Health care providers across settings must be trained to manage anaphylaxis by (1) removing the offending allergen if still present; (2) positioning the patient with legs elevated, and if respiratory distress is present, allow the patient to sit upright with legs extended and elevated; (3) immediately administering epinephrine (adrenaline) intramuscularly (IM) or intranasally (IN) every 5 to 15 minutes for persistent anaphylaxis; and (4) optimizing airway, breathing, and cardiovascular (ABC) resuscitation. This may include supplemental oxygen, noninvasive or invasive positive-pressure ventilation, and intravenous fluid resuscitation. For life-threatening or refractory presentations, (5) IM/IN epinephrine should be administered every 5 minutes while addressing ABC derangements; this includes aggressive intravenous fluid resuscitation for patients in anaphylactic shock. Providers may continue IM or IN epinephrine or switch to the other, as both routes are considered equally efficacious based on pharmacokinetic data. An intravenous epinephrine infusion should be prepared for patients with persistent anaphylaxis after 2 doses of IM/IN epinephrine and initiated after the third dose, or earlier at the provider's discretion. In settings without epinephrine infusions, repeat IM/IN epinephrine should be administered every 5 minutes, along with other ABC interventions, and the patient should be transferred quickly to a setting equipped to provide advanced resuscitative care.

BACKGROUND:Podcasts are a popular educational tool in health professions that appeal to learners for their accessibility and flexibility. Skeptics criticize podcasts for issues related to quality and credibility, despite established quality criteria. METHODS:A podcast guideline was developed using a rapid review of the literature. Selected articles underwent synthesis and analysis. From these, key areas and recommendations were developed. RESULTS:Forty-eight articles informed the narrative synthesis that revealed 6 areas. Recommendations for areas included directives for 3 pertinent audiences: podcast producers, educators, and listeners and learners. DISCUSSION:High-quality podcasts are especially important to advocate for best practices in pediatric healthcare. The podcast guideline outlines evidence-based standards to guide podcast production and use for competency-based education for learner-centered outcomes. More research is needed to understand how podcast listening affects clinical outcomes. There is potential for artificial intelligence to advance podcasts, but it should be used cautiously and ethically.

Background:Clinicians caring for children in emergency departments have variable pediatric training. This study aimed to identify practicing emergency clinicians' perceptions on pediatric topic prioritization, information seeking behaviors, and preferred learning modalities. Methods:A survey was iteratively developed by experts in general and pediatric emergency medicine utilizing survey science best practices. The final survey contained sections on demographics, pediatric topic prioritization, information seeking behaviors, and preferred learning modalities. The survey was disseminated via publication as a link on the WikEM website, the WikEM application, and via e-mails to registered WikEM users. Results:Five-hundred and forty-two surveys were completed by 397 attending physicians (APs) and 145 advanced practice providers (APPs). The top three priority topics among APs were neonatal emergencies, airway and respiratory emergencies, and pediatric-specific procedures, and among APPs were abdominal emergencies, airway and respiratory emergencies, and bronchiolitis. Both APs and APPs indicated that they currently receive most of their pediatric information through online medical resources and communication with colleagues. The least used methods included webinars, social media, courses, and academic journals. APs preferred education modalities included clinical evidence-based pathways, podcasts, and websites/blogs. APPs preferences were clinical evidence-based pathways, podcasts, and online didactic experiences. Both APs and APPs reported that insufficient time and not knowing where to find resources were the largest barriers to pediatric education. Conclusions:Attending physicians and advanced practice emergency providers identified airway and respiratory emergencies as priority topics. Information was most often accessed using online resources and through discussions with colleagues. Evidence-based pathways and podcasts were identified as the preferred modality. These data can inform priority topics for content development and best practices for dissemination of content to practicing clinicians.

