The adjuncts for endotracheal tube passage in simulated pediatric airways (AET-SPA) study.

Objectives: To investigate whether the use of adjuncts such as stylet, railroaded bougie, and preloaded bougie increases first-pass success rate and decreases time to successful intubation when intubating simulated infant airways using direct laryngoscopy. Methods: A crossover study using experienced practitioners (who were required to carry out emergency pediatric intubations as part of their usual practice) was completed. Participants completed a random sequence of 4 intubations in simulated "easy" airways and 4 intubations in simulated "difficult" airways, using naked endotracheal tube, stylet, railroaded bougie, and preloaded bougie on standardized infant airway manikins. First-pass success rates and times to successful intubations were measured. Results: From June 1 to December 30, 2019, 109 participants performed a total of 872 intubation attempts. In the easy airway, both naked endotracheal tube (mean 96.3% [95% confidence interval 90.9%-99.0%]) and stylet (mean 98.2% [95% confidence interval 93.5%-99.8%]) had higher first-pass success rates than railroaded bougie and preloaded bougie. In the difficult airway, stylet (mean 76.1% [95% confidence interval 67.0%-83.8%]) had the highest first-pass success rate, followed by the naked endotracheal tube, and then both the railroaded bougie and preloaded bougie. Differences in first-pass success rates were independent of the participants' numbers of previous pediatric intubations. Conclusion: Results of this simulation-based study suggest that stylet should be used as the first attempt technique for infant intubations regardless of the presence or absence of predicted airway difficulty. This finding needs further validation using alternative models and in non-simulation settings.

Quality in paediatric emergency medicine: Measurement and reporting.

There is a clear demand for quality in the delivery of health care around the world; paediatric emergency medicine is no exception to this movement. It has been identified that gaps exist in the quality of acute care provided to children. Regulatory bodies in Australia and New Zealand are moving to mandate the implementation of quality targets and measures. Within the paediatric emergency department (ED), there is a lack of research into paediatric specific indicators. The existing literature regarding paediatric acute care quality measures has been recently summarised, and expert consensus has now been reported. It is clear that there is much work to be performed to generalise this work to ED. We review suggestions from the current literature relating to feasible indicators within the paediatric acute care setting. We propose options to develop a quality 'scorecard' that could be used to assist Australian and New Zealand EDs with quality measurement and benchmarking for their paediatric patients.

Preventing child unintentional injury deaths: prioritizing the response to the New Zealand Child and Adolescent Injury Report Card.

OBJECTIVE: To develop recommendations for child unintentional injury prevention by comparing New Zealand's child unintentional injury mortality and injury prevention policies with those of European countries. METHODS: Unintentional child injury death rates based on external cause of injury were calculated and ranked. NZ's score for each of the 12 domains (based on external causes of injury) from the New Zealand Child and Adolescent Report Card was compared to European scoring. Policy priorities are identified by domains where mortality makes up a high proportion of overall child unintentional injury mortality (high burden of injury) and where report card score for that domain is low in comparison to other countries (under-utilisation of effective interventions). RESULTS: Death as a motor vehicle occupant accounts for 49% of all child unintentional injury deaths, followed by pedestrian (10%) and drowning deaths (8%). The overall score for the 12 policy domains of the NZ Report Card ranks NZ as 15(th) among the 25 European countries. There are important policy and legislative actions which NZ has not implemented. CONCLUSIONS: A number of evidence-based injury prevention policy and legislative actions are available that could target areas of greatest childhood injury mortality in NZ. IMPLICATIONS: A set of injury prevention policy and legislation priorities are presented which, if implemented, would result in a significant reduction in the injury mortality and morbidity rates of NZ children.

Child and adolescent injury report card: New Zealand 2009.

AIM: Injury is the leading cause of death of children and adolescents. Among the Organisation for Economic Co-operation and Development nations, New Zealand has the highest rate of child and adolescent injury death. This study aimed to evaluate the status of New Zealand's child and adolescent unintentional injury prevention. METHODS: The methodology of the European Child Safety Alliance Child Safety Report Card (completed for 24 countries in Europe, generating a standardised assessment of child and adolescent injury prevention) was applied to New Zealand's injury prevention position. New Zealand's position with regard to 102 questions (spanning 12 injury topics) was investigated. This information was systematically presented to a panel of child and adolescent injury experts, and agreed scores for each item were derived. RESULTS: New Zealand's overall score was 33/60. Deficiencies were identified across many injury prevention topics including passenger and driver safety, pedestrian safety, water safety, falls, poisoning, burns/scalds and choking/strangulation. New Zealand lacks a robust home visiting programme and injury prevention strategies with specific child and adolescent targets. CONCLUSIONS: New Zealand has not implemented a number of evidence-based injury prevention policies. The information from this study should be interpreted in conjunction with the epidemiology of child and adolescent injury in New Zealand. The Child Safety Report Card provides a useful methodology to guide a country's child and adolescent injury prevention policy direction.

Achieving a neutral cervical spine position in suspected spinal cord injury in children: analysing the use of a thoracic elevation device for imaging the cervical spine in paediatric patients.

BACKGROUND: Paediatric patients with suspected cervical spine injury (CSI) are routinely immobilised on a firm surface using a hard collar, which results in excessive flexion of the cervical spine due to the relatively large size of the occiput. The objective of this study was to determine whether the use of a thoracic elevation device (TED) results in a more neutral cervical spine position and reduces the occurrence of cervical spine hyperflexion. METHODS: A prospective cohort study was conducted at two Emergency Departments (sites A and B) from January 2006 to May 2007. Children < or =10 years of age with suspected CSI requiring cervical imaging were included. Those at site A received a wedge-shaped TED and those at site B did not. x-Rays from both sites were analysed for flexion, extension or neutrality of the cervical spine as defined by the Cobb angle. RESULTS: A total of 76 patients were identified at site A and site B. There were four exclusions at each site for poor quality images. 51 patients in the site A group were found to be in neutral position (71%), compared to 29 patients in the site B group (43%) (p=0.001). One patient (1%) who had a TED was found to be hyperflexed (>10 degrees), whereas 12 (18%) patients at site B were hyperflexed (p=0.001). CONCLUSIONS: The use of a TED appears to produce a greater proportion of neutral cervical spine films in children < or =10 years of age presenting for suspected CSI.

Ontology-based modeling of clinical practice guidelines: a clinical decision support system for breast cancer follow-up interventions at primary care settings.

Breast cancer follow-up care can be provided by family physicians after specialists complete the primary treatment. Cancer Care Nova Scotia has developed a breast cancer follow-up Clinical Practice Guideline (CPG) targeting family physicians. In this paper we present a project to computerize and deploy the said CPG in a Breast Cancer Follow-up Decision Support System (BCF-DSS) for use by family physicians in a primary care setting. We present a semantic web approach to model the CPG knowledge and employ a logic-based proof engine to execute the CPG in order to infer patient-specific recommendations. We present the three stages of the development of BCF-DSS--i.e., (a) Computerization of the paper-based CPG for Breast Cancer follow-up; (b) Development of three ontologies--i.e., the Breast Cancer Ontology, the CPG ontology based on the Guideline Element Model (GEM) and a Patient Ontology; and (c) Execution of the Breast Cancer follow-up CPG through a logic-based CPG execution engine.