Look for dedicated posts on PEMBlog reviewing each of these papers and how they might be applicable to your practice. For now, enjoy the live tweet which summarizes my initial thoughts.
The post PEMPix 2016 – Live Tweet from the AAP NCE SOEM Program appeared first on PEM Blog.
Javier has been such a wonderful mentor and fried to so many of us – yours truly included. Congratulations Javier!
Here is a summary of the second abstract session from the 2016 AAP NCE Section on Emergency Medicine Day 1 Program.
Spatial Analysis of Asthma Emergency Department Visits in California
- In California EDs asthma visits are distributed in geographical clusters
- Patient visits to EDs were abstracted from principal diagnostic codes and mapped using ZIP codes
- In the primary cluster for high ED visits 82.8% of ZIP codes fall under healthcare shortage areas, compared to 14.2% in the primary cluster for low ED visits (p < .001)
- Higher ozone problem areas were also amongst high visit locales
Development of a Clinical Decision Rule to Identify Pediatric Patients with Headache at Low Risk for Intracranial Pathology
Meghan Cain, MD, FAAP
- Very few kids with headache have badness – 5% or less. But, a lot of kids still get imaging (CT and sometimes MRI)
- The investigators are currently conducting a prospective cohort and at AAP presented an interim analysis that showed that only one imaged patient had a significant finding (tumor) and that those who were imaged as outpatients none had clinically important findings
- Once the study is concluded this may further support a low-risk approach to image avoidance in the ED
- Read more here on this PEMBlog post on headache
The Effectiveness of Texting Compared with Voice Calls in Contacting Adolescent Patients with Sexually Transmitted Infection Test Results from the Pediatric Emergency Department
Melissa Van Cain
- Follow up of gonorrhea and chlamydia testing is a sensitive issue. The investigators randomized patients to getting a call or a text.
- The study is still ongoing – to date patients who were texted their results were reached at similar rates to calls
- It will be interesting to see if this is a preferred method of communication – especially since SMS texts can be automated
The Association between Mitochondrial Complexes Enzyme Activity and Prognosis in Septic Children
- This study is looking at mitochondrial markers in the prognosis of children with sepsis
- Markers like these have promise in prognosticating sepsis outcomes
A Quality Improvement Collaborative Improves Care for Pediatric Septic Shock
Raina Paul, MD
- Sepsis is a leading cause of morbidity and mortality – early recognition and management are very important
- There are 15 hospitals in the Children’s Hospital Association Collaborative. the investigators looked at 1737 patients with sepsis (656 of which had severe sepsis)
- Improvements in initial clinical assessment were noted over time – 46% to 60% (p < 0.001) – as were administration of first fluid bolus from 38 to 46% (p <0.015)
- 30-day mortality was reduced in severe sepsis from 11% to 3% (p=0.029), with a trend towards improved 3 day mortality (4% to 1%, p=NS)
- This is important work – but does face some barriers including difficulties with defining sepsis, retrospectively defining time of sepsis onset, implementing electronic health record (EHR) strategies and automating data capture
Use of Ultrasound in Diagnosing Acute Appendicitis in the Emergency Room – Do Results from Real World Application Mirror Those Seen in Observational Trials?
Srikanth Aravapalli, MD
- Le Bonheur Children’s in Memphis instituted a Pediatric Appendicitis Score + Ultrasound Pathway (PAS+US) that was highly sensitive and specific
- They noted that ultrasound was being used first in lieu of the pathway, and wanted to see if this change was meaningful
- A retrospective review noted the following results in the table seen below:
- Will this change in practice be more efficient in the long run? Time will tell? What about the cost if extra patients are imaged?
Hypothermia as an Outcome Predictor Tool in Pediatric Trauma: A Propensity Matched Analysis
Thomas McCarty, MD, FAAP
- In adults hypothermia (≤36 C) is an independent risk factor for increased mortality in trauma
- The investigators studies hypothermia in isolated pediatric head trauma using the National Trauma Database
- They created a 1:1 matched case control and noted that amongst 10, 976 patients that hypothermia was associated with the following;
- increased mortality (5% vs. 2.9%, p < 0.0001)
- increased rate of neurosurgical intervention (9.4% vs. 7.9%, p=0.0001)
- longer length of hospital stay (4.2 vs. 4.0 days, p=0.0033)
- higher rate of transfer to other care facilities following hospital discharge (14.6% vs. 12.2%, p <0.0001)
- The authors note that hypothermia was not studied strictly in level one centers, and that objective justification for temperature stabilizing intervention is most certainly needed. Still, provocative work.
The post 2016 AAP SOEM Abstract Session Highlights – Part 2 appeared first on PEM Blog.
Here is a summary of the first abstract session from the 2016 AAP NCE Section on Emergency Medicine Day 1 Program.
