Here is a summary of the first abstract session from the 2016 AAP NCE Section on Emergency Medicine Day 1 Program.

The Clinical Utility of Telemedicine in Pediatric Mental Health Emergencies in the ED/UC Setting

Alison Brent, MD, FAAP

  • Mental health visits are increasing – resources aren’t
  • A retrospective chart review of >500 patients showed that half of telemedicine patients were discharged home and that satisfaction rates were very high
  • It was also significantly less expensive
  • I’ve used this, and it represents a great option to potentially get families in touch with a familiar provider

Caregiver Willingness to Provide‐Accept Analgesia for Pain in Acute Care Settings: Multicenter Cohort Study

Caroline Whiston

  • Providers self report high levels of pain medicine provision, medicine was actually ordered less often in this multi center prospective cohort
  • The proportion of children offered analgesia at home, in the ED, and overall was 226/743 (30.4), 408/743 (54.9), and 414/743 (55.7)
  • Children were significantly more likely to be offered analgesia in the ED if they were older (OR: 1.1, 95% CI:1.0, 1.1, p = 0.02) and reported greater pain (OR: 1.3, 95% CI: 1.1, 1.4, p < 0.01)
  • Parents who didn’t give pain medicines at home did not do so because they worry that “it would make it hard for the doctors to figure out what’s going on or mask the seriousness of the illness”
  • A minority of caregivers felt opioids were addictive 18% or harmful 25%

The Effect of Bedside Ultrasound Assistance on Infant Lumbar Puncture: A Randomized Controlled Trial

Jeffrey Neal, MD, FAAP

  • The rate of unsuccessful LP is up to 40%
  • A non blinded RCT of 128 patients showed that when location was marked by ultrasound trainees were more likely to be successful on first attempt (57.8% vs 31.3%, p < 0.01) and within three attempts (75% vs 43.8%, p < 0.001)
  • The ultrasound was used to mark location primarily
  • Did the ultrasound arm represent better teaching and precepting on  location marking?

Ultrasound‐ Fluoroscopy‐Guided Reduction of Pediatric Forearm Fractures: Prospective Observational Study

John Kanegaye, MD, FAAP

Fluoroscopy is not always available for orthopedic reductions. But, ultrasound generally is. The investigators of this study prospectively enrolled 60 patients with isolated radius and or ulna fractures to see if U/S was just as good a X-Rays.

They noted that fluoro identification of post reduction was largely similar to ultrasound identification

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Novel Video‐enhanced Advanced Airway Curriculum for Pediatric Residents: Randomized Controlled Trial

Kelsey Miller

  • 50 interns were randomized to either a standard didactic curriculum for neonatal intubation or a new curriculum involving recording with a video laryngoscope
  • Each group was assessed on 4 simulated scenarios initially and then at a three month follow up on the “difficult” scenarios
  • The investigators noted that the video group had a significantly shorter time to intubation – 18.5 sec for video vs 22 sec for not – HR 1.65 95% CI 1.25-2.19
  • Participation in the video based group also saw decreased odds of >1 attempt and esophageal intubation
  • Time to intubation continued to be shorter at 3 months for the video group – but the results were not statistically significant

Outcomes for Children with Non‐Diagnostic Ultrasounds in the Evaluation for Suspected Appendicitis

Kristy Williamson, MD, FAAP

  • Acute appendicitis is a common diagnosis, and ultrasound is the primary imaging modality in most centers
  • The objective of this study was to see what happens to those patients  with “appendix not visualized” or “indeterminate” ultrasounds
  • They started with a retrospective review of patients that received an ultrasound for appendicitis and then performed logistic regression analysis of relevant factors on a randomized group of the non-diagnostic patients – choosing this randomized group reduced the number to review, but what about the ones they didn’t review?
  • There were 3,245 ultrasounds performed for appendicitis; 14% showed appendicitis, 31% no appendicitis, and 54% were non‐diagnostic (n=1765)
  • 13% of the randomized patients who received a non‐diagnostic ultrasound were diagnosed with appendicitis (95% CI: 9.55%, 17.88%)
  • 2.3% (3/130) of those discharged without a definitive diagnosis who were able to be contacted for follow up were ultimately diagnosed with appendicitis
  • Patients with happy confirmed on follow up imaging (CT) had WBC and ANC significantly associated with diagnosis of appy (p < 0.0001, and p=0.0001, respectively). This makes sense if you consider the validated pediatric appendicitis score.
  • Should we get a CBC on equivocal ultrasound patients?

Postpartum Depression Screening in a Pediatric ED: High Prevalence and Screening Acceptability

Lenore Jarvis, MD, FAAP and Kristin Breslin, MD, MPH

  • Post-partum depression is seen in over 20% of mothers in the US
  • The investigators looked at postpartum depression in the ED via surveys of 209 women
  • They noted that 27% screened positive with 7% having SI
  • Almost half had never been screened before – representing a worrisome number of mothers seen in the ED
  • Current unemployment status was associated with a positive PPD screen (aOR 2.3; 95% CI 1.1, 4.9) when adjusting for maternal age, education level, marital status, infant age, and infant insurance status
  • At 1 month follow‐up PPD screened positive mothers reported that the ED screening was important and felt that access to support and seeking help from their primary doctor/child’s pediatrician was valuable
  • The bottom line is that we should screen for Postpartum depression in mothers of newborns who present to the ED