Illinois — Targeted Issue

Description

DKA management in pediatric patients is complex, time sensitive, and requires a multidisciplinary approach. Key best ED DKA management practices highlighted by this study include establishing specific DKA guidelines and ensuring access to a pediatric endocrinologist. To increase the knowledge base and comfort level of prehospital and ED providers managing pediatric DKA patients, the Illinois EMSC team developed this PowerPoint educational module.

Description

Targeting all health care providers who care for children, this course contains 10 narrated chapters along with appendices that contain additional resources. Key areas of focus include recommendations for appropriate triage/management of mild traumatic head injuries, guidelines for neuroimaging, child maltreatment screening, patient education, and head injury prevention strategies.

Author(s)/Presenter(s)

Carapetian, S., J. Hageman, E. Lyons, D. Leonard, K. Janies, K. Kelley and S. Fuchs

Abstract/Description

Workup of simple febrile seizures (SFS) has changed as the American Academy of Pediatrics made revisions to practice guidelines. In 2011, revisions were made regarding need for lumbar puncture (LP) as part of the SFS workup. This study surveyed more than 100 emergency departments regarding workup of children with SFS and performed a medical record review of workup that was performed. The survey shows that laboratory workup is done routinely and LP is done infrequently. The majority documents a complete exam. The medical record review demonstrates documentation of the examination, frequent laboratory and infrequent LP evaluation. Consistent with the American Academy of Pediatrics' revisions, survey and record reviews demonstrate that LP testing is infrequent. Contrary to the guideline, laboratory studies are routinely performed. This study suggests there is an opportunity to improve management of SFS by directing efforts toward finding the source of the fever and away from laboratory workup.

Author(s)/Presenter(s)

Taylor, C., J. Piantino, J. Hageman, E. Lyons, K. Janies, D. Leonard, K. Kelley and S. Fuchs

Abstract/Description

The purpose of this survey and record review was to characterize emergency department management of unprovoked seizures and status epilepticus in children in Illinois. The survey was sent to 119 participating emergency departments in the Emergency Medical Services for Children program; responses were received from 103 (88% response rate). Only 44% of the emergency departments had a documented protocol for seizure management. Only 12% of emergency departments had child neurology consultation available at all times. Record review showed that 58% of patients were discharged home, 26% were transferred to another institution, and 10% were admitted to a non-intensive care unit setting. Ninety percent of patients were treated with anticonvulsants. Seizure education was provided by the primary emergency department nurse (97%) and the treating physician (79%). This project demonstrated strengths and weaknesses in the current management of pediatric seizure patients in Illinois emergency departments.

Author(s)/Presenter(s)

Barrios, Ellen K. MD; Hageman, Joseph MD; Lyons, Evelyn RN, MPH; Janies, Kathryn BA; Leonard, Daniel MS; Duck, Stephen MD; Fuchs, Susan MD

Abstract/Description

This study aimed to investigate the management of pediatric patients with diabetic ketoacidosis (DKA) presenting to emergency departments (EDs) participating in the Illinois Emergency Medical Services for Children (EMSC) Facility Recognition program.

In 2010, Illinois EMSC conducted a survey (including case scenarios) and medical record review regarding management of pediatric patients with DKA. Data were submitted by 116 EDs.

Results: Survey response rate was 94%. Only 34% of EDs had a documented DKA guideline/policy; 37% reported that they did not have hospital adult or pediatric endocrinology services. Case scenarios identified a high percentage of respondents given an intravenous (IV) isotonic sodium chloride solution of 10 to 20 mL/kg during the first hour. However 17% to 21% would use an alternative choice such as administering initial IV solution of 0.45 sodium chloride, initiating an insulin drip before fluids, or waiting for more laboratory results before giving fluids or insulin. A total of 532 medical record reviews were submitted. In 87% of records, patients received an initial IV isotonic sodium chloride solution within the first hour. In 74%, patients received IV insulin infusion/drip (0.1 U/kg/h) after the initial fluid bolus. Of the patients, 51% were transferred to another facility; 22% were admitted to an intensive care unit.

Conclusions: Best ED practice management of pediatric DKA includes establishing a specific guideline/protocol and ensuring access to a pediatric endocrinologist. Both were identified as improvement areas in this project. Illinois EMSC has developed an educational module and provided direct feedback to all participating EDs, to improve their management of pediatric patients with DKA.