The Clinical Utility of Telemedicine in Pediatric Mental Health Emergencies in the ED/UC Setting
Alison Brent, MD, FAAP
- Mental health visits are increasing – resources aren’t
- A retrospective chart review of >500 patients showed that half of telemedicine patients were discharged home and that satisfaction rates were very high
- It was also significantly less expensive
- I’ve used this, and it represents a great option to potentially get families in touch with a familiar provider
Caregiver Willingness to Provide‐Accept Analgesia for Pain in Acute Care Settings: Multicenter Cohort Study
- Providers self report high levels of pain medicine provision, medicine was actually ordered less often in this multi center prospective cohort
- The proportion of children offered analgesia at home, in the ED, and overall was 226/743 (30.4), 408/743 (54.9), and 414/743 (55.7)
- Children were significantly more likely to be offered analgesia in the ED if they were older (OR: 1.1, 95% CI:1.0, 1.1, p = 0.02) and reported greater pain (OR: 1.3, 95% CI: 1.1, 1.4, p < 0.01)
- Parents who didn’t give pain medicines at home did not do so because they worry that “it would make it hard for the doctors to figure out what’s going on or mask the seriousness of the illness”
- A minority of caregivers felt opioids were addictive 18% or harmful 25%
The Effect of Bedside Ultrasound Assistance on Infant Lumbar Puncture: A Randomized Controlled Trial
Jeffrey Neal, MD, FAAP
- The rate of unsuccessful LP is up to 40%
- A non blinded RCT of 128 patients showed that when location was marked by ultrasound trainees were more likely to be successful on first attempt (57.8% vs 31.3%, p < 0.01) and within three attempts (75% vs 43.8%, p < 0.001)
- The ultrasound was used to mark location primarily
- Did the ultrasound arm represent better teaching and precepting on location marking?
Ultrasound‐ Fluoroscopy‐Guided Reduction of Pediatric Forearm Fractures: Prospective Observational Study
John Kanegaye, MD, FAAP
Fluoroscopy is not always available for orthopedic reductions. But, ultrasound generally is. The investigators of this study prospectively enrolled 60 patients with isolated radius and or ulna fractures to see if U/S was just as good a X-Rays.
They noted that fluoro identification of post reduction was largely similar to ultrasound identification
Novel Video‐enhanced Advanced Airway Curriculum for Pediatric Residents: Randomized Controlled Trial
- 50 interns were randomized to either a standard didactic curriculum for neonatal intubation or a new curriculum involving recording with a video laryngoscope
- Each group was assessed on 4 simulated scenarios initially and then at a three month follow up on the “difficult” scenarios
- The investigators noted that the video group had a significantly shorter time to intubation – 18.5 sec for video vs 22 sec for not – HR 1.65 95% CI 1.25-2.19
- Participation in the video based group also saw decreased odds of >1 attempt and esophageal intubation
- Time to intubation continued to be shorter at 3 months for the video group – but the results were not statistically significant
Outcomes for Children with Non‐Diagnostic Ultrasounds in the Evaluation for Suspected Appendicitis
Kristy Williamson, MD, FAAP
- Acute appendicitis is a common diagnosis, and ultrasound is the primary imaging modality in most centers
- The objective of this study was to see what happens to those patients with “appendix not visualized” or “indeterminate” ultrasounds
- They started with a retrospective review of patients that received an ultrasound for appendicitis and then performed logistic regression analysis of relevant factors on a randomized group of the non-diagnostic patients – choosing this randomized group reduced the number to review, but what about the ones they didn’t review?
- There were 3,245 ultrasounds performed for appendicitis; 14% showed appendicitis, 31% no appendicitis, and 54% were non‐diagnostic (n=1765)
- 13% of the randomized patients who received a non‐diagnostic ultrasound were diagnosed with appendicitis (95% CI: 9.55%, 17.88%)
- 2.3% (3/130) of those discharged without a definitive diagnosis who were able to be contacted for follow up were ultimately diagnosed with appendicitis
- Patients with happy confirmed on follow up imaging (CT) had WBC and ANC significantly associated with diagnosis of appy (p < 0.0001, and p=0.0001, respectively). This makes sense if you consider the validated pediatric appendicitis score.
- Should we get a CBC on equivocal ultrasound patients?
Postpartum Depression Screening in a Pediatric ED: High Prevalence and Screening Acceptability
Lenore Jarvis, MD, FAAP and Kristin Breslin, MD, MPH
- Post-partum depression is seen in over 20% of mothers in the US
- The investigators looked at postpartum depression in the ED via surveys of 209 women
- They noted that 27% screened positive with 7% having SI
- Almost half had never been screened before – representing a worrisome number of mothers seen in the ED
- Current unemployment status was associated with a positive PPD screen (aOR 2.3; 95% CI 1.1, 4.9) when adjusting for maternal age, education level, marital status, infant age, and infant insurance status
- At 1 month follow‐up PPD screened positive mothers reported that the ED screening was important and felt that access to support and seeking help from their primary doctor/child’s pediatrician was valuable
- The bottom line is that we should screen for Postpartum depression in mothers of newborns who present to the ED
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