Pediatric Emergency Medical Care Research Articles

Collecting Sociodemographic Data in Pediatric Emergency Research: A Working Group Consensus.

Understanding and addressing health care disparities relies on collecting and reporting accurate data in clinical care and research. Data regarding a child's race, ethnicity, and language; sexual orientation and gender identity; and socioeconomic and geographic characteristics are important to ensure equity in research practices and reported outcomes. Disparities are known to exist across these sociodemographic categories. More consistent, accurate data collection could improve understanding of study results and inform approaches to resolve disparities in child health. However, published guidance on standardized collection of these data in children is limited, and given the evolving nature of sociocultural identities, requires frequent updates. The Pediatric Emergency Care Applied Research Network, a multi-institutional network dedicated to pediatric emergency research, developed a Health Disparities Working Group in 2021 to support and advance equitable pediatric emergency research. The working group, which includes clinicians involved in pediatric emergency medical care and researchers with expertise in pediatric disparities and the conduct of pediatric research, prioritized creating a guide for approaches to collecting race, ethnicity, and language; sexual orientation and gender identity; and socioeconomic and geographic data during the conduct of research in pediatric emergency care settings. Our aims with this guide are to summarize existing barriers to sociodemographic data collection in pediatric emergency research, highlight approaches to support the consistent and reproducible collection of these data, and provide rationale for suggested approaches. These approaches may help investigators collect data through a process that is inclusive, consistent across studies, and better informs efforts to reduce disparities in child health.

Pediatric Emergency Medical Care in Yerevan, Armenia: A Knowledge and Attitudes Survey of Out-of-hospital Emergency Nurses

BackgroundEmergency Medical Services (EMS) system in Armenia follows the Franco-German model in which physician - nurse dyads staff ambulances. This study aims to evaluate the knowledge and attitudes of EMS nurses regarding pediatric rapid assessment and resuscitation. MethodsThis is a cross-sectional, anonymous, self-administered survey study of a convenience sample of 200 out-of-hospital emergency nurses in June and July 2015. ResultsResponse rate was 87.5%. Half of respondents failed to achieve the pre-defined passing score of 70% on the 10-question knowledge test (sample mean 6.32 ± 1.85 SD). Test score was positively correlated with pediatric training, current pediatric continuing medical education (CME), years with EMS and female gender. Questions regarding recognition of shock and initiation of neonatal and pediatric cardiopulmonary resuscitation were most frequently missed. Nurses were least confident in their ability to care for neonates and infants. 79.4% indicated that they would benefit from further pediatric training, and 86.1% indicated that knowledge from the Anglo-American model of emergency medicine could improve pediatric emergency care (PEC) in Armenia. ConclusionsThere is a need for additional PEC training and continuing education for EMS nurses in Yerevan, Armenia. Training EMS nurses would improve first responder awareness of pediatric acute management and resuscitation and enhance the quality of emergency care of children.

The application effect of prospective care quality management model in pediatric emergency medical care management and its effect on SF-36 score of children

Objective To explore the effect of prospective care quality management model in pediatric emergency medical care management and its effect on SF-36 score of children. Methods A total of 100 cases of all kinds of emergency children admitted to this hospital were selected.They were randomly divided into the control group and the study group, 50 cases of each group.The control group received routine emergency care.The study group received prospective care.The nursing effect of the two groups was compared. Results The satisfaction of the children in the study group was significantly higher than that in the control group, and the difference was statistically significant(P<0.03). In addition, the satisfaction of nurses, doctors and related departments in the study group was higher than that of the reference group, and the difference was statistically significant(P<0.03). The total nursing efficiency of the study group was higher than that of the reference group, while the incidence of disputes and complaints in the study group was significantly lower than that of the reference group, and the differences were statistically significant(P<0.05). The time of first aid in the study group was significantly shorter than that in the control group, and the difference was statistically significant(P<0.02). The scores of physiological function, energy, mental health, general health and emotional function of the study group were better than those of the reference group, while the scores of somatic pain were lower than those of the reference group, and the differences were statistically significant(P<0.02). Conclusions The application effect of prospective care quality management mode in the nursing management of pediatric emergency department is ideal, which can effectively shorten the time of first aid, improve nursing efficiency and satisfaction, reduce disputes and complaints, and promote the rehabilitation of children. Key words: Prospective; Pediatric emergency medicine; Nursing management; SF-36 score

