Self-Reported Usage of Safety Equipment Provided Through a Community Partnership Approach to Injury Prevention in the Pediatric Emergency Department.

OBJECTIVES: Previous studies have shown that educational programs in conjunction with provision of free or low-cost safety equipment increases the likelihood of parents changing behaviors at home. This project surveyed caregivers in the pediatric emergency department (ED) about safety behaviors before and after provision of education and safety equipment related to medication storage, firearm storage, and drowning. METHODS: A convenience sample of families presenting to the ED for any complaint with a child of any age were approached for participation in this feasibility study. Exclusion criteria included patients presenting for a high acuity problem (Emergency Severity Index 1 or 2) and non-English-speaking caregivers. Enrollment, surveys, and educational intervention were performed by the graduate student investigator from the School of Public Health. Participants were surveyed regarding presence of firearms and medications within the home and their storage practices. Additional questions included relationship to the patient, number and age of children younger than 18 years in the home, and zip code of residence. Educational handouts were reviewed, and participants were provided with a medication lock box, trigger lock, toilet lock, and/or pool watcher tag as indicated by answers given to the survey questions. Process measures were collected for number of products given out, number of children potentially affected by the intervention, and time spent by the investigator. Follow-up calls assessed use of the products provided. RESULTS: The student investigator spent a total of 180 hours and enrolled 357 caregivers accounting for 843 children. Fifty-seven percent of the participants answered the follow-up phone call. Only 9% initially reported that they stored medications in a locked or latched place. Medication lock boxes were given to 316 participants. On follow-up, 88% of those who received a lock box reported using it to store medications and 86% reported satisfaction with the lock box and how it worked. Of the 161 participants who admitted to gun ownership, 45% reported storing their guns locked and unloaded. Of those who reported unsafe manners of gun storage, 96% also reported unsafe manners of medication storage. Although only 161 participants endorsed gun ownership, 236 participants took a gun lock when offered. At follow-up, 66% of participants had used the gun lock and 67% of participants who took the gun lock reported satisfaction with the device. For water safety, 195 toilet latches and 275 drowning prevention lanyards were provided. On follow-up, 48% of those who had received a toilet latch were using it and 62% reported satisfaction with the device. Data were not collected on use of or satisfaction with the drowning prevention lanyards. CONCLUSIONS: Families often report unsafe home storage of medications and firearms, which together account for a large amount of morbidity and mortality in pediatrics. Drowning risk for young children is ubiquitous in the home setting, and low rates of use of home safety devices indicates need for further education and outreach on making the home environment safe. Despite relying on self-reported behaviors and the risk of reporting bias skewing the data, the behaviors reported in the preintervention survey were still very unsafe, suggesting that children may have a much higher risk of injury in the actual home environments. The ED is traditionally thought of as a place to receive care when injuries happen, but any encounter with families should be seen as an opportunity for injury prevention messaging. Partnering with a local school of public health and other community resources can result in the establishment of a low-cost, consistent, and effective injury prevention program in the pediatric ED that reaches a large number of individuals without the added burden of additional tasks that take time away from already busy ED providers and staff.

Utilization of Monitored Beds for Children Admitted With Unintentional Poisonings.

OBJECTIVES: Children with unintentional poisonings (UPs) are frequently admitted to monitored beds (MBs), though most require minimal interventions. We aimed to (1) describe clinical factors and outcomes for children admitted for UPs and (2) identify clinical factors associated with MB placement. METHODS: In this single-center retrospective cohort study, we studied patients younger than 6 years admitted from the emergency department (ED) for UPs over a 5-year period to a quaternary-care children's hospital. Primary outcome was disposition (MB vs non-MB). Secondary outcomes included length of stay, escalation of inpatient care, 7-day readmission, and death. Covariates included age, certainty of ingestion, altered mental status, and ED provider training level. Subanalysis of drug class effect on disposition was also studied. Associations of clinical factors with MB placement were tested with multivariable logistic regression. RESULTS: Of 401 patients screened, 345 subjects met inclusion criteria. Most subjects (308 of 345 [89%]) were admitted to MBs. Children with high certainty of ingestion (adjusted odds ratio [aOR], 4.2; 95% confidence interval [CI], 1.52-11.58), altered mental status (aOR, 5.82; 95% CI, 2.45-13.79), and a fellow (vs faculty) ED provider (aOR, 2.34; 95% CI, 1.04-5.24) were more likely to be admitted to MBs. No escalations of care, readmissions, or deaths occurred. Exposures to cardiac drugs had increased MB placement (aOR, 6.74; 95% CI, 1.93-23.59). CONCLUSIONS: The majority of children admitted for UPs were placed in MBs. Regardless of inpatient placement, no adverse events were observed, suggesting opportunities for optimized resource utilization. Future research may focus on direct costs, inpatient interventions, or prospective outcomes to validate these findings.

