Pediatric Emergency Department Study of Cardiac Risk in the Novel Patient (PED SCReeN).

OBJECTIVE: We compare pediatric cardiac risk classification and management recommendations between emergency physicians (EPs) and pediatric cardiologists (PCs) in children with a suspected new cardiac disorder. METHODS: We prospectively compared the work-up, assessment, classification, and disposition of patients aged 0 to 21 years presenting to the emergency department with a potential cardiac etiology in whom an electrocardiogram (ECG) was performed. The criterion standard was a blinded assessment by the PC-electrophysiologist after review of the history, physical examination, ancillary tests, and ECG. RESULTS: In 508 subjects, the median age was 15 years (interquartile range, 11-17 years), with a slight female predominance (281, 55.3%). The most common reasons for obtaining an ECG were: chest pain (158, 31.1%) and syncope, presyncope, or possible seizure (146, 28.7%). The most common auxiliary study was a chest radiograph (432, 85% of subjects). A total of 617 electrocardiographic diagnoses were made by EPs and 984 diagnoses by PCs. Sensitivities and specificities varied by discrete class, but disposition decisions were concordant (home or admission). The EPs were highly accurate for the need for emergent cardiology involvement (area under the curve, 0.89). CONCLUSIONS: The EPs and PCs agreed on the evaluation and disposition of children at either low risk or high risk for an acute cardiac presentation in the emergency department. There was considerable variation in management recommendations in the intermediate risk children needing cardiology outpatient follow-up. We recommend the development and implementation of focused training modules on emergency pediatric cardiology and increased communication with pediatric cardiology to improve patient safety and resource utilization.

Palpitations and Arrhythmias and Sudden Cardiac Arrest/Sudden Cardiac Death in Children and Adolescents.

Palpitations are a common complaint, particularly in teenagers, with etiologies ranging from no detectable cardiac dysrhythmia to life-threatening dysrhythmias. Despite the fact that as many as 50% of children and adolescents may be asymptomatic prior to experiencing sudden cardiac arrest, the occurrence of palpitations may afford the opportunity to detect a potentially lethal arrhythmia condition. This article discusses the evaluation of palpitations in the pediatric population by focusing on the two most common life-threatening arrhythmia diagnoses that may initially manifest itself in the pediatric population with the chief complaint of palpitations-Wolff-Parkinson-White syndrome and the long QT syndrome.

Pregnancy in postural orthostatic tachycardia syndrome.

INTRODUCTION: Postural orthostatic tachycardia syndrome (POTS) is a rare disease characterized by syncope, sinus tachycardia, and orthostasis due to autonomic dysfunction. METHODS AND RESULTS: Two women aged 26 and 24 years with severe POTS became pregnant. Both women experienced hyperemesis gravidarum with subsequent marked improvement in their POTS symptoms until 6 months gestation, when their syncope and sinus tachycardia caused clinical decompensation. Both patients delivered healthy babies at 37 weeks by elective cesarean section. CONCLUSION: In long-term follow-up, both women reported improvement in their prepartum symptoms. We describe the first report, to our knowledge, of two successful pregnancy outcomes in severe POTS, including the first report of midodrine use in pregnant women.

Concept mapping assessment in medical education: a comparison of two scoring systems.

BACKGROUND: Concept mapping has the potential to measure important aspects of a student's evolving knowledge framework in a way that conventional examinations cannot. This is important because development of an elaborate and well-structured knowledge framework is a critical step toward becoming an expert in a particular field. Little is known about the best way to score concept maps in the setting of medical education. Therefore, as a preliminary step in addressing this question, we compared two different scoring systems for validity: a structural method based on the organization of a map's hierarchical structure and a relational method based, not on structure, but on the quality of each individual map component. METHODS: A total of 21 paediatric resident doctors completed concept map training, drew a preinstruction concept map about "seizures", completed a seizure education course, and then drew a postinstruction seizure map. Two raters using both structural and relational methods scored each map. RESULTS: Structural scores increased significantly after instruction and were higher in more experienced residents, but relational scores were not significantly different. Interrater scoring reliability for both methods ranged from moderate to strong, but was greater using the relational scoring method. CONCLUSIONS: These data suggest that scoring systems for evaluating concept maps in postgraduate medical education may need to account for structural features of maps, if scores are to reflect changes in the developing knowledge frameworks of resident doctors. More research to further evaluate reliability and validity is critical prior to any future use of concept mapping assessment in medical education.