- Email: [email protected]
331 Youth Heart Rescue Pilot: A School-Centered Out-of-Hospital Cardiac Arrest Educational Intervention
Research Forum Abstracts who were not described as quiet (28 11.6 years) (P<.001). “Quiet” SASs were also more likely to have known their assailant (47.03% versus 39.5% not quiet, P<.0367) and to accept prophylaxis for STIs (81.7% versus 75.58%, P<.0114). SASs described as “responsive to questions” were more likely to have known their assailant (71.27% versus 61.34%, P<.0026) and to accept prophylaxis for STIs (81.62% versus 72.4%, P<.0057). SASs who were crying during SANE examination were more likely to agree to prophylaxis for STIs (85.51% versus 76.07%, P<.0118) and HIV (43.69% versus 25.73%, P<.0001). Conclusion: Our data suggests that a simple PSAB profile helps identify assault characteristics such as assailant relationship and patient willingness to accept prophylaxis for STIs and HIV in the ED. The further development of and use of this profile may aid in identifying patients at risk for therapeutic non-compliance and help the ED clinician in obtaining valuable information through a more patient-focused intake process.
331
Youth Heart Rescue Pilot: A School-Centered Out-ofHospital Cardiac Arrest Educational Intervention
Cano A, Del Rios M, Aldeen A, Campbell T, Demertsidis E, Heinert S, VandenHoek T/ University of Illinois at Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL; University of Chicago, Chicago, IL
Study Objective: Approximately 424,000 cases of out-of-hospital cardiac arrest (OHCA) occur each year in the United States. Striking geographic variation in OHCA survival has been observed, from 0.2% in Detroit, MI, to 16% in Seattle, WA. Variation in survival closely follows rates of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use. When considering that most OHCA occur in the home, increasing the number of children trained in CPR may increase the likelihood of someone promptly initiating CPR in an OHCA victim. The purpose of this pilot study was to determine the feasibility, efficiency, and knowledge acquisition of a 45-minute compression-only cardiopulmonary resuscitation and defibrillator educational curriculum in an urban school setting. Methods: Subjects were students of grades 6-12 in four demographically distinct schools in Chicago, Illinois: one predominantly white school, one predominantly Latino school, one predominantly African American School, and one mixed neighborhood school. Participants in the Youth Heart Rescue pilot received a 45minute training on OHCA recognition, activation of 911, compression-only CPR, and AED use. The primary outcome measure was post-training CPR and AED knowledge as determined by immediate post-assessment surveys. Our secondary outcome measure was our training efficiency index for cardiac arrest, defined as the number of volunteer hours per person trained. Results: During the year 2013, 201 students participated in groups of 20-30 in our Youth Heart Rescue program. Immediate recall was excellent: 96% properly identified rate of compressions (100 per minute); 99% knew the function of the defibrillator; 90% correctly identified “automated external defibrillator” as the name of the device when shown a picture of one; 96.5% identified the AED as easy to use. Chest compression were recognized by 99.5% of participants as the next step after calling 911 and 87% included the defibrillator as part of the cardiac arrest response. Most participants (76%) pledged to teach their family members. Twenty-five volunteer hours were invested for a training efficiency index of 0.12 volunteer hours per person trained. Conclusion: The results of this pilot study suggest that our 45-minute Youth Heart Rescue educational intervention is a feasible way to disseminate knowledge and awareness of cardiac arrest amongst school aged children. Further research with a larger sample is necessary to measure long-term knowledge retention and dissemination into the community. Because schools provide large-scale, centrally organized settings to which all children and their families have access, a school-centered educational intervention can reach large segments of the population in demographically diverse neighborhoods frequently overlooked.
