Sarah V. Duzinski

Investigating pediatric trauma team communication effectiveness phase two: Achieving inter-rater reliability for the Assessment of Pediatric Resuscitation Communication Team Assessment

Abstract Trauma team communication errors made during pediatric resuscitations compromise both patient and healthcare provider safety. Unnecessary patient injury and even death have been linked to miscommunication among trauma team members. In addition, trauma team members are experiencing a steady increase in malpractice claims brought against them due to medical errors that occurred because of miscommunication among team members. Although miscommunication is a problem during trauma resuscitations, few instruments exist to evaluate the communication effectiveness between trauma team members during resuscitations. To fill this void, the Assessment of Pediatric Resuscitation Communication Team Assessment (APRC-TA) was created to assess the communication effectiveness of trauma teams during resuscitations. The instrument was designed to identify specific team communication errors that occur during resuscitations. The purpose of this study is to further validate the APRC-TA by determining the inter-rater reliability of the instrument. Once the APRC-TA is validated, healthcare providers and researchers will be able to use the instrument to identify team communication errors and improve the overall communication effectiveness of trauma resuscitations.

Threat of paediatric hyperthermia in an enclosed vehicle: a year-round study

Objective To describe temperature change throughout the workday in an enclosed vehicle in Austin, Texas across the calendar year while accounting for heat index. Methods In this observational study, vehicular temperature was measured 1 day per month during 2012 in Austin, Texas. Data were recorded at 5-min intervals via an EL-USB-1-PRO digital temperature sensor from 8:00 to 16:00. Selected days were primarily cloud-free (with ‘clear’ or ‘few clouds’) with a predicted ambient temperature high within ±20°F of the 30-year normal high. Referent temperature and 30-year normal data were collected via the nearest National Weather Service (NWS) weather station. The NWS heat index and corresponding hazard levels were used as a guideline for this study. Results Per NWS guidelines, the enclosed vehicle temperature rose to ‘danger’ levels of ≥105°F (41°C) in all months except January and December and to ‘extreme caution’ levels of ≥90°F (32°C) in every month of the year. In June, the vehicle rose to ≥105°F (41°C) by 9:25. The hottest vehicular temperature achieved was 137°F (58°C). In 9 months of the year, the vehicle reached ≥90°F (32°C) by noon. We also found that an ambient temperature as low as 68°F was associated with vehicular temperatures ≥105°F (41°C). Conclusions Infants and children in states that experience mild winter temperatures face the threat of vehicular hyperthermia disability and death across the calendar year. Prevention efforts that focus on awareness of a childhood heat vulnerability, parental perception of susceptibility to forgetting a child in a vehicle and universal availability of vehicular safety devices may reduce paediatric vehicular hyperthermia death.

Investigating pediatric trauma team communication effectiveness phase one: the development of the assessment of pediatric resuscitation communication

Abstract Trauma team communication effectiveness is usually not assessed during pediatric trauma resuscitations. Consequently, ineffective team communication is regarded as a root cause of medical errors made within the trauma setting. In order to identify the communication errors made during pediatric trauma resuscitations, researchers must have the tools necessary to evaluate the communication effectiveness of trauma team members and leaders. To address this need, the Assessment of Pediatric Resuscitation Communication (APRC) was recently created. Thus, the purpose of this manuscript is to describe the development of the APRC instrument, preview future plans for validation, and explain how the instrument can be used to improve the overall communication effectiveness of trauma teams and leaders. The APRC instrument was developed following a series of focus groups, interviews, and observations with trauma team members and leaders.

The association between positive screen for future persistent posttraumatic stress symptoms and injury incident variables in the pediatric trauma care setting.