A Scale of Parental Anxiety about Pediatric Emergency Medical Care Services of Japan: Development, Reliability, Validity, Generalizability and Usefulness

Aim: The purpose of this study was to develop a scale, “parental anxiety about pediatric emergency medical care services” (PAPEMCS), and to evaluate its psychometric properties. Methods: Participants were 14,510 parents with children 6 years old or younger in Kagawa Prefecture. Using each half of the participants, exploratory factor analysis was performed to generate items and factors for the PAPEMCS, and confirmatory factor analysis (CFA) was used to establish the construct validity. The generalizability of the PAPEMCS was evaluated by congruence tests and multigroup CFA. The usefulness of the PAPEMCS was established by the relationship between the PAPEMCS and non-urgent usage of pediatric emergency medical care services (PEMCS). Results: The PAPEMCS compromised 4 factors: “anxiety about quality of PEMCS”, “anxiety about PEMCS system”, “anxiety about public support”, and “anxiety about private support”. All reliability estimates (polychoric ordinal alpha coefficients, item-rest correlations), the item discrimination, 5 fit indices for CFA, the convergent validity (indicator reliabilities, composite reliabilities, average variance extracteds), and the discriminant validity fulfilled the acceptability thresholds. All generalizability estimates fulfilled the predetermined levels of acceptability (Tucker’s congruence coefficients, congruence tests, strict factorial invariance). The usefulness of the PAPEMCS was established by the higher scores of the PAPEMCS being related to non-urgent usage of PEMCS. Conclusions: The PAPEMCS demonstrated satisfactory reliability, validity, generalizability and usefulness. The PAPEMCS is useful to quantify the contents and extent of parental anxiety about PEMCS, and to clarify the mechanisms of non-urgent PEMCS usage.

The Benefits and Issues Regarding Sick Child Care Services in Double Income Nuclear Families with Children

Purpose: As the benefits of sick child care services are usually evaluated based on parents’ work-related views, very few studies have reported those on health recovery or parenting of sick children. This study investigated the usage and evaluation of sick child care services in double-income nuclear families, in order to clarify their benefits and issues. Methods: This study used a qualitative and descriptive approach. Semi-structured interviews were conducted involving 27 mothers of double-income nuclear families after obtaining their written consent.The survey consisted of: the age and number of children, child-raising status, strategies to cope with children’s illness, and usage and needs of sick child care services and pediatric emergency medical care services. Results: The mothers of double-income nuclear families worked with hope of self-realization. They used sick child care services to balance their child-raising and career in a situation where there is no one to rely on. By experiencing positive reactions and early recovery of their children, the mothers developed a sense of security and trust towards high quality medical, nursing, and child nursery care of the service and childcare education provided to mothers. On the other hand, they desired improvement with regard to expensive care fees, short-hours of service, and the capacity to accept children, as well as the operation of transportation service from nursery school to the sick child care facility Conclusions: The results of this study demonstrated that sick child care services were beneficial in promoting healthy recovery of children and for improving childcare skills of mothers of doubleincome nuclear families. The results also suggest the need to develop measures based on the needs of sick child care users.

Pediatric emergency medical care in Yerevan, Armenia: a knowledge and attitudes survey of out-of-hospital emergency physicians.

