Pediatric emergency care最新文献

{"title":"The Interplay of Pollution, Child Opportunity, and High Health Care Utilization in Children With Asthma in San Diego County.","authors":"Tatyana G Mills, Kelly Robinson, Suzan Mahdai, Sweta Parija, Jacob Parker, Manaswitha Khare, Margaret Nguyen, Sydney Leibel","doi":"10.1097/PEC.0000000000003365","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003365","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to (1) compare air pollution and child opportunity between neighborhoods with and without high health care utilization (HHU) for asthma, and (2) compare health care utilization frequency by race, ethnicity, primary language, and insurance type at the patient level.</p><p><strong>Methods: </strong>This retrospective cohort study examined children with asthma within the Rady Children's Health System (2015-2020) who met HHU criteria [≥2 emergency department (ED) visits in 6 months or ≥2 hospitalizations in 12 mo]. Patient addresses were geocoded to census tracts, and ArcGIS was used to map CalEnviroScore 4.0 and the Child Opportunity Index. Descriptive statistics assessed health care utilization differences based on patient demographics.</p><p><strong>Results: </strong>This study included 1070 individuals. The median HHU asthma rate was 1.7 per 1000 children (interquartile range: 0.9 to 3.1) across 408 census tracts. Pollution burden was significantly higher in tracts with HHU asthma cases than those without (P = 0.002). Census tracts with HHU asthma cases had lower Child Opportunity Index scores compared with those without (P < 0.001). Black patients had more ED visits than white patients (P = 0.002). Hispanic patients had more inpatient hospitalizations than non-Hispanics (P = 0.043). Medicaid/Medi-Cal patients had more ED and inpatient encounters than those with commercial insurance (P = 0.001).</p><p><strong>Conclusions: </strong>We identified disparities in pollution and child opportunity among pediatric asthma patients with HHU. These differences are linked to race, ethnicity, and insurance type. These findings can guide efforts to improve child health equity.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606023","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}

{"title":"Developing the Standardized Workload Assessment Metric for Pediatric Emergency Departments: Initial Steps Using a Modified Delphi Method.","authors":"Jake Rose, Alyssa Chong, Kenneth McKinley, Garth Meckler, Tibor Van Rooij, Matthias Görges, Tania Principi, Jocelyn Gravel, Devin Singh, Katrina Hurley, Bruce Wright, Troy Turner, Ahmed Mater, Brett Burstein, Quynh Doan","doi":"10.1097/PEC.0000000000003353","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003353","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to develop a comprehensive list of patient care components performed by pediatric emergency department (PED) physicians that could be individually scored on their subjective workload using the National Aeronautics and Space Administration Task Load Index (NASA-TLX). These \"care components,\" alongside patient and environmental factors that influence workload (\"modifiers\"), will form the basis of the Standardized Workload Assessment Metric for Pediatric Emergency Departments (SWAMPED). We sought to obtain preliminary workload scores for each care component and assess the face validity of the NASA-TLX-derived workload tool.</p><p><strong>Methods: </strong>After establishing a working list of \"care elements\" and modifiers, we convened an expert panel during a 3-day workshop to curate a comprehensive list of PED patient care components and modifiers affecting physician workload using a modified Delphi process. Experts completed a pilot version of the NASA-TLX-derived workload survey for each care component. A virtual follow-up was held 5 months after the initial meeting to finalize the list of modifiers and care components.</p><p><strong>Results: </strong>Of the 93 initial care elements and 75 modifiers, 46 care components were retained, alongside 6 final modifiers. Preliminary workload scores showed \"high acuity, low occurrence procedures (cricothyroidotomy, thoracotomy, pericardiocentesis, burr hole, etc.),\" with the highest median workload score of 106, while \"immobilization device simple (prefabricated)\" had the lowest median workload score of 22.</p><p><strong>Conclusions: </strong>The SWAMPED, derived through expert consensus, holds promise as a standardized assessment tool for PED physician workload. Validation studies involving larger cohorts are crucial for refining the SWAMPED and allowing widespread adoption of this novel quantitative workload metric.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605983","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}

{"title":"The Need to Screen and Treat Iron Deficiency in Women.","authors":"Toby Richards","doi":"10.1097/PEC.0000000000003356","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003356","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557670","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}

