Importance:Achievable benchmarks of care (ABCs) are a process by which performance is anchored on a select high-achieving group. ABCs can motivate systemic quality improvement toward realistically achievable goals. The establishment of multisite ABCs in pediatric emergency medicine has been limited. Objective:To report ABCs for pediatric emergency care management (encounters with asthma, infections, or pain), readiness (vital measurement, timeliness, and throughput), and quality (return visits). Design, Setting, and Participants:This cross-sectional study analyzed visits at 12 emergency department (9 pediatric emergency departments [EDs] and 3 affiliate community sites) from January 1, 2017, to December 31, 2024, in the Pediatric Emergency Care Applied Research Network (PECARN) Registry. Data were analyzed from August 2025 to March 2026. Main Outcomes and Measures:An ABC was calculated for each performance measure and derived from the 10% of visits attended to by the highest-performing clinicians both within individual sites and in the database overall using the pared mean method. ABCs for each performance measure are described at the network and site level by year and overall. Results:A total of 5 302 587 visits (median [IQR] patient age, 5.1 [1.8-11.0] years; 52.6% male patients) were included, of which 4 364 658 were quaternary pediatric ED visits and 937 929 were to affiliate community sites. Quality metrics varied across network sites and settings, with ranges of 56.8% to 99.3% for vital sign documentation, 61.4% to 92.6% for 2-point pain reduction for encounters with long bone fractures, and 93.1% to 99.2% for systemic corticosteroids given for visits with asthma exacerbation. Return visit with admission rate and antibiotic stewardship metrics had minimal variability across sites and care settings. There was significant ABC variability in throughput metrics (time-to-clinician and length of stay) across sites and pediatric ED vs affiliate setting. Overall, throughput metrics worsened over the study period. Performance measures more within clinicians' locus of control (care of encounters with asthma, pain reduction in encounters for long bone fractures) had wider variation between the site's mean performance and ABC, indicating practice variation within the sites. Conclusions and Relevance:This cross-sectional study from 12 EDs established ABCs for pediatric care management using electronic health record data. These can be used to compare quality outcomes of pediatric emergency care and provide benchmarking relevant to settings that care for children.

Objectives/Goals: Community engagement in pediatric emergency medicine research is completed mostly when an exemption from informed consent (EFIC) is involved. A campaign was designed to engage the community surrounding an academic pediatric emergency department in an informal discussion on any pediatric acute care and research topics they felt were important. Methods/Study Population: A flyer inviting members of the community to a virtual session was circulated through social media and word of mouth. Five members of the community attended the first session, including one with healthcare expertise and another with clinical research experience. The participants were not asked any personal characteristic questions and were allowed to self-identify during the discussion, to maintain the informal nature of the session. Results/Anticipated Results: All the participants identified as women, and mothers to children ranging in age from 11 weeks to 14 years. The participants highlighted community engagement as pivotal for advancing children’s health. They stressed the inclusion of groups traditionally underrepresented in healthcare systems, including patients and families who rarely utilize acute services and whose children have no chronic medical conditions. Critical issues in emergency and urgent care for children were extensively discussed, with a focus on when acute medical treatment is necessary and determining appropriate healthcare settings – emergency departments, urgent care centers, or primary care offices. The participants unanimously supported research leading to practical solutions for improving children’s health outcomes. Discussion/Significance of Impact: A group of community caregivers can lead to an established collaborative effort to enhance children’s healthcare outcomes through community engagement, informed decision-making, and practical application of research findings to families and caregivers. A standing community meeting is planned based on the feedback from the first session.

