Emergency department management of pediatric acute asthma: an evidence-based review.

Asthma is the most common chronic disease of childhood. Although home action plans and the use of maintenance medications have improved daily management and control of asthma, many children still require emergency department care at least once per year. Emergency clinicians must be able to manage patients with acute asthma exacerbations and determine their safe disposition. This issue reviews the current evidence-based emergency department management recommendations for moderate to severe acute asthma in pediatric patients. Timely use of bronchodilators and systemic corticosteroids, as well as adjunct modalities, are discussed. Current challenges in asthma management related to vaping and COVID-19 are also addressed.

Measuring Assessment Quality With an Assessment Utility Rubric for Medical Education.

INTRODUCTION: Prior research has identified seven elements of a good assessment, but the elements have not been operationalized in the form of a rubric to rate assessment utility. It would be valuable for medical educators to have a systematic way to evaluate the utility of an assessment in order to determine if the assessment used is optimal for the setting. METHODS: We developed and refined an assessment utility rubric using a modified Delphi process. Twenty-nine graduate students pilot-tested the rubric in 2016 with hypothetical data from three examinations, and interrater reliability of rubric scores was measured with interclass correlation coefficients (ICCs). RESULTS: Consensus for all rubric items was reached after three rounds. The resulting assessment utility rubric includes four elements (equivalence, educational effect, catalytic effect, acceptability) with three items each, one element (validity evidence) with five items, and space to provide four feasibility items relating to time and cost. Rater scores had ICC values greater than .75. DISCUSSION: The rubric shows promise in allowing educators to evaluate the utility of an assessment specific to their setting. The medical education field needs to give more consideration to how an assessment drives learning forward, how it motivates trainees, and whether it produces acceptable ranges of scores for all stakeholders.

Adolescents' perceptions of interpersonal communication, respect, and concern for privacy in an urban tertiary-care pediatric emergency department.

OBJECTIVES: To measure adolescents' perceived overall satisfaction with health care in a pediatric emergency department (PED), identify key factors that contributed to satisfaction, and determine how these factors interacted with length of stay (LOS) and triage acuity. METHODS: Prospective observational design with a convenience sample of 100 adolescents 13 to 21 years old recruited from the PED between February and June 2007. Participants completed a self-administered 27-item written survey with closed and open-ended items. RESULTS: Survey response rate was 99%. Respondents completed the survey in a mean time of 6.6 minutes (range, 3-12 minutes; SD, 2.0 minutes). Most (95%) reported being satisfied with their overall PED experience, and 91% would recommend the PED to other adolescents. Interpersonal communication and respect correlated significantly with respondents' overall satisfaction. There were no statistically significant differences in overall satisfaction rates by sex, age, socioeconomic status, or ethnicity, or by LOS, triage acuity score, or hospital admission. Most (94%) answered a qualitative survey item that asked how their PED care could be improved with 4 distinct responses: no changes necessary, enhance interpersonal communication, improve comfort of stay, and shorten LOS. CONCLUSIONS: Adolescents expressed high levels of satisfaction with their overall PED experience at our institution. Interpersonal communication and respect highly correlated with overall satisfaction. A multicenter study using a similar self-administered survey would further support the relationship between key factors and PED adolescent satisfaction. Utilization of a self-administered survey for adolescent research is feasible in the PED and could be used to improve quality control measures for adolescent care.