Pediatric Attending Research Articles

Emergency department frequent users in the paediatric population: a retrospective analysis in Rome

Abstract Background Recent studies have reported the increasing utilisation of the Emergency Departments (EDs) for non-urgent attendances by people aged <18 years. The aim of this study is to describe the characteristic of the paediatric frequent user (FU) population, highlighting the differences between FUs and non-FUs, and to identify factors linked to appropriate ED attendance, comparing the level of variability attributed to the geographical and family physician components. Methods A retrospective cohort study was carried out of the ED attendances in 2022 in the 8 EDs of the Local Health Authority Roma 1 geographical area, in Rome. The cohort was enrolled from the regional Healthcare Emergency Information System. Records included information on number of attendance, age and gender, usage of emergency medical service (EMS), triage code, appropriateness of attendance. Multivariable nested logistic regression was performed to identify the characteristics of FU and non-FU attendances and the predictors for appropriateness of attendances. Results In 2022, the total number of children with at least 1 ED attendance is 24.824 and a total of 35.691 attendances were recorded. The regression analysis highlights that the appropriateness of attendances is associated to the female gender (OR male: 0.84), age <1 year (OR: 2.06), the usage of EMS (OR: 2.00), high triage code and being a FU (OR FU: 1.53). The family physician group have a greater influence of District group but lower influence of single patient characteristics group to determine the appropriateness of paediatric ED attendances (MOR District: 1.73; MOR PCP: 1.84; MOR single patient characteristics: 2.75). Conclusions Frequent use of the ED is partially associated with an inappropriate use of EDs, mostly due to the specific patients’ characteristics. It is therefore necessary to adopt strategies to improve the appropriate use of health service resources in order to provide quality health solutions to real health needs. Key messages • This is the first study that defines an ED paediatric FU profile in Italy. • It compares the level of variability attributed to the geographical component and family physician components.

Usability Testing Via Simulation: Optimizing the NEAR4PEM Preintubation Checklist With a Human Factors Approach.

To inform development of a preintubation checklist for pediatric emergency departments via multicenter usability testing of a prototype checklist. This was a prospective, mixed methods study across 7 sites in the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) collaborative. Pediatric emergency medicine attending physicians and senior fellows at each site were first oriented to a checklist prototype, including content previously identified using a modified Delphi approach. Each site used the checklist in 2 simulated cases: an "easy airway" and a "difficult airway" scenario. Facilitators recorded verbalization, completion, and timing of checklist items. After each simulation, participants completed an anonymous usability survey. Structured debriefings were used to gather additional feedback on checklist usability. Comments from the surveys and debriefing were qualitatively analyzed using a framework approach. Responses informed human factors-based optimization of the checklist. Fifty-five pediatric emergency medicine physicians/fellows (4-13 per site) participated. Participants found the prototype checklist to be helpful, easy to use, clear, and of appropriate length. During the simulations, 93% of checklist items were verbalized and more than 80% were completed. Median time to checklist completion was 6.2 minutes (interquartile range, 4.8-7.1) for the first scenario and 4.2 minutes (interquartile range, 2.7-5.8) for the second. Survey and debriefing data identified the following strengths: facilitating a shared mental model, cognitively offloading the team leader, and prompting contingency planning. Suggestions for checklist improvement included clarifying specific items, providing more detailed prompts, and allowing institution-specific customization. Integration of these data with human factors heuristic inspection resulted in a final checklist. Simulation-based, human factors usability testing of the National Emergency Airway Registry for Pediatric Emergency Medicine Preintubation Checklist allowed optimization prior to clinical implementation. Next steps involve integration into real-world settings utilizing rigorous implementation science strategies, with concurrent evaluation of the impact on patient outcomes and safety.

