Pediatric emergency care最新文献

{"title":"Changes in Care in Spanish Pediatric Emergency Departments After the First Immunization With Nirsevimab.","authors":"Paula Vazquez-Lopez, Aristides Rivas-Garcia, Carles Luaces-Cubells, Elena Perez-Gonzalez, María Luisa Ales-Palmer, Nuria Cahis-Vela, Esther Lera-Carballo, Carmen Solano-Navarro, Estefanía Romero-Castillo, Eva Patricia Torres-Begara, Maria Jesus Sanchez-Alvarez, Javier Benito-Fernandez, Laura Sanz-Rueda, María Angeles Garcia-Herrero, Alba Henares-Rodriguez, Sandra Yañez-Mesia, Antonio de Francisco-Profumo, Abel Martinez-Mejias, Maria Elena May-Llanas, Sofia Mesa-Garcia, Alejandro Aranda-Mora, Concepcion Baquero-Gomez, Daniel de la Rosa-Sanchez, Maria de Ceano-Vivas, Mercedes de la Torre Espí, Silvia Oliva-Rodriguez-Pastor, Jo Se Lorenzo Guerra-Diez, Sara Pons-Morales, Arantxa Gomez-Carabaza, Carmen Campos-Calleja, Antonio Ramon Torres-Torres","doi":"10.1097/PEC.0000000000003339","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003339","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study is to assess the changes in the pediatric care of patients seen in the Pediatric Emergency Departments (PED) during the bronchiolitis season following the introduction of immunization with a monoclonal antibody against RSV (nirsevimab).</p><p><strong>Methods: </strong>An observational, retrospective, multicenter study was conducted, analyzing the Bronchiolitis Registry of the Spanish Society of Pediatric Emergency Medicine. This registry, containing data on bronchiolitis cases, was initiated in December 2022. A total of 30 hospitals participated, all of which are members of the Spanish Society of Pediatric Emergency Medicine. Data from a 26-day period in 2 bronchiolitis seasons (2022: preimmunization and 2023: postimmunization) were included. Variables regarding health care burden were recorded for both periods. Quantitative variables were described using mean and SD, and the Student t test was used for comparisons between the 2 periods.</p><p><strong>Results: </strong>Twenty-five hospitals from 11 autonomous communities were included with a mean of 47,811 PED visits/year (SD: 26,675). The number of bronchiolitis cases presenting to the PED and bronchiolitis-related admissions decreased by 41.6%(95% CI: 34.9%-48.2%) and 55.4% (95% CI: 46.6%-64.2%), respectively, while admissions for RSV bronchiolitis decreased by 60.3% (95% CI: 51.9%-68.7%). Admissions to pediatric intensive care units decreased by 81.3% (95% CI: 57.9%-100%). Furthermore, the occupancy rate in the pediatric intensive care units decreased by 30% (95% CI: 22.8%-37.3%), while a reduction of 22.4% (95% CI: 13.2%-31.5%) was observed in the occupancy rate of observation units. The number of bronchiolitis cases transferred to other hospitals decreased by 73.4% (95% CI: 29.0%-100%). Finally, there was a 60.9% (95% CI: 26.5%-95.3%) reduction in the need for high-flow oxygen therapy among bronchiolitis patients.</p><p><strong>Conclusions: </strong>After the introduction of nirsevimab, a large portion of indicators related to the burden of care associated with bronchiolitis during its epidemic season decreased significantly.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365028","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 Golf Cart Injuries and Morbidity: A Single-Center Trauma Experience.","authors":"Kaitlyn Boggs, Andrew Wortham, Mathew J Gregoski, Christopher M Pruitt, Lucas A McDuffie","doi":"10.1097/PEC.0000000000003350","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003350","url":null,"abstract":"<p><strong>Objective: </strong>The primary aim of this study was to characterize pediatric golf cart injuries at our center including demographic, clinic, and outcome data. The secondary outcomes explored were associations between patient and driver age and mechanism of injury with hospital admission, length of stay, and surgical interventions.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of golf cart injuries at a pediatric American College of Surgeons Level I trauma center (2013-2023). Demographic information, mechanism of injury, location in the cart, driver age, injury locations and types, and other clinical factors were assessed. Possible differences in hospital admission, length of stay, and surgical intervention were assessed.