Acute epistaxis: a comprehensive overview in the acute care setting.

Epistaxis is a common problem in pediatric patients. Most cases are benign in nature and resolve with minimal intervention. However, there are many unusual conditions that present with epistaxis that can be very serious and should be promptly investigated and treated. This review aids in the distinction between the benign causes of epistaxis and those that are more serious and require further evaluation. The various etiologies of epistaxis are discussed, and recommendations for general and scenario-specific management of pediatric patients with epistaxis are provided.

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.

Injury Rates, Patterns, Mechanisms, and Risk Factors Among Competitive Youth Climbers in the United States.

INTRODUCTION: Competitive rock climbing is a fast-growing sport. Despite comprehensive reviews on adult climbing-related injuries, few pediatric-specific reviews exist, and studies exclusively on competitive youth climbers are needed. Objectives of this study include 1) estimating the injury rate (IR); 2) describing injury patterns and mechanisms; and 3) identifying injury risk factors in competitive youth climbers. METHODS: The study design was cross-sectional. Competitive youth climbers were included. Participants completed an anonymous questionnaire to document climbing injuries over the preceding 12 mo. Demographic data and data regarding injuries were collected. The IR was calculated. Analyses were performed to assess association between injury and multiple variables. Multivariate logistic regression was completed for significant variables to control for exposure time. RESULTS: The IR was 2.7 injuries per 1000 climbing hours. Hand/Finger injuries were most frequent; chronic overuse was the most common etiology. Injury severity was low overall. Risk factors significantly associated with climbing injury were climbing discipline (bouldering > sport/lead climbing), return to climbing while still in pain, finger taping, higher number of hours climbed per session and per year, climbing at higher bouldering difficulties, and unsupervised climbing. CONCLUSIONS: The IR in competitive youth climbers was found to be lower than previously reported but higher than suggested by adult studies or those that exclude chronic injuries. Findings are consistent with types, severity, and mechanisms reported in other studies. Modifiable risk factors, especially return to climbing while still injured, warrant further prospective investigation.

Changing Who Has a Seat and Voice at the Table: How the Academic Pediatric Association is Responding to Systemic Racism.

The Academic Pediatrics Association has taken multiple steps over the last 2 years to incorporate the lenses of anti-racism and social justice into our mission and work. In this commentary, we discuss the creation and work of the Anti-Racism and Diversity Task Force, which was charged by the Academic Pediatrics Association's Board of Directors with identifying strategies to promote anti-racism and advance the diversity, equity and inclusion agenda.

Point-of-Care Ultrasound for Central Venous Assessment in the Emergency Department: A Prospective Study Comparing the Femoral and Internal Jugular Veins.

OBJECTIVES: The objective of this study was to estimate the width, height, and depth of the femoral vein (FV) and internal jugular vein (IJV), both sites of potential central line placement in children, using point-of-care ultrasound. METHODS: This was a prospective observational study. Point-of-care ultrasound was used to measure the width, height, and depth of the right FV and IJV in 100 children. The primary outcome was a comparison of the widths of the FV and the IJV in the same child. Our primary hypothesis was that the IJV would be wider than the FV. Secondary outcome measures included comparison of the heights and depths the FV and IJV and description of vessel overlap frequency between the 2 sites. RESULTS: A total of 106 children were enrolled, with 6 subjects excluded, and equally divided into 5 age groups (0-30 days, 1-24 months, 2-5 years, 6-11 years, and 12-17 years). The FV/IJV width ratios (95% confidence interval) by age were 0.58 (0.49-0.68), 0.53 (0.43-0.66), 0.57 (0.49-0.67), 0.68 (0.55-0.85), and 0.73 (0.62-0.85), all P < 0.002. The FV/IJV height ratios were <1 in all age groups, with P < 0.003 in the 4 youngest age groups. The FV/IJV depth ratios were >1 in 6 to 11 years (P = 0.018) and 12 to 17 years (P < 0.001). CONCLUSIONS: The IJV was significantly wider and taller than the FV in the same child in all age groups. The FV was significantly deeper than the IJV in children 6 years and older. This supports the use of the IJV as a potential site when placing ultrasound-guided central lines in children.

Virtual Interviewing for Pediatric Emergency Medicine Fellowship-A National Survey.

OBJECTIVE: This study aimed to evaluate both applicant and interviewer satisfaction with the virtual interviewing process for pediatric emergency medicine (PEM) fellowship in hopes to improve the fellowship interviewing process. It was proposed that fellowship programs and applicants would prefer virtual interviews over traditional interviews. METHODS: A survey developed in collaboration with UT Southwestern PEM fellowship leaders and national PEM leaders was sent to all PEM fellowship applicants and programs at the conclusion of the 2020 interview season and rank list submission. The applicant survey obtained information on ease of virtual interviews and whether applicants felt that they obtained adequate information from virtual interviews to make informed program selections. Program director surveys collected data on thoughts and feelings about virtual interviews and obstacles encountered during the recruitment season. Both surveys asked about costs for interviews and interview type preference. RESULTS: A response rate of 49% from applicants and 47% from programs was obtained. Virtual interview days were similar in the amount of time and staff hours used compared with traditional days. Applicants spent less on virtual interviews compared with those who underwent traditional interviews (average $725 vs $4312). Programs received more applications than the prior year and spent less money during the virtual cycle. The majority of the applicants (90%) were comfortable with the virtual interview platform, and most (66%) agreed that virtual interviews provided adequate information to determine program rank. Geography was the number 1 rank determining factor. Programs and applicants preferred a form of in-person interviews. CONCLUSIONS: Virtual interviews provide cost savings for both applicants and programs. Despite this, both parties prefer a form of in-person interviews.

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.

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.