BackgroundOut-of-hospital emergency care is at an early stage of development in Armenia, with the current emergency medical services (EMS) system having emergency physicians (EPs) work on ambulances along with nurses. While efforts are underway by the Ministry of Health and other organizations to reform the EMS system, little data exists on the status of pediatric emergency care (PEC) in the country. We designed this study to evaluate the knowledge and attitudes of out-of-hospital emergency physicians in pediatric rapid assessment and resuscitation, and identify areas for PEC improvement.MethodsWe distributed an anonymous, self-administered Knowledge and Attitudes survey to a convenience sample of out-of-hospital EPs in the capital, Yerevan, from August to September 2012.ResultsWith a response rate of 80%, the majority (89.7%) of respondents failed a 10-question knowledge test (with a pre-defined passing score of ≥7) with a mean score of 4.17 ± 1.99 SD. Answers regarding the relationship between pediatric cardiac arrest and respiratory issues, compression-to-ventilation ratio in neonates, definition of hypotension, and recognition of shock were most frequently incorrect. None of the participants had attended pediatric-specific continuing medical education (CME) activities within the preceding 5 years. χ2 analysis demonstrated no statistically significant association between physician age, length of EMS experience, type of ambulance (general vs. resuscitation/critical care), or CME attendance and pass/fail status. The majority of participants agreed that PEC education in Armenia needs improvement (98%), that there is a need for pediatric-specific CME (98%), and that national out-of-hospital PEC guidelines would increase PEC safety, efficiency, and effectiveness (96%).ConclusionsOut-of-hospital emergency physicians in Yerevan, Armenia are deficient in pediatric-specific emergency assessment and resuscitation knowledge and training, but express a clear desire for improvement. There is a need to support additional PEC training and CME within the EMS system in Armenia.

Validation of the New Diagnosis Grouping System for Pediatric Emergency Department Visits Using the International Classification of Diseases, 10th Revision

A clinically sensible diagnosis grouping system (DGS) is needed for describing pediatric emergency diagnoses for research, medical resource preparedness, and making national policy for pediatric emergency medical care. The Pediatric Emergency Care Applied Research Network (PECARN) developed the DGS successfully. We developed the modified PECARN DGS based on the different pediatric population of South Korea and validated the system to obtain the accurate and comparable epidemiologic data of pediatric emergent conditions of the selected population. The data source used to develop and validate the modified PECARN DGS was the National Emergency Department Information System of South Korea, which was coded by the International Classification of Diseases, 10th Revision (ICD-10) code system. To develop the modified DGS based on ICD-10 code, we matched the selected ICD-10 codes with those of the PECARN DGS by the General Equivalence Mappings (GEMs). After converting ICD-10 codes to ICD-9 codes by GEMs, we matched ICD-9 codes into PECARN DGS categories using the matrix developed by PECARN group. Lastly, we conducted the expert panel survey using Delphi method for the remaining diagnosis codes that were not matched. A total of 1879 ICD-10 codes were used in development of the modified DGS. After 1078 (57.4%) of 1879 ICD-10 codes were assigned to the modified DGS by GEM and PECARN conversion tools, investigators assigned each of the remaining 801 codes (42.6%) to DGS subgroups by 2 rounds of electronic Delphi surveys. And we assigned the remaining 29 codes (4%) into the modified DGS at the second expert consensus meeting. The modified DGS accounts for 98.7% and 95.2% of diagnoses of the 2008 and 2009 National Emergency Department Information System data set. This modified DGS also exhibited strong construct validity using the concepts of age, sex, site of care, and seasons. This also reflected the 2009 outbreak of H1N1 influenza in Korea. We developed and validated clinically feasible and sensible DGS system for describing pediatric emergent conditions in Korea. The modified PECARN DGS showed good comprehensiveness and demonstrated reliable construct validity. This modified DGS based on PECARN DGS framework may be effectively implemented for research, reporting, and resource planning in pediatric emergency system of South Korea.

Now and future of the pediatric emergency medical care systems

Now and future of the pediatric emergency medical care systems

Twenty Years of Emergency Medical Services for Children

The 20th anniversary of the federal Emergency Medical Services for Children (EMSC) program should be cause for great celebration within the emergency medical services (EMS) community and for all child health care advocates. Over the past 20 years, the EMSC program has helped lead the way toward systematic improvements in the delivery of emergency care to children in every state in the United States. Contributions by the EMSC program have resulted in remarkable advances in pediatric emergency care and substantial improvements in the quality of life of countless ill and/or injured children. The EMSC program is undoubtedly responsible for saving many young lives. A review of the EMSC program’s accomplishments over these past 2 decades should stimulate a great sense of satisfaction, even pride, within our profession. Many practitioners who care for acutely ill or injured children have likely benefited from products developed by the EMSC program (eg, educational tools and training programs; pediatric medication and equipment standards; and pediatric emergency care protocols, practice guidelines, and facility preparedness standards).1–3 Some of you may also be actively engaged in EMSC-sponsored activities within your institution, state, or professional organization. The sense of satisfaction and pride we have in the EMSC program’s accomplishments are only exceeded by the anticipation of the advances in pediatric emergency medical care that lie directly ahead. It is unfortunate that as we celebrate EMSC’s 20th anniversary, current events threaten the program’s future and should be a cause of great concern to all of us. The President’s budget for fiscal year 2006, released on February 7, 2005, requested no funding for EMSC, effectively proposing to eliminate the program. In addition, the program’s authorization is scheduled to expire at the end of this fiscal year. The future of EMSC, and the great promise it holds for additional …