</p><p><strong>Results: </strong>There were 156 patients who sustained golf cart injuries, with 39% requiring trauma activation upon initial presentation. The majority of patients were 13 years old or younger (75.6%), injured from a fall from the cart (55.8%), and admitted to the hospital (51.9%). Over half of the patients had more than one injury type, most commonly affected areas were head, neck, or face (61.5%) and extremities (66.7%). There was a disproportionate number of privately insured patients who presented with golf cart-related injuries compared with the general emergency department population (64.1 vs. 18.5%, 45.6% difference, 95% CI: 37.8%-52.7%, P<0.0001). Over half (63%) of patients with a documented driver age were in golf carts driven by a minor, with a median driver age of 13 years old. Patients in accidents where the drivers were minors were more likely to be admitted to the hospital (P<0.001).</p><p><strong>Conclusions: </strong>Golf carts are a considerable source of injury for our pediatric population, with some accidents leading to serious morbidity. There is a need for consistent safety regulation of golf carts and increased public knowledge of the hazards they pose to children.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256297","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":"Point-of-Care Ultrasound Diagnosis of Restrictive Cardiomyopathy in a 3-Year-Old Patient.","authors":"Thuy Nguyen, Arjith Rathakrishnan, Madison Bompard, Trent She, Henry Chicaiza","doi":"10.1097/PEC.0000000000003343","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003343","url":null,"abstract":"<p><p>Restrictive cardiomyopathy is a rare form of cardiomyopathy in children, representing only 2.5%-3% of all pediatric cardiomyopathies, and is typically diagnosed between the ages of 6 and 10. The underlying etiology varies depending on age and region; however, idiopathic, genetic, and endomyocardial fibrosis are among the most common. Cohort studies have demonstrated mortality as high as 50% within 2 years of diagnosis, as well as high rates of adverse events including thromboembolism, pulmonary hypertension, and sudden cardiac death. There is a paucity of literature on point-of-care ultrasound (POCUS) for the diagnosis of pediatric restrictive cardiomyopathy. We present a case of a 3-year-old female whose diagnosis of heart failure was rapidly identified via POCUS which subsequently expedited life-saving treatment.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123407","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":"Changes in Seasonal Patterns for Common Pediatric Respiratory Viruses During the COVID Pandemic.","authors":"Tara Lozy, Rimma Perotte, Austin Eigen, Karen Eigen, Ashley Kourgialis, Timothy Scheinert, Sondra Maureen Nemetski","doi":"10.1097/PEC.0000000000003340","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003340","url":null,"abstract":"<p><strong>Objectives: </strong>Observed alterations in seasonal patterns of common pediatric respiratory viruses during and immediately after the COVID-19 pandemic had far-reaching implications for the care of ill children. Here, we quantify the effects of the pandemic and related nonpharmaceutical interventions on the prevalence and seasonality of common pediatric respiratory illnesses.</p><p><strong>Methods: </strong>We performed a retrospective chart review within a large health network to identify incidence rates of common respiratory viruses and compared them to historical trends. Time series analyses using seasonal autoregressive integrated moving average models were utilized to identify seasonal patterns for the different virus types and quantify deviations from expected incidence rates.</p><p><strong>Results: </strong>Overall, we noted a steep decline in non-COVID viral infection rates at the onset of the COVID pandemic in March 2020, largely coincident with the institution of mask mandates and lockdown measures. This trend continued until the Spring of 2021, at which time non-COVID infections resurged to rates higher than pre-COVID levels. In addition, the historically observed seasonality of these viruses was significantly disrupted by the pandemic. In particular, the historical peaks for influenza A and human metapneumovirus shifted from February and March, respectively, to bimodal peaks in December 2021 and May 2022; respiratory syncytial virus demonstrated an unprecedented Spring/Summer season in 2021; parainfluenza type 1 was unusually active in 2022, an even-numbered year; and influenza B virtually disappeared during and immediately after the pandemic.</p><p><strong>Conclusions: </strong>Our observations add to the growing body of literature supporting the hypothesis that human interactions are one of the key drivers of pediatric respiratory viral seasonality in addition to climate. Understanding the effect of human interactions on disease spread is crucial for the development of effective mitigation measures for future pandemics while avoiding dangerous spikes of other illnesses once those interventions are lifted.