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Background: Bedside ultrasound (BUS) can provide critical information in a rapid and noninvasive manner to the emergency physician. It is widely used in emergency departments (ED) throughout the nation. Literature shows that BUS shortens patient stay and increases patient satisfaction. General emergency medicine (EM) residencies incorporate BUS training in their curricula. However, there are limited data about the training that pediatric emergency medicine (PEM) fellows receive. Objective: To determine the extent of training and use of BUS in PEM fellowship programs. Methods: A 29-question survey was mailed to all (57) PEM fellowship program directors in the spring of 2006. Results: The response rate was 81% (46/57). Fifty-seven percent (26/46) of the responding PEM fellowship program directors reported that their faculty used BUS in their departments. At 50% (23/46) of programs, fellows perform BUS studies. Sixty-five percent (30/46) of PEM fellowships reported that their fellows receive some BUS training, but only 15 of these programs included BUS training in the curriculum as a 2- to 4-week ultrasound rotation. Sixty-five percent (30/46) of PEM fellowship programs had access to an ultrasound machine, but only 28% (13/46) of programs had their own machine. The main reason not to own an ultrasound machine was a lack of ultrasound expertise in their department (67%, 22/33). Bedside ultrasound training was provided by general EM physicians in 57% (17/30) of programs. Eighty-seven percent of the directors agree that BUS training would benefit their practice. The 2 factors significantly associated with the likelihood of having formal BUS training were access to an ultrasound machine (87% vs 55% P = 0.04) and presence of an adult ED with an EM residency at the program (80% vs 42% P = 0.03). Pediatric emergency medicine fellowship programs at children's hospitals were significantly less likely to have formal training (33.3% vs 74.2%; P = 0.01). Conclusions: Despite literature supporting the benefits of BUS in the ED, many PEM fellowship programs do not incorporate BUS training for their PEM fellows. Most PEM fellows who receive training in BUS are instructed by physicians trained in EM, not PEM.

Purpose of review To provide an update on the diagnosis and management of skin, soft-tissue, and osteoarticular infections in children. Recent findings Our understanding of the epidemiology of skin and soft-tissue infections and osteoarticular infections is changing rapidly. Community-associated methicillin-resistant Staphylococcus aureus has become a predominant cause of childhood skin and soft-tissue infections. Kingella kingae is also increasingly identified as a cause of osteoarticular infections. Challenges in Staphylococcus aureus treatment and Kingella kingae identification are changing the approach to skin and soft-tissue infections and osteoarticular infections. Summary Community-associated methicillin-resistant Staphylococcus aureus should be considered a cause of skin and soft-tissue infections. Empiric antimicrobial choices should be modified in areas in which there is a more than 10% prevalence of community-associated methicillin-resistant Staphylococcus aureus infection. Decontamination of shared sports equipment should be undertaken to minimize person-to-person spread. No established guideline for eradication of carriage of community-associated methicillin-resistant Staphylococcus aureus exists. Kingella kingae is a more prevalent cause of osteoarticular infections than previously recognized and can cause outbreaks of invasive infection via person-to-person transmission. Modification of culturing procedures for osteoarticular infections including inoculation of infected joint fluid and bone in blood-culture bottles should be considered.

Objectives. The objectives of this study were to describe the number of children with suspected abuse or neglect (CAN) cared for in selected children’s hospitals, to determine how they are tracked and followed, and to better describe the composition, function, and financial support of child protection teams (CPTs).Methods. A self-administered survey was mailed to child abuse contact leaders at institutions that were members of the National Association of Children’s Hospitals and Related Institutions in 2001. Responses from rehabilitation hospitals and those that did not indicate whether a CPT was present were excluded.Results. One hundred thirty-four of 157 leaders responded. One hundred twenty-two (91%) met study criteria. Eighty-eight hospitals (72%) had a CPT—54% were pediatric facilities, 59% had >100 beds, and 89% had a pediatric residency. Compared with institutions without a CPT, institutions with a CPT were less likely to be located in the South (28% vs 70%) and more likely to have >200 beds (26% vs 1%), a medical school affiliation (92% vs 74%), and a pediatric residency (98% vs 68%).Sixty-one percent of institutions cared for Fifty-two percent of CPTs had an annual budget of $500 000 or less. The most common primary source of financial support for CPTs was the hospital (51%), although funding was usually composed of a combination of funds from the hospital, patient fees, and state government.Functions performed by CPTs included consulting on cases of CAN (89%), functioning as a liaison with child protective services (85%), tracking cases of abuse or neglect (70%), providing quality assurance on CAN cases (63%), and filing reports with child protective services (61%). Twenty-four hour consultative coverage was provided by most CPTs (79%), for which 94% provided phone consultation and 81% provided in-person consultation when necessary.Conclusions. The institutions surveyed cared for many children suspected of abuse and neglect. Thirty-eight percent did >300 evaluations per year. In general, institutions with CPTs provided more comprehensive documentation and follow-up of children suspected of having been abused or neglected than institutions without CPTs. Whether this is associated with better outcomes for children suspected of abuse or neglect is unknown.