Development and Validation of a Trauma-Informed Care Communication Skills Assessment Tool

BackgroundTrauma-informed care (TIC) is growing in medical education as health care systems recognize trauma’s impact on health outcomes. TIC acknowledges and responds to the effects of trauma on physical, psychological, and emotional health. As TIC trainings are developed and delivered to health care professionals across the learner continuum, curricula need evaluation beyond learner satisfaction and knowledge to better assess changes in skills. We developed the Gap Kalamazoo Communication Skills Assessment Form for Trauma-Informed Care (GKCSAF-TIC) to evaluate pediatric trainees' communication skills in TIC. We describe the development and validity evidence of the GKCSAF-TIC in assessing pediatric residents' TIC skills during standardized patient encounters. MethodsWe developed and implemented the TIC communication skills assessment tool in a one-year prospective cohort study involving pediatric residents. We conducted simulated patient encounters conducted before and after TIC training, with two pediatric faculty attendings assessing each encounter. We gathered validity evidence using Messick’s framework, focusing on content, response process, internal structure, and relationship with other variables. ResultsWe analyzed 57 standardized patient encounters with 33 pediatric interns, including 23 pre-post matched pairs. The development process and rater training supported content and response process validity. Internal consistency, measured by Cronbach’s alpha, ranged from 0.93 to 0.96, while inter-rater reliability, measured by intraclass correlations, ranged from 0.80 to 0.83. There was a significant improvement in scores from pre-training to post-training (3.7/5 to 4.05/5; P < 0.05). ConclusionThe GKCSAF-TIC demonstrated strong preliminary validity and offers educators a valuable means to assess and provide formative feedback to pediatric trainees about TIC.

Attending physicians and trainees' perspective of patient safety culture in operating room: A mixed methods study

BackgroundRegulatory quantitative assessments are routinely undertaken to understand the patient safety culture within an organization. However, adjunctive qualitative approaches to explore low-scoring areas of safety culture in the operating room (OR) are lacking and may provide additional insight. Thus, we explored OR patient safety culture perceptions of pediatric surgical providers, specifically among attending physicians and trainees. MethodsA cross-sectional survey was pilot-tested by pediatric surgical attending physicians and surgical trainees from one academic hospital OR. The “Safer Culture” survey was developed using validated survey measures of concepts from the Safer Culture framework and modified by cognitive interviews with subject-matter experts. The survey was electronically administered, and the results were analyzed descriptively, and percent positive scores were computed. Semi-structured interviews with a purposive sample of participants were then conducted and thematically analyzed. ResultsOf the 144 participants, 67 completed the survey (response rate: 46.5 %). Safety competence (>95 %) and individual commitment & prioritization of safety (>90 %) were rated highest by attending physicians and trainees. Trainees rated policies & resources for safety and cohesion the lowest (<60 %). Attending physicians and trainees rated just culture the lowest (<56 %). Interview data revealed three overarching themes explain the lowest ratings: 1) feedback and fear influence incident reporting, 2) lack of accountability and learning affect just culture, and 3) individual and group preparedness impact safe surgical care. ConclusionsSafer Culture survey identified low-performing issues affecting OR safety culture by pediatric surgical providers. Their perceptions specified areas to focus initiatives to improve OR safety culture. Levels of evidenceLevel III.

Lack of standardization and faculty development in pediatric colonoscopy: A qualitative study.

A standard curriculum for pediatric colonoscopy training has neither been required nor universally implemented in North American fellowship programs. This qualitative study assessed the needs of colonoscopy training in pediatric gastroenterology to determine the standardized components of procedural teaching. Focus groups with pediatric gastroenterology attendings, fellows, procedural nurses, and interviews with advanced endoscopists, all practicing at a single institution, were conducted between March and June 2018. Data were analyzed using thematic analysis principles. Four themes emerged: (1) lack of standardization of colonoscopy performance, (2) lack of professional development of procedure teaching skills, (3) need for teaching behaviors that promote learner's performance, and (4) barriers to effective teaching and learning. A conceptual framework was created for developing a standardized "train-the-trainer" curriculum. Our needs assessment supports expansion of efforts to make this comprehensive training available to all pediatric gastroenterologists involved in procedure teaching.

The Impact of an Antimicrobial Stewardship Program on Days of Therapy in the Pediatric Center: An Interrupted Time-Series Analysis of a 19-Year Study.

