Pediatric emergency care最新文献

Objective: The aim of this study was to examine the association between prolonged time in the COVID-19 pandemic and rates of positive routine suicide screens among youth accessing healthcare in the pediatric emergency department.

Methods: Participants were English- and Spanish-speaking youth aged 10-18 years presenting without an acute mental/behavioral health concern to the emergency department or urgent care of a large hospital system, serving a 7-state region, who completed routine screening for suicide risk. Visits between March 1, 2019 and December 31, 2021 were included. We conducted a quasi-experimental interrupted time series analysis and categorized visits into the prepandemic year, COVID-19 year 1 (Y1), and COVID-19 year 2 (Y2). The primary outcome measure was rate of positive suicide screen.

Results: A total of 33,504 children completed routine suicide screening; 2689 children had a positive screen. The overall rate of positive suicide screens increased throughout the pandemic compared with baseline (7.5% prepandemic, 8.4% Y1, 9.3% Y2; P < 0.01). Rates of positive suicide screens in Y1 increased 0.04% per week and surpassed prepandemic rates, then decreased 0.1% per week throughout Y2 ( P < 0.01), during a time when social distancing mitigation efforts decreased.

Conclusions: Cumulative time in the COVID-19 pandemic was associated with increased positive suicide screens in children. School reopening and normalization of social routines preceded an observed negative trend in rates of positive suicide screens in Y2 of the pandemic. This study demonstrates fluctuating trends in suicide screen positivity, potentially influenced by social distancing and public health measures. Our study may support that maintaining social connectedness and access to school-based or community resources may be a protective factor for youth suicide risk during a pandemic or other natural occurrence.

Objectives: Chest tube thoracostomy site selection is typically chosen through landmark identification of the fifth intercostal space (ICS). Using point-of-care ultrasound (POCUS), studies have shown this site to be potentially unsafe in many adults; however, no study has evaluated this in children. The primary aim of this study was to evaluate the safety of the fifth ICS for pediatric chest tube placement, with the secondary aim to identify patient factors that correlate with an unsafe fifth ICS.

Methods: This was an observational study using POCUS to evaluate the safety of the fifth ICS for chest tube thoracostomy placement using a convenience sample of pediatric emergency department patients. Safety was defined as the absence of the diaphragm appearing within or above the fifth ICS during either tidal or maximal respiration. Univariate and multivariable analyses were used to identify patient factors that correlated with an unsafe fifth ICS.

Results: Among all patients, 10.3% (95% confidence interval [CI] 6.45-16.1) of diaphragm measurements crossed into or above the fifth ICS during tidal respiration and 27.2% (95% CI 19.0-37.3) during maximal respiration. The diaphragm crossed the fifth ICS more frequently on the right when compared with the left, with an overall rate of 45.0% (95% CI 36.1-54.3) of right diaphragms crossing during maximal respiration. In both univariate and multivariate analyses, a 1-kg/m 2 increase in body mass index was associated with an increase of 10% or more in the odds of crossing during both tidal and maximal respiration ( P = 0.003 or less).

Conclusions: A significant number of pediatric patients have diaphragms that cross into or above the fifth ICS, suggesting that placement of a chest tube thoracostomy at this site would pose a significant complication risk. POCUS can quickly and accurately identify these unsafe sites, and we recommend it be used before pediatric chest tube thoracostomy.

Objectives: This study aims to assess the current state of advanced pediatric emergency medicine (PEM) point-of-care ultrasound (POCUS) training in North America, including trends in dedicated PEM POCUS fellowships and alternative advanced POCUS training pathways, to better guide future educational efforts within the field.

Methods: We identified and surveyed 22 PEM POCUS fellowship directors across the United States and Canada regarding PEM POCUS fellowship application trends, potential barriers to pursuing additional POCUS training, and novel training models that meet the needs of the PEM POCUS workforce.

Results: The past 5 years have seen a growth in both PEM POCUS fellowship program number and trainee positions available, with a general impression by fellowship directors of a high demand for faculty who have these training credentials. However, there was a discordant drop in fellowship applicants and corresponding match rate in 2022, the cause of which is not clear. A number of programs are offering alternative advanced training options including combined PEM/POCUS fellowships and POCUS tracks within PEM fellowship.

Conclusion: As POCUS use within PEM evolves, a growing number of advanced training options are being developed. Understanding the motivations and barriers for pursuing advanced POCUS training can help to shape these options going forward, to ensure the experience incorporated within each model meets the needs of trainees, the needs of PEM divisions, and the future needs of our field.