Pediatric asthma exacerbations represent a significant cause of emergency department use and hospitalizations. Despite available treatment options, many children's exacerbations are refractory to standard therapies and require adjunct treatments. The Intravenous Magnesium: Prompt use for Asthma in Children Treated in the Emergency Department study investigated the pharmacology of intravenous magnesium sulfate (IVMg) in treating pediatric asthma exacerbations. Specifically, the objectives of the study included (1) externally validating a previously published population pharmacokinetic model and (2) linking serum magnesium concentrations with outcomes including asthma severity score (efficacy) and hypotension (safety). Data were obtained from 49 children prospectively treated with IVMg (placebo, 50 or 75 mg/kg) after presenting to the pediatric emergency department with an acute asthma exacerbation. Reductions in Pediatric Respiratory Assessment Measure scores were associated with both total and ionized serum magnesium area under the concentration-time curve (AUC(0-2 h)). Despite frequent study-specific blood pressure monitoring, hypotension was uncommon in IVMg-treated participants (n = 2/31), and no concentration dependence was observed. The findings signal that IVMg may be an efficacious and safe option for treating moderate-severe pediatric acute asthma exacerbations in the ED. Importantly, this study is the first to suggest a serum exposure target (total serum magnesium AUC(0-2 h) >63.1 mg h/L) reflective of effective IVMg dosing in pediatric acute asthma. While further study in a larger clinical trial is needed to refine and validate this exposure target, these findings support the continued study of IVMg therapy as an adjunct therapeutic option in the setting of pediatric asthma exacerbations.

Rationale While there are numerous published paediatric asthma scores, it is unknown how commonly scores are recommended in asthma guidelines across different geographical regions globally, and what their validation status is. Objectives (1) To describe which clinical guidelines recommend asthma scores across different geographical regions. (2) To describe the initial and subsequent validation of the commonly recommended asthma scores. Methods Observational study of asthma scores recommended in guidelines for the management of acute paediatric asthma from institutions across the Pediatric Emergency Medicine Network; global paediatric emergency medicine research network comprising all eight local and regional paediatric emergency medicine research networks. Main results 158 guidelines were identified. Overall, 83/158 (53%) guidelines recommend a bedside clinical score for assessment of asthma severity. While a single country-specific clinical score was recommended in all guidelines from Spain and Canada, 27/28 (96%) of the USA guidelines recommend a wide variety of scores, and scores are rarely recommended in guidelines from other research networks (PERUKI, Paediatric Emergency Research in the UK and Ireland and PREDICT, Paediatric Research in Emergency Departments International Collaborative in Australia and New Zealand) and other countries (Costa Rica, South Africa, Nigeria, Singapore, India). The Pediatric Respiratory Assessment Measure (PRAM) and the pulmonary score (PS) were the most frequently used scoring instruments. While the PRAM has undergone the most extensive validation, including construct validity, validation studies for the PS are limited. Inter-rater reliability, as well as the criterion, responsiveness and discriminative validity aspects represent the most common limitations in many of the scores. Conclusions There are marked geographical differences in both the recommendation for and the type of clinical asthma score in clinical practice guidelines. While many asthma scores are recommended, most have insufficient validation.

INTRODUCTION:To determine anxiety and depression levels among pediatric acute care nurses and physicians before and after vaccine implementation during the coronavirus disease 2019 pandemic. METHODS:Prospective cross-sectional study of emergency medicine and urgent care providers at a metropolitan quaternary pediatric emergency department, including 2 satellite emergency departments and 7 urgent care sites. Anxiety and depression symptoms were assessed using the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-2. Nurses and physicians were surveyed twice using the Generalized Anxiety Disorder-7 in May 2020 and March 2021 and once with the Patient Health Questionnaire-2 in March 2021. RESULTS:In total, 189 surveys were completed in May 2020 (response rate 48%), and 243 surveys were completed in March 2021 (response rate 52%). Nurses reported higher Generalized Anxiety Disorder-7 scores compared to physicians for both years, though Patient Health Questionnaire-2 scores were similar. Mean Generalized Anxiety Disorder-7 scores decreased for both nurses and physicians between the 2 response periods. Amongst those who had a history of anxiety, chronic medical conditions, or were living with a high-risk individual, higher rates of anxiety were observed. Respondents endorsed the need for increased psychological support during a pandemic, with adequate and timely psychological support provided by the hospital, and stated their households were financially affected by the pandemic. Respondents reported fewer feelings of anxiety after self and public vaccination. DISCUSSION:Study findings support increased psychological support for frontline nurses and physicians during a pandemic, particularly for those with a history of anxiety or chronic medical conditions, or those living with a high-risk individual.

