Morparia K, Berg J, Basu S. Confidence level of pediatric trainees in management of shock states. World J Crit Care Med 2018; 7(2): 31-38 [PMID: 29736378 DOI: 10.5492/wjccm.v7.i2.31]
Corresponding Author of This Article
Kavita Morparia, MD, Attending Physician, Department of Pediatric Critical Care, Children’s Hospital of New Jersey, Newark Beth Israel Medical Center, 201 Lyons Avenue, Newark, NJ 07112, United States. kavita.morparia@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Clinical Practice Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. May 4, 2018; 7(2): 31-38 Published online May 4, 2018. doi: 10.5492/wjccm.v7.i2.31
Confidence level of pediatric trainees in management of shock states
Kavita Morparia, Julie Berg, Sonali Basu
Kavita Morparia, Department of Pediatric Critical Care, Children’s Hospital of New Jersey, Newark Beth Israel Medical Center, Newark, NJ 07112, United States
Julie Berg, Department of Emergency Medicine, Children’s National Health System, Washington, DC 20010, United States
Sonali Basu, Department of Critical Care Medicine, George Washington University, Children’s National Health System, Washington, DC 20010, United States
Author contributions: Morparia K and Basu S designed the research methodology and survey; Morparia K and Berg J were responsible for distribution of survey and data collection; Morparia K, Berg J and Basu S contributed to writing the manuscript; Morparia K was responsible for subsequent revisions.
Institutional review board statement: The study was reviewed by the Institutional Review Board at the Children’s National Medical Center Institutional Review Board and certified as “exempt” since it was an anonymous survey sent to trainees and did not involve real patients.
Informed consent statement: The study was exempt from informed consent as it did not involve any patients.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kavita Morparia, MD, Attending Physician, Department of Pediatric Critical Care, Children’s Hospital of New Jersey, Newark Beth Israel Medical Center, 201 Lyons Avenue, Newark, NJ 07112, United States. kavita.morparia@gmail.com
Telephone: +1-973-9268081 Fax: +1-973-9266452
Received: February 6, 2018 Peer-review started: February 7, 2018 First decision: March 7, 2018 Revised: March 12, 2018 Accepted: April 22, 2018 Article in press: April 22, 2018 Published online: May 4, 2018 Processing time: 85 Days and 18.7 Hours
Abstract
AIM
To assess overall confidence level of trainees in assessing and treating shock, we sought to improve awareness of recurrent biases in clinical decision-making to help address appropriate educational interventions.
METHODS
Pediatric trainees on a national listserv were offered the opportunity to complete an electronic survey anonymously. Four commonly occurring clinical scenarios were presented, and respondents were asked to choose whether or not they would give fluid, rank factors utilized in decision-making, and comment on confidence level in their decision.
RESULTS
Pediatric trainees have a very low confidence level for assessment and treatment of shock. Highest confidence level is for initial assessment and treatment of shock involving American College of Critical Care Medicine/Pediatric Advanced Life Support recommendations. Children with preexisting cardiac comorbidities are at high risk of under-resuscitation.
CONCLUSION
Pediatric trainees nationwide have low confidence in managing various shock states, and would benefit from guidance and teaching around certain common clinical situations.
Core tip: Pediatric trainees at all levels of training across the United States express a low degree of confidence in management of various types of shock. Children with cardiac comorbidity are at very high risk of under-resuscitation when presenting with shock. Central venous pressure is often used in isolation for decision-making regarding fluid administration and supersedes other subjective and objective measures of intravascular fluid status and shock state.
