Emergency Medicine Research Research Articles

LO60: Health research methodology education in Canadian emergency medicine residency programs: a national survey of curriculum assessment

Introduction: With a shift towards competency-based medical education, it is crucial to not only emphasize learner abilities such as clinical skills but also leadership in the conduct of research. Though the Royal College of Physicians and Surgeons of Canada's (RCPSC) training objectives for Emergency Medicine (EM) residents state that the specialist physician be able to describe the principles of research, the research methodology curriculum across EM training programs in Canada is likely variable. The primary goal of this study was to describe the variability of research methodology teaching among RCPSC-EM residency programs. Methods: An electronic survey was distributed to English-speaking RCPSC-EM program directors (PDs) and EM residents. The survey investigated residents' and PDs’ thoughts on the adequacy of their local curriculum and asked them to quantify their research methodology teaching. The primary outcome was the frequency and content of current research methodology and research ethics teaching as well as a description of scholarly project requirements of EM residency programs across Canada. The data was presented with simple descriptive statistics. Results: 79 EM residents and 7 PDs responded (response rate 22.3% and 58.3%, respectively). All 7 PDs indicate having a research methodology curriculum while 71.6% of residents are aware of this curriculum. Only 57.1% of PDs report having formal assessments. Most programs (71.4%) teach via small groups while 28.6% of programs use large group sessions. Residents identify teaching as led by research staff (68.9%), staff physicians (60%), and EM researchers (57.8%), while only 17.8% use outside educators. Students noted various modalities of curriculum feedback such as online surveys, weekly forms, and verbal feedback. Regarding the strength of the curricula, 85.7% of PDs believed their curriculum prepares residents for board exams, while only 62.2% of residents felt similarly. When asked about using a standard web-based curriculum module if available, 60.5% of residents responded in favour. Conclusion: This study demonstrates that EM residency programs across Canada vary with respect to research methodology curriculum and discrepancies exist between residents’ and program directors’ perceptions of the curriculum. Given the lack of a standardized research methodology curriculum for these residency programs, there is an opportunity for curriculum development to improve training in research methodology.

Scientific Publication Productivity of Emergency Physicians: A Bibliometric Analysis of the Last Decade.

A significant increase has been observed in scientific research in emergency medicine in the past 10years. However, the contribution of emergency physicians (EPs) to the emergency medicine literature is not known. The aim of this study was to analyze the contribution of EPs to the emergency medicine literature and their scientific publication productivity during a recent 10-year period. Manuscripts published by EPs in emergency medicine journals in the Science Citation Index Expanded database during a recent 10-year period (2008-2017) were included in the study. The number of articles published by EPs, the distribution of the manuscripts by country and year, the impact factors, the citations per article, and the Hirsch (H) index were determined. A total of 15,281 original articles were published in a total of 24 journals by all EPs worldwide between 2008 and 2017. EPs from the United States published the highest number of articles (54.4% of all articles), followed by Canada (7.2%), Australia (6.2%), Turkey (4.3%), and the UK (4.1%). The countries with the highest H index were the United States (80), Canada (43), and the UK (40), respectively. South Korea had the highest increase in scientific production during the 10-year period (average annual growth rate of 17.89%). The number of articles increased from 2008 to 2017 in the whole world and in the United States. EPs from the United States were the most productive, both qualitatively and quantitatively.

Lidocaine and phenylephrine versus saline placebo nasal spray for the pain and distress of nasogastric tube insertion in young children and infants: a randomised, double-blind, controlled trial