BACKGROUND Posttraumatic stress (PTS) disorder after injury is a significant yet underaddressed issue in the trauma care setting. Parental anxiety may impact a child’s risk of future, persistent PTS symptoms after injury. This study aimed to: (1) identify injury incident and demographic variables related to a positive screen for future, persistent PTS symptoms in children; and (2) examine the relationship between parental anxiety and a positive screen for future, persistent PTS symptoms in children. METHODS From November 2009 to August 2010, 124 patients were enrolled at a pediatric trauma center. Inclusion criteria were as follows: (1) age 7 years to 17 years; (2) hospitalized for at least 24 hours after physical trauma; and (3) English or Spanish speaking. State and trait anxiety were measured for both pediatric patients and their parents/guardians via the state trait anxiety inventory for children and state trait anxiety inventory, respectively. Risk for future, persistent PTS, among pediatric patients was assessed via the screening tool for early predictor of posttraumatic stress disorder (STEPP). RESULTS Of 116 participants assessed via the STEPP, 32 (28%) screened positive for risk of future, persistent PTS symptoms. Motor vehicle collision and parental presence at injury were associated with a positive STEPP screen. The effect of parental presence on positive STEPP screen was modified by parental trait anxiety. Children of anxious parents present at injury were over 14 times as likely to screen positive for risk of future, persistent PTS, as those without a parent present. CONCLUSION The risk of future, persistent PTS, after injury among the pediatric population is substantial. Parents with existing trait anxiety are shown to influence their child’s risk for future, persistent PTS, particularly if present at the injury event. Further study of PTS prevention and control strategies are needed among this population within the trauma care setting. (J Trauma Acute Care Surg. 2012;72: 1640–1646. Copyright

Perceptions of injury prevention and familial adjustment among mothers of teen parents

INTRODUCTION Injury is a leading cause of death for infants and children. Teen mothering has been shown to put children at increased risk of injury. The mothers of teen parents often play a predominant role in the lives and caregiving of the children born to their children. METHOD This article presents the findings of three focus groups conducted with 21 mothers of teen parents. Grounded theory methodology was used to explore family dynamics and how they relate to injury prevention beliefs and practices regarding infants and children. RESULTS Our findings revealed the difficulty mothers of teen parents and the teens themselves have in adjusting to the knowledge of the pregnancy. Unique barriers to injury prevention were also uncovered. CONCLUSIONS Our findings provide evidence for the need of a multigenerational approach to programs aimed at improving the safety and well-being of children in this context.

Teaching Safety at a Summer Camp: Evaluation of a Water Safety Curriculum in an Urban Community Setting

Objectives: The purpose of this project was to evaluate a water safety curriculum in a low-income, minority-focused, urban youth summer camp. The curriculum is available to Safe Kids Coalitions across the country; however, it has not previously been evaluated. Methods: Participants were pre-K to third-grade students (n = 166). Children watched a video and received the curriculum in a classroom setting. Each child was given a pre-, post-, and 3-week retention exam to assess knowledge change. Mean test scores and number of safety rules participants could list were analyzed using paired Student’s t tests. Parents were given a baseline survey at the beginning (n = 140) and end of the weeklong curriculum (n = 118). Results: The participants were 50% male, 27.5% Hispanic, 68.7% African American, and 3.8% biracial. Children were divided into three groups: pre-K/kindergarten, first and second grade, and third grade. Children in each of the groups received higher knowledge scores at the posttest (p = .0097, p < .0001, and p < .0001, respectively), with little decline in scores at the 3-week retention exam. Similar results were seen for the ability to list safety rules, though the number fell slightly between the posttest and retention test. Conclusion: The study demonstrates that children possessed more knowledge of water safety after receiving this curriculum. This knowledge increase was maintained through the 3-week retention exam. Further evaluation of the curriculum’s content and its impact on water safety beliefs, attitudes, and behaviors are needed, as well as evaluation of additional settings, risk areas, and the role of parental involvement.

