Agreement between noninvasive oscillometric and invasive intra-arterial blood pressure in children with ruptured brain arteriovenous malformations.

BACKGROUND: Divergence between intra-arterial catheters blood pressure (ABP) and noninvasive oscillometry (NIBP) may affect the care of children with brain arteriovenous malformations (bAVMs). We described the agreement between ABP and NIBP in these children. METHODS: We conducted a retrospective review of patients admitted to the pediatric intensive care unit between 2017 and 2023 with bAVM rupture. Paired ABP and NIBP measurements were collected. Bland-Altman analyses were used to assess agreement. Correlation analysis was conducted between higher ABP and divergence between systolic BP (SBP) measurements. Hypertension was defined as mean arterial pressure (MAP) exceeding age-based 95th percentile. RESULTS: Thirty-four patients with 1901 BP pairs were observed. Bias overall was acceptable, but standard deviation (SD) was high. The best agreement of MAP was in non-hypertensive (bias 1.23 mmHg, SD 8.03 mmHg) and radial arterial catheters (bias 1.83 mmHg, SD 9.08 mmHg) subgroups. Bias for SBP was higher in hypertension (10.98 mmHg) and in infratentorial bAVMs (7.42 mmHg), suggesting poorer agreement in these subgroups. There were significant correlations between intra-arterial MAP and SBP divergence (R = +0.346, p<.001) and between intra-arterial SBP and SBP divergence (R = +0.677, p<.001), suggesting divergence widens with higher BP. Around 25 % of measurement pairs diverged to where one measurement crossed the clinical threshold for treatment, while the other did not, with ABP being more frequently higher than NIBP. CONCLUSIONS: There is good agreement between ABP and NIBP, particularly in non-hypertensive ranges and with radial arterial catheters. Measurements, however, diverge in hypertension. Further research must define age-based thresholds, validate methods of BP measurement, and determine the effect of BP reduction on outcomes in these children.

Language-discordant care in pediatric neurosurgery: parent and provider perspectives on challenges and multilevel solutions to reduce disparities.

OBJECTIVE: In the United States, Spanish is the second most spoken language, with nearly 42 million individuals speaking Spanish at home. Spanish speakers have been noted to have higher rates of unfavorable neurosurgical outcomes; however, to the authors' knowledge, no study has explored the experiences of patients, caregivers, and providers receiving or delivering neurosurgical care in language-discordant settings. In this study, the authors sought to identify challenges faced by pediatric neurosurgery providers and Spanish-speaking parents communicating with a language barrier and propose solutions to address those challenges. METHODS: Spanish-speaking parents and pediatric neurosurgery providers were invited to participate in semistructured interviews. Purposeful sampling was used to recruit Spanish-speaking parents whose child had recently undergone neurological surgery at the authors' institution and to identify pediatric neurosurgery clinical team members to interview, including physicians, advanced practice providers, and interpreters. Codes were inductively developed and applied to transcripts by two researchers. Thematic analysis was conducted to identify challenges faced by parents and providers. RESULTS: Twenty individuals were interviewed, including parents (n = 8), advanced practice providers (n = 5), physicians (n = 3), interpreters (n = 2), a social worker (n = 1), and a nurse (n = 1). Three challenges were identified. 1) Compared with English-speaking parents, providers noted that Spanish-speaking parents were less likely to ask questions or raise new concerns. Concurrently, Spanish-speaking parents expressed a desire to better understand their child's future medical needs, care, and development. 2) There is a dearth of high-quality resources available in the Spanish language to supplement patient and parent neurosurgical education. 3) Both parents and providers invariably prefer in-person interpreters; however, their availability is limited. CONCLUSIONS: Three challenges were identified by Spanish-speaking parents of pediatric neurosurgery patients and providers when receiving or delivering care through a language barrier. The authors discuss multilevel solutions that, if deployed, could directly address these shared challenges. Furthermore, optimizing communication may help mitigate the disparities experienced by non-English-speaking Hispanic/Latino individuals when receiving neurosurgical care.

A Multifaceted Intervention to Improve Teamwork on an Inpatient Pediatric Neurosurgery Service.

BACKGROUND: Increased safety reports related to interprofessional teamwork on an acute care unit at a quaternary children's hospital prompted a teamwork-focused improvement effort on the pediatric neurosurgery service. METHODS: An interprofessional workgroup was formed and met twice monthly throughout the project. A survey using modified validated items was disseminated to pediatric neurosurgery nurses, advanced practice providers (APPs), and physicians in March 2021 to identify opportunities for improvement. Structured debriefs on survey results promoted discourse on teamwork. The researchers implemented two interventions: (1) nursing-centered interprofessional education and (2) a rounding checklist before redistributing the survey in December 2021. RESULTS: Baseline and follow-up survey response rates were 84.1% (58/69) and 71.4% (50/70), respectively. Nurses at baseline perceived lower teamwork scores for 12 items compared to physicians and APPs (p < 0.05). Nurse perceptions improved after interventions in: "using 'we' rather than 'they'" (21.3% vs. 51.2% agree, p = 0.003), "I am confident that this team works effectively" (46.8% vs. 80.5%, p = 0.001), "shared understanding of each other's role on the team" (48.9% vs. 73.2% agree, p = 0.02), and "getting others on the team to listen" (46.8% vs. 75.6%, p = 0.004). Mean teamwork effectiveness improved from 4.12 to 5.25 (out of 7; p < 0.0001). Nurses ranked three interventions as most effective: interprofessional training (35/41, 85.4%), educational clinical pearls (14/41, 34.1%), and structured opportunities to discuss teamwork (10/41, 24.4%). CONCLUSION: Interprofessional training, a teamwork survey, and structured debriefing improved nurse perceptions of teamwork. Interventions targeting social components of change can improve teamwork even without process changes.