We aimed to analyze the effects of an antimicrobial stewardship program (ASP) on the proportion of antimicrobial-resistant pathogens in bacteremia, antimicrobial use, and mortality in pediatric patients. A retrospective single-center study was performed on pediatric inpatients under 19 years old who received systemic antimicrobial treatment from 2001 to 2019. A pediatric infectious disease attending physician started ASP in January 2008. The study period was divided into the pre-intervention (2001-2008) and the post-intervention (2009-2019) periods. The amount of antimicrobial use was defined as days of therapy per 1,000 patient-days, and the differences were compared using delta slope (= changes in slopes) between the two study periods by an interrupted time-series analysis. The proportion of resistant pathogens and the 30-day overall mortality rate were analyzed by the χ². The proportion of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia increased from 17% (39 of 235) in the pre-intervention period to 35% (189 of 533) in the post-intervention period (P < 0.001). The total amount of antimicrobial use significantly decreased after the introduction of ASP (delta slope value = -16.5; 95% confidence interval [CI], -30.6 to -2.3; P = 0.049). The 30-day overall mortality rate in patients with bacteremia did not increase, being 10% (55 of 564) in the pre-intervention and 10% (94 of 941) in the post-intervention period (P = 0.881). The introduction of ASP for pediatric patients reduced the delta slope of the total antimicrobial use without increasing the mortality rate despite an increased incidence of ESBL-producing gram-negative bacteremia.

Practice Patterns Affecting Delays in Care of Testicular Torsion

To compare impact of day or on-call team, pediatric or adult attending, and patient age on testicular torsion management and outcomes. A retrospective study of patients with testicular torsion between 2012 and 2022 at a single institution was conducted. Variables impacting management time were assessed using univariate analyses. 134 patients were included: 49 underwent orchiectomies and 84 underwent orchiopexies. There was no significant difference between efficiency of on-call versus day team regarding time to ultrasound or time to operating room (OR). There were no significant differences between pediatric versus adult attending surgeons for time to surgery, intraoperative length of surgery, or testicular salvage rates. However, when patients were stratified by age greater or younger than 18 years, older patients had significantly longer symptom duration (91.9 vs 20.0 min, p = 0.005), time to receive an ultrasound from emergency room (ER) registration (152 vs 87 min, p < 0.001), time to OR from ER registration (268 vs 185 min, p < 0.001), and time to OR from ultrasound read (187 vs 123 min, p = 0.03). Older patients also had lower rates of testicular salvage approaching significance (orchiectomy rate 48.8% vs 31.5%, p = 0.057). While no significant delays in testicular torsion management were detected between management by on-call versus day team nor pediatric versus adult attending, increased age of patient was associated with delays in definitive surgical management. Greater index of suspicion for testicular torsion diagnosis in adult patients may improve the rate of testicular salvage.

Pediatric injury attendances in different population groups in Israel before, during, and after COVID-19 lockdowns: a descriptive study, 2018–2022

BackgroundLockdowns and quarantines during the COVID-19 pandemic influenced healthcare services’ usage patterns such as emergency department (ED) attendance. During the pandemic, Israel issued three lockdowns (March–May 2020, September–October 2020, and December 2020–February 2021) to mitigate the spread of COVID-19. Little is known about the impact of these lockdowns on ED attendance for injuries in the diverse population of Northern Israel.MethodsWe described patterns of ED attendance before, during, and after COVID-19 lockdowns. We extracted data from medical records of all northern Israeli children aged 0–17 years old who attended Ziv Medical Center (ZMC) emergency department (ED) due to injury, between 01/01/2018 and 10/02/2022. We compared the volume and characteristics of ED attendance during lockdown periods to the same time periods in the 2 years before the pandemic and 1 year after the lockdowns, using chi-square tests.ResultsSeven thousand six hundred nineteen northern children attended ZMC ED during the time periods of the study for injuries and were analyzed. Mean attendance numbers during lockdowns decreased compared to previous years, with an increase in injuries proportion (67.8% (1502/2216) vs. 52.7% (2038/3868) p < 0.001). The proportion of 0–4-year-olds attending for injuries during the lockdown increased compared to pre-pandemic (39.68% vs. 30.7%, p < 0.0001). Minority population attendance decreased (27.47% vs. 30.71% p = 0.02). Hospitalization rates increased (13.21% vs. 10.65% p = 0.01). Post-lockdown periods saw a return to the pre-pandemic age and ethnicity distribution.ConclusionsCompared to previous years, the volume of injuries was lower during lockdowns for all ages, with a relative increase in the proportion of injuries among younger children attending the ED. A lower proportion of attendance from minority groups suggests different health-seeking behavior patterns during emergencies compared to the general population. Understanding these differences will help better plan for future emergencies.

