2016 AAP SOEM Abstract Session Highlights – Part 2

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

Margaret Nguyen

Patient visits to EDs were abstracted from principal diagnostic codes and mapped using ZIP codes
In the primary cluster for high ED visits 82.8% of ZIP codes fall under healthcare shortage areas, compared to 14.2% in the primary cluster for low ED visits (p < .001)
Higher ozone problem areas were also amongst high visit locales

Meghan Cain, MD, FAAP

Very few kids with headache have badness – 5% or less. But, a lot of kids still get imaging (CT and sometimes MRI)
The investigators are currently conducting a prospective cohort and at AAP presented an interim analysis that showed that only one imaged patient had a significant finding (tumor) and that those who were imaged as outpatients none had clinically important findings
Once the study is concluded this may further support a low-risk approach to image avoidance in the ED
Read more here on this PEMBlog post on headache

Melissa Van Cain

Follow up of gonorrhea and chlamydia testing is a sensitive issue. The investigators randomized patients to getting a call or a text.
The study is still ongoing – to date patients who were texted their results were reached at similar rates to calls
It will be interesting to see if this is a preferred method of communication – especially since SMS texts can be automated

Ning Li

This study is looking at mitochondrial markers in the prognosis of children with sepsis
Markers like these have promise in prognosticating sepsis outcomes

Raina Paul, MD

Sepsis is a leading cause of morbidity and mortality – early recognition and management are very important
There are 15 hospitals in the Children’s Hospital Association Collaborative. the investigators looked at 1737 patients with sepsis (656 of which had severe sepsis)
Improvements in initial clinical assessment were noted over time – 46% to 60% (p < 0.001) – as were administration of first fluid bolus from 38 to 46% (p <0.015)
30-day mortality was reduced in severe sepsis from 11% to 3% (p=0.029), with a trend towards improved 3 day mortality (4% to 1%, p=NS)
This is important work – but does face some barriers including difficulties with defining sepsis, retrospectively defining time of sepsis onset, implementing electronic health record (EHR) strategies and automating data capture

Srikanth Aravapalli, MD

Le Bonheur Children’s in Memphis instituted a Pediatric Appendicitis Score + Ultrasound Pathway (PAS+US) that was highly sensitive and specific
They noted that ultrasound was being used first in lieu of the pathway, and wanted to see if this change was meaningful
A retrospective review noted the following results in the table seen below:

Will this change in practice be more efficient in the long run? Time will tell? What about the cost if extra patients are imaged?

Thomas McCarty, MD, FAAP

In adults hypothermia (≤36 C) is an independent risk factor for increased mortality in trauma
The investigators studies hypothermia in isolated pediatric head trauma using the National Trauma Database
They created a 1:1 matched case control and noted that amongst 10, 976 patients that hypothermia was associated with the following;
- increased mortality (5% vs. 2.9%, p < 0.0001)
- increased rate of neurosurgical intervention (9.4% vs. 7.9%, p=0.0001)
- longer length of hospital stay (4.2 vs. 4.0 days, p=0.0033)
- higher rate of transfer to other care facilities following hospital discharge (14.6% vs. 12.2%, p <0.0001)
The authors note that hypothermia was not studied strictly in level one centers, and that objective justification for temperature stabilizing intervention is most certainly needed. Still, provocative work.

About the Author: Brad Sobolewski, MD, MEd