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Burns B, Bailey J, Hartenstein M, Sullivan D, Burns E, Lin A, Chan D, Plainkum P, Techapaitoon S, Pandee U, Ma OJ. A novel program to enhance pediatric emergency medicine training in Thailand. AEM EDUCATION AND TRAINING 2021; 5:e10596. [PMID: 34124528 PMCID: PMC8171775 DOI: 10.1002/aet2.10596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND In Thailand, there are few pediatric emergency medicine (PEM) fellowship-trained providers, and emergency departments (EDs) are staffed by pediatricians and emergency physicians. Our pediatric ED collaborated with Thailand's largest private hospital system to develop a training program designed to improve emergency care for children. OBJECTIVE The objective was to develop, implement, and assess the efficacy of a curriculum to improve PEM care by emergency providers in a Thai health system. METHODS We conducted a prospective study from January 2018 to July 2019. After an initial needs assessment, we developed a curriculum with 22 modules, divided into basic and advanced courses. Each course began with baseline testing, consisting of written tests and several simulated cases led by physician-nurse teams. Each course was administered longitudinally through electronic modules over 6 months, with in-person shadowing and skills workshops at the course midpoint, culminating in final summative examinations and repeat simulation testing. RESULTS On written examination scores for the basic course, physicians (n = 5) improved by 37.6% (95% confidence interval [CI] = 29.8% to 45.4%, p < 0.001), while nurses (n = 5) improved by 55.7% (95% CI = 45.8% to 65.6%, p < 0.001). For simulation testing among physician-nurse dyads, performance improved by 19.5% (95% CI = 3.9% to 35.1%, p = 0.004) for critical action items and by 3.0 points (95% CI = 2.3 to 3.7, p < 0.001) on a 16-point teamwork scale. For the advanced course, physicians improved on the written examination by 36.9% (95% CI = 29.2% to 44.7%, p < 0.001) and nurses by 50.6 (95% CI = 47.3% to 54.0%, p < 0.001). For simulation testing, performance improved from 22.2% (95% CI = 8.2% to 35.6%, p < 0.001) for critical actions and 1.3 points (95% CI = 0.2 to 2.2, p = 0.005) on teamwork measures. CONCLUSIONS We designed an interdisciplinary curriculum and successfully trained Thai physicians and nurses to improve PEM knowledge and teamwork.
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Affiliation(s)
- Beech Burns
- Department of Emergency MedicineOregon Health and Science UniversityPortlandOregonUSA
| | - Jessica Bailey
- Department of Emergency MedicineOregon Health and Science UniversityPortlandOregonUSA
| | - Melinda Hartenstein
- Department of Emergency MedicineOregon Health and Science UniversityPortlandOregonUSA
| | - Danielle Sullivan
- Department of Emergency MedicineOregon Health and Science UniversityPortlandOregonUSA
| | - Erin Burns
- Department of PediatricsOregon Health and Science UniversityPortlandOregonUSA
| | - Amber Lin
- Department of Emergency MedicineOregon Health and Science UniversityPortlandOregonUSA
| | - Daniela Chan
- Department of Emergency MedicineOregon Health and Science UniversityPortlandOregonUSA
| | - Parit Plainkum
- Department of Emergency MedicineSamitivej Children’s HospitalBangkokThailand
| | | | - Uthen Pandee
- Department of Emergency MedicineSamitivej Children’s HospitalBangkokThailand
| | - O. John Ma
- Formerly affiliated with the Department of Emergency MedicineOregon Health and Science UniversityPortlandOregonUSA
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Jahn HK, Jahn IHJ, Roland D, Behringer W, Lyttle M. Prescribing in a paediatric emergency: A PERUKI survey of prescribing and resuscitation aids. Acta Paediatr 2021; 110:1038-1045. [PMID: 32869877 DOI: 10.1111/apa.15551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/03/2020] [Accepted: 08/20/2020] [Indexed: 01/27/2023]
Abstract
AIM The aim was to investigate the use of paper-based and electronic prescribing and resuscitation aids in paediatric emergency care from a departmental and individual physician perspective. METHODS A two-stage web-based self-report questionnaire was performed. In stage (i), a lead investigator at PERUKI sites completed a department-level survey; in stage (ii), individual physicians recorded their personal practice. RESULTS The site survey was completed by 46/54 (85%) of PERUKI sites. 198 physicians completed the individual physicians' survey. Individual physicians selected the use of formulary apps for checking of medication dosages nearly as often as hardcopy formularies. The APLS WETFLAG calculation and hardcopy aids were widely accepted in both surveys. A third of sites accepted and half of the individual physicians selected resuscitation apps on the personal mobile device as paediatric resuscitation aids. CONCLUSION Our survey shows a high penetrance of the British National Formulary app, a success of NHS digital policy and strategy. Despite potential advantages, many physicians in our survey do not use resuscitation apps. Reluctance to engage with apps is likely to be multifactorial and includes human factors. These obstacles need to be overcome to create a digital healthcare culture.
