Developing and Integrating Asynchronous Web-Based Cases for Discussing and Learning Clinical Reasoning: Repeated Cross-sectional Study.

Background: Trainees rely on clinical experience to learn clinical reasoning in pediatric emergency medicine (PEM). Outside of clinical experience, graduate medical education provides a handful of explicit activities focused on developing skills in clinical reasoning.

Objective: In this paper, we describe the development, use, and changing perceptions of a web-based asynchronous tool to facilitate clinical reasoning discussion for PEM providers.

Practice patterns and perceptions of influenza testing amongst pediatric urgent care providers.

Introduction: Despite a sensitivity of 50% to 70% the rapid influenza diagnostic test (RIDT) continues to play an important role in clinical decision-making due to its quick turn-around time, high specificity, relative simplicity of use, and low cost.

Methods: A quantitative study using a web-based survey was distributed to 110 members of the Society of Pediatric Urgent Care aimed to assess RIDT use for diagnosis and management of influenza in outpatient pediatric patients.

Results: Responses from 61 providers were received.

Under-triage: A New Trigger to Drive Quality Improvement in the Emergency Department.

Unlabelled: The emergency department (ED) is a care setting with a high risk for medical error. In collaboration with our nursing colleagues, we identified a new trigger, under-triage, and demonstrated how its implementation could detect and reduce medical errors in the ED.

Methods: We defined under-triage as patient visits with an Emergency Severity Index (ESI) score of 4 or 5 (ie, low acuity), and the patient was admitted to the hospital during the same visit.

Utility of the DIVA score for experienced emergency department technicians.

Background: The DIVA score is validated for predicting success of the initial attempt at peripheral intravenous insertion by nurses and physicians. A score of 4 or greater is 50% to 60% likely to have a failed first attempt. The study objective was to assess the validity of this score for emergency department technicians.

Oculocardiac Reflex in a Pediatric Trauma Patient.

We describe the case of a 6-year-old boy who presented to a tertiary care emergency department after a motor vehicle accident with facial trauma and bradycardia. The patient was found to have an orbital floor fracture and inferior rectus muscle entrapment with resulting bradycardia secondary to the oculocardiac reflex. The oculocardiac reflex is an uncommon cause of bradycardia in the setting of trauma but should be considered because it can necessitate surgical intervention.

A Pediatric Case of Persistent Thrombocytopenia in a Patient Who Developed All.

Inherited thrombocytopenia is a topic that was expanded greatly over the last decade and many new genes are being identified. However, inheritance patterns are not always easy to identify because sporadic cases from de novo mutations may in fact be more common. Few studies have assessed the relationship between thrombocytopenia and malignancies, specifically acute lymphoblastic leukemia (ALL).

Age-related differences pre-, intra-, and postcholecystectomy: A retrospective cohort study of 6,868 patients.

Background: Cholecystectomy (CCY) is increasingly performed in older individuals. We sought to examine age-related differences in pre-, intra-, and postoperative factors at a community hospital, using a very large, single-institution cholecystectomy database.

Materials And Methods: A retrospective review of 6868 patients who underwent CCY from 2001 to 2013 was performed.

Predicting gangrenous cholecystitis.

Background: Gangrenous cholecystitis (GC) is often challenging to treat. The objectives of this study were to determine the accuracy of pre-operative diagnosis, to assess the rate of post-cholecystectomy complications and to assess models to predict GC.

Methods: A retrospective single-institution review identified patients undergoing a cholecystectomy.