Objective documentation of hypospadias anatomy with three-dimensional scanning

The absence of a standardized classification of hypospadias hinders understanding of the anatomic differences among patients and the evaluation of outcomes following surgical repair. In working towards a standardized, objective method of recording patients' hypospadias anatomy, we describe our initial experience using a non-invasive three-dimensional scanner. An Artec3D Space Spider scanner was used to obtain 3D scans in 29 patients undergoing hypospadias repair. Measurements of the urethral plate width, urethral plate length, glans width, penile shaft length, and penile shaft width were made by 2 pediatric urology attendings and 1 pediatric urology fellow. Measurements were compared and inter-rater reliability was calculated. A total of 435 measurements were made on 29 successfully generated 3D scans, ranging from distal to proximal hypospadias. The inter-rater reliability of measurements from the generated 3D models shown good inter-rater reliability of urethral plate width (ICC0.87 [95%CI:0.76,0.93]), penile shaft length (ICC0.87 [95%CI:0.70,0.94]) and glans width (ICC0.83 [95%CI:0.68,0.92]), excellent inter-rater reliability of urethral plate length (ICC0.96) and moderate inter-rater reliability of penile shaft width (ICC0.69 [95%CI:0.44,0.84]). There was a high degree of reliability of measurements made across multiple users. Calculation of the ratio of the urethral plate length/total penile shaft length objectively defined the initial position of the urethral meatus. When compared to the 3-dimensional volume of the glans, a more proximally positioned urethral meatus was associated with a lower glans volume. 3D scanning offers a rapid, reproducible, and non-invasive method of documenting hypospadias anatomy. The ability to evaluate three dimensional features (i.e. glans volume) offers an exciting opportunities for robust investigation of hypospadias outcomes and further understanding of the relationship between a patient's genotype and phenotype.

Chest pain attendances to a Paediatric Emergency Department pre- and post-COVID-19 vaccination.

Introduction of the mRNA vaccination for coronavirus disease 2019 (COVID-19) has been associated with an increase in cases of peri/myocarditis. In our retrospective cross-sectional study, we aim to (I) describe paediatric chest pain attendance, and (II) study resource utilisation in the Emergency Department (ED) of KK Women's and Children's Hospital (KKH), stratified by pre-pandemic, during the pandemic pre- and post-COVID vaccination introduction in adolescents. We reviewed records of adolescents aged 12 to 18 years old who presented to our ED with the triage complaint of chest pain between 1 January 2019 to 31 January 2022, and determined the attendance rates, aetiologies and resource utilisation during the above time periods. There were 2,418 ED attendances for chest pain in our study population. Among 887 inpatient admissions for chest pain, 1.8% were attributed to a cardiac cause. Comparing the pre-pandemic period to the period after the mRNA COVID-19 vaccination was introduced, ED chest pain rates increased from a median of 0.5% of ED attendances [interquartile range (IQR), 0.3-0.5%] to 0.9% (IQR, 0.7-2.0%) (P<0.001), while admission rates increased from a median of 26.2% of ED attendances (IQR, 24.1-29.1%) to 40.9% (IQR, 37.6-56.6%) (P<0.001). Cardiac enzyme orders among ED visits for chest pain increased from a pre-pandemic median of 0% (IQR, 0.0-2.6%) to a post-vaccination median of 26.1% (IQR, 17.2-56.2%) (P<0.001) and were due to concerns for vaccine-related myocarditis. Seven cases of probable vaccine-related myocarditis presented with chest pain to our ED. Paediatric chest pain is largely non-cardiac in origin. ED chest pain attendance rates and resource utilisation increased after the introduction of mRNA COVID-19 vaccination in adolescents.

A Multisite Survey of Pediatric Hospitalists' Practices in Soliciting Feedback From Trainees.

