scholarly journals Practice variability in the management of complex febrile seizures by pediatric emergency physicians and fellows

CJEM ◽  
2011 ◽  
Vol 13 (03) ◽  
pp. 145-149 ◽  
Author(s):  
Justin W. Sales ◽  
Blake Bulloch ◽  
Mark A. Hostetler
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Lumbar Puncture ◽  
Online Survey ◽  
Admission Rate ◽  
Febrile Seizures ◽  
Pediatric Emergency ◽  
Pediatric Emergency Medicine ◽  
Case Vignettes ◽  
Department Evaluation

ABSTRACT Objective: Febrile seizures are the most common type of childhood seizure and are categorized as simple or complex. Complex febrile seizures (CFSs) are defined as events that are focal, prolonged (> 15 minutes), or recurrent. The management of CFS is poorly defined. The objective of this study was to determine the degree of variability in the emergency department evaluation of children with CFSs. Methods: An online survey questionnaire was developed and sent to physicians identified via the listserv of the emergency medicine section of the American Academy of Pediatrics and the pediatric emergency medicine discussion list. The questionnaire consisted of five hypothetical case vignettes describing children under 5 years of age presenting with a CFS. Following review of the first four vignettes, participants were asked if they would (1) obtain blood and urine for evaluation; (2) perform a lumbar puncture; (3) perform neurologic imaging while the child was in the emergency department; (4) admit the child to the hospital; or (5) discharge with follow-up as an outpatient, with either the primary care provider or a neurologist. The final vignette determined if antiepileptic medication would be prescribed by the physician on discharge. Results: Of the 353 physicians who participated, 293 (83%) were pediatric emergency medicine attending physicians and 60 (17%) were pediatric emergency medicine fellows. Overall, 54% of participants indicated that they would obtain blood for evaluation, 62% would obtain urine, 34% would perform a lumbar puncture, and 36% would perform neurologic imaging. The overall hypothetical admission rate for the case vignettes was 42%. Conclusions: This study indicates that extensive variability exists in the emergency department approach to patients with CFS. Our findings suggest that optimal management for CFS remains unclear and support the potential benefit of future prospective studies on this subject.

scholarly journals How to conduct implementation trials and multicentre studies in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (3) ◽  
pp. 448-452
Author(s):  
Ian G. Stiell ◽  
Jeffrey J. Perry ◽  
Jamie Brehaut ◽  
Erica Brown ◽  
Janet A. Curran ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Implementation Research ◽  
Pediatric Emergency ◽  
Research Infrastructure ◽  
Pediatric Emergency Medicine ◽  
Structured Interviews ◽  
Local Study ◽  
Multicentre Studies ◽  
Implementation Studies

AbstractObjectiveThe objective of Panel 2b was to present an overview of and recommendations for the conduct of implementation trials and multicentre studies in emergency medicine.MethodsPanel members engaged methodologists to discuss the design and conduct of implementation and multicentre studies. We also conducted semi-structured interviews with 37 Canadian adult and pediatric emergency medicine researchers to elicit barriers and facilitators to conducting these kinds of studies.ResultsResponses were organized by themes, and, based on these responses, recommendations were developed and refined in an iterative fashion by panel members.ConclusionsWe offer eight recommendations to facilitate multicentre clinical and implementation studies, along with guidance for conducting implementation research in the emergency department. Recommendations for multicentre studies reflect the importance of local study investigators and champions, requirements for research infrastructure and staffing, and the cooperation and communication between the coordinating centre and participating sites.

scholarly journals A Roadmap for the Student Pursuing a Career in Pediatric Emergency Medicine

2019 ◽  
Vol 21 (1) ◽  
pp. 12-17
Author(s):  
Aaron Leetch ◽  
Joshua Glasser ◽  
Dale Woolridge
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Critical Care ◽  
Comparative Analysis ◽  
Training Programs ◽  
Pediatric Emergency ◽  
Pediatric Emergency Medicine ◽  
Pediatric Residency ◽  
Minimum Requirements ◽  
The Difference

Introduction: Three pathways are available to students considering a pediatric emergency medicine (PEM) career: pediatric residency followed by PEM fellowship (Peds-PEM); emergency medicine residency followed by PEM fellowship (EM-PEM); and combined EM and pediatrics residency (EM&Peds). Questions regarding differences between the training pathways are common among medical students. We present a comparative analysis of training pathways highlighting major curricular differences to aid in students’ understanding of these training options. Methods: All currently credentialed training programs for each pathway with curricula published on their websites were included. We analyzed dedicated educational units (EU) core to all three pathways: emergency department (ED), pediatric-only ED, critical care, and research. Minimum requirements for primary residencies were assumed for fellowship trainees. Results: Of the 75 Peds-PEM, 34 EM-PEM, and 4 EM&Peds programs screened, 85% of Peds-PEM and EM-PEM and all EM&Peds program curricula were available for analysis. Average Peds-PEM EUs were 20.4 EM, 20.1 pediatric-only EM, 5.8 critical care, and 9.0 research. Average EM-PEM EUs were 33.2 EM, 18.3 pediatric-only EM, 6.5 critical care, and 3.3 research. Average EM&Peds EUs were 26.1 EM, 8.0 pediatric-only EM, 10.0 critical care, and 0.3 research. Conclusion: All three pathways exceed pediatric-focused training required for EM or pediatric residency. Peds-PEM has the most research EUs, EM-PEM the most EM EUs, and EM&Peds the most critical care EUs. All prepare graduates for a pediatric emergency medicine career. Understanding the difference in emphasis between pathways can inform students to select the best pathway for their own careers.

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