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Infants with single ventricle physiology in the emergency department: are physicians prepared?
Katherine Cashen1, Pooja Gupta, Mary Lieh-Lai
1Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI 48201, USA.
Insights
Infants with single ventricle (SV) physiology frequently visit the emergency department (ED) between surgeries. Most ED physicians feel unprepared to treat these complex pediatric patients, highlighting a need for better education.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Emergency Medicine
Background:
- Infants with single ventricle (SV) physiology require staged surgical palliation.
- The period between surgical stages presents unique challenges for infant care.
Purpose of the Study:
- To evaluate emergency department (ED) use by infants with SV physiology.
- To assess emergency physician preparedness for managing these infants between surgical stages.
Main Methods:
- Retrospective review of infant records post-stage I palliation.
- Cross-sectional survey of emergency department physicians in Michigan.
Main Results:
- 79% of infants with SV physiology had ED visits, often for respiratory distress.
- Physicians reported uncertainty regarding oxygen saturation and felt unprepared for treatment.
- Infants with ED visits had significantly longer initial hospital stays.
Conclusions:
- Infants with SV physiology have high ED utilization and acuity between surgical stages.
- Emergency physicians often lack preparedness and confidence in managing these infants.
- Educational initiatives are crucial to improve ED preparedness for SV physiology patients.
Objective:
To assess emergency department (ED) utilization and physician preparedness for infants with single ventricle (SV) physiology between stage 1 and stage 2 surgical palliation.
Study Design:
Records of infants with SV physiology discharged after stage I palliation between July 2006 and June 2009 were retrospectively reviewed. Next, a cross-sectional survey of registered ED physicians in Michigan was performed.
Results:
Thirty-three of 42 patients (79%) required 65 ED visits, most commonly presenting with respiratory distress (35%). Six patients died in the ED; 35 other visits resulted in hospital admission, 4 requiring urgent surgery or catheterization. Median initial hospital stay in those with ED visits was significantly longer (21 days; IQR, 17-45 days) than those without (12 days; IQR, 5.5-24 days) (P = .032). Three hundred seventy-six of 915 surveyed ED physicians responded. Most (72%) were unsure of the acceptable range of arterial oxygen saturation for these infants, and 58% felt "uncomfortable" or "worried" about their treatment. Despite these concerns, 59% deemed education in SV physiology as low priority.
Conclusions:
Between stages I and II, infants with SV physiology utilized the ED frequently, often with high disease acuity. Most ED physicians surveyed appeared underprepared for these infants. These findings underscore the need for educational efforts aimed at increasing ED preparedness.
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