{"title":"Perceptions and Experiences of Refugee Families in the Pediatric Emergency Department: A Qualitative Interview Study.","authors":"Ronine L Zamor, Jamie Pattee, Abhiram R Manda, Rishab H Bhatt, Joanna Yu, Saria Hassan, Brittany Murray","doi":"10.1097/PEC.0000000000003357","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003357","url":null,"abstract":"<p><strong>Objectives: </strong>Refugees face significant barriers that make acculturation and utilization of the US health care system challenging. Prior literature regarding health care access for the refugee population has focused on adult refugee patients. However, children and adolescents account for approximately 40% of refugees arriving in the United States annually. The objective of this study is to explore the perceptions and experiences of refugee families in the pediatric emergency department when accessing emergent care for their children.</p><p><strong>Methods: </strong>We performed a qualitative study of pediatric refugee families presenting for emergency care through semistructured interviews of refugee families within the pediatric emergency department and focus group sessions with community stakeholders in Atlanta, Georgia over a 3-month period. Interviews were conducted until thematic saturation was reached. All interviews were transcribed and reviewed using an iterative and inductive approach to discover emerging themes.</p><p><strong>Results: </strong>A total of 1000 families were screened, and 40 (4.0%) were eligible refugee families. Of these families, 20 (50%) completed interviews, 10 (25%) declined participation, and 10 (25%) agreed to participate but had scheduling conflicts. Four major themes emerged from the thematic analysis: (1) impact of social support on navigating the US healthcare system, (2) exacerbation of pre-existing family stressors, (3) language and communication, and (4) respect during the health care encounter.</p><p><strong>Conclusions: </strong>This study identified important areas of concern to families of pediatric refugees when accessing emergent care. These areas should be further explored as potential areas to optimize equitable emergency department care for pediatric refugee patients.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542993","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}

{"title":"Antivenom Administration Strategies in Pediatric Snake Envenomation.","authors":"Kevin Baumgartner, David B Liss, Michael E Mullins","doi":"10.1097/PEC.0000000000003361","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003361","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542985","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}

{"title":"Pediatric Difficult Intravenous Access Scores in a Low-Resource Setting: An External Validation Study.","authors":"Panida Kanjanauptom, David Kessler, Sirin Khongjaroensakun, Suphalak Darunaitorn, Worapant Kriengsoontornkij","doi":"10.1097/PEC.0000000000003332","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003332","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to establish and evaluate validity data for pediatric difficult intravenous access (DIVA) scores in low-resource emergency care settings within low- to middle-income countries (LMIC). We also sought to explore associated factors for DIVA that could contribute to a modified pediatric DIVA score with optimal performance in our setting.</p><p><strong>Methods: </strong>We performed a prospective cross-sectional study in children aged 0 to 15 years who required urgent or emergent peripheral intravenous access (PIVA) over a 10-month period in a large university hospital in Bangkok, Thailand. DIVA was defined as a failure of PIVA on the first attempt. For each candidate DIVA model, receiver operating characteristic curves were constructed, and the area under the curves was calculated. Additional candidate predictive factors of patients and providers were collected and analyzed using a logistic regression model.</p><p><strong>Results: </strong>Among a convenience sample of 392 children enrolled, the DIVA rate was 30.1%. Three-variable DIVA (DIVA3) and 4-variable DIVA scores (DIVA4) demonstrated similar test characteristics in our population in identifying patients with first attempt failure rate of at least 50%. Vein visibility, vein palpability, younger age, and history of DIVA were statistically significant factors related to DIVA. Through the inclusion of 4 factors associated with DIVA, the LMIC-DIVA score was developed and exhibited superior discriminative ability compared with the DIVA3 and DIVA4 scores. The area under the curves for LMIC-DIVA, DIVA3, and DIVA4 were 0.79 (95% CI=0.74-0.83), 0.65 (95% CI=0.59-0.70), and 0.62 (95% CI=0.56-0.67), respectively.</p><p><strong>Conclusion: </strong>This study provides external validation data for DIVA3 and DIVA4 scores in the LMIC setting. The novel modified 4-variable LMIC-DIVA score improves test characteristics and accuracy in identifying pediatric DIVA in our population.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542988","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}

