Psychosocial Care Models for Families of Critically Ill Children in Pediatric Emergency Department Settings: A Scoping Review

Introduction: Endotracheal intubation (ETI) of critically ill children is a high acuity, low frequency procedure in the pediatric emergency department that presents unique challenges to both pediatric and general acute care providers. COVID-19 and the associated requirements for PPE use, limitations of in-room personnel, communication difficulties, and reorganization of equipment have created new complexities. Objective: To use video review to compare intubator training level, first-attempt ETI success and presence of hypoxia during ETI attempts in the pediatric emergency department in the pre-COVID and COVID era. Methods: This is a retrospective multi-center case series of videorecordings of endotracheal intubations at the four tertiary care pediatric emergency departments comprising the VIPER Collaborative. All children undergoing emergent ETI between 1/1/2019-6/1/2020 in whom videorecordings were available were included for analysis. Data on patient age and intubator background was collected. Outcomes were first-attempt intubation success and hypoxia, defined as SpO2 <90%. Data was compared before (PRE) and after (POST) implementation of COVID-19 airway protocols, which each PED adopted in March 2020. Univariate analysis comparing PRE and POST for both outcomes was done by c2 testing. Multivariate analysis with a generalized estimating equation to control for clustering by site was done to determine the independent association between PRE and POST and outcomes. Results: Between 1/1/2019 and 6/1/2020, a total of 272 patients underwent ETI (239 PRE, 33 POST). Overall first attempt success was 155/239 (65%) in PRE and 28/33 (85%) in POST (p=0.02). Hypoxia was noted in 15% of PRE patients and in 12% of POST patients. Analysis of the training level of the intubator was notable for a significant increase in the number of intubations performed by anesthesiologists (55% POST vs. 13% PRE, p<0.001). In multivariate analysis controlling for intubator background, the POST phase was associated with greater first attempt success (AOR 2.4, 95% CI 1.6 – 3.7). Conclusion: Pediatric ETI in the COVID-19 era is associated with increased first attempt success when compared to the pre-COVID era.

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Relative Productivity of Nurse Practitioner and Resident Physician Care Models in the Pediatric Emergency Department

Pediatric Emergency Care ◽

10.1097/pec.0000000000000349 ◽

2015 ◽

Vol 31 (2) ◽

pp. 101-106 ◽

Cited By ~ 8

Author(s):

William M. McDonnell ◽

Pamela Carpenter ◽

Kammy Jacobsen ◽

Howard A. Kadish

Keyword(s):

Emergency Department ◽

Nurse Practitioner ◽

Pediatric Emergency ◽

Resident Physician ◽

Pediatric Emergency Department ◽

Care Models ◽

Physician Care ◽

Relative Productivity

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Epidemiology of Pediatric Critically-ill Patients Presenting to the Pediatric Emergency Department

Klinische Pädiatrie ◽

10.1055/s-0032-1331168 ◽

2013 ◽

Vol 225 (01) ◽

pp. 18-23 ◽

Cited By ~ 8

Author(s):

W.-C. Yang ◽

Y.-R. Lin ◽

L.-L. Zhao ◽

Y.-K. Wu ◽

Y.-J. Chang ◽

...

Keyword(s):

Emergency Department ◽

Critically Ill ◽

Critically Ill Patients ◽

Pediatric Emergency ◽

Pediatric Emergency Department

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Critically Ill Children in a Swiss Pediatric Emergency Department With an Interdisciplinary Approach: A Prospective Cohort Study

Frontiers in Pediatrics ◽

10.3389/fped.2021.721646 ◽

2021 ◽

Vol 9 ◽

Author(s):

Leopold Simma ◽

Martin Stocker ◽

Markus Lehner ◽

Lea Wehrli ◽

Franziska Righini-Grunder

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Critically Ill ◽

Pediatric Intensive Care ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

Inclusion Criteria ◽

Cns Disorders ◽

High Acuity ◽

Scale Category

Objective: Delivery of prompt and adequate care for critically ill and injured children presenting to the pediatric emergency department (PED) is paramount for optimal outcomes. Knowledge of the local epidemiology, patient profile, and presentation modes are key for organizational planning, staff education strategy, and optimal care in a PED. Our aim was to analyze the profile of critically ill and injured children admitted to a tertiary, non-academic Swiss PED, to investigate potential risk factors associated with admission to the pediatric intensive care unit (PICU), and the outcomes mortality and PICU admission.Methods: Prospective cohort study of critically ill and injured children presenting to the PED over a two-year period (2018–2019). Inclusion criteria were Australasian triage scale category (ATS) 1, trauma team activation (TTA), medical emergency response (MER) activation, additional critical care consult, and transfer to an outside hospital.Results: Of 42,579 visits during the two-year period, 347 presentations matched the inclusion criteria (0.81%). Leading presentations were central nervous system (CNS) disorders (26.2%), trauma (25.1%), and respiratory emergencies (24.2%). 288 out of 347 cases (83%) arrived during the day or evening with an even distribution over the days of the week. 128 out of 347 (37%) arrived unexpectedly as walk-ins. 233 (67.15%) were ATS category 1. 51% of the cohort was admitted to PICU. Australasian triage scale category 1 was significantly more common in this group (p = 0.0001). Infants with respiratory disease had an increased risk of PICU transfer compared to other age groups (OR 4.18 [95%CI 2.46, 7.09] p = 0.0001), and this age group presented mainly as walk-in (p = 0.0001). Pediatric intensive care unit admissions had a longer hospital stay (4 [2, 8] days vs. 2 [1, 4] days, p = 0.0001) compared to other patients. 0.045% of all PED patients had to be transferred out. Three deaths (0.86%) occurred in the PED, 10 patients died in the PICU (2.9%).Conclusions: High acuity presentations in the PED were rare, more likely to be young with CNS disorders, trauma and respiratory diseases. A significant proportion were unexpected walk-in presentations, mainly during day and evening shifts. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED.

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