A Modified Delphi Study for Development of a Pediatric Curriculum for Emergency Medicine Residents.

OBJECTIVES: Emergency medicine (EM) trainees are expected to learn to provide acute care for patients of all ages. The American Council for Graduate Medical Education provides some guidance on topics related to caring for pediatric patients; however, education about pediatric topics varies across residency programs. The goal of this project was to develop a consensus curriculum for teaching pediatric emergency care. METHODS: We recruited 13 physicians from six academic health centers to participate in a three-round electronic modified Delphi project. Participants were selected on the basis of expertise with both EM resident education and pediatric emergency care. The first modified Delphi survey asked participants to generate the core knowledge, skills, and experiences needed to prepare EM residents to effectively treat children in an acute care setting. The qualitative data from the first round was reformulated into a second-round questionnaire. During the second round, participants used rating scales to prioritize the curriculum content proposed during the first round. In round 3, participants were asked to make a determination about each curriculum topic using a three-point scale labeled required, optional, or not needed. RESULTS: The first modified Delphi round yielded 400 knowledge topics, 206 clinical skills, and 44 specific types of experience residents need to prepare for acute pediatric patient care. These were narrowed to 153 topics, 84 skills, and 28 experiences through elimination of redundancy and two rounds of prioritization. The final lists contain topics classified by highly recommended, partially recommended, and not recommended. The partially recommended category is intended to help programs tailor their curriculum to the unique needs of their learners as well as account for variability between 3- and 4-year programs and the amount of time programs allocate to pediatric education. CONCLUSION: The modified Delphi process yielded the broad outline of a consensus core pediatric emergency care curriculum.

Globe rupture and nonaccidental trauma: two case reports.

The association of globe rupture and nonaccidental trauma is not established in the literature. We present 2 cases involving a 9-month-old infant girl and a 14-month-old girl who experienced inflicted traumatic globe rupture. In the first case, the infant had isolated eye findings on physical examination, but extensive injuries were revealed on the skeletal survey and computed tomography of the head. In the second case, the toddler had a prior history of abuse, so our index of suspicion for nonaccidental trauma was heightened. Despite isolated eye findings on physical examination, this toddler also had evidence of additional injury on skeletal survey. These cases illustrate the importance of considering nonaccidental trauma in infants and toddlers who present with globe rupture and performing a complete evaluation for child abuse if no history is given or if the history is inconsistent with the injury.

Brief focal ultrasound with topical anesthetic decreases the pain of intravenous placement in children.

OBJECTIVE: To determine whether brief, focal pretreatment of children's skin with low-frequency ultrasound followed by a 5-minute application of a 4% lidocaine topical anesthetic decreases the pain of intravenous (IV) catheter placement. METHODS: A randomized, double-blind, placebo-controlled trial enrolling children 8 to 18 years of age undergoing IV placement as part of their care in a pediatric emergency department. Thirty-eight children received pretreatment followed by 5-minute application of a topical anesthetic. Thirty-nine children received pretreatment followed by 5-minute application of a placebo cream. Children and parents rated the pain associated with IV placement using the visual analog scale (VAS). RESULTS: There were no significant differences in demographics between the 2 groups. Children in the treatment group had significantly lower VAS scores (mean, 2.29) than children in the control group (mean, 3.23) (P = 0.023; 95% confidence interval of the mean difference, -1.87 to -0.02). The parents' VAS scores of the child's pain were also lower for the treatment group (mean, 2.47 vs 3.39; P = 0.038; confidence interval, -1.97 to 0.11). CONCLUSIONS: Visual analog scale scores measuring children's pain and parents' perception of the child's pain were lower in those who were pretreated with brief focal ultrasound and 5 minutes of 4% lidocaine cream when compared with those pretreated with ultrasound and placebo.

Emergency department visits for sledding injuries in children in the United States in 2001/2002.

OBJECTIVES: To describe the characteristics of nonfatal sledding-related injuries in U.S. children resulting in emergency department (ED) visits in 2001/2002 and to explore the implications of these findings for injury prevention efforts. METHODS: A stratified probability sample of U.S. hospitals providing emergency services in the National Electronic Injury Surveillance System-All Injury Program was utilized for 2001/2002. ED visits resulting from injuries involving sleds, snow discs, snow tubes, and toboggans were analyzed for patients 19 years of age or younger. RESULTS: In 2001/2002, there were an estimated 57,866 ED visits for sledding-related injuries in the United States for all age groups. Of these, 41,272 (71%) occurred in patients 19 years of age or younger, 58% of whom were male. The highest number of injuries occurred in children between five and 14 years of age (74%), and the injuries were most often caused by falls or collisions (75%). The head or neck was the most frequently injured body region among those 0-9 years of age, while the extremities were injured most commonly among those 10-19 years of age. Head and neck injuries occurred in 56% (95% confidence interval [CI] = 32% to 81%) of children 0-4 years of age versus 19% (95% CI = 9% to 29%) of patients 15-19 years of age. Nine percent (95% CI = 6% to 12%) of patients sustained a traumatic brain injury. Three percent (95% CI = 1% to 5%) of patients required admission to the hospital. CONCLUSIONS: Sledding injuries resulting in ED visits predominantly affect children and are a source of measurable morbidity in this population. An increase in injury prevention efforts for this activity is warranted.