Homme, James L.

Objectives: Dermatological diseases constitute 4% to 12% of all emergency department (ED) visits and may contribute to high health care costs. However, little is known about pediatric visits. The aim of this study was to determine characteristics, photo app utilization, and diagnostic concordance at follow-up of pediatric visits to the ED with dermatological complaints. Methods: This was a retrospective study conducted in the ED at an academic medical center. Patients younger than or equal to 18 years of age who presented with a dermatologic concern between May 2022 and April 2023 were included. The association between clinical characteristics and the use of a photo application in the ED was evaluated using logistic regression. Results: In 380 patients who met inclusion criteria, the most common final diagnoses were rash (30%, N=115), burn (10%, N=39), and cellulitis (9%, N=35). Fourteen patients (4%) had an emergent triage category (ESI 2). Photo app was used in 38% (N=143) encounters. Factors associated with the photo app use in multivariate analysis included ESI category 2 (odds ratio [OR]: 4.08, 95% CI: 1.17-14.18, P =0.027), ESI category 3 (OR: 1.74, 95% CI: 1.07-2.82, P =0.025), and duration of illness >1 week (OR: 3.50, 95% CI: 1.54-7.96, P =0.003). The diagnosis at follow-up was identical in 68% (N=78) of cases; clarified for 22% (N=25) and altered in 11 patients (10%). Conclusions: Most pediatric visits presenting to the ED with dermatological complaints are non-urgent and ER physicians can accurately diagnose the majority of these cases. Triage category ESI 2, ESI 3, and illness duration >1 week were associated with the photo app use.

Objectives: The aim of this study was to investigate differences in utilization of diagnostic imaging between the adult and pediatric trauma teams when caring for adolescent trauma patients. Methods: This was a retrospective observational study from 2015 to 2019 comparing pediatric trauma team activations for patients ages 12 to 14 and adult trauma team activations for patients ages 15 to 17 at a single institution verified as both a level I adult and a level I pediatric trauma center. Data were collected from a prospective trauma registry and manual chart review of the electronic medical records. The primary outcome was the frequency of whole body computed tomography (WBCT) and computed tomography (CT) imaging of individual body regions. Results: We identified 191 adult and 100 pediatric trauma team cases, with similar proportions transferred from outside hospitals (40% vs. 43%). Among patients presenting directly from the scene, WBCT use was significantly higher in the adult trauma team group (64% vs. 12%; RR: 5.21; 95% CI: 2.57-10.58), as was CT of all individual body regions. For transferred patients, the adult trauma team more often performed WBCT and individual CT scans, excluding head CT. CT imaging rates before transfer did not differ between groups. No significant differences were observed in injury severity scores, altered mental status, length of stay, or missed injuries. Conclusions: Among adolescents with similar injury severity, the adult trauma team more frequently utilizes WBCT and regional CT than the pediatric team. However, CT use before transfer from outside hospitals without dedicated pediatric trauma teams was similar across age groups.

Background Educational conferences play a crucial role in advancing global health by addressing challenges in diverse settings and fostering bidirectional knowledge exchange. Many new healthcare providers in Ghana lack hands-on experience in life-saving emergency skills, which is further compounded by limited resources and inadequate infrastructure. This highlights the need for targeted educational initiatives. Methods This paper describes a 3-day conference, the Young Doctors Conference, hosted by a non-governmental organization and aimed at improving emergency care skills for early-career healthcare professionals in Ghana. The conference includes interactive sessions on basic life support, newborn resuscitation, obstetric emergencies, point-of-care ultrasound, and communication case studies. An observational study was done using anonymous surveys that were conducted over four years to assess participants’ experiences and the conference’s impact. Results A total of 95 new physicians responded (out of 127), with over 90% reporting being ‘very satisfied’ with the conference. Common descriptors included “high quality,” “useful,” and “inspirational.” Furthermore, 100% of participants rated the quality of the conference as ‘very high’ or ‘high’. Basic life support training significantly increased comfort in managing cardiac arrest and breathing difficulties, while newborn resuscitation improved confidence in caring for critically ill infants. Additionally, 100% of participants stated they were ‘likely’ or ‘highly likely’ to attend again. Conclusions The Young Doctors Conference has been highly rated as an effective initiative in advancing emergency care communication and education. It serves as a valuable model for similar programs in other resource-limited settings, improving skills, communication, and confidence among early-career healthcare professionals. These findings highlight the need for ongoing hands-on education within Ghana’s healthcare system and how partnerships can fill these gaps. Future research is needed to examine long-term outcomes of this conference.

Objective This survey study assessed trainee attitudes and perceptions of the longitudinal public speaking curriculum at Mayo Clinic Pediatric and Adolescent Residency Program. Methods This 3-part survey of Mayo Clinic pediatric residents was conducted from 2013 to 2017 and utilized yes/no questions, Likert scales, and open-ended questions. Code book content analysis was used to analyze open-ended questions. Results A total of 121 participants (96.8%, n = 121/125) completed the survey. Most respondents (93.3%, n = 111/119) either agreed or strongly agreed that the public speaking requirement enabled them to be more effective in delivering information to large groups. Most respondents (89.2%, n = 107/120) agreed or strongly agreed that they incorporated feedback from previous public speaking feedback sessions into subsequent presentations. The 2 activities that respondents found most useful for preparing later presentations were setting goals for future presentations in a feedback session and discussing performance in a feedback session. Conclusions There was a perceived effectiveness of a longitudinal public speaking curriculum among pediatric residents at our program. Multidimensional feedback seems to be a critical aspect of a public speaking curriculum in graduate medical education.