BACKGROUND:High-quality, granular, accessible, and timely data are essential for evaluating regional trauma ecosystems and implementing programs to improve trauma care. State trauma registries play a crucial role in collecting, disseminating, and sharing data for clinicians, researchers, implementation scientists, and policymakers. This study aimed to assess the status and progress of statewide trauma registries in the United States over the past 20 years. METHODS:A structured electronic survey was administered to eligible and consenting state trauma registry managers or emergency medical services personnel between July 2024 and November 2024. The survey gathered information on registry infrastructure, data collection and reporting processes, and data quality assurance measures. Findings were compared with those from a similar survey conducted in 2004. RESULTS:All 50 states and the District of Columbia participated in the survey. Forty-seven states (92 %) reported an active trauma registry, an increase of 15 since 2004. Four states have never had a statewide registry, though two are planning to develop one. Among states with registries, only 18 (38 %) mandate data submission from all hospitals. While many registries have transitioned to web-based systems and updated software over the last two decades, 34 registries (72 %) still rely on manual data abstraction, and 28 (60 %) lack integration with electronic health records. Additionally, only 20 (43 %) state registries contribute data to national collection efforts. CONCLUSIONS:Although progress has been made in establishing and modernizing state trauma registries since 2004, significant gaps remain, particularly in the absence of comprehensive mandatory reporting, the reliance on manual data entry, and the lack of integration with electronic health records and national databases. Addressing these challenges is essential for reducing the burden on registry teams and providing accurate, actionable, and timely data for improving trauma care.

Objectives:Uncontrolled hemorrhage is the most preventable cause of death following traumatic injury; children may be called to act as bystanders when hemorrhage control is necessary. The earliest age that children can learn hemorrhage control remains undetermined. We aimed to identify whether children aged 8 to 12 years can identify when and how to use a combat application tourniquet (CAT) and can appropriately place and tighten it to achieve hemorrhage control. Methods:We conducted a prospective study of children aged 8 to 12 years old. A trained facilitator taught hemorrhage control and CAT placement on manikins in small group sessions. After each session, we assessed the comprehension and application skills of each participant using a standardized 4-question tool. If at least 60% of children within each age group correctly performed both comprehension (cognitive) and skills (psychomotor) assessments, the group was considered successful. We compared success rates between age groups and analyzed the association between performance and participant age, sex, and body mass index (BMI). Results:Of 326 eligible children, 322 completed the training and assessment (99%). Overall, 70% (225/322) of participants completed all 4 assessment questions correctly, 88% (284/322) of participants were able to answer both comprehension (cognitive) questions correctly, and 76% (246/322) of participants were able to accurately demonstrate both CAT placement skills (psychomotor) correctly. All age groups exceeded the 60% success rate in both assessments. Age, sex, and BMI were not significantly associated with assessment performance. Conclusion:Children as young as 8 years old can successfully learn hemorrhage control techniques and combat application tourniquet application, suggesting this training can begin as early as third grade.

BACKGROUND:Rapid cycle deliberate practice (RCDP) is a form of simulation debriefing that incorporates repeated cycles of hands-on practice, characterized by within-simulation directed feedback and repeated practice with the goal of mastering a skill. RCDP debriefing has been shown to improve immediate performance; however, evidence of improved retention and superiority to traditional styles of debriefing is lacking. OBJECTIVES:To compare RCDP and traditional debriefing for knowledge and skills acquisition and retention as part of a longitudinal residency simulation curriculum. DESIGN:Participants were first-year pediatrics residents who underwent two simulation scenarios, focusing on basic airway and cardiac arrest management, at the beginning of their intern year. Participants were block randomized to either the RCDP or the traditional debriefing arm. Knowledge was assessed in a pre-post format at time 0 and at 12 months using a multiple-choice quiz. All interns received a repeat simulation teaching session at three, six, nine, or 12 months, remaining in their RCDP or traditional debriefing arm. Skills were assessed via a video-recorded simulated scenario prior to an initial simulation session (RCDP vs. traditional debriefing) at time 0 and three, six, nine, and 12 months, and before and after their repeat simulation teaching session. Videos were scored by two pediatric emergency medicine physicians using a resuscitation skills assessment tool. RESULTS:There was no statistical difference in overall knowledge (via paired t-test) or skills acquisition (via linear mixed effects model) between residents who received traditional debriefing and those who received RCDP debriefing. The RCDP group showed significant improvement in skills when compared with the traditional group for those who received repeat education at three months; however, there was no difference in the other time groups. There was no difference between groups in skills retention at three months after the repeat teaching session, as assessed via the ANOVA analysis. CONCLUSION:Overall, we demonstrated similar knowledge and skills gain and retention in traditional debriefing and RCDP groups, with the exception of those residents who received repeat teaching at the three-month time point. This may indicate that a three-month time interval could be the most appropriate timing for repeated RCDP resuscitation teaching. Higher power randomized controlled trials comparing RCDP to traditional simulation and/or qualitative studies assessing the efficacy of RCDP would add to current evidence.

