Benjamin Nti

Background: Existing literature indicates that patients respond positively to point‐of‐care ultrasound (POCUS) across various clinical settings. However, limited research explores how patient‐families perceive its use in pediatric emergency department (ED) care. Our study aims to evaluate POCUS's impact on patient experience, stress, and anxiety in the pediatric ED. Methods: We conducted a randomized study (1:1) of pediatric patients (≤ 17 years) presenting with a clinical indication for POCUS (lung, FAST, cardiac, or soft tissue applications). Patients were assigned to either a POCUS or non‐POCUS group, excluding those who were unstable or had prior POCUS evaluations. Patient‐families completed pre‐ and post‐surveys (5‐point Likert scale) at triage and ED disposition. Demographic data were obtained from the electronic medical record. Statistical analyses included Chi‐Square, Fisher's Exact, Wilcoxon, and sign tests ( α = 0.05) to compare group responses and assess for changes in responses over time. Results: A total of 200 patient‐families were enrolled. The cohort was primarily English‐speaking, non‐Hispanic White males, with an average age of 5.16 years (SEM ±0.37). Common chief complaints included cough (34%), fever (15%), abdominal pain (14%), and shortness of breath (13%). No significant differences were observed in patient experience or ED length of stay. Sign tests indicated significant reductions in stress and anxiety within both groups from pre‐ to post‐survey assessments [Anxiety: p < 0.0001 (POCUS), p = 0.0003 (non‐POCUS); Stress: p < 0.0001 (POCUS), p < 0.0001 (non‐POCUS)]. POCUS patient‐families reported a significantly greater perceived importance of imaging and stated that POCUS directly alleviated their stress and anxiety. Conclusion: The primary outcome, magnitude of change in stress and anxiety, demonstrated significant reductions in both POCUS and non‐POCUS groups. Despite similar findings within each group, families receiving POCUS reported greater perceived importance of imaging and strong support for its use, highlighting its potential to enhance patient‐centered care and support further research into its optimal implementation in pediatric emergency care.

Anaphylaxis is a common, severe, and life-threatening allergic reaction that occurs rapidly after exposure to an allergen which can affect multiple systems in the body. In rare cases, it may lead to additional neurological manifestations that are poorly understood. We present a case of a 14-year-old boy who experienced severe anaphylaxis necessitating airway intervention and admission to critical care. While his initial presentation and treatment aligned with current standards, he subsequently developed prolonged neurological deficits, including weakness, prosopagnosia, amnesia, and loss of basic functions, during an extended recovery period. This rare neurological manifestation following anaphylaxis may be overlooked by many clinicians. Therefore, it is imperative to highlight this potential complication to improve the management of patients experiencing anaphylaxis.

Background: Ultrasound has established utility within pediatric emergency medicine and has an added benefit of avoiding excessive radiation exposure. The serial focused assessment with sonography in trauma (sFAST) examination is a potential alternative to improve pediatric trauma evaluation. We sought to evaluate the accuracy of sFAST in pediatric patients with blunt abdominal trauma. Methods: We performed a multicenter, retrospective observational study of electronic medical records, trauma registry data, and image archiving records of previous sFAST examinations. Examinations from pediatric patients (18 years or younger) who presented to an emergency department with blunt abdominal trauma were eligible for inclusion as long as the period between the first and second FAST was at least 30 minutes but no more than 24 hours. Demographic data and patient and outcomes were collected. Results: Data collected from 3 institutions found a total of 38 sFAST performed between July 2017 and September 2021 on eligible patients. Of these, there were 6 (15.4%) FAST examinations that were positive after an initial negative or indeterminate interpretation. The overall sensitivity and specificity of sFAST were 66.7% (95% confidence interval 22.3–95.7%) and 93.8% (79.2–99.3%), respectively. Conclusions: This pilot study found that sFAST can enhance blunt trauma evaluation and improve sensitivity and diagnostic accuracy. More data are needed to determine how sFAST can be utilized in pediatric patients with blunt abdominal trauma.

Background Anaphylaxis is a common yet severe yet life-threatening allergic reaction that occurs rapidly after exposure to an allergen which can affect multiple system in the body. In rare cases, it may lead to additional neurological manifestation that is poorly understood. Case Presentation: We present a case of a 14-year-old boy who experienced severe anaphylaxis necessitating airway intervention and admission to critical care. While his initial presentation and treatment aligned with current standards, he subsequently developed prolonged neurological deficits, including weakness, prosopagnosia, amnesia, and loss of basic functions, during an extended recovery period. Conclusion This rare neurological manifestation following anaphylaxis may be overlooked by many clinicians. Therefore, it is imperative to highlight this potential complication to improve the management of patients experiencing anaphylaxis.

Objective: Point‐of‐care ultrasound (POCUS) is a core component of emergency medicine (EM) residency training. No standardized competency‐based tool has gained widespread acceptance. The ultrasound competency assessment tool (UCAT) was recently derived and validated. We sought to externally validate the UCAT in a 3‐year EM residency program.Methods: This was a convenience sample of PGY‐1 to ‐3 residents. Utilizing the UCAT and an entrustment scale, as described in the original study, six different evaluators split into two groups graded residents in a simulated scenario involving a patient with blunt trauma and hypotension. Residents were asked to perform and interpret a focused assessment with sonography in trauma (FAST) examination and apply the findings to the simulated scenario. Demographics, prior POCUS experience, and self‐assessed competency were collected. Each resident was evaluated simultaneously by three different evaluators with advanced ultrasound training utilizing the UCAT and entrustment scales. Intraclass correlation coefficient (ICC) between evaluators was calculated for each assessment domain; analysis of variance was used to compare UCAT performance and PGY level and prior POCUS experience.Results: Thirty‐two residents (14 PGY‐1, nine PGY‐2, and nine PGY‐3) completed the study. Overall, ICC was 0.9 for preparation, 0.57 for image acquisition, 0.3 for image optimization, and 0.46 for clinical integration. There was moderate correlation between number of FAST examinations performed and entrustment and UCAT composite scores. There was poor correlation between self‐reported confidence and entrustment and UCAT composite scores.Conclusions: We had mixed results in our attempt to externally validate the UCAT with poor correlation between faculty and moderate to good correlation with faculty to diagnostic sonographer. More work is needed to validate the UCAT before adoption.