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Affiliation(s)
- Haiko Kurt Jahn
- Emergency Department Royal Belfast Hospital for Sick Children Belfast UK
- Friedrich Schiller University Jena Jena Germany
| | | | - Damian Roland
- Emergency Department Leicester Royal Infirmary University of Leicester Leicester UK
| | | | - Mark Lyttle
- Emergency Department Bristol Royal Hospital for Children Bristol UK
- Faculty of Health and Applied Sciences University of the West of England Bristol UK
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Anzan M, Alwhaibi M, Almetwazi M, Alhawassi TM. Prescribing errors and associated factors in discharge prescriptions in the emergency department: A prospective cross-sectional study. PLoS One 2021; 16:e0245321. [PMID: 33434202 PMCID: PMC7802932 DOI: 10.1371/journal.pone.0245321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 12/29/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Evidence regarding the prevalence of medication prescribing errors (PEs) and potential factors that increase PEs among patients treated in the emergency department (ED) are limited. This study aimed to explore the prevalence and nature of PEs in discharge prescriptions in the ED and identify potential risk factors associated with PEs. METHODS This was a prospective observational cross-sectional study in an ambulatory ED in a tertiary teaching hospital. Data were collected for six months using a customized reporting tool. All patients discharged from ED with a discharged prescription within the study period were enrolled in this study. RESULTS About 13.5% (n = 68) of the 504 prescriptions reviewed (for 504 patients) had at least one error. Main PEs encountered were wrong dose (23.2%), wrong frequency (20.7%), and wrong strength errors (14.6%). About 36.8% of identified PEs were related to pediatric prescriptions, followed by the acute care emergency unit (26.5%) and the triage emergency unit (20.6%). The main leading human-related causes associated with PEs were lack of knowledge (40.9%) followed by an improper selection from a computer operator list (31.8%). The leading contributing systems related factors were pre-printed medication orders (50%), lack of training (31.5%), noise level (13.0%), and frequent interruption of prescriber and distraction (11.1%). Prescribers' involved with the identified errors were resident physicians (39.4%), specialists (30.3%), and (24.4%) were made by general practitioners. Physicians rejected around 12% of the pharmacist-raised recommendations related to the identified PEs as per their clinical judgment. CONCLUSION PEs in ED setting are common, and multiple human and systems-related factors may contribute to the development of PEs. Further training to residents and proper communication between the healthcare professionals may reduce the risk of PEs in ED.
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Affiliation(s)
- Mona Anzan
- Pharmacy Services, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mansour Almetwazi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M. Alhawassi
- Pharmacy Services, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Patel R, Green W, Shahzad MW, Church H, Sandars J. Using a self-regulated learning-enhanced video feedback educational intervention to improve junior doctor prescribing. MEDICAL TEACHER 2020; 42:886-895. [PMID: 32301633 DOI: 10.1080/0142159x.2020.1748183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Introduction: Medical school graduates in the UK consistently report feeling underprepared for the task of prescribing when embarking on practice. The effective application of self-regulated learning (SRL) approaches and feedback on complex tasks are associated with improved outcomes in practice-based clinical skills.Aims: This study aimed to investigate the effectiveness of an educational intervention using SRL-enhanced video feedback for improving the prescribing competency of junior doctors.Methods: A prospective cohort study was designed to compare intervention and control cohorts of junior doctors undertaking simulated clinical encounters at the beginning and end of their 4-month rotation through renal medicine.Results: The improvement in prescribing competency for the intervention cohort was significant (p < 0.001) with large effect size (d = 1.42). Self-efficacy improved in both cohorts with large (control cohort p = 0.026, r= 0.64) and medium (intervention cohort p = 0.083, d = 0.55) effect sizes. Goal setting and self-monitoring skills improved in the intervention cohort only with medium effect size (p = 0.096, d = 0.53).Conclusions: SRL-enhanced video feedback is effective for improving prescribing competency and developing SRL processes such as goal setting and self-monitoring skills in simulated clinical encounters. Further research is required to evaluate transferability to other clinical sub-speciality contexts and investigate the effectiveness of the intervention for improving prescribing in non-simulated settings.