Background: Limited research exists on when to administer epinephrine (adrenaline) or activate emergency medical services (EMS) during acute allergic reactions in community settings. This contributes to suboptimal patient care, including both the underuse and overuse of epinephrine, as well as potentially unnecessary emergency department visits. Objective: We developed consensus recommendations for administering epinephrine and activating EMS during acute allergic reactions. Methods: From January 2024 to May 2025, we assembled a 34-member international panel of experts to develop clinical scenarios reflecting varying severity levels within and across organ systems, candidate modifiers that may lower the threshold for epinephrine administration (eg, history of asthma), and candidate EMS activation recommendations. In phase 1, the panel engaged in a modified Delphi process to reach consensus on these outputs. In phase 2, we tested each consensus modifier by embedding it into scenarios where epinephrine was not recommended or lacked consensus, to assess potential impacts on treatment decisions. Results: The expert panel developed 24 clinical scenarios, 9 candidate modifiers, and 12 candidate EMS activation recommendations. During the first phase, 21 statements reached consensus to recommend epinephrine, 2 reached consensus not to recommend it, and 1 did not reach a consensus. There were 5 consensus modifiers and 10 consensus EMS activation recommendations. In the second phase, 2 of the 15 clinical scenarios reached consensus to recommend epinephrine administration. Conclusion: We developed consensus recommendations for administering epinephrine and activating EMS during acute allergic reactions in community settings. Integrating them into technology-based decision support tools may enhance reaction management, improve patient outcomes, optimize health care utilization, and empower patient and caregiver self-efficacy.

BACKGROUND:The lower clinical exposure of Pediatric Emergency Medicine (PEM) fellows to critical procedures may impede skill acquisition. We sought to determine the tracheal intubation learning curve of PEM fellows during training and compared PEM fellow success against standards for tracheal intubation success. METHODS:This was a retrospective, video-based study of a cohort of PEM fellows at a single academic pediatric emergency department (PED). All forms of tracheal intubation were included (rapid sequence intubation and crash or no medication). The cohort consisted of 36 PEM fellows from all or part of 5 consecutive fellowship classes. Data were collected by structured review of both existing ceiling-mounted videos and the electronic medical record. The main outcome was PEM fellows' success on the first or second attempt. We used cumulative summation to generate tracheal intubation learning curves. We specifically assessed the proportion of PEM fellows who reached 1 of 4 thresholds for procedural performance: 90% and 80% predicted success on the first and the first or second attempt. RESULTS:From July 2014 to June 2020, there were 610 patient encounters with at least 1 attempt at tracheal intubation. The 36 PEM fellows performed at least 1 attempt at tracheal intubation for 414 ED patient encounters (65%). Median patient age was 2.1 years (interquartile range, 0.4-8.1). The PEM fellows were successful on the first attempt for 276 patients (67%) and on the first or second attempt for 337 (81%). None of the 36 PEM fellows reached the 90% threshold for either first or second attempt success. Four fellows (11%) met the 80% threshold for first attempt success and 11 (31%) met the 80% threshold for first or second attempt success. CONCLUSIONS:Despite performing the majority of attempts, PEM fellows often failed to reach the standard thresholds for performance of tracheal intubation. Clinical exposure alone is too low to ensure acquisition of airway skills.

Background:Free open access medical education (FOAM) resources have become increasingly popular in graduate medical education. Despite their accessibility, the assessment of FOAM resources' quality is challenging due to their decentralized nature and the diverse qualifications of their authors and distribution platforms. In this first pediatric systematic online academic resource (SOAR) review, we utilized a systematic methodology to aggregate and assess the quality of FOAM resources on pediatric respiratory infectious disease topics. Methods:We searched 177 keywords using FOAMSearch, the top 50 FOAM websites on the Social Media Index, and seven additional pediatric emergency medicine-focused blogs. Following a basic initial screen, resources then underwent full-text quality assessment utilizing the revised Medical Education Translational Resources: Impact and Quality (rMETRIQ) tool. Results:The search yielded 44,897 resources. After 44,456 were excluded, 441 underwent quality assessment. A total of 36/441 posts (8% of posts) reached the high-quality threshold score (rMETRIQ ≥ 16). The most frequent topics overall were pneumonia and bronchiolitis. A total of 67/441 posts (15% of posts) were found to have a rMETRIQ score of less than or equal to 7, which may indicate poor quality. Conclusions:We systematically identified, described, and performed quality assessment on FOAM resources pertaining to the topic of pediatric respiratory infectious disease. We found that there is a paucity of high-quality posts on this topic. Despite this, the curated list of high-quality resources can help guide trainees and educators toward relevant educational information and suggest unmet needs for future FOAM resources.