Nasogastric tube insertion is a common but distressing procedure in young children. We aimed to compare the efficacy of topical local anaesthetic and vasoconstrictor nasal spray with placebo for distress related to nasogastric tube insertion. We did a prospective, randomised, controlled, double-blind, superiority trial in a single tertiary paediatric emergency department in Australia. Eligible participants were children aged 6 months to 5 years who were planned to have a nasogastric tube inserted as part of their emergency department treatment. Patients were assigned using computer-generated block randomisation to receive lidocaine and phenylephrine nasal spray (10 mg lidocaine and 1 mg phenylephrine for children weighing 6-12 kg; 20 mg lidocaine and 2 mg phenylephrine for children weighing >12 kg), or 0·9% sodium chloride placebo nasal spray, before nasogastric insertion. Guardians, observers, and proceduralists were all masked to the intervention. The primary outcome was procedure-related distress, measured using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale during the final attempt at nasogastric tube insertion. All patients were included in the primary analysis (intention-to-treat). FLACC scores were compared using the Wilcoxon rank-sum test, and categorical outcomes were compared using χ2 or Fisher's exact tests as appropriate. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000092695. Between July 30, 2014, and Aug 17, 2017, 107 children in a convenience sample were randomly assigned to receive lidocaine and phenylephrine nasal spray (n=54) or placebo (n=53). Seven children did not receive study medication (six no longer required nasogastric tube insertion and one withdrew consent). 50 children received each intervention; all were included in the analysis. There was no difference in median FLACC score at time of nasogastric tube insertion (9 [IQR 7-10] for lidocaine and phenylephrine vs 9 [IQR 8-10] for placebo; median difference between groups -1, 95% CI -2·7 to 0·7, p=0·21). Adverse effects of the spray or nasogastric tube insertion (most commonly vomiting and gagging) occurred in 14 (28%) of those who received lidocaine and phenylephrine and 21 (42%) of those who received placebo. Lidocaine and phenylephrine nasal spray does not reduce procedure-related distress associated with nasogastric tube insertion in young children compared with placebo. Further research addressing distress associated with nasogastric tube insertion in young children is needed. Monash Health Senior Medical Staff Association, Australasian College for Emergency Medicine, Emergency Medicine Research Foundation.

Feasibility of pharmacists to contribute to multicenter emergency medicine research

ObjectivesA flexible, rapid, and scalable multicenter network is needed for pharmacotherapy research in emergency medicine (EM). The objective of this study was to evaluate the types of studies EM pharmacists are willing to conduct in multicenter research.MethodsThis was a cross‐sectional national survey conducted in the United States. The survey was developed using an iterative process to establish face and content validity. Members of the American College of Clinical Pharmacy EM Practice and Research Network were invited to complete the survey using Research Electronic Data Capture. Online consent was obtained prior to survey completion. The survey consisted of 14 questions, which was expected to take less than 5 minutes to complete. Data were descriptively evaluated.ResultsThere were a total of 637 potentially eligible participants for the survey. Of these, 98 completed the survey (15% response rate). In terms of types of studies, 91 (93%) would participate in studies involving retrospective acquisition of data, 83 (85%) in observational studies not requiring patient consent, 48 (49%) in observational studies involving a patient consent procedure, and 26 (27%) in implementing and conducting a clinical trial. Overall, 85 (87%) would participate without funding and 66 (67%) would participate without receiving authorship.ConclusionsA substantial number of EM pharmacists are willing to participate in multicenter research. The number of participants decreases without provision of authorship or for studies involving patient consent.

Contribution of Experimental Animal Research Studies to the Emergency Medicine Literature.

The aim of this study is to provide a detailed analysis of emergency medicine (EM) research literature to unveil the trends while underlining the importance of experimental research for all territories of science. To this end, the experimental animal research articles published in EM journals indexed to the Science Citation Index Expanded database with a date of publication between January 1, 2008, and December 31, 2017, were reviewed retrospectively. All data regarding the journal name, publication year, country, department and institution of the first author, subject species, type of the experimental model, target organ/system/functions, evaluation method, outcome measures, and citation counts were noted. Resultantly, a total of 736 articles were found to be published in 18 journals. Resuscitation (n=285, 38.7%) had the highest number of articles followed by Injury (n=143, 19.4%), Turkish Journal of Trauma and Emergency Surgery (n=128, 17.4%), and American Journal of Emergency Medicine (n=63, 8.6%). The USA was the largest contributor with 199 studies (27%). The department of the first author was EM in 190 (28.8%) of the reports. Various versions of cardiac arrest models were applied in 257 (34.9%) studies while brain (n=101, 13.7%) was the most commonly explored area. The main outcome measures were clinical outcomes/survival rates (n=408, 55.43%). The molecular mechanisms of the injury were evaluated in 37 (5%) of the studies. In conclusion, experimental animal studies are essential in the progress of contemporary scientific knowledge. EM journals should encourage and consider giving more place to experimental research given their undisputed worth and potential future contributions to science, including the field of EM.