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Affiliation(s)
- Rakesh Patel
- School of Medicine, University of Nottingham, Nottingham, UK
| | - William Green
- Innovation, Technology and Operations Division, University of Leicester School of Business, University of Leicester, Leicester, UK
| | - Muhammad Waseem Shahzad
- Innovation, Technology and Operations Division, University of Leicester School of Business, University of Leicester, Leicester, UK
| | - Helen Church
- School of Medicine, University of Nottingham, Nottingham, UK
| | - John Sandars
- Health Research Institute, Faculty of Health, Social Care and Medicine, Edge Hill University Medical School, Ormskirk, UK
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Foster M, Tagg A. A systems-centred approach to reducing medication error: Should pre-hospital providers and emergency departments dose children by age during resuscitation? J Paediatr Child Health 2019; 55:1299-1303. [PMID: 31517422 DOI: 10.1111/jpc.14626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 11/29/2022]
Abstract
The high-risk, high-stress and high-stakes environment of out-of-hospital or emergency department paediatric resuscitation is prone to human error, and medication errors are common. This could be contributing to the difference in survival rate of resuscitation in the out-of-hospital versus inpatient setting. Medication for children during resuscitation requires estimation of the child's weight and calculation of the corresponding drug dose. Whilst both of these steps can lead to error, calculation errors (including 10-fold errors) are much more common and harmful than weight errors. Previous solutions aim to optimise each stage of the medication dosing process. Currently, Australian guidelines suggest using the highly inaccurate original advanced paediatric life support formula, weight = 2 × (age + 4), to dose medications in these settings. This means age is converted to weight, which is then converted to dose. There is no evidence that this is causing harm to patients. Therefore, it could be suggested that age could safely be converted straight to dose according to preset doses. This eliminates the need for any weight estimation or dose calculation, thus reducing the potential for error and harm.
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Affiliation(s)
- Mieke Foster
- Deakin University School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Andrew Tagg
- Sunshine Hospital Emergency Department, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Validation of a mobile app for reducing errors of administration of medications in an emergency. J Clin Monit Comput 2018; 33:531-539. [PMID: 30073445 DOI: 10.1007/s10877-018-0187-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Abstract
Medication errors occur frequently and are a risk to patient safety. To reduce mistakes in the medication process in emergencies, a mobile app has been developed supporting the calculation of doses and administration of drugs. A simulation study was performed to validate the app as a tool to reduce medication errors. This was a randomised crossover study conducted in the Academic Hospital. The participants included were residents and attendings in anaesthesiology. 74 Participants performed four simulation scenarios in which they had to calculate and administer drugs for emergencies. Two scenarios were performed with the app ("app scenarios") and the other two scenarios were performed without the use of the app ("control scenarios"). The order of drugs, simulation patients and usage of aid were randomized. The accuracy of administered drug doses were measured. Medications were categorised as either "accurate" ([Formula: see text]% of target dosage) or "wrong" (less than 50% or more than 200% of target dosage). The dosage calculated and the dosage administered were documented separately to differentiate between calculation and handling errors. During app scenarios, there were no "wrong" dosages, whereas 6.8 (95% CI 2.7-10.8%) of dosages in control scenarios were evaluated as "wrong". The probability of giving an "accurate" dosage was increased from 77.7 (70.9-84.5%) in control scenarios to 93.9 (90-97.8%) in app scenarios. Calculation errors were the main cause for wrong dosing. The app is an appropriate and feasible tool to reduce calculation and handling errors and may increase patient safety.
