Interdisciplinary onsite team-based simulation training in the neonatal intensive care unit: a pilot report.

OBJECTIVE: Simulation training improves individual clinician confidence, performance and self-efficacy in resuscitation and procedural training experiences. The reality of resuscitation experiences in the neonatal intensive care unit (NICU) is that they are team-accomplished events. However, limited data exist on team-based simulation training (TBST) in the NICU. We report the experience of TBST over a 4-year period. STUDY DESIGN: This is a retrospective report of 65 TBST events in a 71-bed Level IV NICU at a regional subspecialty children's hospital. Participants were more than 500 NICU staff, including neonatal/cardiac/surgical attendings, neonatal fellows, neonatal nurse practitioners, pediatric residents, registered nurses and respiratory therapists. Background work, common case scenarios, training objectives and learning opportunities were reported, along with discipline-specific, and team and system areas for improvement. Qualitative, subjective data were tracked and efforts at collecting quantitative, objective data are ongoing. RESULTS: Seventy-five TBST events were scheduled from November 2010 through December 2014; 10 of these were canceled. TBST events occurred both night (n=23) and day (n=42), and also on weekends (n=19), using high-fidelity (n=42) and low-fidelity (n=23) systems. Resuscitation team participants at each TBST were 12-30 providers and staff. The duration of each TBST event was 30-65 min including debriefing. Systems issues were identified and corrected, including problems activating the code pathway, issues using a pager activation system and confusion over resuscitation team roles and responsibilities. Educational needs were addressed, focused on topic areas that included arrhythmias and use of extracorporeal cardiopulmonary resuscitation. CONCLUSION: With appropriate planning and implementation, TBST is feasible and realistic in a busy NICU.

Artificial neural network predicts CT scan abnormalities in pediatric patients with closed head injury.

BACKGROUND: Artificial neural networks (ANNs) use nonlinear statistical modeling techniques to explore relationships in complex clinical situations. This study compared predictive ability of a trained ANN model to that of physician prediction of cranial computed tomographic (CT) scan abnormalities in children with head injury. METHODS: A prospective cohort of 351 patients who presented with head trauma and underwent CT scans were studied. All pertinent data on historical and demographic information, and clinical features were recorded. Emergency department physicians used clinical judgment to record pretest probability of abnormal CT scans for all patients prospectively. Similar data from a retrospective chart review of 382 patients with head injury in the immediate preceding year were collected and used to train the ANN. Data from the prospective study was used to validate the ANN, construct a logistic regression model, and compare physician prediction. RESULTS: Forty-five (12.9%) of 351 patients had abnormal CT scans. In predicting CT scan abnormality, the ANN model was more sensitive (82.2%) compared with physician prediction (62.2%). CONCLUSION: ANNs may serve as a useful aid for decision support for emergency physicians in predicting intracranial abnormalities in closed head injury.

Childhood burn injuries related to gasoline can home storage.

OBJECTIVE: To examine the risks associated with home storage of gasoline and to outline prevention strategies to avoid further injury and death. DESIGN: Case series. PATIENTS AND OTHER PARTICIPANTS: Twenty-five patients less than 6 years old were selected for study (3 by presentation to a tertiary care Children's Hospital Emergency Department, and 22 from the National Electronic Injury Surveillance System Data during the same calendar year). MAIN OUTCOME MEASURES: Data collected included child's age; burn injury, either percent body surface area or minor, moderate, or major burn classification; mortality; circumstances related to ignition of gasoline, such as behaviors, and if can was opened or closed; and flame source. RESULTS: Boys were involved in 95% of cases. Mean age was 2.7 years. The source of ignition was a pilot light in 100% of cases. Forty-four percent of patients died. Only vapors were ignited in 56% of cases. The gasoline can was described as closed in 64% of cases. CONCLUSION: Gasoline is dangerous. The rectangular red metal gasoline can is not safe either. National building codes and can specifications are needed to prevent serious injury and deaths among young children.