Professor Emerita, Pediatrics, Virginia Tech Carilion School of Medicine, Roanoke, VA *See also p. 646. Dr. Ackerman has disclosed that she does not have any potential conflicts of interest.

Every year, millions of pediatric patients seek emergency care. Significant barriers limit access to optimal emergency services for large numbers of children. The American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nurses Association have a strong commitment to identifying these barriers, working to overcome them, and encouraging, through education and system changes, improved access to emergency care for all children.

Department of Pediatrics, Virginia Tech Carilion School of Medicine, Roanoke, VA *See also p. 1819. Dr. Ackerman has disclosed that she does not have any potential conflicts of interest.

Since Elizabeth Blackwell became the first woman to graduate from an American medical school in 1849, women have made many gains in the health care field. However, as Spector et al1 point out in this issue of Pediatrics , the battle for gender equity in medicine in general, and in pediatrics in particular, is far from over. The real questions for those of us who, like myself, have been in positions to make change are why have we not achieved more progress, and what exactly are we going to do about it? Medicine is doing better than business, in which only 5% of companies had women chief executive officers in 2016,2 and nonmedical higher education, in which only 30% of colleges and universities had women at the highest level of leadership.3 Some progress is being made, as reflected in improvements in the trends toward pay equity, representation among the leadership of academic medical centers and other health care organizations, participation on journal editorial boards, research funding, and recognition by medical societies … Address correspondence to Alice D. Ackerman, MD, MBA, 4069 Postal Dr, #20834, Roanoke, VA 24018. E-mail: adackerman{at}vt.edu

Department of Pediatrics, Virginia Tech Carilion School of Medicine, Roanoke, VA *See also p. e530. Dr. Ackerman has disclosed that she does not have any potential conflicts of interest.

Department of Pediatrics, Virginia Tech Carilion School of Medicine, Roanoke, VA *See also p. e176. Dr. Ackerman received funding from Carilion Clinic.

DePriest, Ashley; Harwayne-Gidansky, Ilana; Gerlach, Anthony; Lough, Mary; Ackerman, Alice; Szakmany, Tamas; Carroll, Christopher

Szakmany, Tamas; Harwayne-Gidansky, Ilana; Ackerman, Alice; Riordan, Brendan; Lough, Mary; Duprey, Matthew; Moore, Kathryn; Carroll, Christopher

Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in a mutually beneficial partnership among patients, families, and health care professionals. Providing patient- and family-centered care to children in the emergency department setting presents many opportunities and challenges. This revised technical report draws on previously published policy statements and reports, reviews the current literature, and describes the present state of practice and research regarding patient- and family-centered care for children in the emergency department setting as well as some of the complexities of providing such care.

Point-of-care ultrasonography is increasingly being used to facilitate accurate and timely diagnoses and to guide procedures. It is important for pediatric emergency medicine (PEM) physicians caring for patients in the emergency department to receive adequate and continued point-of-care ultrasonography training for those indications used in their practice setting. Emergency departments should have credentialing and quality assurance programs. PEM fellowships should provide appropriate training to physician trainees. Hospitals should provide privileges to physicians who demonstrate competency in point-of-care ultrasonography. Ongoing research will provide the necessary measures to define the optimal training and competency assessment standards. Requirements for credentialing and hospital privileges will vary and will be specific to individual departments and hospitals. As more physicians are trained and more research is completed, there should be one national standard for credentialing and privileging in point-of-care ultrasonography for PEM physicians.

This multiorganizational literature review was undertaken to provide an evidence base for determining whether recommendations for out-of-hospital termination of resuscitation could be made for children who are victims of traumatic cardiopulmonary arrest. Although there is increasing acceptance of out-of-hospital termination of resuscitation for adult traumatic cardiopulmonary arrest when there is no expectation of a good outcome, children are routinely excluded from state termination-of-resuscitation protocols. The decision to withhold resuscitative efforts in a child under specific circumstances (decapitation or dependent lividity, rigor mortis, etc) is reasonable. If there is any doubt as to the circumstances or timing of the traumatic cardiopulmonary arrest, under the current status of limiting termination of resuscitation in the field to persons older than 18 years in most states, resuscitation should be initiated and continued until arrival to the appropriate facility. If the patient has arrested, resuscitation has already exceeded 30 minutes, and the nearest facility is more than 30 minutes away, involvement of parents and family of these children in the decision-making process with assistance and guidance from medical professionals should be considered as part of an emphasis on family-centered care because the evidence suggests that either death or a poor outcome is inevitable.

Carilion Clinic Children’s Hospital Roanoke, VA * See also p. 97. Dr. Ackerman received royalties from Lippincott (editor of Rogers’ Textbook of Pediatric Intensive Care) and received support for travel from the American Academy of Pediatrics and from the Association of Medical School Pediatric Department Chairs.

2917 8. Jørgensen EO, Malchow-Møller A: Natural history of global and critical brain ischaemia. Part I: EEG and neurological signs during the first year after cardiopulmonary resuscitation in patients subsequently regaining consciousness. Resuscitation 1981; 9:133–153 9. Jørgensen EO, Malchow-Møller A: Natural history of global and critical brain ischaemia. Part III: Cerebral prognostic signs after cardiopulmonary resuscitation. Cerebral recovery course and rate during the first year after global and critical ischaemia monitored and predicted by EEG and neurological signs. Resuscitation 1981; 9:175–188 10. Cloostermans MC, van Meulen FB, Eertman CJ, et al: Continuous electroencephalography monitoring for early prediction of neurological outcome in postanoxic patients after cardiac arrest: A prospective cohort study. Crit Care Med 2012; 40:2867–2875 11. Rundgren M, Westhall E, Cronberg T, et al: Continuous amplitude-integrated electroencephalogram predicts outcome in hypothermia-treated cardiac arrest patients. Crit Care Med 2010; 38:1838–1844 12. Nielsen N, Wetterslev J, Al-Subaie N, et al: Target temperature management after out-of-hospital cardiac arrest—A randomized, parallel-group, assessor-blinded clinical trial-rationale and design. Am Heart J 2012; 163:541–548 13. Azzopardi DV, Strohm B, Edwards AD, et al; TOBY Study Group: Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 2009; 361:1349–1358 14. Shah DK, de Vries LS, Hellström-Westas L, et al: Amplitude-integrated electroencephalography in the newborn: A valuable tool. Pediatrics 2008; 122:863–865 15. Toet MC, Hellström-Westas L, Groenendaal F, et al: Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 1999; 81:F19–F23

Pediatric observation units (OUs) are hospital areas used to provide medical evaluation and/or management for health-related conditions in children, typically for a well-defined, brief period. Pediatric OUs represent an emerging alternative site of care for selected groups of children who historically may have received their treatment in an ambulatory setting, emergency department, or hospital-based inpatient unit. This clinical report provides an overview of pediatric OUs, including the definitions and operating characteristics of different types of OUs, quality considerations and coding for observation services, and the effect of OUs on inpatient hospital utilization.