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Pilkey D, Edwards C, Richards R, Olson LM, Ely M, Edgerton EA. Pediatric Readiness in Critical Access Hospital Emergency Departments. J Rural Health 2018; 35:480-489. [PMID: 30062684 DOI: 10.1111/jrh.12317] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Critical Access Hospitals (CAHs), often the first point of access for emergency care, see few children and are challenged to remain proficient in caring for pediatric patients. Our analysis provides guidance to facilitate increasing CAHs staffs' ability to provide effective pediatric emergency care. METHODS The National Pediatric Readiness Project (NPRP) assessment of 4,146 emergency departments (EDs) was linked with the CAHs list from Centers for Medicare and Medicaid Services. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS). A WPRS of 100 indicates that the ED meets essential guidelines for pediatric readiness. Using descriptive statistics, we also compared low (fewer than 5 children a day) and medium patient volume (5-14 children a day) EDs in 6 core areas of readiness. FINDINGS Eighty-six percent (1,140) of CAHs were linked to the NPRP. In the study, 80% were low and 20% medium volume. The median WPRS was 59.0 for low and 67.3 for medium volume. While some differences were found by patient volume, overall 63% of CAHs had a pediatric emergency care coordinator, 34% had a pediatric patient care review process, 62% had interfacility transfer guidelines, and 45% weighed children only in kilograms. CAHs participating in a facility recognition program had significantly higher median WPRS scores (84.3) compared to those not participating (59.5). CONCLUSION CAHs have challenges in being ready to care for children in the areas of pediatric emergency care coordinators, policies, procedures, and patient safety. Minimal cost interventions are available to increase the readiness of CAHs to care for children.
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Affiliation(s)
- Diane Pilkey
- Emergency Medical Services for Children Program, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland
| | - Christy Edwards
- Federal Office of Rural Health Policy, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland
| | - Rachel Richards
- National Emergency Medical Services for Children Data Analysis Resource Center, Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, Utah
| | - Lenora M Olson
- National Emergency Medical Services for Children Data Analysis Resource Center, Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, Utah
| | - Michael Ely
- National Emergency Medical Services for Children Data Analysis Resource Center, Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, Utah
| | - Elizabeth A Edgerton
- Division of Child and Adolescent Health, Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland
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Castronovo A, Gervais F, Mongaret C, Slimano F. Pharmacists' interventions on prescription problems in one French community pharmacy: A prospective pilot study. ANNALES PHARMACEUTIQUES FRANÇAISES 2018; 76:299-305. [PMID: 29555106 DOI: 10.1016/j.pharma.2018.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/14/2018] [Accepted: 02/16/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES While many international studies widely describe pharmacists' interventions (PIs) on drug-related problems (DRP) in community pharmacies, in France, these activities are underreported. The aim of this study is to describe the PI rate, given as the number of interventions in among all prescriptions reviewed during the study period. MATERIAL AND METHODS This study was conducted in one French rural community pharmacy during a 7-month period. Age, sex, type of prescriber, type of problems, intervention and the outcome were prospectively recorded. PIs were prospectively formalized and classified using the validated tool from the French Society of Clinical Pharmacy. In addition, all interventions were reviewed by an independent pharmacist. RESULTS Among the 20,238 prescriptions, n=211 pharmacists' interventions on 159 prescriptions (0.79%) were performed. Prescriptions were ordered by general practitioners in 78.6%. The most common DRP were the improper prescription (30.8%), a drug or medical device not received by the patient (21.8%, all linked to drug shortages) or a dosage problem (18.9%). Antibiotics were the most common drugs involved in DRP (13.3%). The main PI were the drug switch/establishment of a therapeutic alternative (38.4%), dose adjustment (25.6%) and optimization of the dispensing/administration modalities (25.1%). The overall acceptance rate of PIs was 93.4%. CONCLUSION We found a PI rate, as well as acceptance rate by prescribers, in the same range than as reported in studies performed in other countries. A consequent large part percentage of PIs can be classified as "administrative". This first prospective French study needs to be further supported by multi-site studies.