A multispecialty approach to immuno-oncology education for community providers.

80 Background: The Association of Community Cancer Centers (ACCC) Immuno-Oncology Institute was developed in 2015 to prepare all members of the multidisciplinary cancer care team for the complex implementation of immuno-oncology in the community setting. Today, with more than 50 cancer immunotherapy indications and over 2,500 clinical trials with cancer immunotherapies, the challenges and issues related to recognizing and managing immune-related adverse events (irAEs) have grown even more complex for community practitioners. Methods: The ACCC Immuno-Oncology Institute assembled 4 working groups focused on addressing the diverse issues around the delivery and management of patients on cancer immunotherapies. The working groups were divided by 4 topics: staff training and education; multispecialty care coordination and communication; telemedicine; and big data. A detailed systemic review of the literature was conducted for each topic in the context of immuno-oncology, to determine the current landscape of information and available resources. The findings were then shared with the working group members and collaborative discussions ensued over 12 virtual committee meetings. The 19 working group members are diverse by discipline, including specialties such as emergency medicine, dermatology, primary care, survivorship, pathology, and academic researchers. Results: The ACCC Working Group Summit convened in September 2018 to develop innovative educational opportunities for community practitioners related to managing irAEs across the 4 topic areas. Eight unique action plans were developed by working group members. Conclusions: For each of the 4 key areas, working group members identified a list of opportunities that would improve how clinicians are managing irAEs for patients being treated with immunotherapy. It is critical for future educational interventions to encompass the multispecialty team perspective related to the management of irAEs.

Machine Learning in Relation to Emergency Medicine Clinical and Operational Scenarios: An Overview.

Health informatics is a vital technology that holds great promise in the healthcare setting. We describe two prominent health informatics tools relevant to emergency care, as well as the historical background and the current state of informatics. We also identify recent research findings and practice changes. The recent advances in machine learning and natural language processing (NLP) are a prominent development in health informatics overall and relevant in emergency medicine (EM). A basic comprehension of machine-learning algorithms is the key to understand the recent usage of artificial intelligence in healthcare. We are using NLP more in clinical use for documentation. NLP has started to be used in research to identify clinically important diseases and conditions. Health informatics has the potential to benefit both healthcare providers and patients. We cover two powerful tools from health informatics for EM clinicians and researchers by describing the previous successes and challenges and conclude with their implications to emergency care.

Emergency Medicine Research Priorities for Early Intervention for Substance Use Disorders.

IntroductionPatients with substance use disorders (SUDs) frequently seek emergency care, and the emergency department (ED) may be their only point of contact with the healthcare system. While the ED visit has been increasingly recognized as providing opportunity for interventions around substance use, many questions remain.MethodsIn December 2016 the Coalition on Psychiatric Emergencies (CPE) convened the first Research Consensus Conference on Acute Mental Illness, which consisted of clinical researchers, clinicians from emergency medicine, emergency psychiatry, emergency psychology, representatives from governmental agencies and patient advocacy groups. Background literature review was conducted prior to the meeting, and questions were iteratively focused, revised, voted on and ranked by perceived importance using nominal group method.ResultsThe main goal of the SUD workgroup was to identify research priorities and develop a research agenda to improve the early identification of and management of emergency department (ED) patients with SUDs with the goal of improving outcomes. This article is the product of a breakout session on “Special Populations: Substance Use Disorder.” The workgroup identified with high consensus six research priorities for their importance related to the care of ED patients with SUDs in these overall domains: screening; ED interventions; the role of peer navigators; initiation of SUD management in the ED; specific patient populations that may impact the effectiveness of interventions including sociogenerational and cultural factors; and the management of the acutely intoxicated patient.ConclusionEmergency providers are increasingly recognizing the important role of the ED in reducing adverse outcomes associated with untreated SUDs. Additional research is required to close identified knowledge gaps and improve care of ED patients with SUD.

