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Background and Aims

Early signs of clinical worsening in children are often missed. To describe criteria relating to admission and discharge to inpatient pediatric context and evaluate potential clinical indices in predicting deterioration and triggering timely interventions.

Methods

All children aged <16 years attended pediatric ER and admitted to ward from July to October 2017 were prospectively enrolled. Predictors, such as demographics, comorbidities, vital signs, and Pediatric Early Warning System (PEWS) scoring were associated with clinical outcome after 48 hours. Data collected in a spreadsheet database and analysed using IBM SPSS Statistics software.

Results

Our study comprised 413 patient visits. Mean age was 5.3±4.5, 216 (52.3%) were males. Mean PEWS score was 2.2±1.6; high-risk patients (scored ≧5) were 34 (8.2%). Majority of subjects (251 cases, 60.8%) exhibited improvement after 48 hours. No death was reported. Improvement was noted in 175 (71.7%) low-risk, 69 (51.1%) medium-risk and 7 (20.6%) high-risk subjects. There was a statistically significant difference between risk proportion and 48-hour outcome (p<0.001).

Conclusions

Our study shows that PEWS performs well in predicting hospital admission and outcome. PEWS may be embraced as a part of everyday clinical practice and be well-accepted in a wider safety culture by staff.

Background and Aims

Resuscitation rooms (RR) are the mainstay of Paediatric Emergency Care. Despite this, few studies describe its patients’ conditions and prognosis. We aim to describe the most frequent motives for admission to RR and the main predictors of subsequent admittance to PICU.

Methods

Data concerning all patients under 18 years of age admitted to a tertiary hospital’s RR during a four-year period was retrospectively collected and analysed.

Results

During this period, 363 patients were admitted to our RR. Main causes for admission were active seizures (AS) (35%) and severe traumatic brain injuries (TBI) (18.8%). 44.1% were admitted to the PICU. Multivariate analysis through binary logistic regression determined that, concerning the likelihood of ICU admission, admittance with spinal board (p=0.012, odds ratio 5.7) and ventilatory support requirement (p=0.001, OR 17.1) were independent positive risk factors; being a frequent user of emergency services (p=0.016, OR 0.27) and admission for AS (p=0.007, OR 0.16) were negative risk factors. Trauma patients were the ones most likely to be admitted to the PICU (p<0.001) [among these, TBI was the most frequent cause for admission (p<0.001)]. Concerning length of PICU stay, the occurrence of cardiorespiratory arrest predicted a longer stay (p=0.023), while admittance due to an active seizure correlated to a relatively shorter stay (p=0.035).

Conclusions

In line with previous literature, we conclude that trauma (especially TBI) is a major cause of RR and PICU admission. Healthcare professionals working in this setting must be familiar with this condition. The importance of regular training sessions, including simulations, cannot be overlooked.

Background and Aims

Paediatric out-of-hospital cardiac arrest (POHCA) has a survival of <10% .There are limited epidemiological studies of POHCA. To enable future large-scale epidemiological studies of POHCA, we evaluated the International Classification of Diseases Tenth Revision (ICD-10) coding system to accurately identify POHCA patients using a local registry of POHCA (CanRoc) as the reference standard.

Methods

The reference cohort included all atraumatic POHCA in London-Middlesex region for 2012-2020. All algorithms included patients transported to emergency department (ED) by ambulance, were 1 day to <18 years and excluded trauma. We tested 3 algorithms against the reference standard using various combinations of ICD-10 codes for cardiac arrest and CPR in the National Ambulatory Care Reporting System and Discharge Abstract Database. For each algorithm’s test-positive cohort, a 2 x 2 table was constructed with the reference standard to determine performance of each algorithm in identifying POHCA.

Results

There were 51 patients in the reference cohort. The algorithm restricted to major diagnosis of cardiac arrest from ED records had a sensitivity of 58.8% for identifying POHCA. The best performing algorithm, which also included sudden infant death syndrome, drowning or asphyxiation with CPR and inpatient records for prior CA, had a sensitivity of 88.2%, specificity of 99.9%, positive predictive value of 72.6% and negative predictive value of 99.9%.

Conclusions

It is important to accurately identify cases using validated algorithms when creating a cohort. The ICD-10 code for cardiac arrest in emergency department records alone misses many POHCA cases but additional codes can improve the sensitivity and maintain specificity.

Background and Aims

Introduction: The novel coronavirus disease 2019 (COVID-19) can be transmitted to clinicians involved in their care, particularly during aerosol-generating procedures (such as, Positive pressure ventilation (PPV), endotracheal intubation and extubation).

Objectives:To demonstrate Covid19 specific steps for PPV , intubation and extubation to prevent transmission of infection to care providers through simulation courses and video demonstration of the process

Methods

Simulation training courses were conducted through video demonstration to pediatric health workers including pediatric Intensive care and emergency physicians, nurses and respiratory therapy teams emphasizing on Guideline for Airway Management and PPE of confirmed or suspected COVID-19 Pediatric patients. then questioneer was distributed to assess knowledge and skills of involved medical practitioner.

The simulation courses and the videoes demonstrate on How to do PPE Donning, Doffing, how to safly manage airway for suspected or confirmed covid-19 patients during intubation and extubation.

Results

preliminary results showed 50 candidates responded to the questioneer from diffrent categories i.e physicians, nurses, respiratory therapiest

more than 95% found the simulation courses and the video demonstration is very helpful

95% could follow the guidline properly for donning, doffing Intubation and extubation as learned in the simulation courses

90% succeded the intubation and extubation procedures as the guidline

Conclusions

simulation training or video demonstration on proper PPE and Airway managment for confirmed and suspected COVID-19 plus adding video demonstration as barcode to the guidline had helped to improve the knowledge and the skills of medical practitioners

Background and Aims

When critical care patients are discharged to ward-level care it is important that the receiving team have a handover for continuity of care and patient safety. This study aims to assess the effectiveness of a tailor-made targeted intensive intervention on improving handover communications for critical care discharges.

Methods

A prospective quality improvement project was conducted. A pre-designed questionnaire was used to collect data on verbal and written communications of the discharge handover from critical care to the ward and asking for suggestions to improve the process. The questionnaire was distributed electronically to middle-grade trainees (n = 26) working respectively in critical care and the ward at study baseline and 1 month post-intervention. A tailor-made targeted intensive intervention including educational resources to improve the discharge handover was delivered to the critical care team.

Results

A written handover was consistently reported to be present amongst critical care trainees (90%) and the ward trainess (93%) at baseline, which improved to 100% amongst the critical care team following the intervention. However, only 70% of critical care trainees recalled giving a verbal handover and 50% of the ward trainees had recollection of receiving one at baseline. This improved after the study intervention, with 71% of ward trainees reporting they always received a verbal handover of patients.

Conclusions

A discord exists amongst the critical care trainees and the receiving teams’ trainees recall of a verbal discharge handover. A simple targeted intensive intervention can improve this process and recollection.