There is evidence that pediatric attending physicians value receiving feedback from trainees. With this study, we sought to determine the extent to which pediatric hospitalists value, solicit, and receive feedback from residents and medical students on specific areas of the attending's performance and identify perceived barriers to trainees' providing feedback. A web-based survey was sent to pediatric hospitalists at 9 institutions in 2022. Survey questions were developed from existing literature, trainee input, faculty expertise, and a framework on the qualities of exemplary pediatric educators. Respondents answered yes-no and multiitem Likert scale questions and selected answers from predetermined lists related to feedback solicitation from trainees. χ-Square and Wilcoxon rank test statistics were used to analyze questions. Responses were gathered from 91 of 189 surveyed individuals (response rate: 48.1%). Respondents almost unanimously "agreed" or "strongly agreed" that feedback from medical students (88, 96.7%) and residents (89, 97.8%) can be valuable, but feedback was considered more valuable from residents (P <.05). Attending physicians asked for and received feedback more from residents than from medical students (P <.05). Attending physicians most commonly asked for feedback on "teaching skills." The largest perceived barriers to receiving feedback from trainees were trainee lacking comfort with giving feedback, trainee lacking awareness that providing feedback is within their role, and fear of retaliation. Although pediatric hospitalist respondents nearly unanimously valued feedback from trainees, attending physicians were inconsistent in their feedback solicitation practices. Attending physicians were more likely to ask for and receive feedback from residents than from medical students.

Pediatric Emergency Medicine Didactics and Simulation: JumpSTART Secondary Triage for Mass Casualty Incidents.

Mass casualty incidents (MCI), particularly involving pediatric patients, are high-risk, low-frequency occurrences that require exceptional emergency arrangements and advanced preparation. In the aftermath of an MCI, it is essential for medical personnel to accurately and promptly triage patients according to their acuity and urgency for care. As first responders bring patients from the field to the hospital, medical personnel are responsible for prompt secondary triage of these patients to appropriately delegate hospital resources. The JumpSTART triage algorithm (a variation of the Simple Triage and Rapid Treatment, or START, triage system) was originally designed for prehospital triage by prehospital providers but can also be used for secondary triage in the emergency department setting. This technical report describes a novel simulation-based curriculum for pediatric emergency medicine residents, fellows, and attendings involving the secondary triage of patients in the aftermath of an MCI in the emergency department. This curriculum highlights the importance of the JumpSTART triage algorithm and how to effectively implement it in the MCI setting.

Impact of the First Year of the COVID-19 Pandemic on Pediatric Emergency Department Attendance in a Tertiary Center in South Italy: An Interrupted Time-Series Analysis.

The evidence shows a reduction in pediatric emergency department (PED) flows during the early stages of the COVID-19 pandemic. Using interrupted time-series analysis, we evaluated the impact of different stages of the pandemic response on overall and cause-specific PED attendance at a tertiary hospital in south Italy. Our methods included evaluations of total visits, hospitalizations, accesses for critical illnesses and four etiological categories (transmissible and non-transmissible infectious diseases, trauma and mental-health) during March-December 2020, which were compared with analogous intervals from 2016 to 2019; the pandemic period was divided into three segments: the "first lockdown" (FL, 9 March-3 May), the "post-lockdown" (PL, 4 May-6 November) and the "second lockdown" (SL, 7 November-31 December). Our results showed that attendance dropped by a mean of 50.09% during the pandemic stages, while hospitalizations increased. Critical illnesses decreased during FL (incidence rate ratio -IRR- 0.37, 95% CI 0.13, 0.88) e SL (IRR 0.09, 95% CI 0.01, 0.74) and transmissible disease related visits reduced more markedly and persistently (FL: IRR 0.18, 95% CI 0.14, 0.24; PL: IRR 0.20, 95% CI 0.13, 0.31, SL: IRR 0.17, 95% CI 0.10, 0.29). Non-infectious diseases returned to pre-COVID-19 pandemic levels by PL. We concluded that that the results highlight the specific effect of the late 2020 containment measures on transmissible infectious diseases and their burden on pediatric emergency resources. This evidence can inform resource allocation and interventions to mitigate the impact of infectious diseases on pediatric populations and the health-care system.