Quality of reporting of systematic reviews and meta-analyses in emergency medicine based on the PRISMA statement

BackgroundEmergency department utilization has increased tremendously over the past years, which is accompanied by an increased necessity for emergency medicine research to support clinical practice. Important sources of evidence are systematic reviews (SRs) and meta-analyses (MAs), but these can only be informative provided their quality is sufficiently high, which can only be assessed if reporting is adequate. The purpose of this study was to assess the quality of reporting of SRs and MAs in emergency medicine using the PRISMA statement.MethodsThe top five emergency medicine related journals were selected using the 5-year impact factor of the ISI Web of Knowledge of 2015. All SRs and MAs published in these journals between 2015 and 2016 were extracted and assessed independently by two reviewers on compliance with each item of the PRISMA statement.ResultsThe included reviews (n = 112) reported a mean of 18 ± 4 items of the PRISMA statement adequately. Reviews mentioning PRISMA adherence did not show better reporting than review without mention of adherence (mean 18.6 (SE 0.4) vs. mean 17.8 (SE 0.5); p = 0.214). Reviews published in journals recommending or requiring adherence to a reporting guideline showed better quality of reporting than journals without such instructions (mean 19.2 (SE 0.4) vs. mean 17.2 (SE 0.5); p = 0.001).ConclusionThere is room for improvement of the quality of reporting of SRs and MAs within the emergency medicine literature. Therefore, authors should use a reporting guideline such as the PRISMA statement. Active journal implementation, by requiring PRISMA endorsement, enhances quality of reporting.

Inclusion of Sex and Gender in Emergency Medicine Research-A 2018 Update.

The objectives were to 1) evaluate the inclusion of sex and gender in publications by emergency medicine (EM) researchers following the 2014 federal mandate and an Academic Emergency Medicine consensus conference on sex- and gender-based research and 2) assess trends compared with 2011 status report that showed 29% studies used sex and gender in the study design and 2% reported it as a primary outcome. Using MEDLINE, the term "emergency" was used to identify all English-language studies of adult humans published between 2014 and 2017 as EM affiliated (i.e., the first, second, or last author belonged to an EM section, division, center, or institution functioning as emergency department). Four trained abstractors reviewed the data using a standardized data abstraction form. The search revealed 6,442 articles using the selected "emergency" terms, and 2,628 original studies coded as EM-affiliated publications were reviewed, 2,340 met inclusion criteria, and 2,336 were analyzed. This compared to 750 articles reviewed in 2011 using similar search strategy. The adjusted inter-rater reliability for data abstraction was 97% (95% confidence interval [CI]=95.4%-98.6%]. The leading study areas contributing the most articles were cardiovascular (17.5%), administration/crowding (15.8%), infectious diseases (9.2%), trauma/injury (9.2%), emergency medical services (6.1%), and pulmonary (6.1%). Eighty-six percent (n=1,921) reported the sex/gender composition of the sample and 0.4% (n=8) reported transgender identity. Thirty-four percent used sex/gender in the study design, with 27% (n=609) reporting it as a control variable, 24% (n=543) as an independent variable, and 2% using sex/gender as primary outcome. Studies funded by federal sources were significantly more likely to include sex/gender in the study design than other sources of funding (odds ratio= 1.77; 95% CI= 1.4-2.2). Compared to 2011, we noted an increase in the number of EM scholarship and use of sex and gender in study design, yet the proportion evaluating it as a primary outcome remained unchanged.