Storage of Medications: A Survey of Families in the Pediatric Emergency Department.

OBJECTIVES: To evaluate caregivers' practice of prescription medication storage, particularly of opioid medications, as well as to provide educational materials to families about the opioid crisis. METHODS: Caregivers of patients in a pediatric emergency department were asked to participate in a survey about medication storage practices and beliefs, focusing on opioid medications. Data were collected through a survey documenting demographic data along with knowledge and behaviors of medication storage. Brief education about the US opioid crisis and safe storage was provided. RESULTS: In total, 233 families participated; 3 families declined; 11.5% of caregivers reported storing prescribed medications in a locked or latched place, although most store them "out of reach." Most believed their child or children's friends could not easily access their medications (81.8%). Families who did not keep their medications in locked or latched places had never thought about it (39.7%). In total, 33% of respondents were unaware of the opioid crisis; 87.4% of caregivers said they would use a medication lock box if given one. CONCLUSIONS: Many caregivers are not aware of the opioid crisis and do not keep opioid medications locked up. Half of the caregivers surveyed stated they "never thought about" locking up medications. Most parents would use a lock box if given to them. This opens the door to further study, education, and interventions.

Social Media Changes in Pediatric Residency Programs During COVID-19 Pandemic.

OBJECTIVE: To describe pediatric residency program's virtual presence and opportunities for the 2021 application cycle. METHODS: A total of 202 pediatric residency programs from the Electronic Residency Application Service (ERAS) were reviewed for departmental and residency Twitter, Instagram, and Facebook accounts. These accounts, residency websites, and the Visiting Student Application Service (VSAS) were reviewed for open house opportunities and virtual subinternships. All data were collected from October 12-15, 2020. RESULTS: A total of 261 social media accounts were identified. 123 (61%) programs had at least one account, with 32 (16%) programs having presence on all 3 platforms. 68 (34%) programs established new accounts after March 1, 2020. Instagram appeared most utilized with 106 (52%) programs having accounts. A total of 115 virtual open house opportunities were offered with most offers on Instagram by 61 (30%) programs. Only 2 virtual subinternships were listed on program websites, 2 on Twitter, 1 on Instagram, and 1 on Facebook. CONCLUSIONS: COVID-19 increased the number of social media accounts used by residency programs. Approximately one-third of all accounts were created after March 1, 2020. However, only 16% of residency programs have a presence on all 3 platforms, allowing for more online growth.

Descriptive Epidemiology of Pediatric Drowning Patients Presenting to a Large Southern US Children's Hospital.

OBJECTIVES: Drowning is the leading cause of death for children ages 1 to 4, and it is among the leading causes of death for children of all ages. National data show disparities in drowning risk for certain racial groups. This study aimed to describe characteristics of patients presenting after a drowning event to guide focused drowning prevention outreach efforts. METHODS: This was a retrospective chart review study designed to analyze the epidemiologic and demographic characteristics of drowning-related injuries and deaths that presented to a large, urban, southern US pediatric hospital from 2016 to 2019. All patients aged 0 to 19 years were identified using International Classification of Diseases, Ninth Revision and Tenth Revision codes for drowning or submersion injuries. RESULTS: One hundred sixty-two patients met the inclusion criteria for the study. Submersion injuries were most common in the 1- to 5-year-old age group. Fifty-eight percent of patients were male. The analysis of race showed that 65% of patients were White and 33% of patients were Black. Pools were the setting for 78% of drowning events. Fifty-four percent of patients received cardiopulmonary resuscitation. Sixty-four percent of patients required hospitalization after the injury. CONCLUSIONS: Characteristics of drowning victims may vary significantly from national data, depending on the area involved. This finding highlights the need for assessing local data to better inform local outreach. Further research is necessary to understand why such variance exists. Drowning prevention education, tailored toward pool safety and preschool-age children, should be a focus of injury prevention efforts.