332
The Reliability of Sick Children Require Evaluation Now to Prioritize Critically Ill Children in Primary Health Care Centers in Low-Resource Settings
Hansoti B, Jenson A, Rothman RE, Kirsch T, Wallis L/Johns Hopkins University, Baltimore, MD; Johns Hopkins University, Baltimore, MD; University of Cape Town, Cape Town, South Africa
Background: The WHO estimates that 10-20% of children presenting to primary health care centers (PHCs) in low and middle-income countries are already critically ill
Volume 64, no. 4s : October 2014
and would benefit from onward referral. Adapting the existing WHO Emergency Triage and Assessment Tool (ETAT), using a modified Delphi technique, developed the Sick Children Require Evaluation Now (SCREN) tool. The tool was further refined using action research methodology during implementation. Non-health care trained individuals apply the SCREN tool to all children that present to PHCs. The purpose of this tool is to screen for critically ill children in PHCs in low-resource settings so that they can be filtered and prioritized on arrival at a clinic to receive early evaluation by a trained health care provider. Study Objectives: This study aims to evaluate the reliability of SCREN in identifying critically unwell children, aged 1 month to 5 years. Methods: The tool was implemented in 5 clinics chosen at random in Cape Town, South Africa. Children presenting to the PHCs were prospectively enrolled. The WHO Integrated Management of Childhood Illnesses (IMCI) is the current nurseinitiated treatment and triage tool used within city health clinics. The study investigators used SCREN, a 6-question subjective tool administered by lay health care assistants, and IMCI to evaluate all children. Critically ill children are defined as IMCI red ie, those children that require urgent referral to a higher level of care. Results: A total of 455 children were enrolled in the study from January 2014 to March 2014. One hundred nineteen (11.8%) children were screened positive using the tool, 14 children were defined as IMCI red and one child as IMCI yellow. The sensitivity and specificity of the tool was found to be 93.1% and 76.1% respectively (P<.00001) for identifying critically unwell children. SCREN has a high negative predicative value of 99.7% (Figure). Conclusion: SCREN is successfully able to identify critically ill children in lowresource primary health care settings. SCREN has a high negative predicative value for identifying critically unwell children when utilized within this setting.
333
Factors Affecting Emergency Department Opioid Prescribing Decisions Vary by Provider Type: A Cross-Sectional Survey at an Urban Academic Center
Pomerleau AC, Schrager JD, Morgan BW/Emory University School of Medicine, Atlanta, GA
Study Objectives: Commensurate with the trend of rising overdose deaths related to prescription opioid analgesics is a trend of increasing opioid prescription by clinical practitioners. Prior studies have shown that opioid prescribing decisions vary greatly among emergency department (ED) providers, but little is known about the factors that underlie these decisions. The main aim of this study was to describe the selfreported importance of different factors in a provider’s decision to prescribe opioid medications. Our primary hypothesis was that opioid prescribing practices and important decisional factors would be highly variable among providers. Methods: We conducted an online, cross-sectional survey of providers at an urban academic emergency medicine residency program. The study population included all clinicians (attendings, residents, midlevel providers) currently delivering patient care at any of five EDs affiliated with the residency program. Potential respondents were emailed a link to the online questionnaire. The study questionnaire was developed based on a similar prior study, then iteratively refined and piloted with emergency physicians. Topics included provider demographics, opioid-prescribing practices at ED
Annals of Emergency Medicine S117
331
Youth Heart Rescue Pilot: A School-Centered Out-ofHospital Cardiac Arrest Educational Intervention
Cano A, Del Rios M, Aldeen A, Campbell T, Demertsidis E, Heinert S, VandenHoek T/ University of Illinois at Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL; University of Chicago, Chicago, IL
Study Objective: Approximately 424,000 cases of out-of-hospital cardiac arrest (OHCA) occur each year in the United States. Striking geographic variation in OHCA survival has been observed, from 0.2% in Detroit, MI, to 16% in Seattle, WA. Variation in survival closely follows rates of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use. When considering that most OHCA occur in the home, increasing the number of children trained in CPR may increase the likelihood of someone promptly initiating CPR in an OHCA victim. The purpose of this pilot study was to determine the feasibility, efficiency, and knowledge acquisition of a 45-minute compression-only cardiopulmonary resuscitation and defibrillator educational curriculum in an urban school setting. Methods: Subjects were students of grades 6-12 in four demographically distinct schools in Chicago, Illinois: one predominantly white school, one predominantly Latino school, one predominantly African American School, and one mixed neighborhood school. Participants in the Youth Heart Rescue pilot received a 45minute training on OHCA recognition, activation of 911, compression-only CPR, and AED use. The primary outcome measure was post-training CPR and AED knowledge as determined by immediate post-assessment surveys. Our secondary outcome measure was our training efficiency index for cardiac arrest, defined as the number of volunteer hours per person trained. Results: During the year 2013, 201 students participated in groups of 20-30 in our Youth Heart Rescue program. Immediate recall was excellent: 96% properly identified rate of compressions (100 per minute); 99% knew the function of the defibrillator; 90% correctly identified “automated external defibrillator” as the name of the device when shown a picture of one; 96.5% identified the AED as easy to use. Chest compression were recognized by 99.5% of participants as the next step after calling 911 and 87% included the defibrillator as part of the cardiac arrest response. Most participants (76%) pledged to teach their family members. Twenty-five volunteer hours were invested for a training efficiency index of 0.12 volunteer hours per person trained. Conclusion: The results of this pilot study suggest that our 45-minute Youth Heart Rescue educational intervention is a feasible way to disseminate knowledge and awareness of cardiac arrest amongst school aged children. Further research with a larger sample is necessary to measure long-term knowledge retention and dissemination into the community. Because schools provide large-scale, centrally organized settings to which all children and their families have access, a school-centered educational intervention can reach large segments of the population in demographically diverse neighborhoods frequently overlooked.
