SGEM #456: We are Young…but we can still Understand

Reference: Ma K et al. A national survey of children’s experiences and needs when attending Canadian pediatric emergency departments. PLoS One. June 2024 Date: Oct 1, 2024 Guest Skeptic: Dr. Andrew (Andy) Tagg is an Emergency Physician with a special interest in education and lifelong learning. He is the co-founder of website lead of Don’t Forget the Bubbles (DFTB). Dr. Andrew Tagg Case: You are working with a medical trainee on her first clinical rotation through the emergency department (ED). One of the first patients she sees is a 12-year-old boy presenting with lower abdominal pain. He is accompanied by his worried parents. Before entering the room, she says to you, “This is the first time I’ve seen a pediatric patient. Do you have any tips for getting the history or performing the physical exam?” Background: Through the course of one emergency department (ED) shift, we have countless interactions with patients from the initial history, examination, assessment, plan, updates on results from laboratory and imaging testing, reassessments, and eventually a final disposition. Working with children in the ED adds another layer of complexity as we are often trying to explain to them and their caregivers what is going to happen during their time in the ED. Dr. Samina Ali Children's healthcare experiences can have a lasting impact on their understanding of health and their comfort in future medical settings. For example, we discussed the importance of pain management with another Peds EM superstar, Dr. Samina Ali, on an SGEM Xtra and learned that poor pain management contributes to avoiding medical care in the future and even vaccine hesitancy. While caregivers often advocate for their children, trying to understand the child's needs and perspectives directly from the child is crucial for optimizing care. Clinical Question: What are children's perspectives on their needs and experiences during visits to Canadian pediatric EDs? Reference: Ma K et al. A national survey of children’s experiences and needs when attending Canadian pediatric emergency departments. PLoS One. June 2024 Population: Children aged 7-17 years and their caregivers who presented to ten Canadian pediatric EDs between 2018 and 2020 Excluded: Children who remained medically unstable during their ED stay, had altered levels of consciousness, were suspected of being abused, or had a caregiver who was not their legal guardian​. The children and caregivers also had to speak either English or French. Intervention: A cross-sectional survey designed for both children and caregivers. The child survey included 24 questions, focusing on emotional, practical, and communication needs, along with satisfaction with care. Comparison: None Outcome: Primary Outcome: Children’s perspectives on their emotional, practical, and general informational needs and experiences. Secondary Outcomes: Compare caregiver vs child perspectives on needs and experiences and relate demographic characteristics and needs within the ED to child’s understanding of their diagnosis and treatment Trial: Descriptive cross-sectional survey Authors’ Conclusions: “While almost all children felt well taken care of and were happy with their visit, close to 1/3 did not understand their diagnosis or its management. Children’s reported satisfaction in the ED should not be equated with understanding of their medical condition. Further, caution should be employed in using caregiver satisfaction as a proxy for children’s satisfaction with their ED visit, as caregiver satisfaction is highly linked to having their own needs being met.” CROSS Quality Checklist for Survey Study Did the study address a clearly focused issue? Yes Did the authors use an appropriate method to answer their question? Yes Was the cohort recruited in an acceptable way? Yes Have the authors identified all-important confounding factors? No