OBJECTIVES/GOALS: LGBTQIA2+ patients experience many healthcare inequities and often do not seek healthcare due to stigma andprevioustraumatic experiences in the healthcare system. A paucity of healthcare centersprovidesreduced-fee or free healthcare to LGBTQIA2+ individuals. METHODS/STUDY POPULATION: This project was initiated by the primary author who volunteered at an established student-run free clinic in Columbus, OH. The primary author engaged other students and faculty members, including the co-authors. A needs assessment was conducted by the authors, highlighting the unique needs of LGBTQIA2+ patients in central Ohio. In April 2022, members of the community and volunteer faculty providers established the Rainbow Clinic. The Rainbow Clinic provides primary care services including sexual health/STI testing and gynecology care. The Rainbow Clinic exclusively serves members of the LGBTQIA2+ community in central Ohio and creates a safe and inclusive space to educate medical and nurse practitioner students on the care of LGBTQIA2+ patients in a culturally sensitive way. RESULTS/ANTICIPATED RESULTS: The Rainbow Clinic has provided care for 60 patients equating to 78 visits. Most patients sought care for general primary care (17.9%), gynecological care (11.5%) or STI testing and treatment (7.7%). In addition to medical services, social work services are also provided as part of available mental health services and to provide additional linkage to care. To our knowledge, The Rainbow Clinic is the first student-run free clinic in Ohio to offer pre-exposure HIV prophylaxis (PrEP) medication as well as the required laboratory monitoring. The Rainbow Clinic has ongoing research evaluating patient comfortability throughout their encounters and has launched research studies to evaluate how best to address social determinants of health that affect the health and healthcare of the LGBTQIA2+ community. DISCUSSION/SIGNIFICANCE: The Rainbow Clinic deliversfree healthcareand social work servicesto patients who experience healthcare inequities anddisparities.Additionally, the Rainbow Clinic is a source of education for medical and nurse practitionerstudents to ensure their cultural humility in treating future LGBTQ+ patients.

BACKGROUND:The COVID-19 pandemic adversely affected children's mental health (MH) and changed patterns of MH emergency department (ED) utilization. Our objective was to assess how pediatric MH ED visits during the COVID-19 pandemic differed from expected prepandemic trends. METHODS:We retrospectively studied MH ED visits by children 5 to <18 years old at nine U.S. hospitals participating in the Pediatric Emergency Care Applied Research Network Registry from 2017 to 2022. We described visit length by time period: prepandemic (January 2017-February 2020), early pandemic (March 2020-December 2020), midpandemic (2021), and late pandemic (2022). We estimated expected visit rates from prepandemic data using multivariable Poisson regression models. We calculated rate ratios (RRs) of observed to expected visits per 30 days during each pandemic time period, overall and by sociodemographic and clinical characteristics. RESULTS:We identified 175,979 pediatric MH ED visits. Visit length exceeded 12 h for 7.3% prepandemic, 8.4% early pandemic, 15.0% midpandemic, and 19.2% late pandemic visits. During the early pandemic, observed visits per 30 days decreased relative to expected rates (RR 0.80, 95% confidence interval [CI] 0.78-0.84), were similar to expected rates during the midpandemic (RR 1.01, 95% CI 0.96-1.07), and then decreased below expected rates during the late pandemic (RR 0.92, 95% CI 0.86-0.98). During the late pandemic, visit rates were higher than expected for females (RR 1.10, 95% CI 1.02-1.20) and for bipolar disorders (RR 1.83, 95% CI 1.38-2.75), schizophrenia spectrum disorders (RR 1.55, 95% CI 1.10-2.59), and substance-related and addictive disorders (RR 1.50, 95% CI 1.18-2.05). CONCLUSIONS:During the late pandemic, pediatric MH ED visits decreased below expected rates; however, visits by females and for specific conditions remained elevated, indicating a need for increased attention to these groups. Prolonged ED visit lengths may reflect inadequate availability of MH services.