IntroductionPodcasts are effective tools for disseminating health education. This study aimed to disseminate a health equity curriculum on best practices.MethodA cross-sectional descriptive study was conducted as part of the Health Equity in Pediatrics podcast series between May and June 2023. Listeners were surveyed following each episode, and both quantitative and qualitative responses of voluntary respondents were analyzed.ResultsEpisodes were downloaded 4,095 times. Survey respondents (n = 66) reported increased knowledge and intended practice change inspired by the podcast. Qualitative responses included themes surrounding knowledge, appreciation, and practice change.DiscussionPodcasts are easily disseminated to wide audiences and can improve health equity knowledge while inspiring practice change. This style can help listeners identify practices that suggest implicit bias and implement more equitable best practices. Future research should examine implicit bias training and standardization of health equity education using podcasts.

BackgroundDespite the promise of oral immunotherapy (OIT) to treat food allergies, this procedure is associated with potential risk. There is no current agreement about what elements should be included in the preparatory or consent process.ObjectiveWe developed consensus recommendations about the OIT process considerations and patient-specific factors that should be addressed before initiating OIT and developed a consensus OIT consent process and information form.MethodsWe convened a 36-member Preparing Patients for Oral Immunotherapy (PPOINT) panel of allergy experts to develop a consensus OIT patient preparation, informed consent process, and framework form. Consensus for themes and statements was reached using Delphi methodology, and the consent information form was developed.ResultsThe expert panel reached consensus for 4 themes and 103 statements specific to OIT preparatory procedures, of which 76 statements reached consensus for inclusion specific to the following themes: general considerations for counseling patients about OIT; patient- and family-specific factors that should be addressed before initiating OIT and during OIT; indications for initiating OIT; and potential contraindications and precautions for OIT. The panel reached consensus on 9 OIT consent form themes: benefits, risks, outcomes, alternatives, risk mitigation, difficulties/challenges, discontinuation, office policies, and long-term management. From these themes, 219 statements were proposed, of which 189 reached consensus, and 71 were included on the consent information form.ConclusionWe developed consensus recommendations to prepare and counsel patients for safe and effective OIT in clinical practice with evidence-based risk mitigation. Adoption of these recommendations may help standardize clinical care and improve patient outcomes and quality of life.

Background:Early identification of shock is vital in decreasing morbidity and mortality in the pediatric population. Although residents are taught the perfusion portion of the rapid cardiopulmonary assessment at our institution, they perform it at the bedside with 8.4% completing 1 part of the assessment and 9.7% verbalizing their findings. Newer technologies, including virtual reality (VR), offer immersive training to close this clinical gap.Objective:To assess senior pediatric residents' performance of a perfusion exam and verbalization of their perfusion assessment following VR-based Just-in-Time/Just-in-Place (JITP) training compared to video-based JITP training. We hypothesized that JITP media training was feasible, and VR JITP was more effective than video-based training.Methods:Residents were randomized to VR or video-based training during shifts in the emergency department. Clinical performance was assessed by review of a video-recorded patient encounter using a standardized assessment tool and by an in-person, two question shock assessment. Residents completed a survey assessing attitudes toward their intervention at the time of training.Results:Eighty-five senior pediatric residents were enrolled; 84 completed training. Sixty-four (76%) residents had a patient encounter available for video review (VR 33; Video 31). Fourteen residents in the VR group (42.4%, 95% CI 25.5% to 60.8%) and 13 residents in the video group (41.9%, 95% CI 24.6% to 60.9%) completed a perfusion exam AND verbalized an assessment during their next clinical encounter (X2 p-value 1.00). Fifty-one of 64 residents (79.7%) completed the two-step shock assessment; 50 (98%) agreed with supervising physician's assessment. VR was rated more effective than reading, low-fidelity manikin, standardized patient encounters, traditional didactic teaching, and online learning. Video was rated more effective than online learning, traditional didactic teaching, and reading.Conclusion:Novel video and VR JITP perfusion exam and assessment trainings are impactful and well-received by senior pediatric residents.

