镇静:一项系统综述和荟萃分析。
IF 1.2 4区 医学
Pediatric emergency care Pub Date : 2025-01-08 DOI: 10.1097/PEC.0000000000003325
Emily Wynia, Kevin Baumgartner, Lauren H Yaeger, Rachel Ancona, Susan Wiltrakis, Brian M Fuller
{"title":"Postintubation Sedation of Pediatric Patients in the Emergency Department: A Systematic Review and Meta-Analysis.","authors":"Emily Wynia, Kevin Baumgartner, Lauren H Yaeger, Rachel Ancona, Susan Wiltrakis, Brian M Fuller","doi":"10.1097/PEC.0000000000003325","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003325","url":null,"abstract":"<p><strong>Context: </strong>Postintubation sedation is a critical intervention for patients undergoing mechanical ventilation. Research in the intensive care unit (ICU) and adult emergency department (ED) demonstrates that appropriate postintubation sedation has a significant impact on patient outcomes. There are minimal published data regarding postintubation sedation for pediatric ED patients.</p><p><strong>Objective: </strong>To identify, describe, and critique published literature on postintubation sedation in pediatric ED patients.</p><p><strong>Data sources: </strong>Embase, Ovid Medline, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.Gov.</p><p><strong>Study selection: </strong>Studies describing postintubation sedation in the ED for pediatric patients (<18 years of age) intubated in the ED via rapid sequence intubation (RSI) were included. Studies reporting intubation outside the ED, intubation not by RSI, or nonpediatric patients were excluded, as were studies not reporting novel human clinical research.</p><p><strong>Data extraction: </strong>Data were abstracted by 2 authors using a standardized worksheet. Data included study design & setting, demographics, medications for RSI and postintubation sedation, administration of any or appropriately timed postintubation sedation, and predictive factors for postintubation sedation-related outcomes.</p><p><strong>Results: </strong>A total of 10 studies were included, all of which were nonrandomized; there was significant heterogeneity and many key variables and outcomes were not consistently reported. Meta-analysis of eligible studies demonstrated pooled estimates of 77.3% (95% confidence interval [CI]: 62.5-92.0) for proportion of patients receiving any postintubation sedation, 43.5% (95% CI: 29.3-57.6) for proportion of patients receiving appropriately timed postintubation sedation, and 18.6 minutes (95% CI: 12.5-24.7) for median time to postintubation sedation, all with significant heterogeneity.</p><p><strong>Conclusions: </strong>Data on postintubation sedation in pediatric ED patients are limited. Administration of postintubation sedation is inconsistent and may be substantially delayed. Further high-quality research into the use of postintubation sedation in this setting is needed, and appropriate postintubation sedation should be a target for quality improvement.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of a Helmet Distribution Program in the Pediatric Emergency Department. 头盔分发计划对儿科急诊室的影响。
IF 1.2 4区 医学
Pediatric emergency care Pub Date : 2025-01-01 Epub Date: 2024-07-01 DOI: 10.1097/PEC.0000000000003233
Nicolas Delacruz, Kathryn Varghese, Allan Pulliam, Angelica Almader-Ruiz, Ee Tein Tay
{"title":"Impact of a Helmet Distribution Program in the Pediatric Emergency Department.","authors":"Nicolas Delacruz, Kathryn Varghese, Allan Pulliam, Angelica Almader-Ruiz, Ee Tein Tay","doi":"10.1097/PEC.0000000000003233","DOIUrl":"10.1097/PEC.0000000000003233","url":null,"abstract":"<p><strong>Objective: </strong>Bicycle helmet use has repeatedly been shown to protect riders from serious injury. Despite this, a majority of children and adolescents do not regularly wear helmets. Our primary objective was to determine if an emergency department (ED)-based helmet distribution program could increase the amount of time children report wearing helmets.</p><p><strong>Methods: </strong>This was a prospective cohort study of children aged 3 to 17 years presenting to the ED of an urban, tertiary care hospital. Participants were surveyed on their helmet use habits and perceptions regarding the efficacy and importance of helmets. Participants then received a bicycle helmet along with safety counseling in the ED and bicycle safety handouts provided by the American Academy of Pediatrics. Participants were contacted for follow-up 8 weeks after enrollment.