Blunt head trauma is a common cause of death and disability in children worldwide. Cranial computed tomography (CT), the reference standard for the diagnosis of traumatic brain injury (TBI), exposes children to ionizing radiation which has been linked to the development of brain tumors, leukemia, and other cancers. We describe the methods used to develop and test the effectiveness of a decision aid to facilitate shared decision-making with parents regarding whether to obtain a head CT scan or to further observe their child at home. This is a protocol for a multicenter clinician-level parallel randomized trial to compare an intervention group receiving a decision aid, ‘Head CT Choice’, to a control group receiving usual care. The trial will be conducted at five diverse emergency departments (EDs) in Minnesota and California. Clinicians will be randomized to decision aid or usual care. Parents visiting the ED with children who are less than 18-years-old, have experienced blunt head trauma within 24 hours, and have one or two risk factors for clinically-important TBI (ciTBI) from the Pediatric Emergency Care Applied Research Network head injury clinical prediction rules will be eligible for enrollment. We will measure the effect of Head CT Choice on: (1) parent knowledge regarding their child’s risk of ciTBI, the available diagnostic options, and the risks of radiation exposure associated with a cranial CT scan (primary outcome); (2) parent engagement in the decision-making process; (3) the degree of conflict parents experience related to feeling uninformed; (4) patient and clinician satisfaction with the decision made; (5) the rate of ciTBI at seven days; (6) the proportion of patients in whom a cranial CT scan is obtained; and (7) seven-day healthcare utilization. To capture these outcomes, we will administer parent and clinician surveys immediately after each clinical encounter, obtain video recordings of parent-clinician discussions, administer parent healthcare utilization diaries, analyze hospital billing records, review the electronic medical record, and conduct telephone follow-up. This multicenter trial will robustly assess the effectiveness of a decision aid on patient-centered outcomes, safety, and healthcare utilization in parents of children with minor head trauma in five diverse EDs. ClinicalTrials.gov registration number: NCT02063087 . Registration date February 13, 2014.

Introduction: Most emergency medicine (EM) applicants use the internet as a source of information when evaluating residency programs. Previous studies have analyzed the components of residency program websites; however, there is a paucity of information regarding EM program websites. The purpose of our study was to analyze information on EM residency program websites. Methods: In April–May 2020, we evaluated 249 United States EM residency program websites for presence or absence of 38 items relevant to EM applicants. Descriptive statistics were performed, including means and standard deviations. Results: Of the 249 EM websites evaluated, the websites contained a mean of 20 of 38 items (53%). Only 16 programs (6%) contained at least three-quarters of the items of interest, and no programs contained all 38 items. The general categories with the least amount of items were social media use (9%), research (46%), and lifestyle (49%), compared to the other general categories such as application process (58%), resident information (63%), general program information (67%), and facility information (69%). The items provided by programs most often included program description (98%), blocks and rotations (91%), and faculty listing (88%). The items provided least often included housing/neighborhood information (17%) and social media links (19%). Conclusion: Our comprehensive review of EM residency websites in the US revealed the absence of many variables on most programs’ websites. Use of this information to enhance accessibility of desired information stands to benefit both applicants and programs in the increasingly competitive specialty of EM.

Visits for pediatric minor blunt head trauma continue to increase. Variability exists in clinician evaluation and management of this generally low-risk population. Clinical decision rules identify very low-risk children who can forgo neuroimaging. Observation before imaging decreases neuroimaging rates. Outcome data can be used to risk stratify children into more discrete categories. Decision aids improves knowledge and accuracy of risk perception and facilitates identification of caregiver preferences, allowing for shared decision making. For children in whom imaging is performed and is normal or shows isolated linear skull fractures, deterioration and neurosurgical intervention are rare and hospital admission can be avoided.

Background: Forearm fractures are common presentations to the emergency department (ED), frequently requiring reduction and immobilization. In the pediatric population, procedural sedation is the gold standard to allow for appropriate analgesia, patient compliance, and ultimate successful reduction. Hematoma block is another means of analgesia prior to reduction. Hematoma block, however, is often associated with less pain control, limiting quality of reduction. Procedural sedation increases length of stay, resource allocation, and can be associated with complications. A possible alternative for analgesia to facilitate reduction of forearm fractures in the ED, are ultrasound-guided nerve blocks. This is especially significant for the pediatric population, as non-surgical treatment is frequently the standard of care. Methods: Illustrative case series of three pediatric patients who underwent supraclavicular nerve block for management of distal forearm fracture at a tertiary hospital. Results: The indication for supraclavicular nerve block was unique in all patients; avoiding procedural sedation to monitor Glasgow Coma Scale, avoidance of numerous doses of opioids for analgesia, and parental preference to avoid risks of complications associated with procedural sedation. Each reduction was successful on the first attempt. There was no surgical intervention or adverse events in our patients. Conclusions: Supraclavicular nerve block provided a successful alternative to procedural sedation for reduction, analgesia, without adverse events. It holds exceptional potential as an alternative to procedural sedation in a variety of clinical scenarios.