Does Specialty Training and Practice Setting Affect Adherence to the Pediatric Emergency Care Applied Research Network Criteria for Pediatric Head Trauma?

OBJECTIVE: The goal was to determine the effects of specialty training and practice settings on the adherence to the Pediatric Emergency Care Applied Research Network (PECARN) criteria. METHODS: A retrospective study was conducted on a 2-campus hospital. Chart documentation was used to determine adherence to PECARN criteria. Inclusion criteria were any traumatic head injury within 24 hours in patients younger than 18 years over a 1-year period. Specialty training was subdivided into 3 groups: pediatric emergency medicine, emergency medicine (EM), and general pediatrics. The 2 hospital campuses are distinctly different practice settings, one being an academic practice setting, which is also a trauma center that has a dedicated pediatric emergency department, staffed by pediatric emergency medicine, EM, and general pediatrics physicians, and the second campus is a community practice and is staffed solely by EM physicians. Statistical analysis was performed using χ and Cochran-Mantel-Haenszel tests. All analyses were 2-sided, and P < 0.05 was considered statistically significant. RESULTS: A total of 709 pediatric patients with traumatic head injuries were analyzed. Overall adherence to PECARN criteria was 93%. No statistical difference was found between different specialty training on the academic campus. In addition, the rate of adherence among EM physicians at the academic and community settings was 94.8% versus 86.5%, respectively (P = 0.004). CONCLUSIONS: Practice setting had an effect on adherence to PECARN criteria in pediatric patients with acute traumatic head injury. The same determination on adherence was not demonstrated among physicians with different specialty trainings.

Double Steal Phenomenon: Emergency Department Management of Recurrent Transient Ischemic Attack.

Double steal phenomenon is a rare condition where occlusion of the innominate (brachiocephalic) artery leads to hemodynamic changes in which blood flow is shunted from the intracranial circulation down the right vertebral artery and subsequently up the right carotid and subclavian circulation. This is a case of a 67-year-old female presenting emergently with recurrent transient ischemic attacks due to double steal phenomenon. Emergency department recognition of the double steal phenomenon and large vessel occlusion by computed tomography angiogram of the head and neck allowed for early treatment, which was critical in avoiding irreversible cerebral infarction.