Rationale There is significant practice variation in acute paediatric asthma, particularly severe exacerbations. It is unknown whether this is due to differences in clinical guidelines. Objectives To describe and compare the content and quality of clinical guidelines for the management of acute exacerbations of asthma in children between geographic regions. Methods Observational study of guidelines for the management of acute paediatric asthma from institutions across a global collaboration of six regional paediatric emergency research networks. Measurements and main results 158 guidelines were identified. Half provided recommendations for at least two age groups, and most guidelines provided treatment recommendations according to asthma severity. There were consistent recommendations for the use of inhaled short-acting beta-agonists and systemic corticosteroids. Inhaled anticholinergic therapy was recommended in most guidelines for severe and critical asthma, but there were inconsistent recommendations for its use in mild and moderate exacerbations. Other inhaled therapies such as helium-oxygen mixture (Heliox) and nebulised magnesium were inconsistently recommended for severe and critical illness. Parenteral bronchodilator therapy and epinephrine were mostly reserved for severe and critical asthma, with intravenous magnesium most recommended. There were regional differences in the use of other parenteral bronchodilators, particularly aminophylline. Guideline quality assessment identified high ratings for clarity of presentation, scope and purpose, but low ratings for stakeholder involvement, rigour of development, applicability and editorial independence. Conclusions Current guidelines for the management of acute paediatric asthma exacerbations have substantial deficits in important quality domains and provide limited and inconsistent guidance for severe exacerbations.

As applied to the clinical research enterprise, "cultural humility" is a continuous process of self-orientation toward caring for others based on self-reflection and assessment, appreciation of others' experiences, and expertise on the social and cultural context of their lives, with an openness to establishing strong relationships within the research team and with study subjects. Applying cultural humility training to a clinical research infrastructure provides open awareness of biases, privileges, and the limitations of one's own knowledge. These insights may enhance one's approaches to interactions with potential subjects during recruitment and with actual subjects during study conduct while complementing existing cultural competency training and, in turn, supporting diversity among team members and research subjects.

OBJECTIVES/GOALS: Our primary objective is to determine the demographic and linguistic characteristics of student research assistants (SRAs) in a large student-run free clinic associated with a mid-western university. Our secondary objective was to determine if the SRAs perceived any impact of those characteristics on their duties and ability to conduct research. METHODS/STUDY POPULATION: We plan to conduct a 15-question electronic survey of Student Research Assistants at the student run free clinic. There are a variety of projects that require varying levels of commitment from researchers, which will be aggregated. This survey has been modified from a previously validated survey that focused on the demographic and linguistic characteristics of pediatric research coordinators. This survey will be emailed out to student research assistants and will be done over a period of 3 months. The study population will be predominantly undergraduate students who are all interested in a career in healthcare, ages expected to range from 18-25. RESULTS/ANTICIPATED RESULTS: We anticipate that the majority of student research assistants will be older students and will be students who identify as non-white/caucasian, as the majority of students volunteering at this free clinic do not identify as white. Additionally, we anticipate that students will feel that their racial/ethnic identity will positively impact their recruitment efforts. We also anticipate that the ability of a student research assistant to speak another language is expected to positively affect their perceived recruitment efforts. We also anticipate that gender will influence the student researchers’ perceptions of their recruitment efforts. DISCUSSION/SIGNIFICANCE: An individual’s background can directly impact how they perceive their contributions towards research. Considering the paucity in research for underinsured and uninsured and the rise in undergraduate student research assistants, optimizing research efforts and SRA confidence is essential to increase the accuracy and efficiency of research.

OBJECTIVES/GOALS: The objective of this project was to evaluate the factors that contribute to LGBTQIA2+ patient comfortability. This information was then used to understand how best to create a comfortable space for LGBTQIA2+ patients. METHODS/STUDY POPULATION: This survey was focused on underinsured and uninsured patients seen at the Rainbow Clinic - a free student-run LGBTQIA2+ clinic. Surveys were distributed by undergraduate volunteers on tablets as a qualtrics survey. Surveys collected demographic information in addition to 5 questions that assessed patient comfortability. These questions included evaluating the patient’s comfort with sharing information with the provider and the patient’s comfort of coming into clinical spaces. These surveys were distributed before and after clinic appointments to capture any changes in comfortability that could have occurred as a result of the appointment. RESULTS/ANTICIPATED RESULTS: Up to May of 2023, 49 patients were seen in Rainbow Clinic. 33 patients filled out the intake survey and 31 patients filled out the check-out survey resulting in a 67% and 63% response rate respectively. Questions were asked on a likert scale (1-5) from Strongly Disagree to Strongly Agree. Questions evaluating patient comfort in sharing information with their provider yielded an average score that was statistically significant, suggesting patients felt comfortable at the Rainbow Clinic. Additionally, patients indicated that the LGBTQIA2+ specific labeling of the Rainbow Clinic made them significantly more comfortable coming into the clinic. DISCUSSION/SIGNIFICANCE: This project suggests that patient comfortability can be improved by training and intentional LGBTQIA2+ labeling. Considering the hesitancy of this community towards healthcare, improving comfortability not only benefits clinical care and outcomes but can also bolster the body of research on this community.