Effect of lock boxes and education on safe storage of medications.

BACKGROUND: Safe medication storage is a proven barrier to ingestions in the pediatric population, but caregivers are often unaware of the importance of safe storage practices or do not have a safe place to store medications. Caregivers may also not be fully aware that the patterns of opioid use and misuse have recently reached crisis levels. The objectives of this study were to define medication storage practices and knowledge of the opioid crisis of participants and to assess the effectiveness of an emergency department intervention on safe medication storage. METHODS: This was a prospective interventional study of caregivers in an urban pediatric emergency department (ED) on safe medication storage and the opioid crisis. Questions assessed the caregivers' current perceptions and practices related to medication storage and disposal, and opioid crisis awareness. The intervention included verbal instruction about recommended safe storage methods and the opioid crisis, provision of a medication safety handout, and distribution of a medication lock box. A follow-up phone survey conducted 2 weeks later asked participants about use of and satisfaction with the lock box. Frequencies of safe storage behaviors were calculated, and the chi-square statistic was used to compare storage behavior after the intervention. RESULTS: Fifty caregivers of 112 children were enrolled. Only 4% reported they currently stored medications in a locked or latched place. Thirty-eight percent reported their main barrier to storing medications safely was that they did not have a locked or latched storage location. Fifty percent were unaware of the opioid crisis. Ninety-two percent reported they would use a lock box if given one. Twenty-eight participants (56%) responded to the follow-up phone call survey 2 weeks later. At follow up 90% (25/28) reported they placed their medications within the provided lock box (p < 0.00001). Ninety-two percent reported being "very satisfied" with the lock box and how it works. CONCLUSIONS: Despite widespread reporting on this issue, many caregivers remain unaware of safe medication storage practices and the opioid crisis. Providing medication lock boxes removes a commonly reported barrier to safely storing medications and improved reported practices.

Knowledge and management of sports concussions among coaches and certified athletic trainers in Alabama.

OBJECTIVES: To identify modifiable barriers in resources, knowledge, and management that may improve the care of young athletes with concussions in the state of Alabama. METHODS: An electronic survey was distributed to 2668 middle and high school coaches of contact sports in Alabama, and a paper survey was completed by 79 certified athletic trainers (ATCs) in 2010. Questions focused on their resource availability, knowledge of concussions based on the 2008 Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport (commonly known as the Zurich consensus statement), and management of concussions. RESULTS: A total of 402 (16% response rate) coaches and 55 ATCs (70% response rate) responded to the survey. This study highlights that ATC coverage often is limited to the high school level, football, and competitions. Both coaches and ATCs primarily use physicians to make return-to-play decisions, although coaches (43.7%) usually refer to primary care physicians, whereas ATCs (43.6%) refer to orthopedic or sports medicine physicians. The study also revealed that coaches and ATCs desire education and could expand concussion awareness by providing education to parents and athletes. No overall difference was seen in the knowledge and management of concussions between coaches and ATCs; however, ATCs were more likely to identify symptoms that are positive for concussions (P = 0.04). Both groups had difficulty recognizing subtle symptoms such as trouble sleeping, personality changes, and dizziness; they also were unaware that strenuous mental activities could delay concussion recovery, although ATCs scored significantly better than coaches (P < 0.001). Neither coaches nor ATCs consistently use standardized measures such as the Sports Concussion Assessment Tool 2 (7.5% vs 56.4%) or neuropsychological testing (5.3% vs 14.5%). CONCLUSIONS: This study describes coaches' and ATCs' varying knowledge and management techniques and highlights areas in which targeted interventions and outreach could be useful. These areas include increased ATC availability, coach/ATC concussion education, improved parent/athlete education, increased "return to think" awareness, and more consistent use of Sports Concussion Assessment Tool 2.

Emergency department poisoning visits in children younger than 6 years: comparing referrals by a regional poison control center to referrals by other sources.