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123404","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":"Comparison of Outcomes for Emergency Medical Services-Transported Infants With Suspected Brief Resolved Unexplained Events Before and After the Coronavirus Disease 2019 Pandemic.","authors":"Jake Toy, Rishi Bhargava, Calvin G Lowe, Phung K Pham, Nishelle Shepard, Myrna Aboudiab, Mohsen Saidinejad, Jessica Chow, Todd P Chang, Caroline Altergott, Ekra Rai, Ilene Claudius, Gabriela Moriel, Ellie Conser, Marianne Gausche-Hill","doi":"10.1097/PEC.0000000000003346","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003346","url":null,"abstract":"<p><strong>Objectives: </strong>This study compares care-seeking behavior, care delivery, and outcomes for infants with suspected brief resolved unexplained events (BRUEs) who were treated by emergency medical services (EMS) and emergency department clinicians before and after the onset of the coronavirus disease 2019 (COVID-19) pandemic and stay-at-home mandates.</p><p><strong>Methods: </strong>This multicenter, retrospective observational study uses prehospital and hospital data on EMS-treated infants (age ≤12 months) with a primary paramedic impression of BRUE. We evaluated interventions, management, and outcomes, including transports and admissions, before (April 2019 to February 2020) and after (April 2020 to February 2021) the start of the pandemic and stay-at-home mandates in March 2020. We also characterized longitudinal trends in transports and hospital admissions for BRUE infants between July 2017 and February 2021. Data were analyzed using descriptive statistics and interrupted time series modeling.</p><p><strong>Results: </strong>There were no significant differences in demographic characteristics or infant presentations before and after the beginning of the pandemic and stay-at-home mandates. We noted an increase in transports during the before period, but transports plateaued in the after period. There was no significant difference in admissions between the before and after periods.</p><p><strong>Conclusions: </strong>For EMS-treated infants with paramedic-suspected BRUE, presentations and hospital admissions were similar before and after the beginning of the COVID-19 pandemic and stay-at-home mandates. There was a longitudinal increase in EMS transports for infants with suspected BRUE before the COVID-19 pandemic and stay-at-home mandates, which then leveled off in the after period.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123405","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":"POCUS the Pelvis: A Case Series of Timely Diagnoses in Pediatric Patients With Abdominal Pain.","authors":"Julie Leviter, Rahul D Shah, Erika Constantine, Antonio Riera","doi":"10.1097/PEC.0000000000003348","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003348","url":null,"abstract":"<p><p>Abdominal pain is a frequent presenting complaint in the pediatric emergency department (PED). Point-of-care ultrasound (POCUS) can expedite the diagnosis and management of patients in the PED with abdominal pain. We present a series of 6 patient cases in which a \"POCUS the pelvis\" approach expedited diagnosis of undifferentiated abdominal pain in the PED, and thus facilitated definitive management.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080824","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":"Accuracy of Visual Estimation of Left Ventricular Ejection Fraction Compared With Echocardiography in Children.","authors":"Seyfeddine Zayani, Farah Thabet, Abir Daya, Ikram Chamtouri, Cyrine Bennasrallah, Chokri Chouchane, Khaldoun Ben Hamda, Slaheddine Chouchane","doi":"10.1097/PEC.0000000000003349","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003349","url":null,"abstract":"<p><strong>Background: </strong>This study compared visual assessments of left ventricular systolic function in children by pediatric physicians with quantitative measurements using the Simpson method.</p><p><strong>Methods: </strong>This was a transverse, cohort study conducted between January and June 2023. Patient's echocardiography were performed by a certified pediatric cardiologist in the presence of 2 pediatricians: a senior pediatric intensivist (S.Z.) and a pediatric resident (A.D.). Both pediatricians had prior training in cardiac ultrasound. Following the visual assessment of the echocardiography, each pediatrician records their evaluation of the left ventricular ejection fraction (LVEF) as a percentage. We compared the visual assessment of LVEF with that obtained with quantitative measurements using the Simpson method by the pediatric cardiologist. Bland-Altman analysis was performed between the pediatrician and the cardiologist's LVEF evaluation. Besides the correlation coefficients (r) were calculated.