Objectives:We conducted a pilot knowledge needs assessment survey of providers at a general academic emergency department (ED) within the catchment area of an academic, tertiary care children's hospital. Methods:We developed a 22-question electronic survey that was validated by combined emergency medicine and pediatric emergency medicine faculty members at the regional children's hospital. Three reminders were sent to the respondent pool at 2, 4, and 8 weeks after the initial survey. Reponses were analyzed using descriptive statistics. Results:A total of 18 surveys were completed. Most respondents were trainees with less than 5 years' experience working in emergency medicine. The most frequently used methods to access information reported by all respondents were websites with a medical or health focus, spending on average 1-5 hours weekly gathering that information. Faculty were more likely to use a laptop or desktop computer to access that information, while trainees were more likely to use a smartphone. All respondents reported that accessible evidence-based clinical practice guidelines and information regarding novel diagnostics and therapeutics in pediatrics were the most relevant items to enhance their clinical practice. Information on pediatric trauma, sepsis, and neurological emergencies were rated as the highest priorities for clinical care in their practice. Conclusion:Our findings can guide future knowledge needs assessments to develop dissemination and implementation efforts of evidence-based guidelines in the acute care of children in general EDs.

Importance Health care disparities are well-documented among children based on race, ethnicity, and language for care. An agenda that outlines research priorities for disparities in pediatric emergency care (PEC) is lacking.Objective To investigate research priorities for disparities in PEC among medical personnel, researchers, and health care-affiliated community organizations.Design, Setting, and Participants In this survey study, a modified Delphi approach was used to investigate research priorities for disparities in PEC. An initial list of research priorities was developed by a group of experienced PEC investigators in 2021. Partners iteratively assessed the list through 2 rounds of electronic surveys using Likert-type responses in late 2021 and early 2022. Priorities were defined as achieving consensus if they received a score of highest priority or priority by at least 60% of respondents. Asynchronous engagement of participants via online web-conferencing platforms and email correspondence with electronic survey administration was used. Partners were individuals and groups involved in PEC. Participants represented interest groups, research and medical personnel organizations, health care partners, and laypersons with roles in community and family hospital advisory councils. Participants were largely from the US, with input from international PEC research networks.Outcome Consensus agenda of research priorities to identify and address health care disparities in PEC.Results PEC investigators generated an initial list of 27 potential priorities. Surveys were completed by 38 of 47 partners (80.6%) and 30 of 38 partners (81.1%) in rounds 1 and 2, respectively. Among 30 respondents who completed both rounds, there were 7 family or community partners and 23 medical or research partners, including 4 international PEC research networks. A total of 12 research priorities achieved the predetermined consensus threshold: (1) systematic efforts to reduce disparities; (2) race, ethnicity, and language data collection and reporting; (3) recognizing and mitigating clinician implicit bias; (4) mental health disparities; (5) social determinants of health; (6) language and literacy; (7) acute pain-management disparities; (8) quality of care equity metrics; (9) shared decision-making; (10) patient experience; (11) triage and acuity score assignment; and (12) inclusive research participation.Conclusions and Relevance These results suggest a research priority agenda that may be used as a guide for investigators, research networks, organizations, and funding agencies to engage in and support high-priority disparities research topics in PEC.