Emergency Department Attendance Gap during COVID-19 Pandemic: A Comparison of Attendance Trends at Wexford General Hospital from 2014 to 2022

Introduction:COVID-19 resulted in 1.8 million reported deaths in 2020 and an excess mortality of at least 3,000,000 to date. Following the announcement of emergency measures mandating various public health interventions, international studies demonstrated a decline in ED attendances, potentiating a delay in seeking health services.The objective was to examine ED attendance trends by age group and to categorize the attendances following the implementation of regulations related to COVID-19.Method:A single-center retrospective observational study of ED attendances from 2014 to 2022 at Wexford General Hospital, a 225-bed acute general hospital. Monthly attendance trends were analyzed covering all phases of the national response. Information was extracted from the electronic health record system iPMS.Results:Overall attendances decreased by 11.5% {42,637 (2019) to 37,751 (2020)}, well below expected annual growth projections from 2019 to 2020. A significant reduction in pediatric attendance (≤16 years) occurred, with 31.68% negative growth (10,351 to 7,071) in 2020 and sustained decrease of 15.3% (8,767 attendances) in 2021. In contrast, geriatric (≥65 years) attendances were unchanged in 2020 (17,751), with a surge of 8.9% to 19,333 attendances in 2021, the largest year-on-year growth since 2018. Comparisons of month-to-month trends in relation to public health measures correlated to a marked decline in attendances at the extremes of age during “lockdown” periods.Conclusion:The reduction in attendances is likely multifactorial, such as a reduction in school-related stress and patients deciding to stay home for fear of attending during the pandemic with non-emergent conditions. The increase in geriatric presentations in 2021 may reflect continuing restricted access to primary care and GP services, or neglect of prior conditions. Examining changing demographic attendances may offer opportunities to develop alternative ways of supporting frail populations and families in community care avoiding ED presentations.

Ethnicity and trends in pediatric specialty care clinic attendance at an academic medical center in the rural southeastern US.

Following the 2016 US Presidential election, immigration enforcement became more aggressive, with variation by state and region depending on local policies and sentiment. Increases in enforcement created an environment of risk for decreased use of health care services among especially among Latino families. of Hispanic ethnicity and/or from Latin American origin (as a group subsequently referred to as Latino). For Latino children with chronic health conditions, avoidance of routine health care can result in significant negative health consequences such as disease progression, avoidable use of acute health care services, and overall increased costs of care. To investigate for changes in visit attendance during the periods before and since increased immigration enforcement, we extracted data on children followed by subspecialty clinics of one healthcare system in the US state of North Carolina during 2015-2019. For each patient, we calculated the proportion of cancelled visits and no-show visits out of all scheduled visits during the 2016-2019 follow-up period. We compared patient characteristics (at the 2015 baseline) according to whether they cancelled or did not show to any visits in subsequent years by clinic and patient factors, including ethnicity. Data were analyzed using multinomial logistic regression of attendance at each visit, including an interaction between visit year and patient ethnicity. Among 852 children 1 to 17 years of age (111 of Latino ethnicity), visit no-show was more common among Latino patients, compared to non-Latino White patients; while visit cancellation was more common among non-Latino White patients, compared to Latino patients. There was no significant interaction between ethnicity and trends in visit no-show or cancellation. Although differences in pediatric specialty clinic visit attendance by patient ethnicity were seen at study baseline, changing immigration policy and negative rhetoric did not appear to impact use of pediatric subspecialty care.

