Caroline Hart

Fifteen-minute consultation: Assessment, surveillance and management of hemihypertrophy

This article aims to provide a structured and concise guide for the general paediatrician managing a child with hemihypertrophy. Hemihypertrophy is a relatively uncommon condition. The significance is that a proportion of those affected are at risk of developing malignancies in childhood. For these children regular surveillance is required. We have outlined how one might assess and investigate a child presenting with hemihypertrophy. We have also formulated a practicable surveillance strategy which is in line with the current Royal College of Paediatrics and Child Health (RCPCH) guideline ‘Wilms’ tumour surveillance in at-risk children’.

Clinician’s gaze behaviour in simulated paediatric emergencies

Aim Differences in the gaze behaviour of experts and novices are described in aviation and surgery. This study sought to describe the gaze behaviour of clinicians from different training backgrounds during a simulated paediatric emergency. Methods Clinicians from four clinical areas undertook a simulated emergency. Participants wore SMI (SensoMotoric Instruments) eye tracking glasses. We measured the fixation count and dwell time on predefined areas of interest and the time taken to key clinical interventions. Results Paediatric intensive care unit (PICU) consultants performed best and focused longer on the chest and airway. Paediatric consultants and trainees spent longer looking at the defibrillator and algorithm (51 180 ms and 50 551 ms, respectively) than the PICU and paediatric emergency medicine consultants. Conclusions This study is the first to describe differences in the gaze behaviour between experts and novices in a resuscitation. They mirror those described in aviation and surgery. Further research is needed to evaluate the potential use of eye tracking as an educational tool.

G168 An observational study of clinician’s gaze behaviour during simulated paediatric emergencies

Aims Clinicians collect, prioritise and respond to visual cues when making decisions about patient care. This is of particular importance in the resuscitation environment where they are required to absorb and process large volumes of complex visual information in a time critical manner. Eye tracking technology allows for the measurement of an observer’s point of gaze based on where their pupil is focused. Eye tracking technology has been used in aviation and surgery to describe differences in the gaze behaviour between experts and novices. The aim of this study was to describe the gaze behaviour of clinicians from different training backgrounds during a simulated paediatric emergency. Methods Twenty-seven clinicians from different clinical areas within a tertiary children’s hospital undertook a standardised, six minute, high fidelity simulated paediatric emergency. Participants wore SMI Eye Tracking Glasses. We measured the number of times participants looked at predefined key areas (fixation count) and the duration of time spent looking at each of these areas (dwell time). The time taken to key clinical interventions was also recorded. Results Participants from all groups looked more frequently and for longer at the patient (chest and airway) than any of the other key areas of interests. Paediatric Intensive Care Unit (PICU) consultants focused longer on the chest and airway than any other groups. The gaze behaviour of paediatric consultants and trainees was similar. Both groups spent longer looking at the defibrillator and algorithm (51,180 ms and 50,551 ms respectively) than the PICU consultants and consultants in paediatric emergency medicine (19,804 ms and 28,095 ms respectively). The PICU consultants were quickest to perform key clinical interventions. Conclusions This study is the first to describe differences in the gaze behaviour between clinicians from different backgrounds during a simulated paediatric emergency. Differences observed between experts and novices are similar to those described in aviation and surgery. Further research is needed to evaluate the potential use as an educational tool in the resuscitation setting.

A diagnosis not to get stuck on

A 2-year-old girl presented to the local emergency department with 4 days of vomiting, poor oral intake and fever. ‘Noisy’ breathing and cough were noted by her parents in the preceding 12 h. She was initially given oral antibiotics for tonsillitis before developing audible stridor. Oral and nebulised steroids were given for presumed croup, and she was transferred to the nearby paediatric emergency department for further management. Intravenous access was established prior to transfer. On paediatric assessment, she appeared pale and sitting in a tripod position with her neck in extension. Soft inspiratory stridor was present with a loud, wet barking cough. Oxygen saturations were maintained with wafting oxygen but desaturated when distressed. She was tachycardic though capillary refill was normal. Intravenous ceftriaxone was administered to cover for bacterial tracheitis, and although she was maintaining her own airway, …