</p><p><strong>Results: </strong>A total of 136 patients, aged between 0 and 18 years, were enrolled. The mean LVEF measured by the cardiologist was 65.05±14.15. The mean LVEF estimated by the senior pediatrician and the pediatric resident was 64.48±13.59 and 64.87±13.17, respectively. Strong correlations were found between visual estimates by both pediatricians and 2-dimensional LVEF (r=0.832 and r=0.763 respectively, P<0.001). The bland-Altman plot showed that the mean difference of LVEF determined by 2-dimensional LVEF and eyeballing by a senior pediatric intensivist and the junior pediatrician was 0.57±3.64% and 0.18±4.37%, respectively.</p><p><strong>Conclusion: </strong>The study suggests that visual assessment of LVEF in children is reliable when conducted by experienced pediatricians familiar with echocardiography. However, the results of this study are primarily applicable to the assessment of normal or near-normal left ventricular function.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080821","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":"Assessment of Facility Readiness for Pediatric Emergency and Critical Care Utilizing a 2-Phase Survey Conducted in Six Hospitals in Uganda and Cameroon: A Quality Improvement Study.","authors":"Bella Hwang, Jessica Trawin, Suiyven Dzelamunyuy, Matthew O Wiens, Abner Tagoola, Stephen Businge, Roberto Jabornisky, Odiraa Nwankwor, Gabrielle Karlovich, Tagbo Oguonu, Emmanuella Talla, Stefanie K Novakowski, Jollee S T Fung, Nicholas West, J Mark Ansermino, Niranjan Kissoon","doi":"10.1097/PEC.0000000000003276","DOIUrl":"10.1097/PEC.0000000000003276","url":null,"abstract":"<p><strong>Objectives: </strong>Each year, 5.3 million children under 5 years of age die in low-resource settings, often due to delayed recognition of disease severity, inadequate treatment, or a lack of supplies. We describe the use of a comprehensive digital facility-readiness survey tool, recently developed by the Pediatric Sepsis Data CoLaboratory, which aims to identify target areas for quality improvement related to pediatric emergency and critical care.</p><p><strong>Methods: </strong>Facility-readiness surveys were conducted at six sub-Saharan African hospitals providing pediatric emergency and critical care in Uganda (n = 4) and Cameroon (n = 2). The tool is a 2-phase survey to assess readiness to provide pediatric essential emergency and critical care: (1) an \"environmental scan,\" focusing on infrastructure, availability, and functionality of resources, and (2) an \"observational scan\" assessing the quality and safety of care through direct observation of patients receiving treatment for common diseases. Data were captured in a mobile application and the findings analyzed descriptively.</p><p><strong>Results: </strong>Varying levels of facility readiness to provide pediatric emergency care were observed. Only 1 of 6 facilities had a qualified staff member to assess children for danger signs upon arrival, and only 2 of 6 had staff with skills to manage emergency conditions. Only 21% of essential medicines required for pediatric emergency and critical care were available at all six facilities. Most facilities had clean running water and soap or disinfectants, but most also experienced interruptions to their electricity supply. Less than half of patients received an appropriate discharge note and fewer received counseling on postdischarge care; follow-up was arranged in less than a quarter of cases.</p><p><strong>Conclusions: </strong>These pilot findings indicate that facilities are partially equipped and ready to provide pediatric emergency and critical care. This facility-readiness tool can be utilized in low-resource settings to assist hospital administrators and policymakers to determine priority areas to improve quality of care for the critically ill child.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"94-103"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584033","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":"Epidemiology of Emergency Department Visits for Children With Clinically Significant Cardiovascular Disease.","authors":"Zaynah Abid, Mark I Neuman, Matt Hall, Brett R Anderson, Peter S Dayan","doi":"10.1097/PEC.0000000000003296","DOIUrl":"10.1097/PEC.0000000000003296","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study is to determine the epidemiology, cost, and factors associated with hospital admission, deterioration if hospitalized, and mortality for children with a history of clinically significant cardiovascular disease (CVD) presenting to pediatric emergency departments (EDs).