ABSTRACT
Background: More than 90% of pediatric patients presenting to emergency departments (EDs) in the United States are evaluated and treated in community-based EDs. Recent evidence suggests that mortality outcomes may be worse for critically ill pediatric patients treated at community EDs. The disparate mortality outcomes may be due to inconsistency in pediatric-specific education provided to emergency medicine (EM) trainees during residency training. There are few studies surveying recently graduated EM physicians assessing perceived gaps in the pediatric emergency medicine (PEM) education they received during residency. Methods: This was a prospective, survey-based, descriptive cohort study of EM residency graduates from 10 institutions across the United States who were <5 years out from residency training. Deidentified surveys were distributed via email. Results: A total of 222 responses were obtained from 570 eligible participants (39.1%). Non-ED pediatric rotations during residency training included pediatric intensive care (60%), pediatric anesthesia (32.4%), neonatal intensive care unit (26.1%), and pediatric wards (17.1%). A large percentage (42.8%) of respondents felt uncomfortable managing neonates and performing tube thoracostomy on pediatric patients (56.3%). The EM graduate's satisfaction with pediatric simulation-based training during residency was positively associated with comfort caring for neonates and infants (p < 0.0070 and p < 0.0002) and performing endotracheal intubation (p < 0.0027), lumbar puncture (p < 0.0004), and Pediatric Advanced Life Support resuscitation (p < 0.0001). Conclusions/discussion: This survey-based cohort study found considerable variation in pediatric-specific experiences during EM residency training and in perceived comfort managing pediatric patients. In general, participants were more comfortable managing older children. This study suggests that the greatest perceived knowledge gaps in PEM were neonatal medicine/resuscitation and pediatric cardiac arrest. Future research will continue to address larger cohorts, representative of the PEM education provided to EM physicians in the United States to promote future educational initiatives.
ABSTRACT
Diagnosis of neurosyphilis remains a challenge due to no existing standardized testing, but it is often made based on a combination of clinical and cerebrospinal fluid (CSF) analysis findings. Neurosyphilis is uncommon now compared to the era before the introduction of penicillin. Syphilis if left untreated may lead to debilitating complications including paresis, progressive dementia, and even death. Presence of ocular or hearing manifestations with positive serum treponemal and non-treponemal tests are diagnostic for neurosyphilis, regardless of presence or absence of CSF abnormalities. The preferred regimen for neurosyphilis is intravenous penicillin G for 2 weeks. Other regimens are not shown to be as effective as penicillin. Here we discuss an interesting case presenting with neurosyphilis along with manifestations consistent with primary and secondary stages of syphilis.