The aim of this study was to develop a reliable and valid self-evaluation tool for use by child protection team (CPT) members.An online survey was administered to members of 10 CPTs. The survey included the following 3 sections: 1) initial conditions (eg, team composition, resources), 2) enabling conditions (eg, team effort, strategy), and 3) team effectiveness (eg, team cohesion, meeting performance standards). Each section contained multiple subscales. Internal consistency was calculated using Cronbach α. To evaluate construct validity, the subscale scores of the most advanced teams who qualified as centers of excellence (n = 3) were compared with the subscale scores of the other teams (n = 7) to determine whether the tool could distinguish between the two.Of 116 team members, 83 (72%) completed the survey. The subscales exhibited good internal consistency (α = .71-.97). The 3 centers of excellence had significantly higher mean scores than the other 7 CPTs on the following subscales: incentives (in the initial conditions section, 61.46 vs 38.89; P = .003), effort (in the enabling conditions section, 79.31 vs 67.70; P = .003), and professional growth (in the team effectiveness section, 83.89 vs 80.40; P = .004).This novel survey demonstrates satisfactory test characteristics and can be used to assess CPT performance and identify areas for improvement.

OBJECTIVES: More than $55 million is spent on hospital-based child protection teams (CPTs) annually, but there is no consensus on what makes CPTs effective. The objective of this study was to create expert consensus on tasks that CPTs should perform and factors that contribute to effectiveness. METHODS: A modified Delphi approach was used to create expert consensus among professionals with experience working on or with hospital-based CPTs. Three initial rounds of surveys were conducted; a first round of open-ended questions generated topics related to CPT tasks and factors related to team effectiveness. A Likert scale (range: 1–7) determined rank. In the fourth round, participants ranked the top 5 variables associated with effectiveness. RESULTS: Twenty-six (90%) of 29 participants completed the first 3 rounds, and 20 (67%) completed the final ranking. Experts believed that CPTs should provide communication of findings to appropriate agencies (mean Likert score: 7.0), court testimony (7.0), medical consultations (6.9), multidisciplinary case review (6.6), and forensic interviews (6.0). CPT success should be determined by professionals who use CPT services (6.6) and CPT members (6.5). Variables that were ranked most often as critical to effectiveness included interdisciplinary collaboration (95% of participants), provision of resources (80%), and team collegiality (75%). Variables that were ranked as most detrimental included inadequate staffing (85%) and lack of collegiality (80%). CONCLUSIONS: A multidisciplinary team working in a collegial atmosphere seems to be the major key to CPT effectiveness. In addition to providing services, CPTs should focus on improving collegiality and interdisciplinary collaboration and should seek performance feedback from referring professionals and CPT members.

Objective Physicians providing emergency department care to children primarily use nebulizers for the delivery of bronchodilators and these physicians have misconceptions regarding the advantages and disadvantages of using metered-dose inhalers (MDIs) with a spacer (MDI + S) for acute asthma exacerbations. Design Self-administered mail survey. Setting Emergency department. Participants Emergency medicine section members of the American Academy of Pediatrics and Canadian Pediatric Society. Interventions Bronchodilator delivery methods in acute pediatric asthma. Main Outcome Measures The 2 principal outcomes for bivariate analysis were self-reported nebulizer use in all patients and MDI + S use in patients with mild acute asthma. Results Of eligible physicians, 333 (51%) of 567 responded. The majority were dual trained in pediatrics and pediatric emergency medicine (72%) and practiced full time (83%) in an urban (83%) pediatric emergency department (80%). The most commonly cited advantages of MDIs were their cost (33%) and speed of use (28%). The most commonly cited disadvantages were patient or parent dissatisfaction (24%) and relative ease of nebulizer use (23%). Only 10% to 21% of participants used MDIs in the emergency department and reserved this delivery method for children with mild asthma exacerbations. There were no significant associations between selected respondent demographic variables and the use of MDIs. Conclusions Misconceptions regarding the efficacy and safety of MDI + S for the treatment of acute asthma exacerbations exist but are limited to a minority of surveyed emergency medicine physicians caring for children. Nebulizers remain the preferred method of routine bronchodilator delivery by physicians providing care to pediatric asthmatics in the emergency department.