</p><p><strong>Study design: </strong>Using the Pediatric Health Information System, we performed a retrospective analysis of ED encounters of children ≤17 years old with clinically significant CVD between 2016 and 2021. Patients were included if they had a cardiovascular complex chronic condition, defined by ICD diagnosis, and procedure codes. We assessed the primary diagnosis, admission rate, ICU transfer rate (as a marker of disease progression), mortality, resource utilization, and costs. We conducted multivariable analyses to identify risk factors for admission, ICU transfer, and mortality.</p><p><strong>Results: </strong>There were 201,551 ED visits (mean 33,592 ± 3354 per year) among 129,938 children with clinically significant CVD. Most ED encounters had a primary diagnosis of a circulatory (21.1%) or respiratory (19.7%) illness. Seventy-six percent of visits had at least one blood test or imaging study conducted. The overall admission rate was 59.7%, with 28.7% admitted to the ICU, and 6.2% transferred to the ICU after the first 24 hours. The median costs for encounters resulting in admission were $13,605 in US 2023 dollars. In multivariable analyses, younger age, a greater number of noncardiac complex chronic conditions, and CVD type were associated with increased odds of admission, ICU transfer after 24 hours, and mortality (all P < 0.05).</p><p><strong>Conclusions: </strong>ED visits for children with clinically significant CVD lead to substantial resource utilization, including frequent hospitalization, ICU level of care, and costs. This baseline data aids in the development of prospective studies to inform the appropriate ED management for children with clinically significant CVD.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"135-142"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584035","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":"Simulation-Based Training in Clinical Event Debriefing Improves Leadership Performance.","authors":"Arianne Cuff L Baker, Michael C Monuteaux, Paul C Mullan, Joshua Nagler, Kate Dorney","doi":"10.1097/PEC.0000000000003264","DOIUrl":"10.1097/PEC.0000000000003264","url":null,"abstract":"<p><strong>Objectives: </strong>Clinical event debriefing (CED) improves healthcare team performance and patient outcomes. Most pediatric emergency medicine (PEM) physicians do not receive formal training in leading CED. Our objectives were to develop a CED curriculum and evaluate its effect on performance, knowledge, comfort, and clinical practice.</p><p><strong>Methods: </strong>This was a single group pre-post-retention study. We developed a hybrid curriculum with simulation, an interactive module, and individual feedback. We invited faculty and fellows from the PEM division of our hospital to participate. During an in-person training day, participants led standardized clinical simulation scenarios followed by simulated CED with immediate feedback on their leadership performance. They watched an interactive module between scenarios. Participants returned for a retention assessment 2-6 months later with a third simulation and debrief. Participants completed surveys measuring attitudes, experiences, and knowledge. Participants also evaluated the curriculum.The primary outcome was CED leadership performance using a novel 21-item tool that we developed, the Debrief Leadership Tool for Assessment (DELTA). A blinded, trained rater measured performance with DELTA. Secondary outcomes included changes in knowledge and comfort and changes in clinical practice.</p><p><strong>Results: </strong>Twenty-seven participants enrolled and completed all parts of the curriculum and assessments. Debrief leadership performance improved by a mean of 3.7 points on DELTA pre-training to post-training (95% confidence interval = 2.7, 4.6, P < 0.01) and by 1.4 points from pre-training to retention (95% confidence interval = 0.1, 2.8, P = 0.03). Knowledge and comfort also significantly improved from pre-training to post-training and were sustained at retention. Most (67%) participants changed their clinical practice of CED after completing the curriculum. All participants would recommend the training to other PEM physicians.</p><p><strong>Conclusions: </strong>A hybrid simulation-based curriculum in leading CED for PEM physicians was associated with improvement in CED leadership performance, knowledge, and comfort. PEM physicians incorporated training into their clinical practice.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"86-93"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605840","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}