Background Despite a better understanding of the epidemiology, pathogenesis, and management of patients with anaphylaxis, there remain knowledge gaps. Enumerating and prioritizing these gaps would allow limited scientific resources to be directed more effectively. Objective We sought to systematically describe and appraise anaphylaxis knowledge gaps and future research priorities based on their potential impact and feasibility. Methods We convened a 25-member multidisciplinary panel of anaphylaxis experts. Panelists formulated knowledge gaps/research priority statements in an anonymous electronic survey. Four anaphylaxis themed writing groups were formed to refine statements: (1) Population Science, (2) Basic and Translational Sciences, (3) Emergency Department Care/Acute Management, and (4) Long-Term Management Strategies and Prevention. Revised statements were incorporated into an anonymous electronic survey, and panelists were asked to rate the impact and feasibility of addressing statements on a continuous 0 to 100 scale. Results The panel generated 98 statements across the 4 anaphylaxis themes: Population Science (29), Basic and Translational Sciences (27), Emergency Department Care/Acute Management (24), and Long-Term Management Strategies and Prevention (18). Median scores for impact and feasibility ranged from 50.0 to 95.0 and from 40.0 to 90.0, respectively. Key statements based on median rating for impact/feasibility included the need to refine anaphylaxis diagnostic criteria, identify reliable diagnostic, predictive, and prognostic anaphylaxis bioassays, develop clinical prediction models to standardize postanaphylaxis observation periods and hospitalization criteria, and determine immunotherapy best practices. Conclusions We identified and systematically appraised anaphylaxis knowledge gaps and future research priorities. This study reinforces the need to harmonize scientific pursuits to optimize the outcomes of patients with and at risk of anaphylaxis.

BACKGROUND:The use of free open-access medical education (FOAM) and other online knowledge dissemination methods has increased over the past decade. However, the role and impact of these tools in the knowledge translation continuum are poorly understood, potentially limiting the ability of knowledge generators to fully harness and exploit their potential. Here, we aim to comprehensively map and synthesize the literature describing the use of online tools for the dissemination of emergency medicine research. METHODS:Using scoping review methodology, we searched the traditional literature via PubMed, CINAHL, EMBASE, ERIC, SCOPUS, and the gray literature for publications exploring online methods to disseminate new research findings. We synthesized the results and constructed a conceptual model of current research dissemination methods. RESULTS:We included 79 out of 655 unique abstracts and articles identified in our search, 62 of which were from the traditional literature. We describe six primary domains: integration with traditional literature, measurement of dissemination, online organizations and communities of practice, professional development, quality assurance tools and techniques, and advantages and disadvantages of FOAM. For each domain we present an exemplar article and prevailing gaps in knowledge. Finally, we propose a current conceptual framework for dissemination of new research findings that describes both traditional and novel methods of dissemination. CONCLUSIONS:This comprehensive review of the literature and current dissemination framework will empower researchers, research networks, and granting organizations to maximize their use of FOAM and other online methods to disseminate new knowledge as well as provide clinicians a better understanding of the tools and methods by which to access and implement new research findings.

Asynchronous nurse practitioner students lack the benefit of live classroom discussions to synthesize and apply didactic knowledge. Responsive podcasts can remotely address identified student learning needs for improved practical application while remaining entertaining. This feasibility study produced a responsive, topical podcast to meet student learning needs. Episodes were electronically distributed and publically available.By January 2022, "The Peds NP" podcast had 39 episodes with a total of 5,477 downloads reaching 43 countries. Podcasts are succinct, focused microlearning tools that are easily produced, distributed, and consumed. Faculty can use them to augment traditional curricula and enhance the applicability of didactic teaching.