Background: Pediatric emergency department (ED) visits for superficial skin and soft tissue infections (SSTI) have steadily been increasing and point-of-care ultrasound (POCUS) continues to be an effective modality to improve management and shorter ED length of stays (LOS). Objective: We sought to determine the impact of a soft tissue POCUS curriculum on POCUS utilization, ED LOS, and cost-effectiveness. Methods: This was a retrospective pre- and post-interventional study of pediatric patients aged 0 to 17 years. Patients presenting to ED with international classification of disease 9 or 10 code for abscess or cellulitis were included. Data were collected a year before and after curriculum implementation with a 1-year washout training period. Training included continuing medical education, greater than 25 quality assured examinations, and a post-test. We compared diagnostic imaging type, ED LOS, and mean charges in patients with SSTI. Results: We analyzed data on 119 total patients, 38 pre- and 81 post-intervention. We found a significant increase in the total number of POCUS examinations performed pre- to post-curriculum intervention, 26 vs. 59 ( p = 0.0017). Mean total charges were significantly decreased from $3,762 (± 270) to $2,622 (± 158; p = 0.0009). There was a significant trend towards a decrease in average ED LOS 282 (standard error of mean [SEM] ± 19) vs 185 (± 13) minutes ( p = 0.0001). Conclusions: Implementation of a soft tissue POCUS curriculum in a pediatric ED was associated with increased POCUS use, decreased LOS, and lower cost. These findings highlight the importance of POCUS education and implementation in the management of pediatric SSTI.

Objectives: As point-of-care ultrasound (POCUS) continues to evolve in pediatric emergency medicine (PEM), new protocols and curricula are being developed to help establish the standards of practice and delineate training requirements. New suggested guidelines continue to improve, but a national standard curriculum for training and credentialing PEM providers is still lacking. To understand the barriers and perception of curriculum implementation for PEM providers, we created an ultrasound program at our institution and observed attitudes and response to training. Methods: Fourteen PEM-fellowship–trained faculty with limited to no previous experience with POCUS underwent training within a 12-month time frame using a modified practice-based training that included didactics, knowledge assessment, and hands-on practice. As part of the curriculum, the faculty completed a 3-phase survey before, after, and 6 months after completion of the curriculum. Results: There was a 100%, 78.6%, and 71.4% response rate for the presurvey, postsurvey, and 6 months postsurvey, respectively. Lack of confidence with using POCUS went from 100% on the presurvey to 57% on the postsurvey and down to 30% on the 6th month postsurvey. All other barriers also decreased from precurriculum to postcurriculum, except for length of time to perform POCUS. Participants rated the curriculum highly, with a mean Likert score and standard error of the mean at 3.9 ± 0.73, respectively. The average rating for whether POCUS changed clinical practice was low (2.6 ± 1.34). Conclusion: These results show that a simplified structured curriculum can improve perception of POCUS and decrease barriers to usage while helping to understand obstacles for implementation of POCUS among PEM-fellowship–trained faculty.

Objectives: Point‐of‐care ultrasound (POCUS) is widely used in the emergency department (ED). Not all practicing emergency physicians received POCUS training during residency, leaving a training gap that is reflected in POCUS privileging. The purpose of this study was to evaluate the success of meeting privileging criteria as well as associated factors, following implementation of a basic POCUS training and privileging program within a large emergency medicine department.Methods: We implemented a POCUS training and privileging program, based on national guidelines, for faculty physicians who worked at one of the following EDs staffed by the same emergency medicine department: a pediatric tertiary site, two tertiary academic sites, and seven community sites. POCUS examinations included aorta, cardiac, first‐trimester obstetrics (OB), and extended focused assessment with sonography in trauma. Pediatric emergency medicine faculty were taught soft tissue and thoracic US instead of aorta and OB. Completion of the program required 16 h of didactics, ≥25 quality‐assured US examinations by examination type, and passing a series of knowledge‐based examinations. Descriptive statistics were calculated. Associations between physician characteristics and successfully becoming privileged in POCUS were modeled using Firth's logistic regression.Results: A total of 176 faculty physicians were eligible. A total of 145 (82.4%) achieved basic POCUS privileging during the study period. Different pathways were used including 86 (48.9%) practice‐based, nine (5.1%) fellowship‐based, and 82 (46.9%) residency‐based. POCUS privileging was lower for those working in a community versus academic setting (odds ratio 0.3, 95% confidence interval 0.1–0.9). A greater number of scans completed prior to the privileging program was associated with greater success.Conclusions: Implementation of a POCUS training and privileging program can be successful in a large emergency medicine department that staffs hospitals in a large‐scale health care system composed of both academic and community sites. Faculty physicians with at least some prior exposure to POCUS were more successful.