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Cardiopulmonary Resuscitation III: AED Use01:23

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Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...
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Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children
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Child physical abuse screening in a pediatric ED; Does TRAIN(ing) Help?

Theodore Heyming1,2, Chloe Knudsen-Robbins3, Supriya Sharma4

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The Timely Recognition of Abusive INjuries (TRAIN) initiative increased skeletal survey rates in infants under six months old, aiding in the recognition of child physical abuse (CPA). This study examined TRAIN

Keywords:
Child maltreatmentChild physical abuseNon-accidental traumaPediatricsSentinel injury

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Area of Science:

  • Pediatric Emergency Medicine
  • Child Abuse Recognition
  • Healthcare Quality Improvement

Background:

  • Child maltreatment is a significant public health issue, often underdiagnosed by healthcare providers.
  • The Timely Recognition of Abusive INjuries (TRAIN) collaborative was developed to improve screening for child physical abuse (CPA).
  • This study evaluates the impact of implementing the TRAIN initiative at a specific pediatric trauma center.

Purpose of the Study:

  • To assess the effect of the TRAIN initiative on the identification and management of sentinel injuries (SIS) in young children.
  • To analyze changes in the incidence of SIS and the utilization of diagnostic procedures post-TRAIN implementation.
  • To determine if the TRAIN initiative influenced the rate of repeat injuries in infants.

Main Methods:

  • Retrospective chart review of Emergency Department (ED) visits for children under 6.01 months.
  • Identification of sentinel injuries (SIS) based on specific diagnoses.
  • Comparison of data from pre-TRAIN (January 2017-September 2018) and post-TRAIN (October 2019-July 2020) periods.
  • Statistical analysis using Chi square, Fischer's exact test, and student's paired t-test.

Main Results:

  • The incidence of SIS in children under 6.01 months remained stable pre- and post-TRAIN (2.8% vs 2.6%).
  • A statistically significant increase in skeletal surveys for patients with SIS was observed post-TRAIN (17.1% vs 27.2%, p=0.01).
  • No significant difference was found in the rate of repeat injuries before and after TRAIN implementation.

Conclusions:

  • Implementation of the TRAIN initiative at this institution is associated with an increased rate of skeletal surveys for infants with sentinel injuries.
  • The TRAIN initiative may enhance diagnostic evaluation for potential child physical abuse in young children.
  • Further research is needed to confirm the long-term impact on patient outcomes.