OBJECTIVES:The primary objective was to survey pediatric emergency medicine (PEM) leaders and fellows regarding point-of-care ultrasound (POCUS) training in PEM fellowship programs, including teaching methods, training requirements, and applications taught. Secondary objectives were to compare fellows' and program leaders' perceptions of fellow POCUS competency and training barriers.METHODS:This was a cross-sectional survey of U.S. PEM fellows and fellowship program leaders of the 78 fellowship programs using two online group-specific surveys exploring five domains: program demographics; training strategies and requirements; perceived competency; barriers, strengths, and weaknesses of POCUS training; and POCUS satisfaction.RESULTS:Eighty-three percent (65/78) of programs and 53% (298/558) of fellows responded. All participating PEM fellowship programs included POCUS training in their curriculum. Among the 65 programs, 97% of programs and 92% of programs utilized didactics and supervised scanning shifts as educational techniques, respectively. Sixty percent of programs integrated numerical benchmarks and 49% of programs incorporated real-time, hands-on demonstration as training requirements. Of the 19 POCUS applications deemed in the literature as core requirements for fellows, at least 75% of the 298 fellows reported training in 13 of those applications. Although less than half of fellows endorsed competency for identifying intussusception, ultrasound-guided pericardiocentesis, and transvaginal pregnancy evaluation, a higher proportion of leaders reported fellows as competent for these applications (40% vs. 68%, p ≤ 0.001; 21% vs. 39%, p = 0.003; and 21% vs. 43%, p ≤ 0.001). Forty-six percent of fellows endorsed a lack of PEM POCUS evidence as a training barrier compared to 31% of leaders (p = 0.02), and 39% of leaders endorsed a lack of local financial support as a training barrier compared to 23% of fellows (p = 0.01).CONCLUSIONS:Although most PEM fellowship programs provide POCUS training, there is variation in content and requirements. Training does conform to many of the expert recommended guidelines; however, there are some discrepancies and perceived barriers to POCUS training remain.

Provision of optimal care to critically ill patients in a pediatric emergency department is challenging. Specific challenges include the following: (a) patient presentations are highly variable, representing the full breadth of human disease and injury, and are often unannounced; (b) care team members have highly variable experience and skills and often few meaningful opportunities to practice care delivery as a team; (c) valid data collection, for quality assurance/improvement and clinical research, is limited when relying on traditional approaches such as medical record review or self-report; (d) specific patient presentations are relatively uncommon for individual providers, providing few opportunities to establish and refine the requisite knowledge and skill; and (e) unscientific or random variation in care delivery. In the current report, we describe our efforts for the last decade to address these challenges and optimize care delivery to critically ill patients in a pediatric emergency department. We specifically describe the grassroots development of an interprofessional medical resuscitation program. Key components of the program are as follows: (a) a database of all medical patients undergoing evaluation in the resuscitation suite, (b) peer review and education through video-based case review, (c) a program of emergency department in situ simulation, and (d) the development of cognitive aids for high-acuity, low-frequency medical emergencies.

Constipation is a common problem in pediatric patients. Abdominal radiographs (AXRs) are frequently obtained in the pediatric emergency department for diagnosis despite their poor reliability to rule out underlying pathology or prognostic ability to determine the degree of constipation. The goal of this quality improvement (QI) initiative was to standardize the diagnosis and management of constipation in the pediatric emergency department and urgent care in patients ages 6 months to 21 years and decrease AXR use by 20% and sustain this reduction for 12 months. METHODS:This prospective QI project involved a multidisciplinary team at a large urban pediatric tertiary care center. The study team constructed a key driver diagram and identified interventions, such as creating a standardized evaluation and management algorithm for constipation, using free open-access medical education platforms, incorporating the electronic medical record interface, and expanding educational conferences to include standardized approach and discharge instructions for patients with constipation across all acuity levels. The primary measure of AXR utilization was tracked overtime on a statistical process control chart to evaluate the impact of interventions. RESULTS:The percentage of visits for constipation that included an AXR decreased from a baseline of 49.6%-37.1%, a 25% reduction. Length-of-stay, return visits within 7 days, and inpatient admissions remained unchanged by the interventions. CONCLUSIONS:QI methodology successfully decreased AXR utilization in the evaluation of constipation across a broad spectrum of acuity levels. Further interventions may help to decrease the length of stay and further decrease AXR utilization.