250. The Development of A Theory-Based, User-Informed, Digital Intervention To Promote Pregnancy Prevention Among Adolescent Female Emergency Department Patients

Over 18 million adolescents use the emergency department (ED) each year. High risk of unintended pregnancy is associated with frequent use of the ED and lack of a primary care provider, making the ED visit an important potential site for intervention. With few adolescent preventive health interventions being implemented and evaluated in the ED setting, the description of the rigorous development of an ED-based pregnancy prevention intervention can guide future adolescent emergency medicine researchers. The objective of this study is to describe a systematic approach, intervention mapping, to develop a theory-based, user-informed, digital intervention aiming to increase contraception use among adolescent female ED patients at high risk of unintended pregnancy. We followed the 6 iterative steps of intervention mapping to create a blueprint for designing, implementing, and evaluating an ED-based, digital, pregnancy prevention intervention: (1) Developed a Logic Model of the Problem—teen pregnancy in the ED setting—based on a needs assessment; (2) Stated the outcomes and objectives of our intervention via a Logic Model of Change, including our theoretical framework; (3) Developed the pregnancy prevention curriculum and plan, including the digital strategy and brand; (4) Produced the intervention, including designing the branched-logic texting algorithms, website, videos, and cartoons; (5) Planned program use, such as implementation strategies in the ED setting; and (6) Developed an evaluation plan. Using the process of intervention mapping, we developed Dr. Erica (Emergency Room Intervention to improve the Care of Adolescents). Dr. Erica is a relatable, empathetic, straightforward and reliable virtual female doctor who sends 10 weeks of personalized and interactive evidence-based text messages that aim to promote healthy sexual behaviors and decrease teen pregnancy risk. Texts are based on key stakeholder input, participatory design, and the Social Cognitive Theory as well as incorporate social media, relatable characters and Motivational Interviewing techniques. Following the outline of intervention mapping led to the development of a theory-based, user-informed, digital pregnancy prevention intervention. Outlining this method may be helpful to future investigators interested in designing and evaluating adolescent preventive health interventions in both the acute and outpatient setting.

A Queensland research support network in emergency healthcare.

The purpose of this paper is to describe the structure and impact of a Queensland Research Support Network (RSN) in emergency medicine (EM). This paper presents a descriptive summary of EM networks, network evaluations and the structure and development of the Emergency Medicine Foundation's (EMF) RSN in Queensland, including an observational pre- and post-study of research metrics. In two years, the RSN supported 33 Queensland emergency departments (EDs), of which 14 developed research strategies. There was an increase in research active clinicians, from 23 in 2015 to 181 in 2017. Collaborator engagement increased from 9 in 2015 to 276 in 2017 as did the number of research presentations, from 6 in 2015 to 61 in 2017. EMF experienced a growth in new researchers, with new investigators submitting approximately 60 per cent of grant applications in 2016 and 2017. EMF also received new applications from a further three HHS (taking EMF-funded research activity from 8 to 11 HHS). This paper describes changes in KPIs and research metrics, which the authors attribute to the establishment of the RSN. However, it is possible that attribution bias plays a role in the KPI improvements. This network has actively boosted and expanded EM research capacity and capability in Queensland. It provides services, in the form of on-the-ground managers, to develop novice clinician-researchers, new projects and engage entire EDs. This model may be replicated nationwide but requires funding commitment. The RSN improves front-line clinician research capacity and capability and increases research activity and collaborations with clear community outcomes. Collaborations were extended to community, primary health networks, non-government organisations, national and international researchers and academic institutions. Evaluating and measuring a network's benefits are difficult, but it is likely that evaluations will help networks obtain funding.

Indigenous health research in emergency medicine.

Indigenous health research in emergency medicine.

Eddy - A hypothetical model for comprehending emergency medicine research themes

Choosing a research topic during emergency medicine residency for postgraduate trainees has always been a daunting task. The difficulty in choosing a research area can be due to the overlapping themes/clinical spectrum and the wide age range that the emergency medicine physician sees during his/her clinical practice. In this brief report we are proposing a model that can be utilized either by the trainees or the postgraduate program of the hospital in order to help them selecting research domains.

