A Comparison of Teleburn to In-Person Consultation of Pediatric Patients in a Children's Emergency Department.

BACKGROUND: Pediatric burn care is an essential component to emergency care and there are disparities in access to regional burn centers. Teleburn is a tool that enables providers without a certified burn center to provide photos of a burn to experts and receive recommendations. The purpose of this study is to evaluate the effectiveness of a Teleburn system to the in-person consultation regarding burn infection rate, clinic follow up rate, post-burn admission rate, and 72-hour bounce back rate. DESIGN/METHODS: Data was collected from December 2019-March 2022 through the electronic medical record. A total of 416 patient encounters that met criteria were analyzed. A non-inferiority study was designed comparing proportional outcomes of Teleburn initial visits to emergency department visits regarding burn infection rate, clinic follow up rate, post-burn admission rate, and 72-hour bounce back rate. The data were compared with a difference of greater than 10% being considered inferior. RESULTS: No differences were identified in rates of readmission - 1.67% difference (95% CI -27%< x< 23.8%) and return within 72 hours - 0.7% difference (-18.4%< x< 19.7%). Teleburn patients were 12.6% less likely to follow up (2.7%< x< 22.40%). Only one infection was identified, which was insufficient to conclude non-inferiority. CONCLUSION: While convenient, Teleburn consult could not be demonstrated to be non-inferior to in-person consultation. No differences in infection rates were identified, and difference in readmission and return were clinically insignificant. This study demonstrates that Teleburn may be effective and feasible to regional burn centers if follow up can be improved.

SNAPTIMED study: does the Scottish and Newcastle Antiemetic Protocol achieve timely intervention and management from the emergency department to discharge for paracetamol poisoning?

BACKGROUND: This study aimed to establish whether the modified 12-hour Scottish and Newcastle Antiemetic Protocol (SNAP) for paracetamol poisoning is associated with improvement in hospital length of stay (LoS), as well as to validate the performance of the protocol for the prevention of anaphylactoid reactions and total infusion duration. METHODS: Retrospective chart review from 25 March 2019 to 25 September 2020. Patients aged 16 or older with a diagnosis of suspected or confirmed paracetamol overdose were included in the analysis if they received treatment for paracetamol poisoning, and the protocol used could be identified. Data were collected for LoS, number of extended treatment infusions used and evidence of anaphylactoid reaction. RESULTS: 1167 records were assessed for eligibility, and 294 were included for analysis. Use of the SNAP was associated with a statistically significant reduction in LoS of -8.8 hours (95% CI -12.6 to -2.0), and a reduced risk of anaphylactoid reaction (Number Needed to Treat=10). CONCLUSION: In this retrospective study, use of the SNAP reduced the duration of inpatient admissions and rate of anaphylactoid reactions.

Evaluating Discrepancies in Percent Total Body Surface Area Burn Assessments Between Prehospital Providers and Burn Center Physicians.

Burns are routinely assessed at the scene of the incident by prehospital or emergency medical services providers. The initial management of burns is based on the calculation of the extent of the injury, reported as percent total body surface area (TBSA). This study evaluates discrepancies in the estimation of TBSA between prehospital providers and burn team physicians over a 3-year period at an academic, university medical center serving as the regional burn center. A total of 120 adult and 27 pediatric patients (younger than age 16 years) were included in this study; 95 (65%) patients were male, 67 (46%) patients were Caucasian, 62 (42%) patients had no healthcare insurance, and the median age was 35 years (interquartile range [IQR] 27). The most common etiology of burns was hot liquid, 39 (26.5%). Median [IQR] and mean (SD) estimated TBSA (%) were 4 [1-10] and 8.6 (12.8) for prehospital providers and 2 [1-6] and 5.9 (9.9) for burn team physicians. Bland-Altman plots evaluating second- and third-degree burns separately and combined demonstrated that, as burns involved more surface area, agreement decreased between emergency medical service providers and burn physicians. Agreement between prehospital providers and burn physicians decreased as TBSA of burns increased. This finding reaffirms the need for more standardized education and training for all medical personnel.

Trauma Arrest and Spinal Injury in a 3-Year-Old Girl.

Management of an acutely injured pediatric patient with multiple traumas is a common challenge facing clinicians in pediatric emergency care. Blunt trauma is more common in the pediatric population with motor vehicle accidents being the most common cause of injury. Spinal injury, especially in young children, is only seen in 1% to 2% of cases and can be lethal. It is incumbent upon clinicians to be able to meet the challenges of patient management including airway management, providing hemodynamic support, and addressing potentially reversible causes of arrest while recognizing presenting symptoms of spinal injury. This case presents a child in trauma arrest after a motor vehicle crash requiring advanced interventions, diagnostics, and support. Her clinical course is described and reveals a complete distraction of the cervical and thoracic spine. This case illustrates pathology and management along with the importance of proper management and interventions by pediatric emergency clinicians to manage the patient and attempt to maximize the patient's outcome.