Reed, JL; Punches, BE; Taylor, RG; Macaluso, M; Alessandrini, EA; Kahn, JA. A Qualitative Analysis of Adolescent and Caregiver Acceptability of Universally Offered Gonorrhea and Chlamydia Screening in the Pediatric Emergency Department. Annals of Emergency Medicine. 2017; 70(6):787-796.e2.
More than 19 million new sexually transmitted infections are diagnosed annually in the United States, with nearly half occurring in individuals aged 15 to 24 years. Early identification of adolescents with gonorrhea and chlamydia can improve long-term sexual health. This study used a convenience sample of 40 adolescents in two pediatric EDs to qualitatively explore adolescent and parent/guardian attitudes regarding benefits and barriers to pediatric ED based universally offered gonorrhea and chlamydia screening and modalities for assessing interest in screening. Nearly all adolescent and parents/guardians supported universally offered gonorrhea and chlamydia screening and indicated that using a tablet-based method to assess interest in screening may overcome identified confidentiality and embarrassment concerns and thus potentially increase participation. This study informs preferred future ED implementation methods for universally offered gonorrhea and chlamydia screening.
Riney, LC; Frey, TM; Fain, ET; Duma, EM; Bennett, BL; Kurowski, E. Standardizing the Evaluation of Nonaccidental Trauma in a Large Pediatric Emergency Department. Pediatrics. 2018; 141(1).
Variability exists in the evaluation of non-accidental trauma (NAT) in the pediatric emergency department because of misconceptions and individual bias of clinicians. Further maltreatment, injury, and death can ensue if these children are not evaluated appropriately. Our quality improvement team aimed to implement interventions to increase the percent of patients evaluated in the emergency department for NAT who receive guideline-adherent evaluation from 47% to 80% by December 31, 2016. A total of 640 encounters had provider concern for NAT and were included in the analysis. Adherence to age-specific guideline recommendations improved from a baseline of 47% to 69%. With our improvement methodology, we successfully increased guideline-adherent evaluation for patients with provider concern for NAT; education and electronic support at the point of care were key drivers for initial implementation.
Schumacher, DJ; Michelson, C; Poynter, S; Barnes, MM; Li, ST; Burman, N; Sklansky, DJ; Thoreson, L; Calaman, S; King, B; Schwartz, A; Grp, A; Elliott, S; Sharma, T: Gonzalez Del Rey, J; Bartlett, K; Scott-Vernaglia, SE; Gibbs, K; McGreevy, JF; Garfunkel, LC; Gellin, C; Frohna, JG. Thresholds and interpretations: How clinical competency committees identify pediatric residents with performance concerns. Medical Teacher (Informa). 2018; 40(1):70-79.
Clinical competency committees (CCCs), which review resident performance data to make summative decisions, are now a requirement for residency training programs.  However, little is known about the optimal structure, review process, and data reviewed to maximize the utility of their work.  This paper, the first of 5 papers from a 14-site study led by Dr. Schumacher, explored how CCC members identify residents with performance concerns.  Early identification of these residents is important for intervening early to help them.  This study found, among other things, that written comments, performance extremes, and developmental trajectory are important to identifying residents with performance concerns.  These findings highlight strategies that can be used by CCCs in their efforts to identify and help residents develop.
Florin, TA; Ambroggio, L; Brokamp, C; Rattan, MS; Crotty, EJ; Kachelmeyer, A; Ruddy, RM; Shah, SS. Reliability of Examination Findings in Suspected Community-Acquired Pneumonia. Pediatrics. 2017; 140(3):e20170310-e20170310.
National guidelines for diagnosis of community acquired pneumonia (CAP) in children recommend use of history and physical examination to support the diagnosis in lieu of chest radiograph. This prospective study of 128 children 3 months to 18 years of age with suspected CAP examined the interrater reliability of physical exam findings commonly used in the diagnosis of childhood CAP. There was fair to moderate reliability among most findings. Of 19 findings examined, only two (retractions and wheezing) had moderate to substantial agreement. Only 3 examination findings had acceptable reliability (lower bound of 95% confidence limit of kappa>0.4) – wheezing, retractions, respiratory rate. The limited reliability of examination findings must be considered in the clinical management and research of pediatric CAP.
Johnson, LH; Beck, AF; Kahn, RS; Huang, B; Ryan, PH; Olano, KK; Auger, KA. Characteristics of Pediatric Emergency Revisits After an Asthma-Related Hospitalization. Annals of Emergency Medicine. 2017; 70(3):277-287.
We reported on a population-based, prospective, observational cohort hospitalized for asthma at an urban pediatric facility and followed for greater than or equal to 12 months, with the goal of identifying and describing predictors for asthma-related emergency revisit within 12 months of discharge. More than 40% of admitted asthmatics returned to the ED within 12 months. In adjusted models, younger children, black children, children with excellent reported access to primary care, and children with a history of inhaled steroids were more likely to experience emergency revisits. Socioeconomic and exposure-related risk factors typically predictive of asthma morbidity were not independently associated with emergency revisit among children in this cohort.