We observed no difference in performance between Manual and EZ-IO devices in children ≤8 kg, but the Manual IO were placed more quickly. We observed lower success rates with EZ-IO devices in children ≤8 kg compared to >8 kg. Future investigations should focus specifically on training for IO placement in children ≤8 kg.
Incidence estimates of AHT are incomplete without including ED. Intracranial bleeding is a cardinal feature of AHT to be considered in case ascertainment to improve public health surveillance.
Incidence estimates of AHT are incomplete without including ED. Intracranial bleeding is a cardinal feature of AHT to be considered in case ascertainment to improve public health surveillance.
Ideal care for septic shock (SS) is difficult. This interprofessional quality improvement intervention in a mid-volume pediatric emergency department aimed to reduce time to vascular access, fluid resuscitation, and antibiotics for SS. Intensive education, a care pathway, and an order set were applied. Outcome measures for patients with criteria for SS before and after intervention were compared. There were 43 patients pre-intervention (January 2009 to June 2011) and 63 post-intervention (June 2012 to June 2013). Median time to vascular access decreased from 37 minutes pre-intervention to 24 minutes post-intervention (p = 0.05). Median time to first fluid bolus decreased from 35 to 26 minutes (p = 0.08). Percentage of boluses delivered rapidly by pressure method increased from 21% to 74% (p < 0.0001). Median time to antibiotics decreased from 92 to 55 minutes (p = 0.02). In conclusion, a multimodal, interprofessional quality improvement intervention in a mid-sized pediatric emergency department improved the time to critical interventions for SS.
Study Objective: The purpose of this study was to compare success rates and time to placement with manual vs EZ-IO for all patients and then compare these outcomes in patients 8kg.Methods: This was a retrospective cross-sectional descriptive study of intraosseous (IO) attempts in a tertiary care pediatric emergency department (PED) from 2006-2014. Cases were identified through ICD-9-CM codes for IO infusion, CPR, and cardiac arrest. Age, weight, emergency severity index (ESI) score, device type, and number of attempts were abstracted. Outcome measures included success rate, complications, duration to IO placement, and survival. Success rate was defined as number of IOs with documented infusion of medications or fluids per number of attempts. Time to placement was defined as time from PED arrival to time of medication or fluid. Categorical variables measures were compared with a Z-test for comparison of 2 proportions and continuous with Student's t-tests.Results: Of 365 charts screened, 35 had an IO attempted. Mean age was 46.6 months. Thirty-two had an ESI of 1. There were 55 total attempts for these 35 patients. Sixty-four percent (35/55) of total and 66% (23/35) of initial attempts were successful. Twenty-six patients had IO type documented. There were 27 manual attempts on 16 patients and 16 attempts with the EZ-IO on 10 patients. The EZ-IO had a higher success rate but the time to placement was longer (Table 1). Time to IO placement was measured only in children with an ESI of 1. In 8kg, there were 25 manual attempts on 14 patients and 4 EZ-IO attempts on 3 patients. Success rate was again higher with the EZ-IO but a longer time to placement (Table 2). The only complication seen was transient leg swelling after EZ-IO placement in 2 patients. Overall survival rate was 11% with only four patients surviving >48hours.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.