</p><p><strong>Results: </strong>We enrolled a total of 94 patients. Post-intervention surveys were obtained from 47% of participants. Our helmet program resulted in a statistically significant increase in the amount of time children reported wearing bicycle helmets. Prior to ED intervention, 48% of participants reported wearing a helmet \"most of the time\" or \"all of the time.\" After participating, 86% of participants indicated that they wore a helmet \"most of the time\" or \"all of the time.\" Participants indicated a variety of reasons for not wearing helmets. Of all patients contacted for follow-up, 16% indicated that they were involved in an accident after participating where the helmet they were given prevented a head injury.</p><p><strong>Conclusions: </strong>Helmet distribution programs based in the pediatric ED increase rates of bicycle helmet usage among pediatric patients. Additional study is needed to determine effect on head injury prevention.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"6-10"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Preferences for Management of Pediatric Pneumonia: A Clinician Survey of Artificially Generated Patient Cases. 小儿肺炎治疗偏好:临床医生对人工生成病例的调查。
IF 1.2 4区 医学
Pediatric emergency care Pub Date : 2025-01-01 Epub Date: 2024-07-01 DOI: 10.1097/PEC.0000000000003231
Sriram Ramgopal, Thomas Belanger, Douglas Lorenz, Susan C Lipsett, Mark I Neuman, David Liebovitz, Todd A Florin
{"title":"Preferences for Management of Pediatric Pneumonia: A Clinician Survey of Artificially Generated Patient Cases.","authors":"Sriram Ramgopal, Thomas Belanger, Douglas Lorenz, Susan C Lipsett, Mark I Neuman, David Liebovitz, Todd A Florin","doi":"10.1097/PEC.0000000000003231","DOIUrl":"10.1097/PEC.0000000000003231","url":null,"abstract":"<p><strong>Background: </strong>It is unknown which factors are associated with chest radiograph (CXR) and antibiotic use for suspected community-acquired pneumonia (CAP) in children. We evaluated factors associated with CXR and antibiotic preferences among clinicians for children with suspected CAP using case scenarios generated through artificial intelligence (AI).</p><p><strong>Methods: </strong>We performed a survey of general pediatric, pediatric emergency medicine, and emergency medicine attending physicians employed by a private physician contractor. Respondents were given 5 unique, AI-generated case scenarios. We used generalized estimating equations to identify factors associated with CXR and antibiotic use. We evaluated the cluster-weighted correlation between clinician suspicion and clinical prediction model risk estimates for CAP using 2 predictive models.</p><p><strong>Results: </strong>A total of 172 respondents provided responses to 839 scenarios. Factors associated with CXR acquisition (OR, [95% CI]) included presence of crackles (4.17 [2.19, 7.95]), prior pneumonia (2.38 [1.32, 4.20]), chest pain (1.90 [1.18, 3.05]) and fever (1.82 [1.32, 2.52]). The decision to use antibiotics before knowledge of CXR results included past hospitalization for pneumonia (4.24 [1.88, 9.57]), focal decreased breath sounds (3.86 [1.98, 7.52]), and crackles (3.45 [2.15, 5.53]). After revealing CXR results to clinicians, these results were the sole predictor associated with antibiotic decision-making. Suspicion for CAP correlated with one of 2 prediction models for CAP (Spearman's rho = 0.25). Factors associated with a greater suspicion of pneumonia included prior pneumonia, duration of illness, worsening course of illness, shortness of breath, vomiting, decreased oral intake or urinary output, respiratory distress, head nodding, focal decreased breath sounds, focal rhonchi, fever, and crackles, and lower pulse oximetry.</p><p><strong>Conclusions: </strong>Ordering preferences for CXRs demonstrated similarities and differences with evidence-based risk models for CAP. Clinicians relied heavily on CXR findings to guide antibiotic ordering. These findings can be used within decision support systems to promote evidence-based management practices for pediatric CAP.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"41-49"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hair Today, OR Tomorrow: A Multicenter Case Series of Gastric Bezoars in Children Diagnosed With Point-of-Care Ultrasound. 今天的头发,明天的手术:利用护理点超声诊断儿童胃大泡的多中心病例系列。
IF 1.2 4区 医学
Pediatric emergency care Pub Date : 2025-01-01 Epub Date: 2024-09-27 DOI: 10.1097/PEC.0000000000003238
Rahul D Shah, Allie Grither, Stephanie G Cohen, Liliana Morales-Perez, Joni Rabiner, Antonio Riera
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