332
The Reliability of Sick Children Require Evaluation Now to Prioritize Critically Ill Children in Primary Health Care Centers in Low-Resource Settings
Hansoti B, Jenson A, Rothman RE, Kirsch T, Wallis L/Johns Hopkins University, Baltimore, MD; Johns Hopkins University, Baltimore, MD; University of Cape Town, Cape Town, South Africa
Background: The WHO estimates that 10-20% of children presenting to primary health care centers (PHCs) in low and middle-income countries are already critically ill
Volume 64, no. 4s : October 2014
and would benefit from onward referral. Adapting the existing WHO Emergency Triage and Assessment Tool (ETAT), using a modified Delphi technique, developed the Sick Children Require Evaluation Now (SCREN) tool. The tool was further refined using action research methodology during implementation. Non-health care trained individuals apply the SCREN tool to all children that present to PHCs. The purpose of this tool is to screen for critically ill children in PHCs in low-resource settings so that they can be filtered and prioritized on arrival at a clinic to receive early evaluation by a trained health care provider. Study Objectives: This study aims to evaluate the reliability of SCREN in identifying critically unwell children, aged 1 month to 5 years. Methods: The tool was implemented in 5 clinics chosen at random in Cape Town, South Africa. Children presenting to the PHCs were prospectively enrolled. The WHO Integrated Management of Childhood Illnesses (IMCI) is the current nurseinitiated treatment and triage tool used within city health clinics. The study investigators used SCREN, a 6-question subjective tool administered by lay health care assistants, and IMCI to evaluate all children. Critically ill children are defined as IMCI red ie, those children that require urgent referral to a higher level of care. Results: A total of 455 children were enrolled in the study from January 2014 to March 2014. One hundred nineteen (11.8%) children were screened positive using the tool, 14 children were defined as IMCI red and one child as IMCI yellow. The sensitivity and specificity of the tool was found to be 93.1% and 76.1% respectively (P<.00001) for identifying critically unwell children. SCREN has a high negative predicative value of 99.7% (Figure). Conclusion: SCREN is successfully able to identify critically ill children in lowresource primary health care settings. SCREN has a high negative predicative value for identifying critically unwell children when utilized within this setting.
333
Factors Affecting Emergency Department Opioid Prescribing Decisions Vary by Provider Type: A Cross-Sectional Survey at an Urban Academic Center
Pomerleau AC, Schrager JD, Morgan BW/Emory University School of Medicine, Atlanta, GA
Study Objectives: Commensurate with the trend of rising overdose deaths related to prescription opioid analgesics is a trend of increasing opioid prescription by clinical practitioners. Prior studies have shown that opioid prescribing decisions vary greatly among emergency department (ED) providers, but little is known about the factors that underlie these decisions. The main aim of this study was to describe the selfreported importance of different factors in a provider’s decision to prescribe opioid medications. Our primary hypothesis was that opioid prescribing practices and important decisional factors would be highly variable among providers. Methods: We conducted an online, cross-sectional survey of providers at an urban academic emergency medicine residency program. The study population included all clinicians (attendings, residents, midlevel providers) currently delivering patient care at any of five EDs affiliated with the residency program. Potential respondents were emailed a link to the online questionnaire. The study questionnaire was developed based on a similar prior study, then iteratively refined and piloted with emergency physicians. Topics included provider demographics, opioid-prescribing practices at ED
Annals of Emergency Medicine S117