Twenty Years of Emergency Medical Services for Children—A Cause for Celebration and a Call for Action

The 20th anniversary of the federal Emergency Medical Services for Children (EMSC) program should be cause for great celebration within the emergency medical services (EMS) community and for all child health care advocates. Over the past 20 years, the EMSC program has helped lead the way toward systematic improvements in the delivery of emergency care to children in every state in the United States. Contributions by the EMSC program have resulted in remarkable advances in pediatric emergency care and substantial improvements in the quality of life of countless ill and/or injured children. The EMSC program is undoubtedly responsible for saving many young lives. A review of the EMSC program’s accomplishments over these past 2 decades should stimulate a great sense of satisfaction, even pride, within our profession. Many practitioners who care for acutely ill or injured children have likely benefited from products developed by the EMSC program (eg, educational tools and training programs; pediatric medication and equipment standards; and pediatric emergency care protocols, practice guidelines, and facility preparedness standards).1–3 Some of you may also be actively engaged in EMSC-sponsored activities within your institution, state, or professional organization. The sense of satisfaction and pride we have in the EMSC program’s accomplishments are only exceeded by the anticipation of the advances in pediatric emergency medical care that lie directly ahead. It is unfortunate that as we celebrate EMSC’s 20th anniversary, current events threaten the program’s future and should be a cause of great concern to all of us. The President’s budget for fiscal year 2006, released on February 7, 2005, requested no funding for EMSC, effectively proposing to eliminate the program. In addition, the program’s authorization is scheduled to expire at the end of this fiscal year. The future of EMSC, and the great promise it holds for additional …

Twenty Years of Emergency Medical Services for Children: A Cause for Celebration and a Call for Action

The 20th anniversary of the federal Emergency Medical Services for Children (EMSC) program should be cause for great celebration within the emergency medical services (EMS) community and for all child health care advocates. Over the past 20 years, the EMSC program has helped lead the way toward systematic improvements in the delivery of emergency care to children in every state in the United States. Contributions by the EMSC program have resulted in remarkable advances in pediatric emergency care and substantial improvements in the quality of life of countless ill and/or injured children. The EMSC program is undoubtedly responsible for saving many young lives. A review of the EMSC program’s accomplishments over these past 2 decades should stimulate a great sense of satisfaction, even pride, within our profession. Many practitioners who care for acutely ill or injured children have likely benefited from products developed by the EMSC program (eg, educational tools and training programs; pediatric medication and equipment standards; and pediatric emergency care protocols, practice guidelines, and facility preparedness standards).1–3 Some of you may also be actively engaged in EMSC-sponsored activities within your institution, state, or professional organization. The sense of satisfaction and pride we have in the EMSC program’s accomplishments are only exceeded by the anticipation of the advances in pediatric emergency medical care that lie directly ahead. It is unfortunate that as we celebrate EMSC’s 20th anniversary, current events threaten the program’s future and should be a cause of great concern to all of us. The President’s budget for fiscal year 2006, released on February 7, 2005, requested no funding for EMSC, effectively proposing to eliminate the program. In addition, the program’s authorization is scheduled to expire at the end of this fiscal year. The future of EMSC, and the great promise it holds for additional …

Access to Pediatric Emergency Medical Care

Hundreds of thousands of pediatric patients require some level of emergency care annually, and significant barriers limit access to appropriate services for large numbers of children. The American Academy of Pediatrics has a strong commitment to identify barriers to access to emergency care, work to surmount these obstacles, and encourage through education increased levels of emergency care available to all children. It is also crucial to involve and incorporate the child's medical home into emergency care, both during acute presentation when the medical home is identified and by assisting in locating a medical home for follow-up when none previously exists.