OBJECTIVE: The study purpose was to compare medical appropriateness and costs of regional poison control center (RPCC) versus non-RPCC referrals to children's hospital emergency department (ED) for acute poison exposure. METHODS: This is a retrospective cross-sectional study of children (<6 years) during an 8-month period, who presented for poison exposure. Demographic and clinical patient characteristics were abstracted onto a uniform data form. Medical appropriateness was determined by presence of 1 of 4 criteria by 3 independent reviewers blinded to the patients' race, source of referral, charges, and disposition. RESULTS: Determination of medical appropriateness was matched by all 3 reviewers in 187 patients who make up the study population. There were 92 RPCC-referred cases and 95 non-RPCC-referred controls. Groups were comparable by age, sex, toxin, and symptoms. For RPCC referrals, 84 were self-transported, and 8 were transported by emergency medical services. For non-RPCC referrals, 60 were self-referred/transported, 26 were transported by emergency medical services, and 9 were physician referred. Regional poison control center referrals had a 39.1% higher rate of medical appropriateness than did non-RPCC referrals (odds ratio, 13.0; 95% confidence interval, 3.6-36.1). For this sample, mean charges for inappropriate ED poison exposure visits were $313.42, and the cost per RPCC call was $25, thus giving a potential return on investment of 12.54 to 1 favoring RPCC triage. CONCLUSIONS: When compared with other referral sources, RPCC triage results in fewer unnecessary ED visits in this age group. Increasing prehospital use of poison centers would likely decrease unnecessary ED referrals and related costs.

Comparison of two forms of albuterol for treatment of acute bronchospasm in pediatric patients.

BACKGROUND: The Circulaire nebulizer (C-Neb) is marketed as superior to low-dose albuterol for acute bronchospasm. METHODS: This clinical trial design compared clinical and fiscal outcomes of patients treated with C-Neb and high-dose albuterol (HDA). Eligibility criteria included reactive airway disease, age >5 years, and asthma score (AS) of 2 to 10. Patients with odd medical record numbers received HDA, and those with even numbers received C-Neb. Treatment was concluded if AS was 0, peak flow was >70% predicted, or after three treatments. RESULTS: One hundred eight patients were enrolled: 48 received HDA, 52 received C-Neb, and 8 were excluded. The two groups were comparable by admission rates (G2 = 0.90, P = 0.34), return visit rates (G2 = 0.73, P = 0.39), and final AS (z = 0.59, P = 0.55). Side effects were similar: change in heart rate (t = 1.61, P = 0.11) and mean arterial pressure (t = 1.36, P = 0.17). Charges per treatment, per delivery, and total charges were greater for HDA. CONCLUSION: The C-Neb is equally effective, has similar side effects, and requires less time and charges than HDA.

Pediatric emergency medicine fellowship training in the new millennium.

OBJECTIVE Fellowship training in pediatric emergency medicine has been available since the early 1980s. Its availability increased rapidly in the late 1980s and early 1990s, but its growth has been much slower in recent years. In this report, we characterize and compare the training programs of today to those that existed 10 years ago. Our study deals with program content and design, focusing on five aspects of fellowship training: demographics, curriculum, clinical emergency department time, research, and benefits. The data gathered in this study are meant to assist programs, both new and old, in enhancing their fellowship training.METHODS A 43-question survey was mailed to all known pediatric emergency medicine fellowship program directors in March of 2000. Two additional attempts were made to obtain survey responses. Forty of the 50 program directors responded, for a response rate of 80%. Statistical analysis was performed, and the data were compared with data that were gathered in two previous studies of fellowship training programs conducted in 1988 and 1991.RESULTS Fellowship training in pediatric emergency medicine continues to grow but at a slower pace than previously experienced. The number of training programs has increased by 27% over the past 10 years; however, the number of first-year positions has only increased by 15%. Clinical fellow supervision has increased significantly over the years, likely as a result of changes in reimbursement. In 1990, 75% of fellows worked unsupervised in the emergency department versus 23% of first-year fellows, 56% of second-year fellows, and 74% of third-year fellows in the year 2000. The structure of the fellowship curriculum has become more standardized during the past 10 years, with numerous core rotations required by most programs. The percentage of programs offering protected research time has changed significantly over the years, with the amount of time increasing from 40% in 1988, to 95% in 1990, to 100% in 2000. The amount of clinical time has also increased with the transition to a 3-year program.CONCLUSIONS Pediatric emergency medicine continues to expand as a pediatric subspecialty but at a slower rate. During the previous decade, fellowship training has become more structured, with greater emphasis being placed on fellow supervision, standardization of education, and research. These data are meant to assist new as well as established fellowship programs with the development of their training curriculum.