Emergency Medicine: Open Access

Emergency Medicine: Open Access
Open Access

ISSN: 2165-7548

+44 1223 790975


Recognition and Initial Treatment of Suspected Intracranial Hypertension by Primary Care Pediatricians: An Advanced Simulation Observational Study

Alexandra Regueiro-García, Miguel Fonte, Ignacio Oulego-Erroz, Jose A. Iglesias-Vázquez, Luis Sánchez-Santos and Antonio Rodríguez-Núñez

Background and objectives: Acute intracranial hypertension (ICH) is a life-threatening event. Any pediatrician should be able to perform its diagnosis, stabilization and initial treatment. Training by means of advanced simulation can improve the pediatrician’s abilities in the management of acute ICH, as well as decreasing errors and increasing patient safety. Our objective was to assess the ability of primary care pediatricians to deal with a simulated case of acute ICH and to detect the aspects that would need to be improved. Material and Methods: We systematically reviewed ICH simulated scenarios during advanced simulation courses designed for pediatricians in Spain. The assessment was based on a previously defined sequence of tasks (technical and non-technical), from diagnosis to initial treatment, stabilization and preparation for transport. Results: A total of 27 scenarios from 21 courses, with the participation of 95 pediatricians were assessed. Suspicion of acute ICH was correctly done in 85% of scenarios after a median time of 7.5 minutes. Osmolar therapy was started in 78% and bag-mask hyperventilation was done in 63%. The patient’s head was elevated in 41% and sedatives were administered in 11%. Median time to ask for a brain imaging was 8.5 minutes and to contact neurosurgery was 12 minutes. The evaluation of non-technical skills showed that in 12 of 27 scenarios this aspect was poor. Conclusions: Primary care pediatricians are able to identify an acute ICH, but need to improve their treatment skills. Systematic analysis of professional’s performance during a simulated scenario permits to detect both strengths and weakness; these evidences should be used to improve training programs.