A family-centered approach to social needs awareness in the pediatric emergency department.

Objective: We aimed to understand family preferences around reporting and receiving health-related social needs (HRSN) information by assessment modality during pediatric emergency department (PED) visits. Methods: Families were randomized into paper (control), cell phone, or tablet modality groups by their child's exam room. Nurses alerted families to complete a single HRSN assessment during routine workflow. We used logistic regression and McNemar's test to assess discordance in modality preference. Results: Forty-seven percent of families disclosed at least one HRSN across a total 611 assessments. Disclosure of HRSN was similar by modality. Twenty-three percent of those assigned tablet preferred cell phone (p < 0.001). Two-thirds of families preferred receiving digitally formatted community resources (email or text). There was no difference in preferred timing of HRSN assessment completion. Conclusions: Assessment modality did not appear to influence family HRSN disclosure. Families were generally satisfied with all HRSN assessment modalities but demonstrated a particular preference in using personal cell phones over tablets. Digitally formatted community referrals also pose numerous advantages over conventional paper handouts. Innovation: Use of personal cell phones is a novel, streamlined method of HRSN interventions in the clinical setting, performing similar to more conventional modalities, with a preference among families when compared to tablets.

Social Care Education and Training Among US Pediatric Emergency Medicine Fellowship Programs.

OBJECTIVE: The aim of the study is to assess the association of social determinants of health (SDOH) education and social needs training on pediatric emergency medicine (PEM) physician perception and practices of social care. METHODS: Data were derived from the 2021 National Social Care Practices Survey of PEM program directors (PDs) and fellows. Ordinal and binary logistic regression modeling were completed for educational/training factors and social care perspective and practice outcomes. RESULTS: A national sample of 44 PDs (49% response rate) and 109 fellows (28%) participated. A minority of fellows received SDOH education and social needs training during fellowship. Fellows and PDs with SDOH education had a 3.1 odds (95% confidence interval CI, 1.4-6.9) of screening for social needs, with 4.4 odds among fellows (95% CI, 1.2-20.7). Those with social needs training were more comfortable assessing social risk, with 2.4 odds overall (95% CI, 1.2-4.7) and 3.1 odds among fellows (95% CI, 1.4-6.7). They also had 2.4 odds overall (95% CI, 1.1-4.9) of screening for social needs, with a 2.9 odds among fellows (95% CI, 1.3-6.8). CONCLUSIONS: Social care education and training appear to be associated with comfort assessing social risk and social needs screening tendency among both PEM PDs and fellows. Key areas for educational interventions are identified among PEM fellows, who are uniquely positioned as clinical leaders and patient advocates.

Sustainably Implementing Social Determinants of Health Interventions in the Pediatric Emergency Department.

This Viewpoint discusses 5 principal challenges and opportunities for the sustainable implementation of social determinants of health interventions in emergency department settings.

Point-of-Care Ultrasound and the Discovery of Pulmonary Arterial Hypertension in a Teenager.

ABSTRACT: We present a case of a teenage patient with new-onset cardiac symptoms discovered to have primary pulmonary arterial hypertension. Point-of-care ultrasound used early in the patient's presentation identified significant right-sided heart dilatation and dysfunction despite the patient's relatively unrevealing physical examination. This article emphasizes the utility of performing focused cardiac ultrasound in pediatric patients early in their presentation. We briefly review focused cardiac ultrasound technique and highlight relevant literature.

Pediatric emergency department organization and social care practices among U.S. fellowship programs.

Background: Social care has become increasingly relevant to the emergency physician and includes activities that address health-related social risk and social needs. The literature has consistently documented substantial health care provider challenges in incorporating social care into routine practice. Yet, interventions on the health care organizational level hold promise to bring about more widespread, sustainable impact. Methods: This study was a subanalysis of the 2021 National Social Care Practices Survey data set among pediatric emergency medicine (PEM) program directors (PDs) and fellows. The purpose was to investigate the association between health care organizational factors and PEM physician social care practices and perceptions among PEM PDs and fellows. We performed binary and ordinal logistic regressions of organizational factors and five specific PEM physician social care perspective and practice outcomes. Results: The sample population included 153 physicians-44 PDs (49% response rate) and 109 fellows (28%). PDs and fellows with access to a social care systematic workflow in their pediatric emergency department (PED) had higher odds of comfort assessing social risk (odds ratio [OR] 2.1%, 95% confidence interval [CI] 1.1-4.0), valuation of social care (OR 3.2, 95% CI 1.3-7.9), preparedness to assist families (OR 2.4, 95% CI 1.1-5.2), screening tendency (OR 2.2, 95% CI 1.1-4.5), and ability to refer to community resources (OR 2.3, 95% CI 1.2-4.6). A similarly directed, but less pronounced pattern was noted with access to a community resource database for referrals and 24-h access to a social worker in the PED. Conclusions: PED organizational factors-particularly access to a social care systematic workflow-appear positively associated with PEM physician practices and perceptions of social care delivery. Further research is under way to advance understanding of PEM training factors in social care.

Social care practices and perspectives among U.S. pediatric emergency medicine fellowship programs.

