Learner's evaluation in paediatric intensive care unit.

OBJECTIVE: To compare post-paediatric intensive care unit (PICU) rotation performance of paediatric residents (PGY-2) and emergency residents (PGY-2) on an online test developed by the subcommittee of the paediatric section of the Society of Critical Care Medicine. Also, to compare residents' performance with that of physician extenders. DESIGN AND SETTINGS: A single centre, longitudinal, retrospective, quality improvement data review in a tertiary care, 20-bed PICU. The test was securely submitted to all residents at the end of their PICU rotation from July 2005 to June 2008. The test was also submitted to physician extenders once only during the 3-year study period. RESULTS: The mean, paediatric residents' (N=30) score was 77.3%±10.8 (SD) and that of emergency residents (N=40) was 82.3%±8.2 (SD) at PGY-2 level (p=0.03). The combined paediatric residents' and emergency residents' mean score was 80.1%±9.7 (SD). The mean physician extenders' (N=7) score was 80.1%±6.5 (SD). CONCLUSION: Emergency residents performed slightly better than paediatric residents on the paediatric-focused knowledge-based online test. The physician extenders' performance was comparable to the individual resident groups' performance and their combined performance.

Detection of traumatic brain injury with magnetic resonance imaging and S-100B protein in children, despite normal computed tomography of the brain.

OBJECTIVE: The objective of this study was to obtain data to further define the extent of traumatic brain injury by using S-100B protein and standard noncontrast magnetic resonance imaging with added fluid-attenuated inversion recovery (FLAIR) and gradient echo sequence in children with normal head computed tomography. DESIGN: Pilot, single cohort, prospective, clinical diagnostic study. SETTING: Pediatric intensive care and intermediate care unit in a tertiary care children's hospital. PATIENTS: Children ages 5-18 yrs who sustained traumatic brain injury, had a negative computed tomography of the brain, and were admitted to hospital were eligible for enrollment. INTERVENTIONS: Two blood samples were drawn for S-100B protein analysis: the first (t-1) as soon as possible or close to 6 hrs of injury and the second (t-2) close to 12 hrs from the time of injury. A magnetic resonance image of the brain was obtained within 96 hrs of injury. MEASUREMENTS AND MAIN RESULTS: Seven of 17 patients (41%) had positive magnetic resonance image. Of the seven patients with positive magnetic resonance image, 100% (seven of seven) had a positive magnetic resonance image with FLAIR sequence, 85% (six of seven) with axial T2 sequence and 50% (three of six) with gradient echo sequence. There was no statistically significant difference in S-100B protein concentrations in patients with a positive magnetic resonance image (n = 7) and those with a negative magnetic resonance image (n = 10; p =.40 at t-1 and p =.13 at t-2). The concentration of S-100B protein was statistically significantly higher in patients with head and other bodily injury (n = 9) compared with isolated head injury (n = 6; p =.018 at t-1 and p =.025 at t-2). Patients with a positive magnetic resonance image had a lower Glasgow Coma Scale score and longer duration of hospital stay. CONCLUSIONS: Magnetic resonance imaging seems to be a useful modality to better define the spectrum of brain injury in children with mild head trauma. The addition of S-100B protein measurement does not seem to be useful in this setting.