Consensus Core Point-of-care Ultrasound Applications for Pediatric Emergency Medicine Training.

BACKGROUND: Pediatric emergency medicine (PEM) physicians have variably incorporated point-of-care ultrasound (POCUS) into their practice. Prior guidelines describe the scope of POCUS practice for PEM physicians; however, consensus does not yet exist about which applications should be prioritized and taught as fundamental skills for PEM trainees. Members of the PEM POCUS Network (P2Network) conducted a consensus-building process to determine which applications to incorporate into PEM fellowship training. METHODS: A multinational group of experts in PEM POCUS was recruited from the P2Network and greater PEM POCUS community if they met the following criteria: performed over 1,000 POCUS scans and had at least 3 years of experience teaching POCUS to PEM fellows, were a local academic POCUS leader, or completed a formal PEM POCUS fellowship. Experts rated 60 possible PEM POCUS applications for their importance to include as part of a PEM fellowship curriculum using a modified Delphi consensus-building technique. RESULTS: In round 1, 66 of 92 (72%) participants responded to an e-mail survey of which 48 met expert criteria and completed the survey. Consensus was reached to include 18 items in a PEM fellowship curriculum and to exclude two items. The 40 remaining items and seven additional items were considered in round 2. Thirty-seven of 48 (77%) experts completed round 2 reaching consensus to include three more items and exclude five. The remaining 39 items did not reach consensus for inclusion or exclusion. CONCLUSION: Experts reached consensus on 21 core POCUS applications to include in PEM fellowship curricula.

The TACTIC: development and validation of the Tool for Assessing Chest Tube Insertion Competency.

OBJECTIVES: Pediatric emergency medicine (PEM) physicians receive little opportunity to practice and perform chest tube insertion. We sought to develop and validate a scoring tool to assess chest tube insertion competency and identify areas where training is required for PEM physicians. METHODS: We developed a 40-point, 20-item (scored 0, 1, or 2) assessment tool entitled the Tool for Assessing Chest Tube Insertion Competency (TACTIC) and studied how PEM physicians and fellows scored when inserting a chest tube into a pork rib model. Participants were scored at baseline and compared to themselves after receiving targeted training using Web-based animations and presentations followed by expert instruction and practice on chest tube insertion task trainers. All insertions were video recorded and reviewed by two blinded reviewers. Eight common videos were reviewed to assess interrater reliability. RESULTS: The TACTIC demonstrated good interrater reliability with an r 2 =0.86. Our cohort demonstrated a significant improvement in TACTIC scores by taking part in targeted training (precourse TACTIC=65%, 95% CI 54-76 v. postcourse TACTIC=84%, 95% CI 80-88), highlighting the construct validity of the TACTIC. Individual participants increased their TACTIC scores by an average of 17%. CONCLUSIONS: The TACTIC demonstrates good interrater reliability, content validity, and construct validity in assessing a PEM practitioner's skill inserting chest tubes in a simulated setting.

Adolescent satisfaction in an urban pediatric emergency department.

OBJECTIVES: We studied the satisfaction reported by adolescents when visiting a pediatric emergency department (ED) and elicited suggestions for improving the ED for teenage patients. METHODS: A 33-question survey was developed for this study assessing adolescents' overall satisfaction with their ED care as well as their views on the waiting time and setting, medical staff, treatment and discharge plans, and comparisons to general hospital EDs. The survey was administered at discharge home or admission to the hospital. RESULTS: Two hundred eighty-two patients completed the survey. Two hundred fifty-nine respondents (92%) rated their experience as good or better. A decreased level of satisfaction was reported among adolescents waiting to see a physician in excess of 2 hours. Satisfaction was not affected by age, diagnosis, procedure, or disposition. Respondents felt safe in our department and were satisfied with the physicians and nurses treating them and their treatment and discharge plans. One hundred seventy respondents offered suggestions for an improved ED setting. Of the 161 patients who had previously attended a general hospital ED, only 11 patients (7%) preferred the general hospital setting. It was concerning that 184 respondents (65% of total) reported not having an opportunity to meet with their physician alone. CONCLUSIONS: Adolescents were satisfied with care in our pediatric ED. Long wait times are associated with decreased level of satisfaction among adolescents. The waiting room setting and meeting a physician alone were important to adolescents visiting our ED.