Research Pioneers in Emergency Medicine—Reflections on Their Paths to Success and Advice to Aspiring Researchers: A Qualitative Study

Research in basic, translational, and clinical emergency medicine has made great strides since the formalization of emergency medicine as a specialty. Our objective is to identify and analyze strategies used by emergency medicine research pioneers to inform further advancement of research in emergency medicine, particularly for aspiring researchers and those in emerging areas, using emergency medicine medical education as one example. This was a prospective, grounded-theory, qualitative study, using a constructivist/interpretivist paradigm. Leading basic science, translational, and clinical emergency medicine researchers who completed residency before 1995 were eligible for structured interviews. Thematic coding followed an iterative process until saturation was reached. A theoretic model was developed and analyzed. Research pioneers valued advanced methodological training and mentorship. Barriers to funding were lack of recognition ofemergency medicine as a specialty, absence of a research history, and lack of training and funding resources. Deliberate interventions to improve emergency medicine research included educational sessions at national meetings, external (to emergency medicine) mentor pairings, targeted funding by emergency medicine organizations, and involvement with funding agencies. Pioneers facilitate research excellence by serving as mentors and allocating funds or protected time to develop researchers. To advance emerging subfields of research in emergency medicine, pioneers recommend advanced methodological training that is specific to the area, deliberate mentorship, and the formation of research consortia to conduct generalizable outcomes-based studies. Research pioneers in emergency medicine cite mentorship, advanced skills obtained through fellowship or graduate degrees, deliberate collaboration with experienced researchers, support from emergency medicine organizations, and forming networks as the cornerstones of success.

Executive Summary: The 2018 Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps.

Emergency care providers share a compelling interest in developing an effective patient-centered, outcomes-based research agenda that can decrease variability in pediatric outcomes. The 2018 Academic Emergency Medicine Consensus Conference "Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps (AEMCC)" aimed to fulfill this role. This conference convened major thought leaders and stakeholders to introduce a research, scholarship, and innovation agenda for pediatric emergency care specifically to reduce health outcome gaps. Planning committee and conference participants included emergency physicians, pediatric emergency physicians, pediatricians, and researchers with expertise in research dissemination and translation, as well as comparative effectiveness, in collaboration with patients, patient and family advocates from national advocacy organizations, and trainees. Topics that were explored and deliberated through subcommittee breakout sessions led by content experts included 1) pediatric emergency medical services research, 2) pediatric emergency medicine (PEM) research network collaboration, 3) PEM education for emergency medicine providers, 4) workforce development for PEM, and 5) enhancing collaboration across emergency departments (PEM practice in non-children's hospitals). The work product of this conference is a research agenda that aims to identify areas of future research, innovation, and scholarship in PEM.

Editorial introductions

Current Opinion in Critical Care was launched in 1995. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of critical care is divided into 13 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the journal's Section Editors for this issue. SECTION EDITORS Thomas RimmeléThomas RimmeléProf. Thomas Rimmelé is the Chairman of the Department of Anaesthesiology and Intensive Care Medicine at Edouard Herriot Hospital, Lyon, France, and Chairman of the Department of Organ Harvest Coordination for the Hospices Civils de Lyon, France. He gained his medical degree in 2004, specialising in anaesthesiology and intensive care, from the Claude Bernard University, Lyon, France, and subsequently completed a PhD on extracorporeal blood purification therapies in sepsis. In addition to blood purification for sepsis, Prof. Rimmelé's academic interests include acute kidney injury, renal replacement therapy in the intensive care unit, and simulation in healthcare as he is also the co-director of the simulation center at Lyon University, France. Prof. Rimmelé is the author or co-author of more than 150 peer-reviewed articles or book chapters and regularly delivers lectures at international meetings. Wesley H. SelfWesley H. SelfDr Wesley H. Self, MD, MPH, is the Vice Chair for Research in the Department of Emergency Medicine at Vanderbilt University Medical Center in Nashville, Tennessee, USA. He is an emergency physician and clinical researcher focused on the intersection of emergency and critical care medicine. He has authored over 100 peer-reviewed publications and widely lectured and presented research findings on the early management of pneumonia, sepsis, and related emergencies. Dr Self was the principal investigator for the Saline Against Lactated Ringer's or Plasmalyte in the Emergency Department (SALT-ED) trial (N Engl J Med 2018), which demonstrated a lower incidence of major adverse kidney events following IV fluid resuscitation with balanced crystalloids compared with saline. He was also a lead investigator in the Etiology of Pneumonia in the Community (EPIC) study (N Engl J Med 2015), which demonstrated a high disease burden from respiratory viruses among patients hospitalized with community-acquired pneumonia in the United States. Dr Self serves as the co-principal investigator of the Vanderbilt Clinical Center in the Prevention and Early Treatment of Acute Lung Injury (PETAL) Clinical Trials Network (www.petalnet.org) funded by the National Heart, Lung and Blood Institute (NHLBI). His current work focuses on embedding pragmatic comparative effectiveness trials into ongoing clinical care to learn how to improve early resuscitation. Dr Self completed medical school at the University of Virginia, USA, residency training in emergency medicine at Northwestern University, USA, and a clinical research fellowship at Vanderbilt University, USA. He is currently an Associate Professor of Emergency Medicine at Vanderbilt University Medical Center, where he leads the Division of Emergency Medicine Research. Karim AsehnouneKarim AsehnouneProf. Karim Asehnoune got his degree as an MD in 1999 at University René Descartes Paris, France. After completing his PhD in immunology in 2001, he spent one year in the lab of Prof. Edward Abraham in the University of Colorado, Denver, USA (2002). He was appointed Professor of Anaesthesiology and Critical Care Medicine in the University of Nantes, France, in 2009. Prof. Asehnoune is the head of the Anaesthesiology department of Hospital Hotel-Dieu, and the director of the 30-bed surgical Intensive Care Unit at the University hospital of Nantes, France. He is currently a member of the scientific committee of the French Society of Anaesthesiology and Critical Care Medicine, and the director of a French network of ICUs (www.ATLANREA.org). Professor Asehnoune was involved as the coordinator of several multi-centre trials, and he was the primary investigator of 2 multicentre double blind randomised studies evaluating corticosteroids in severe trauma patients. He is the director of a lab dedicated to the study of host-pathogen interactions (http://www.ea3826.univ-nantes.fr/). He has published more than 180 peer-reviewed articles.