Background: The emergence of social emergency medicine-the incorporation of social context into the structure and practice of emergency care-has brought forth greater embracement of the social determinants of health by medical professionals, yet workforce practices and training have remained elusive. Academic literature particularly in the field of pediatric emergency medicine (PEM) fellowship training is lacking relative to general pediatrics and adult emergency medicine. Methods: The primary objective of this study was to assess the social care knowledge, perspectives, and training of PEM program directors (PDs) and fellows across a national cross-sectional sample. A secondary aim was to uncover key actionable areas for the development of social care curricula in PEM training programs. A social care practices assessment tool was developed via snowball sampling interviews among clinician researcher experts and disseminated to PEM PDs and fellows nationally in accredited academic PEM training institutions. Results: A total of 153 participants-44 PDs (49% response rate) and 109 fellows (28%)-completed the assessment tool. Responses among PDs and fellows were highly concordant. Only 12% reported regular use of a standardized social needs screening tool. The majority felt unprepared to assist families with social needs and less than half felt comfortable talking to families about social need. At the same time, social care was highly valued by 73% of participants. All participants felt that providing social care training during PEM fellowship would be beneficial. PDs and fellows identified five priority areas for PEM curricular development. Conclusions: PEM PDs and fellows have an overall favorable perception of social care yet report significant deficits in current practice organization and training. This study is part of a larger national collaborative advocacy project to organize and advance social care delivery across academic PEM training institutions through evidence-based approaches, best practices, and expert consensus.

Clinical and Radiologic Features of Fulminant Pediatric Autoimmune Encephalitis: A Case Report.

There is a growing body of literature and scientific discovery on pediatric autoimmune encephalitides. This is a heterogenous group of neuroinflammatory conditions leading to often perplexing acute and progressive neurologic and/or neuropsychiatric symptoms. This report demonstrates the evaluation and management of an adolescent with myelin-oligodendrocyte glycoprotein (MOG) antibody-associated fulminant acute disseminated encephalomyelitis (ADEM) in the context of current literature. The featured magnetic resonance imaging uniquely highlights progressive central nervous system lesions detected over the course of the first week of disease. Topics: Encephalitis, encephalopathy, ADEM, MOG.

An Unusual Case Report of a Toddler with Metastatic Neuroblastoma Mimicking Myasthenia Gravis.

Pediatric neuroblastoma is famously characterized by an abdominal mass in a toddler with "raccoon eyes," Horner syndrome, and/or opsoclonus myoclonus. However, rare cases may present with non-discrete symptoms and signs which create challenges for timely diagnosis. This case depicts a toddler with bulbar symptoms, including bilateral ptosis, dysphagia, drooling, head tilt and ataxia in a post-viral course mimicking other neurologic diagnoses, including myasthenia gravis. Magnetic resonance imaging (MRI) of the brain and spine uncovered a right adrenal mass along with heterogenous enhancement in multiple vertebral bodies and the clivus, consistent with metastatic disease. A diagnosis of neuroblastoma was confirmed with elevated homovanillic acid (HMA) and vanillylmandelic acid (VMA) levels and adrenal biopsy. The patient was treated with plasmapheresis for suspected paraneoplastic neurological syndrome and subsequent chemotherapy. In this case presentation, we review neurologic syndromes causing acute-onset pediatric bulbar weakness along with the patient's key MRI findings. Topics: Toddler weakness, neuroblastoma, paraneoplastic syndrome.

Not Another Presentation of Cellulitis: A Case Report of Erythromelalgia.

Cellulitis is among the more common conditions diagnosed and treated within pediatric emergency departments. However, unusual distribution, recurrence, and/or poor response to antibiotics may point towards another pathologic process. This case presentation illustrates a teenager with recurrent episodes of painful erythematous and swollen extremities misdiagnosed repeatedly as cellulitis. Careful history, exam, laboratory evaluation and rheumatologist consultation aided in making the correct diagnosis of erythromelalgia, which was successfully treated with supportive measures. This report reviews a rare presentation of erythromelalgia, as well as its pathophysiology, recommended therapies, and common misdiagnoses. Topics: Painful extremities; recurrent swelling; erythromelalgia.

A Case Report of Neonatal Vomiting due to Adrenal Hemorrhage, Abscess and Pseudohypoaldosteronism.

Neonatal adrenal hemorrhage is a rare phenomenon which may occur in utero or in the intrapartum period. This case illustrates ultrasound and subsequent abdominal computed tomography (CT) imaging of a 30-day-old neonate who initially presented with acute vomiting and was found to have an abscess at the site of a previous right-sided adrenal hemorrhage. Ultrasound-guided fine needle aspiration of the abscess was ultimately the key diagnostic and therapeutic intervention, which detected Escherichia coli (E. coli) infection. The discussion addresses the connection between key pathologic features of this case, while reviewing the acute management of clinical sequelae in the emergency department. Topics: Neonatal vomiting, adrenal hemorrhage, retroperitoneal abscess, pseudohypoaldosteronism.

Participation Rates and Perceptions of Caregiving Youth Providing Home Health Care.

Little is known about the population of caregiving youth in the United States. We sought to describe the participation rates, demographics, and caregiving tasks among sixth graders served by the American Association of Caregiving Youth (AACY) in its Caregiving Youth Project (CYP) in Palm Beach County, FL and evaluate the perceived benefit of AACY services. Sixth grade enrollment data from eight middle schools between 2007 and 2013 were obtained from The School District of Palm Beach County and the AACY. Data were obtained using a retrospective review of AACY program participant files. These files contained responses to evaluative questions from both students and family members. Overall, 2.2 % of sixth graders enrolled and participated in the program. Among the 396 caregiving sixth graders studied, care recipients were predominantly a grandparent (40.6 %) or parent (30.5 %). Common activities included providing company for the care recipient (85.6 %), emotional support (74.5 %), and assistance with mobility (46.7 %). Youth reported a median of 2.5 h caregiving on weekdays and 4 h on weekend days, while families reported fewer hours (1.6 and 2.3, respectively). At the end of the school year, the sixth graders reported improvement in school (85.5 %), caregiving knowledge (88.5 %), and self-esteem (89.5 %). Slightly over 2 % of sixth graders participated in the CYP. While support services may mitigate the negative effects of the time spent by caregiving youth, more prospective research is needed to better define the true prevalence, tasks, and time spent caregiving among this subpopulation.