Effectiveness of a Pediatric Abusive Head Trauma Prevention Program Among Spanish-Speaking Mothers

Introduction: This study aimed to evaluate participants’ knowledge of and intent to share key messages of the Period of PURPLE Crying abusive head trauma prevention program among a majority Spanish-speaking population. Methods: This study was a retrospective review of a postintervention survey administered in the perinatal unit of a community birthing hospital. Surveys were administered to mothers of newborns by perinatal nurses as part of routine process evaluation prior to hospital discharge between May 30, 2014, and May 15, 2015. Results: A majority of participants (86.4%) answered all six knowledge questions correctly. Among participants who reported that the father or significant other was not present during the PURPLE education (44.1%), all (100%) reported intending to share the PURPLE information with their partners. The majority of participants (88.1%) intended to share the information with others who take care of their infants. Conclusion: The PURPLE abusive head trauma prevention program demonstrated positive preliminary results in knowledge and intended behavior among a population of majority Spanish-speaking participants. These findings offer an important first step toward provision of effective universal abusive head trauma prevention among growing Spanish-speaking populations. Further evaluation is needed of acceptability, retention of messages, and postintervention behavior change among Spanish-speaking participants and nurses.

Youth Suicide Attempt Nomenclature Used in Two Central Texas Hospitals

Background: Surveillance systems capturing instances of self-directed violence (SDV) continue to lack uniform nomenclature and classification methodology. Aims: To apply and compare two retrospective surveillance approaches to youth experiencing SDV presenting to two urban hospitals with Level I Trauma Centers. Method: Two suicide attempt surveillance methods where retrospectively applied to our SDV cohort: (a) a rigorous method facilitated by medical record review and application of standardized classification; and (b) a common surveillance method conducted by systematic queries of suicide attempt key terms and diagnosis codes among hospital databases. Results: Rigorous surveillance identified 249 patients attempting suicide. The common methods querying suicide attempt in the chief complaint field had a high positive predictive value and specificity; however, sensitivity was low. Limitations: Authors were unable to determine whether all SDV encounters during the study timeframe were identified for initial screening owing to the hospitals lack of a uniform nomenclature or classification system. Conclusion: Results showed underreporting of suicide attempt cases, inadequate sensitivity and specificity in common surveillance methods, and skewed demographic representation compared with the rigorous surveillance method. This study elucidates the negative impact of inconsistent SDV nomenclature including impeding effective patient identification, treatment, surveillance, and generalizable research.

Do Inflatable Bounce Houses Pose Heat-Related Hazards to Children?

AbstractInflatable bounce houses provide a popular summer activity for children. Injuries such as sprains and fractures are widely acknowledged, but there is less awareness about possible hazards from excessive heat exposure. This study aims to identify whether conditions in the bounce house are more oppressive than ambient conditions on a typical summer day in Athens, Georgia. Results show that maximum air temperatures in the bounce house can reach up to 3.7°C (6.7°F) greater than ambient conditions, and peak heat index values may exceed outdoor conditions by 4.5°C (8.1°F). When considered within the context of the National Weather Service heat index safety categories, the bounce house reached the “danger” level in more than half of the observations, compared with only 7% of observations for ambient conditions. Parents and caregivers should be aware of heat-related hazards in bounce houses and closely monitor children, adjusting or canceling activities as conditions become more oppressive.

Does restraint status in motor vehicle crash with rollover predict the need for trauma team presence on arrival? An ATOMAC study

PURPOSE Restraint status has not been combined with mechanistic criteria for trauma team activation. This study aims to assess the relationship between motor vehicle crash rollover (MVC-R) mechanism with and without proper restraint and need for trauma team activation. METHODS Patients <16years old involved in an MVC-R between November 2007 and November 2012 at 6 Level 1 pediatric trauma centers were included. Restraint status, the need for transfusion or intervention in the emergency department (ED), hospital and intensive care length of stay and mortality were assessed. RESULTS Of 690 cases reviewed, 48% were improperly restrained. Improperly restrained children were more likely to require intubation (OR 10.24; 95% CI 2.42 to 91.69), receive blood in the ED (OR 4.06; 95% CI 1.43 to 14.17) and require intensive care (ICU) (OR; 3.11; 95% CI 1.96 to 4.93) than the properly restrained group. The improperly restrained group had a longer hospital length of stay (p<0.001), and a higher mortality (3.4% vs. 0.8%; OR 4.09; 95% CI 1.07 to 23.02) than the properly restrained group. CONCLUSION Unrestrained children in MVC-R had higher injury severity and were significantly more likely to need urgent interventions compared to properly restrained children. This supports a modification to include restraint status with the rollover criterion for trauma team activation.