{"title":"Letter to the Editor Regarding 'Excessive Use of Benzodiazepines Is a Risk Factor for Endotracheal Intubation in Children Who Present to Emergency With Prehospital Status Epilepticus'.","authors":"Emel Ulusoy, Murat Duman","doi":"10.1097/PEC.0000000000003301","DOIUrl":"10.1097/PEC.0000000000003301","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"e18"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584038","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}

{"title":"Use of Emergency Telemedicine Physicians for Telephone Triage Disposition of Pediatric Patients.","authors":"Meghan R Cain, Benjamin W Iliff, Christopher S Russi, Aidan F Mullan, Ronna L Campbell","doi":"10.1097/PEC.0000000000003312","DOIUrl":"10.1097/PEC.0000000000003312","url":null,"abstract":"<p><strong>Objectives: </strong>Telemedicine is a growing field, with limited data around its utility supporting pediatric emergency care telephone triage. We instituted telemedicine physician support for nurse telephone triage decisions. When the nursing protocols recommended urgent or emergent care, a telemedicine physician reviewed and modified care urgency if appropriate. Our primary study objectives were to evaluate the proportion of patients who were downgraded to less urgent care and assess for potential harm related to the downgrade in care urgency.</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study of pediatric telephone calls to the Mayo Clinic Health System nurse triage line that were directed to the emergency department telemedicine physician from January 1, 2019, to December 31, 2019. Electronic medical records of patients whose care urgency was downgraded and presented to medical care within 72 hours of the triage call were reviewed.</p><p><strong>Results: </strong>There were 8559 nurse line calls regarding pediatric patients, 882 of which were referred to the telemedicine physician. Among these, 396/882 (44.9%, 95% confidence interval 41.6-48.3) were downgraded. Of downgraded cases, 198 (50.0%) patients sought care within 72 hours of the original call, of which 193 (97.5%) patients were discharged home from that medical visit and 5 (2.5%) patients required admission. No patients were determined to have suffered harm due to the downgrade of visit urgency.</p><p><strong>Conclusions: </strong>Our data suggests that telemedicine physicians can safely downgrade nurse triage care recommendations for pediatric patients. Most downgraded patients sought outpatient care, avoiding unnecessary utilization of the emergency department without evidence of associated harm.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"190-194"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789628","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}

{"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":"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":"165-171"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","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}

{"title":"Virtual Reality as Active Distraction in Laceration Repair: A Game Changer?","authors":"Anne O McEvoy, Olivia B Vincent, Turaj Vazifedan, Todd P Chang, Joel M Clingenpeel, Rupa Kapoor","doi":"10.1097/PEC.0000000000003319","DOIUrl":"10.1097/PEC.0000000000003319","url":null,"abstract":"<p><strong>Objectives: </strong>We conducted an unblinded, randomized control trial to determine if immersive virtual reality (VR) goggles decrease pain and fear scores in children undergoing laceration repair in the pediatric emergency department (PED) compared to the standard of care. Secondary outcomes included duration of procedure, physical holding, anxiolytic usage, and desire to use VR goggles again.</p><p><strong>Methods: </strong>Ninety-one patients aged 6-17 years in a PED with simple lacerations sutured by PED staff completed surveys. Eligible patients were randomized to receive either VR or standard of care. Guardians and providers also completed surveys. Self-reported pain scores were assessed by the Wong-Baker Faces Pain Scale and fear scores by Children's Fear Scale.</p><p><strong>Results: </strong>There were significant reductions in pain and fear scores for VR goggles compared to standard of care. Patients rated their mean pain score as 3.7 in controls and 2.3 in the VR group, and mean fear score of 3.0 and 2.2. The likelihood of physical holding was significantly lower among those who used VR goggles (adjusted odds ratio = 0.34, 95% confidence interval [0.13-0.92], P  = 0.033). The likelihood of receiving anxiolytics was lower among the 12- to 17-year-olds (adjusted odds ratio = 0.27, 95% confidence interval [0.11-0.69], P  = 0.006). There was no significant difference in the procedure duration ( P  = 0.06). A total of 97.9% of parents, 93.6% of patients, and 95.7% of providers would use VR again.</p><p><strong>Conclusion: </strong>Virtual reality goggles are an effective tool for distraction for simple laceration repairs. Their use leads to decreased pain and fear. Children who used VR goggles did not require to be held as often for sutures. There was no significant difference in anxiolytics or duration of procedure.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"208-212"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786437","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}