MP54-16 PRACTICE PATTERNS AFFECTING DELAYS IN CARE OF TESTICULAR TORSION

You have accessJournal of UrologyCME1 Apr 2023MP54-16 PRACTICE PATTERNS AFFECTING DELAYS IN CARE OF TESTICULAR TORSION Kelley Zhao, Brian Shkolnik, Jennifer Lu, Rachel Davis, and Pankti Kothari Kelley ZhaoKelley Zhao More articles by this author , Brian ShkolnikBrian Shkolnik More articles by this author , Jennifer LuJennifer Lu More articles by this author , Rachel DavisRachel Davis More articles by this author , and Pankti KothariPankti Kothari More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Testicular salvage after testicular torsion is largely dependent on time to definitive management. Therefore, delay in presentation, diagnosis, or management can increase the risk of testicular loss. While several studies have examined the time burden of multiple components of the management course for testicular torsion, our study aims to evaluate other factors, including management by the day or on-call team, management by a pediatric or adult attending, and impact of patient age. METHODS: A retrospective case-controlled study of patients with a history of testicular torsion between 2012 and 2022 at a single institution was conducted. Variables impacting testicular torsion management time was assessed using univariate analyses. RESULTS: 134 patients were included, of whom 49 underwent an orchiectomy and 84 underwent an orchiopexy. There was no significant difference between efficiency of the on-call team versus day team regarding time from registration to ultrasound (113 vs 97 min, p=0.37), ultrasound to urology consult (66 vs 86 min, p=0.46), ED registration to OR (219 vs 196 min, p=0.39), ultrasound to OR (155 vs 126 min, p=0.30), and testicular salvage rate (35.7% vs 38.8%, p=0.80). A difference was seen, however, when patients were stratified by age (>18 vs≤18 years old). Patients greater than 18 years of age had significantly longer symptom duration (91.9 vs 20.0 min, p=0.005), longer time to receive an ultrasound from ER registration (152 vs 87 min, p<0.001), longer time to OR from ER registration (268 vs 185 min, p<0.001) and longer time to OR from ultrasound read (187 vs 123 min, p=0.03). In comparing pediatric attendings to adult attendings, there was no difference in time to surgery, intraoperative length of surgery, or testicular salvage rates. Intra-operatively, adult attending urologists had shorter length of surgery approaching significance (58 minutes vs 65 min, p=0.07) and older patients had lower rates of testicular salvage approaching significance (orchiectomy rate 48.8% vs 31.5%, p=0.057). CONCLUSIONS: While no significant delays in testicular torsion management was detected between management by on-call versus day team nor pediatric versus adult attending, age of patient was associated with greater delays in receiving definitive surgical management of testicular torsion. Greater suspicion for testicular torsion diagnosis in older patients with acute scrotum may improve the rate of testicular salvage. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e760 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kelley Zhao More articles by this author Brian Shkolnik More articles by this author Jennifer Lu More articles by this author Rachel Davis More articles by this author Pankti Kothari More articles by this author Expand All Advertisement PDF downloadLoading ...

Coaching the coach: A randomized controlled study of a novel curriculum for procedural coaching during intubation.

Videolaryngoscopy allows real-time procedural coaching during intubation. This study sought to develop and assess an online curriculum to train pediatric emergency medicine attending physicians to deliver procedural coaching during intubation. Curriculum development consisted of semistructured interviews with 12 pediatric emergency medicine attendings with varying levels of airway expertise analyzed using a constructivist grounded theory approach. Following development, the curriculum was implemented and assessed through a multicenter randomized controlled trial enrolling participants in one of three cohorts: the coaching module, unnarrated video recordings of intubations, and a module on ventilator management. Participants completed identical pre and post assessments asking them to select the correct coaching feedback and provided reactions for qualitative thematic analysis. Content from interviews was synthesized into a video-enhanced 15-min online coaching module illustrating proper technique for intubation and strategies for procedural coaching. Eighty-seven of 104 randomized physicians enrolled in the curriculum; 83 completed the pre and post assessments (80%). The total percentage correct did not differ between pre and post assessments for any cohort. Participants receiving the coaching module demonstrated improved performance on patient preparation, made more suggestions for improvement, and experienced a greater increase in confidence in procedural coaching. Qualitative analysis identified multiple benefits of the module, revealed that exposure to video recordings without narration is insufficient, and identified feedback on suggestions for improvement as an opportunity for deliberate practice. This study leveraged clinical and educational digital technology to develop a curriculum dedicated to the content expertise and coaching skills needed to provide feedback during intubations performed with videolaryngoscopy. This brief curriculum changed behavior in simulated coaching scenarios but would benefit from additional support for deliberate practice.

