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Pediatrics - Emergency Medicine

Houston, Texas

BCM pediatricians care for children in various clinical and hospital environments.
Pediatrics - Emergency Medicine
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Fellow Research Projects

Advocacy

Differences in Demographics, Beliefs, and Attitudes Regarding EMS Utilization Among Families of Children in Houston

Despite existing data on Emergency Medical Services (EMS) over-utilization, the topic of EMS under-utilization, or coming to the Emergency Department (ED) via private conveyance rather than EMS, is not well elucidated. The purpose of this study is to determine if, in children with high-acuity conditions requiring immediate medical attention at time of ED presentation, there are differences in demographic factors, attitudes, and beliefs of patients whose caregivers activate EMS and are transported compared to those arriving to the ED via private conveyance. Secondary outcomes include identifying subgroups of patients who are likely to under-utilize EMS and identifying perceived barriers and disparities in access to pediatric prehospital care.

PI: Casandra Quinones, M.D.
Mentors: Manish Shah, M.D.; Andrea Cruz, M.D., MPH


Global Health

Blueprints for Constructing an Emergent Care Clinic in Rural Uganda: The Stakeholders' Perspective

Many international groups are working to improve healthcare in developing countries around the world. Investment by local stakeholders is essential for sustainability. Little is known about local stakeholder perceptions of these efforts. This study uses mixed methods to examine the perspectives, attitudes and beliefs of five groups of key stakeholders regarding the construction of an emergent care clinic by an international NGO in their rural community in Uganda. These five stakeholder groups include: community members, community leaders, healthcare workers, NGO workers and local representatives of the Uganda Ministry of Health. The majority of data collected is qualitative and has been obtained through semi-structured interviews, focus groups and open-ended surveys. Analysis is currently underway.

PI: Carol Chen, M.D.
Mentors: Andrea Cruz, M.D.; Heather Honore Goltz, Ph.D.

Development of a Pediatric Emergency Medicine Curriculum in Rwanda

Children living in sub-Saharan Africa are much more likely to die in childhood than those living in developed countries, in large part due to inability to access many of the medical services readily available in other parts of the world. As the importance of emergency care to evaluate and stabilize critically ill patients is being recognized in many developing countries, there is a need to train practitioners in emergency medicine. The Rwandan Ministry of Health and National University of Rwanda Faculty of Medicine are partnering with Columbia University's Systems Improvement at District Hospitals and Regional Training of Emergency Care (sidHARTe) Program and Brown University through the Rwanda's Human Resources for Health program to teach a two-year, part-time Post-graduate Diploma (PGD) in Emergency and Critical Care Medicine. The PGD in Emergency and Critical Care Medicine for Rwandan general practitioners (GPs) will prepare GPs for working in the district hospitals' emergency departments. In addition to preparing GPs for district hospitals' emergency wards, the PGD will serve as the first year of a 4-year MMED residency program. The Baylor fellowship project is one 4 week module in Pediatric Emergency Medicine. Participants will complete a 4 week pediatric emergency medicine module, and performance on written and OSCE-style pre- and post- tests will be assessed.

PI: Marideth Rus, M.D.
Mentors: Heather Machen, M.D., MPH (Baylor College of Medicine); Rachel Moresky, M.D., MPH (Columbia University)


Laboratory Testing

Performance Characteristics of Urinalyses for the Diagnosis of Pediatric Urinary Tract Infection

We compared the performance of the point-of-care urinalysis test against laboratory urinalysis done in the emergency department for the diagnosis of urinary tract infections (UTIs) in the pediatric population. We found that laboratory urinalysis was more accurate for the diagnosis of UTIs, though it has a longer result time than the point-of-care test. The comparison between the two assays has not previously been studied, and there is wide variation in practice among emergency providers with regard to which test is used. Additionally, we found that the accuracy of the tests varied in patients of different demographics. This information may lead to standardization of practice in urinalysis testing among pediatric emergency departments.

PI: Beena Kazi, M.D.
Mentors: Gregory J. Buffone, Ph.D.; Paula A. Revell, Ph.D.; Lakshmi Chandramohan, Ph.D.; Michael Dowlin; Andrea Cruz, M.D., MPH


Quality Improvement

Improving Pain Management in Patients with Sickle Cell Pain Crisis

Children with vaso-occlusive crisis require prompt evaluation and treatment of pain. The purpose of this study was to improve the time from ED arrival to first dose of pain medication in patients with sickle cell disease presenting to the emergency department in moderate to severe pain. Educational interventions and process improvements were implemented, and data was collected for 6 months pre- and 6 months post-intervention to determine the success of the interventions.

PI: Marideth Rus, M.D.
Mentors: Corrie Chumpitazi, M.D.; Binita Patel, M.D.


Simulation

Cluster-Randomized, Controlled Trial of Rapid-Cycle, Deliberate Practice Simulation vs. Traditional Simulation for Teaching Pediatric Resuscitation Skills to Resident Physicians in the Emergency Center

High-fidelity simulation is an evidence-based method of preparing physicians for high-stakes, low-frequency events. One of the greatest challenges in the training of residents is providing them with sufficient opportunities to develop competence in pediatric cardiorespiratory events requiring resuscitation. Our project is a randomized trial comparing two methods of simulation-based education for teaching resuscitation skills to teams of residents rotating through the emergency center at Texas Children's Hospital.

PI: Bram Welch-Horan, M.D.
Mentor: Dan Lemke, M.D.

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