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Affiliation(s)
- A Castronovo
- Ferrieres' Pharmacy, 82, rue de Ferrières, 76220 Gournay-en-Bray, France
| | - F Gervais
- Pharmacy, Edouard-Herriot Hospital, 5, place d'Arsonval, 69003 Lyon, France
| | - C Mongaret
- Faculty of Pharmacy, Reims University, 51, rue Cognacq-Jay, 51100 Reims, France; Department of Pharmacy, CHU de Reims, avenue du Général-Koenig, 51100 Reims, France
| | - F Slimano
- Faculty of Pharmacy, Reims University, 51, rue Cognacq-Jay, 51100 Reims, France; Department of Pharmacy, CHU de Reims, avenue du Général-Koenig, 51100 Reims, France.
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Siebert JN, Ehrler F, Lovis C, Combescure C, Haddad K, Gervaix A, Manzano S. A Mobile Device App to Reduce Medication Errors and Time to Drug Delivery During Pediatric Cardiopulmonary Resuscitation: Study Protocol of a Multicenter Randomized Controlled Crossover Trial. JMIR Res Protoc 2017; 6:e167. [PMID: 28830854 PMCID: PMC5585594 DOI: 10.2196/resprot.7901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/05/2017] [Accepted: 08/09/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusions is complex and time-consuming. The need for individual specific weight-based drug dose calculation and preparation places children at higher risk than adults for medication errors. Following an evidence-based and ergonomic driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion. In a prior single center randomized controlled trial, medication errors were reduced from 70% to 0% by using PedAMINES when compared with conventional preparation methods. OBJECTIVE The purpose of this study is to determine whether the use of PedAMINES in both university and smaller hospitals reduces medication dosage errors (primary outcome), time to drug preparation (TDP), and time to drug delivery (TDD) (secondary outcomes) during pediatric CPR when compared with conventional preparation methods. METHODS This is a multicenter, prospective, randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drug infusion rate table in the preparation of continuous drug infusion. The evaluation setting uses a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin. The study involving 120 certified nurses (sample size) will take place in the resuscitation rooms of 3 tertiary pediatric emergency departments and 3 smaller hospitals. After epinephrine-induced return of spontaneous circulation, nurses will be asked to prepare a continuous infusion of dopamine using either PedAMINES (intervention group) or the infusion table (control group) and then prepare a continuous infusion of norepinephrine by crossing the procedure. The primary outcome is the medication dosage error rate. The secondary outcome is the time in seconds elapsed since the oral prescription by the physician to drug delivery by the nurse in each allocation group. TDD includes TDP. Stress level during the resuscitation scenario will be assessed for each participant by questionnaire and recorded by the heart rate monitor of a fitness watch. The study is formatted according to the Consolidated Standards of Reporting Trials Statement for Randomized Controlled Trials of Electronic and Mobile Health Applications and Online TeleHealth (CONSORT-EHEALTH) and the Reporting Guidelines for Health Care Simulation Research. RESULTS Enrollment and data analysis started in March 2017. We anticipate the intervention will be completed in late 2017, and study results will be submitted in early 2018 for publication expected in mid-2018. Results will be reported in line with recommendations from CONSORT-EHEALTH and the Reporting Guidelines for Health Care Simulation Research . CONCLUSIONS This paper describes the protocol used for a clinical trial assessing the impact of a mobile device app to reduce the rate of medication errors, time to drug preparation, and time to drug delivery during pediatric resuscitation. As research in this area is scarce, results generated from this study will be of great importance and might be sufficient to change and improve the pediatric emergency care practice. TRIAL REGISTRATION ClinicalTrials.gov NCT03021122; https://clinicaltrials.gov/ct2/show/NCT03021122 (Archived by WebCite at http://www.webcitation.org/6nfVJ5b4R).
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Affiliation(s)
- Johan N Siebert
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Frederic Ehrler
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, University Hospitals of Geneva, Geneva, Switzerland
| | - Christophe Combescure
- Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
| | - Kevin Haddad
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Alain Gervaix
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Sergio Manzano
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
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