BACKGROUND AND OBJECTIVE: Pediatric firearm injuries increased during the coronavirus disease 2019 pandemic, but recent trends in firearm injury emergency department (ED) visits are not well described. We aimed to assess how pediatric firearm injury ED visits during the pandemic differed from expected prepandemic trends. METHODS: We retrospectively studied firearm injury ED visits by children <18 years old at 9 US hospitals participating in the Pediatric Emergency Care Applied Research Network Registry before (January 2017 to February 2020) and during (March 2020 to November 2022) the pandemic. Multivariable Poisson regression models estimated expected visit rates from prepandemic data. We calculated rate ratios (RRs) of observed to expected visits per 30 days, overall, and by sociodemographic characteristics. RESULTS: We identified 1904 firearm injury ED visits (52.3% 15-17 years old, 80.0% male, 63.5% non-Hispanic Black), with 694 prepandemic visits and 1210 visits during the pandemic. Death in the ED/hospital increased from 3.1% prepandemic to 6.1% during the pandemic (P = .007). Firearm injury visits per 30 days increased from 18.0 prepandemic to 36.1 during the pandemic (RR 2.09, 95% CI 1.63-2.91). Increases beyond expected rates were seen for 10- to 14-year-olds (RR 2.61, 95% CI 1.69-5.71), females (RR 2.46, 95% CI 1.55-6.00), males (RR 2.00, 95% CI 1.53-2.86), Hispanic children (RR 2.30, 95% CI 1.30-9.91), and Black non-Hispanic children (RR 1.88, 95% CI 1.34-3.10). CONCLUSIONS: Firearm injury ED visits for children increased beyond expected prepandemic trends, with greater increases among certain population subgroups. These findings may inform firearm injury prevention efforts.

Transitioning from student to nurse practitioner can be challenging, prompting a need to enhance transition-to-practice education in graduate curricula. This survey aimed to improve the educational curriculum by assessing knowledge needs among recent nurse practitioner graduates for smoother transitions to professional practice. Survey results identified career development, licensure, billing, pharmacology, and diagnostics as knowledge gaps. Webinar sessions were developed to address these gaps. After webinar participation, surveys after the session showed participants felt significantly more prepared to enter the workforce. Implementing focused webinars is an effective strategy to support a successful transition to practice

The COVID-19 pandemic highlighted the significance of readily available and easily performed viral testing for surveillance during future infectious pandemics. The objectives of this study were: to assess the performance of the Xpert Xpress Flu and/or RSV test, a multiplex PCR assay for detecting influenza A and B virus and respiratory syncytial virus nucleic acids in respiratory tract specimens, relative to the Quidel Lyra Influenza A+B assay and the Prodesse ProFlu+ assay, and the system's ease of use by minimally trained operators. Overall, the Xpert Xpress Flu/RSV test demonstrated a high positive and negative percent agreement with the comparator assays, and was easy to use and interpret results, based on the operators' feedback. We concluded that the Xpert Xpress Flu/RSV test is sensitive, specific, and easy to use for the diagnosis of influenza and RSV by minimally trained operators and can be a valuable tool in future infectious clusters or pandemics.

We conducted a survey study of clinical research coordinators (CRCs) at the member institutions of the Pediatric Emergency Care Applied Research Network, to determine the demographic and linguistic characteristics of CRCs around the network, and any perceived impact of those characteristics on their duties. A total of 53/74 CRCs completed the survey. Most respondents identified as "female," "white," and "not Hispanic/Latino." Most respondents felt that their race/ethnicity and their ability to speak a language other than English would positively impact recruitment. Four female respondents felt that their gender hindered their recruitment efforts and their sense of belonging within the research team.

Most children seeking emergency care are evaluated and treated in general emergency departments (EDs) that are not pediatric focused. Data from the 2013 Pediatric Readiness Survey has shown that many general emergency departments are not prepared to treat pediatric patients, and that critically ill patients treated in emergency department with low readiness scores have a higher mortality (1). General emergency departments and non-pediatric hospitals often lack the equipment and expertise to implement treatment plans according to the latest pediatric guidelines and procedures. Furthermore, they are often located in hospitals without pediatric inpatient capabilities, resulting in transfers and delayed care (2).

Purpose: Our objective was to develop a set of physical exam and laboratory findings that in selected pediatric patients, combined with the FAST exam results, were sensitive and specific in detecting intra-abdominal injuries that correlated with CT scan results. Methods: This was a retrospective chart review of all trauma patients aged 0-17 years who were evaluated at an academic American College of Surgeons (ACS) verified …