OBJECTIVES: Many PICU admissions start with presentation in the emergency department (ED). However, we do not know whether there are any ED-related factors associated with the subsequent development of pediatric delirium (PD) within 24 hours of PICU admission. DESIGN: Retrospective cohort study. SETTING: Single-center ED and PICU serving a quaternary referral center in the United States. PATIENTS: Children younger than 18 years old presenting to the ED between January 2022 and December 2023 who required direct admission to the PICU, and who had at least one positive delirium screening within 24 hours of the admission. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The presence of delirium in the PICU was defined as a Cornell Assessment of Pediatric Delirium (CAPD) score of 9 and higher. We identified 138 patients for the final analysis. Overall, 51 of 138 patients (37%) developed PD within 24 hours of admission. The majority of delirium cases were classified as hypoactive (53%, 27/51) and mixed (31%, 16/51) subtypes, while only 16% (8/51) were identified as hyperactive delirium. Factors associated with greater odds (95% CI) of delirium in the PICU in multivariable analysis were use of mechanical ventilation (odds ratio [OR], 3.42 [95% CI, 1.09–10.78]; p = 0.04) and intermittent urinary catheterization (OR, 3.7 [95% CI, 1.21–11.30]; p = 0.02). Initial CAPD score positively correlated with PICU length of stay (LOS; r = 0.32; p < 0.01), Pediatric Index of Mortality 3 (PIM 3) score ( r = 0.26; p < 0.01), and negatively correlated with emergency severity index (ESI) in the ED ( r = –0.35; p < 0.01). CONCLUSIONS: Mechanical ventilation and intermittent urinary catheterization in the ED are associated with greater odds of PD within 24 hours of PICU admission. CAPD at admission positively correlates with PICU LOS, PIM 3 scores, and negatively correlates with ESI in the ED.

AbstractIntroductionMany emergency medicine (EM) residency programs include clinical rotations in rural emergency departments (“rural rotations”) as part of their curriculum. These rotations are designed to expose residents to clinical scenarios that are less frequently encountered in tertiary centers. The objective of this study was to determine the rate at which residents were exposed to certain clinical and procedural experiences (CPEs) while on rural rotations compared to their usual academic training hospital.MethodsWe conducted a retrospective chart review of all patient encounters involving EM residents at a large academic hospital in Rochester, Minnesota, compared with two rural hospitals in Austin, Minnesota, and Albert Lea, Minnesota, from July 1, 2019, to June 30, 2020. The frequency of each CPE was calculated and expressed as the number of CPEs encountered per 100 clinical hours worked. These values were compared between the rural and academic sites.ResultsA total of 33,417 patient encounters over a total of 41,700 resident clinical hours were analyzed between the three study sites. The two settings (rural vs. academic) had significant differences in baseline patient demographics including age, acuity, and admission rates. Several CPEs were found to occur at a higher frequency in the rural hospitals versus the academic hospital: ambulance necessity documentation (9.3/100 h rural vs. 0.07/100 h academic, p ≤ 0.0001), laceration repair (3.39/100 h rural vs. 2.0/100 h academic, p = 0.0004), and splint/cast application (1.53/100 h rural vs. 0.07/100 h academic, p ≤ 0.0001).ConclusionsRural EM rotations provide residents exposure to a variety of valuable educational experiences. These rotations may provide residents with superior exposures to some clinical experiences compared to academic hospitals, particularly out‐of‐ED transfers and orthopedic procedures. Residency programs without a current rural rotation should consider creating this as an option for their trainees.

Abstract Purpose Twenty five percent of practicing physicians in the US are International Medical Graduates (IMGs) – physicians who completed their medical school training outside of the United States and Canada. There are multiple studies demonstrating higher socio-economic background is associated with medical school matriculation in the US. However, despite a substantial prevalence of IMGs in the American healthcare system, studies of the association between demographics, socio-economic background, and securing a residency position in the match are lacking. Methods We created a survey with questions on residency match-related data and information on personal socio-economic background. An invitation to participate in the study was sent to all IMGs that applied to the included residency programs after the conclusion of the 2022 residency match. We used multivariable logistic regression to compare survey responses to the odds of securing a residency match. Results The total number of survey respondents was 744 (response rate 15.1%). We found that younger age, higher United States Medical License Examination (USMLE) scores, higher-income country of origin (including the United States), fewer match attempts, applying to fewer specialties, having parents with college degree or higher, and coming from higher-than-average or lower-than-average family income were associated with increased odds of matching. Gender, personal income, and visa status did not demonstrate significant associations with residency match. Conclusions Residency match is a significant expense for IMGs, especially for those from lower-income countries. International applicants from higher socio-economic backgrounds might have advantages in securing medical residency positions in the United States when controlling for other variables.