First-Person Point-of-View Instructional Video on Lumbar Puncture Procedure.

OBJECTIVES: Tutorial videos filmed from a first-person point of view (FP-POV) are generally well received. Pediatric residents are expected to be competent in performing the lumbar puncture (LP). The educational effectiveness of a FP-POV in lumbar puncture procedure training for resident physicians has yet to be evaluated. We compared a FPPOV LP video with a standard in-person demonstration of the LP. METHODS: We designed an assigned cohort study to compare a FP-POV procedural instructional video of a simulated pediatric LP to the standard in-person procedure demonstration.After the intervention, residents completed an LP observed by one of two blinded reviewers who assessed the procedure using a modified, published assessment tool.Participants completed preintervention and postintervention surveys to rate self-confidence and usefulness of the FP-POV educational method. The data was analyzed using a Wilcoxon Rank sum test. z Scores were calculated on the raw assessment scores. RESULTS: Eighteen first year pediatric residents participated, nine in each group. The median modified assessment tool score was 17 in the FP-POV group (min, 14; max, 17; IQR:, 1.5) and 14 in the standard demonstration group (min, 6; max, 17; IQR, 4.5), with the higher score being more successful. There was a statistical difference between the assessment scores between the 2 groups (z score = 2.18, P = 0.04). Postintervention survey data demonstrated relative satisfaction with the FPPOV educational method. CONCLUSIONS: This study supports the educational effectiveness of a FP-POV procedure tutorial.Future studies with a larger sample size are needed.

Hemorrhagic Transformation Following Childhood Cardioembolic Stroke Is Not Increased in Anticoagulated Patients.

OBJECTIVE: To characterize the risk of hemorrhagic transformation following cardioembolic stroke in childhood, and whether anticoagulation impacts that risk. METHODS: Ninety-five children (1 month-18 years) with cardioembolic arterial ischemic stroke between January 1, 2009, and December 31, 2019, at 2 institutions were identified for retrospective chart review. Neuroimaging was reviewed to assess for hemorrhagic transformation. RESULTS: There were 11 cases of hemorrhagic transformation; 8 occurred within 2 days of stroke diagnosis. Risk of hemorrhagic transformation did not differ in patients with and without anticoagulation use (15% vs 9%, estimated risk difference 5%; CI -9%, 19%). Stroke size did not predict hemorrhagic transformation (OR 1.004, 95% CI 0.997, 1.010). Risk of hemorrhagic transformation was higher in strokes that occurred in the inpatient compared with the outpatient setting (16% vs 6%). CONCLUSION: Hemorrhagic transformation occurred in 11% of pediatric cardioembolic ischemic stroke, usually within 2 days of stroke diagnosis, and was not associated with anticoagulation or stroke size.

A Retrospective Observational Study of Presentations to an Australian Emergency Department for Injuries Sustained in Exercise Pursuits Over 14 Years.

Background: Concurrent with the increase in the number of local gyms and the number of people engaged in fitness pursuits, exercise-related emergency department (ED) presentations have also increased. Identifying these injuries and the associated activities and equipment will help inform prevention strategies and potentially reduce the burden on the healthcare system. Methods: We reviewed the presentations to an Australian tertiary hospital ED resulting from running/jogging and gym-based exercise from 2005 to 2018. Results: From more than 750,000 ED visits, we identified 1,402 exercise-related presentations. Approximately two-thirds of the patients were males. Nontrauma such as chest pain and shortness of breath accounted for 11% of the presentations. Running and jogging contributed 47% of the total presentations, followed by combat activities (boxing and martial arts) with 31% of the total presentations. In the latter group, most injuries were to the head (25%) and upper limbs (39%). Injuries associated with weights/resistance activities (n=94) and falls from treadmills (n=49) accounted for 55% of the 260 injuries from use of noncombat-sports-related gym equipment. Twenty-three percent of all presentations arrived by ambulance, and overall, 9% of presentations required hospital admission. Over a 14-year period, the annual presentations rate rose from <1 to >2.5 per 1,000. Conclusion: Although the annual rate of presentations to the ED from exercise has more than doubled, exercise-related presentations still constitute only a small proportion of total presentations. Nevertheless, any reduction would be advantageous to an already overstretched health system. Risk awareness and effective education about equipment and its use at point of sale and in gyms could potentially prevent many presentations.