Assessing the New Norm: A Simulation Study to Assess Pediatric Emergency Physician Success in Critical Procedures With an Air Purifying Respirator.

INTRODUCTION: Physicians caring for patients with COVID-19 are at high risk for contracting the disease, thus, significant emphasis has been placed on personal protective equipment (PPE). The study aims to assess the impact of advanced PPE across 4 common procedures: endotracheal intubation, bag-valve mask ventilation, intraosseous (IO) insertion, and lumbar puncture (LP) performed by pediatric emergency physicians. METHOD: Physicians performed the procedures in a simulated environment. Lumbar puncture and IO were performed with standard precautions versus an air purifying respirator (APR). A direct comparison was drawn for endotracheal intubation and bag-valve mask ventilation between 2 commonly used APRs. Success rate and number of attempts toward successful completion was recorded for all 4 procedures. Physicians filled out a postprocedure survey to assess their ease of use of the APR. RESULTS: Twenty participants performed IO and LP using an APR and standard precautions. There was no statistical difference in the success rate, number of attempts, average time, or maintenance of sterility (LP only) for both procedures. Twenty total participants divided across 2 types of APR groups performed intubation and BMV. Success rate and number of attempts had no statistical difference for both procedures. Physician feedback surveys to assess the ease of use of APR compared with standard precautions had no statistically significant difference for all 4 procedures. CONCLUSIONS: Wearing increased levels of PPE did not impact procedural success, length of time, sterility, number of attempts, or the physicians' ease in our study. Physicians should be encouraged to wear all appropriate PPE.

Does a prehospital Glasgow Coma Scale score predict pediatric outcomes?

BACKGROUND: Although the Glasgow Coma Scale (GCS) score is widely used by medical professionals to evaluate and predict neurological outcomes, studies using the prehospital (P) GCS score to predict neurological outcomes in children are few. OBJECTIVE: The objective of this study was to determine the agreement between the P GCS score and the emergency department (ED) GCS score, and the association between P GCS score and outcomes at hospital discharge in pediatric patients 5 to 18 years of age. METHODS: Medical record review of children 5 to 18 years old with traumatic brain injury (TBI) was conducted. Children with documented P and ED GCS scores were eligible for enrollment. The hospital records of each enrolled child were reviewed, and the Glasgow outcome score and the disability rating scale scores were calculated. Agreement between the P and ED GCS scores was calculated using χ (κ statistic). RESULTS: One hundred eighty-five subjects were included. There was strong agreement between P and ED GCS scores (κ = +0.69; confidence interval, 0.57-0.81). The Glasgow outcome score category improved with improving GCS category. The median disability rating scale score was also similar for P and ED GCS scores and was higher with decreasing GCS. CONCLUSIONS: Our data showed strong agreement between P and ED GCS scores. Also, there was strong association between P GCS scores and short-term outcomes in children with TBI. The results support the use of GCS in prehospital transport destination guidelines for children with TBI.

Decreasing review and notification times of genital and urine cultures in a pediatric emergency department: An observational before and after study.

OBJECTIVES: The review of positive culture results by clinical pharmacists in pediatric patients discharged from the emergency department (ED) has not been described. This study aimed to compare review and family notification times of genital and urine cultures before and after initiation of review of positive cultures by clinical pharmacists in a pediatric ED. METHODS: This was a retrospective review of charts for the study period of 1 year before and 1 year after initiation of review of positive cultures by clinical pharmacists. Positive culture timing results as well as types and rates of interventions were obtained from the electronic chart records. RESULTS: A total of 681 urine and 171 genital cultures were analyzed. The number of genital and urine cultures were similar in the nurse-driven and pharmacist-driven periods. For urine cultures, the cumulative percentage of notifications in the pharmacist-driven period exceeded that in the nurse-driven period until about 24 hours and again between 24 and 48 hours. By 12 hours, 5.4% of families had been notified in the pharmacist-driven period compared with 1.8% in the nurse-driven period (P = 0.011). More positive cultures were reviewed early in the pharmacist-driven period as well, but by 12 hours, the cumulative percentages were similar: 30.4% in the pharmacist-driven period compared with 27.7% in the nurse-driven period (P = 0.431). For genital cultures, the distribution of notification and review times were similar in both periods. CONCLUSIONS: The review of positive cultures by clinical pharmacists in a pediatric ED can shorten review and notification times compared with nurses, especially in the first 12 hours.