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PurposeIncreases in pediatric firearm-related injuries during the COVID-19 pandemic may be due to changes in where children and adolescents spent their time. This paper examines changes in the frequency of pediatric firearm-related encounters as a function of schooling mode overall and by race/ethnicity and age group at a large trauma center through 2021.MethodsWe use data from a large pediatric and adult trauma center in Tennessee from January 2018 to December 2021 (N=211 encounters) and geographically linked schooling mode data. We use Poisson regressions to estimate smoothed monthly pediatric firearm-related encounters as a function of schooling mode overall and stratified by race and age.ResultsCompared to pre-pandemic, we find a 42% increase in pediatric encounters per month during March 2020 to August 2020, when schools were closed, and a 23% increase in encounters after schools returned to in-person instruction. Effects of schooling mode are heterogeneous by race. Encounters increased among non-Hispanic Black children and adolescents across all periods relative to pre-pandemic. Among non-Hispanic white children and adolescents, encounters increased during the closure period and decreased on return to in-person instruction. Effects of schooling mode are also heterogeneous by age. Relative to pre-pandemic, pediatric firearm-related encounters increased 205% for children aged 5 to 11 and 69% for adolescents aged 12 to 15 during the school closure period.ConclusionCOVID-19-related changes to school instruction mode in 2020 and 2021 are associated with changes in the frequency and composition of pediatric firearm-related encounters at a major trauma center in Tennessee.

BACKGROUND Tibial shaft fractures are the most common injuries preceding acute compartment syndrome (ACS), so it is important to understand the incidence of and risk factors for ACS after pediatric tibial shaft fractures. The purposes of this study were to determine the rate at which ACS occurs and if any patient or fracture characteristics are significantly associated with developing ACS. METHODS All patients aged 5 to 17 years treated for a tibial shaft fracture at a level 1 pediatric trauma center, a level 1 adult trauma center, and an outpatient orthopaedic practice between 2008 and 2016 were retrospectively identified. Demographics, mechanisms of injury, and fracture characteristics were collected from the medical records. Radiographs were reviewed by study authors. ACS was diagnosed clinically or by intracompartmental pressure measurement. Univariable analysis was performed using the Fisher exact test for nominal variables and simple logistic regression for continuous variables. Multivariable analysis was performed using stepwise logistic regression. RESULTS Among 515 patients with 517 tibial shaft fractures, 9 patients (1.7%) with 10 (1.9%) fractures developed ACS at a mean age of 15.2 years compared with a mean age of 11 years in patients without ACS (P=0.001). One patient with bilateral tibial fractures developed ACS bilaterally. Age greater than 14 years (P=0.006), higher body mass index (P

Educators need efficient and effective means to track students' clinical experiences to monitor their progress toward competency goals.To validate an electronic scoring system that rates medical students' clinical notes for relevance to priority topics of the medical school curriculum.The Vanderbilt School of Medicine Core Clinical Curriculum enumerates 25 core clinical problems (CCP) that graduating medical students must understand. Medical students upload clinical notes pertinent to each CCP to a web-based dashboard, but criteria for determining relevance of a note and consistent uploading practices by students are lacking. The Vanderbilt Learning Portfolio (VLP) system automates both tasks by rating relevance for each CCP and uploading the note to the student's electronic dashboard. We validated this electronic scoring system by comparing the relevance of 265 clinical notes written by third year medical students to each of the 25 core patient problems as scored by VLP verses an expert panel of raters.We established the threshold score which yielded 75% positive prediction of relevance for 16 of the 25 clinical problems to expert opinion.Automated scoring of student's clinical notes provides a novel, efficient and standardized means of tracking student's progress toward institutional competency goals.

Clinical task, or “to-do” lists are a common element in the physician document known as signout. Such lists are used to capture and track patient care plan items, supporting daily workflow and collaborative patient management continuity across care transitions. While physician task lists have been shown to be important to patient safety, the tasks themselves have not been systematically examined for their subject matter, structure, or components. A manual sublanguage analysis of 500 signout tasks was conducted, and a hierarchical conceptual model for clinical tasks was inductively constructed. Tasks were classified by action type (Assess, Order, Communicate, Perform) and corresponding components. The most common task action types were Assess and Order. The most common task components were “What” type components such as Tests, including subtypes Laboratory and Imaging. This study yielded several important design considerations for future electronic health record systems that support collaborative clinical task management.