Current state of female pediatric urologists at Societies for Pediatric Urology fellowship accredited programs

PurposeGender inequities in medicine exist. Urology is a male dominated surgical specialty, with recent census data showing females represent only 10.9% of the workforce. We aimed to characterize the composition of female pediatric urologists across the Societies for Pediatric Urology (SPU) pediatric urology fellowship accredited programs, with particular attention to academic promotion and leadership positions.MethodsIn January 2023, we reviewed the official websites of the 27 pediatric urology programs listed on the SPU website as fellowship accredited programs. We identified pediatric urology surgery attendings, their gender, academic title, and if they were named a director of an internal program or had a hospital leadership position. We identified the program chief and fellow/resident program director. This data was associated with years in practice.ResultsFemales represented 27.4% of pediatric urology surgical attendings. Four programs (14.8%) had no female attendings. Female staff were in practice a median shorter time than that of males (6 vs. 16 years, p&amp;lt;0.0001). A significantly higher proportion of females were assistant professors (62.2 vs. 35.2%; p=0.0041) while a significantly higher proportion of men were professors (37.0 vs. 18.9%; p=0.0421). Only one program (3.7%) had a female department/division chief. There was no difference between genders regarding being named a director of a program and/or having an identified hospital position of leadership. Female professors had been in practice a significantly shorter time than male professors (p=0.0003); women with an internal or hospital leadership position had also been in practice a significantly shorter time than males (p&amp;lt;0.001).ConclusionsFemales are represented more in SPU pediatric urology fellowship accredited programs than the overall urology workforce. Fewer female attendings are professors compared to male attendings; however, differences in promotion could be impacted by female attendings being earlier in their career. Hopefully with time, we will see more equal representation amongst genders in pediatric urology programs overall, but especially where we are training the next generation.

Scheduled and attended pediatric primary care telemedicine appointments during COVID-19.

The aim of this study was to examine pediatric primary care telemedicine visit scheduling and attendance during the first year of telemedicine. Using electronic health record data from two academic pediatric primary care practices between April 2020-March 2021, we used Pearson χ2 tests and logistic regression models to identify child-, family-, and appointment-level characteristics associated with scheduled and attended telemedicine appointments. Among 5178 primary care telemedicine appointments scheduled during the 12-month period, the proportion of appointments scheduled differed over time for children in families with a language preference other than English or Spanish (4% quarter 1 vs. 6% in quarter 4, p = 0.01) and residing in ZIP codes with the lowest household technology access (24% in quarter 1 vs. 19% in quarter 3 (p = 0.01). Four thousand one hundred and forty-eight of 5178 scheduled telemedicine appointments were attended. Likelihood of attending a telemedicine appointment was highest for children in families with a language preference other than English or Spanish (90%, 95% CI 86-94% compared to Spanish 74%, 95% CI 65-84%), and same-day appointments (86%, 95% CI 85-87%). Attendance among families preferring Spanish language was higher in later months compared to earlier months. We found disparities in scheduling and attending telemedicine appointments, but signs of greater language equity over time.

Pediatric resident education in pediatric cardiology – A needs assessment

BackgroundDetermining the topics general pediatric residents are taught during an inpatient pediatric cardiology rotation must be selected based on numerous factors, including resident career goals, core topics for board exams, and educator preferences. ObjectivesThis study aims to determine the preferred core cardiology concepts of both learners and educators as well the preferred teaching modalities of general pediatric residents while on an inpatient pediatric cardiology rotation. MethodsAll eligible residents in the Children's National Hospital pediatric residency program who had completed a cardiology rotation as well as pediatric cardiology fellows and attendings were asked to complete a survey. Participation in the study was voluntary. Respondents were asked to answer questions related to the perceived effectiveness and applicability of the cardiology curriculum, specifically inquiring about methods of teaching, the level taught, and the utility of topics selected. ResultsForty-seven (44 %) of the 106 eligible participants completed the survey. Seventeen unique topics in pediatric cardiology were ranked. The highest rated topics included congenital heart disease, murmurs, cardiac physiology, ECG interpretation, and syncope/dizziness. Participants reported the highest satisfaction with whiteboard and bedside teaching. ConclusionsThis study demonstrates a strong correlation between what learners and educators perceive should be the topics taught to residents to prepare them for their intended future career goals. These data provide a framework, both in teaching modalities and core concepts, for continued development and reassessment of inpatient pediatric cardiology rotations to optimally prepare pediatric residents with a strong foundation in pediatric cardiology.