The importance of developing global emergency medicine research network

Despite the fact that emergency care can impact health of populations, the global epidemiology of emergencies in children and adults is unknown and substantial variation exists in emergency infrastructure among different nations, especially among the low and middle income countries. Various research networks which are etiology specific or subspecialty specific, including emergency care based networks have positively impacted the health of populations. However, emergency departments (ED) in low and middle income counties are underrepresented in most international networks. Creation of a global ED based research network will help generate generalizable evidence that can then be translated into locally relevant evidence-based guidelines, nurture future researchers in emergency medicine, standardize training/education and improve patient outcomes by reducing variation in clinical care.

Patient and paramedic engagement in prehospital emergency medicine research.

KEY POINTS Half a million patients with neck injury are transported to Ontario emergency departments each year for investigation for serious bone or spinal-cord damage, yet less than 1% have a fracture or ligament instability; even fewer patients (0.5%) have a spinal-cord injury or nerve damage.[1][

Pediatric Case Exposure During Emergency Medicine Residency.

While emergency medicine (EM) physicians treat the majority of pediatric EM (PEM) patients in the United States, little is known about their PEM experience during training. The primary objective was to characterize the pediatric case exposure and compare to established EM residency training curricula among EM residents across five U.S. residency programs. We performed a multicenter medical record review of all pediatric patients (aged<18 years) seen by the 2015 graduating resident physicians at five U.S. EM training programs. Resident-level counts of pediatric patients were measured and specific counts were classified by the 2016 Model of Clinical Practice of Emergency Medicine (MCP) and Pediatric Emergency Care Applied Research Network (PECARN) diagnostic categories. We assessed variability between residents and between programs. A total of 36,845 children were managed by 68 residents across all programs. The median age was 6 years. The median number of patients per resident was 660 with an interquartile range of 336. The most common PECARN diagnostic categories were trauma, gastrointestinal, and respiratory disease. Thirty-two core MCP diagnoses (43% of MCP list) were not seen by at least 50% of the residents. We found statistically significant variability between programs in both PECARN diagnostic categories (p<0.01) and MCP diagnoses (p<0.01). There is considerable variation in the number of pediatric patients and the diagnostic case volume seen by EM residents. The relationship between this case variability and competence upon graduation is unknown; further investigation is warranted to better inform program-specific curricula and to guide training requirements in EM.