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Learning Objectives: Evaluate the economic impact of the COVID-19 pandemic on the post graduate plans of the 2020 and 2021 graduating emergency medicine residency classes to aid in the future career guidance by emergency medicine faculty.Background: The strict lockdown measures in response to the COVID-19 pandemic had significant effects in all aspects of the economy and the healthcare industry, including a reduction in emergency department visits by 42%, according to the CDC. This decrease in volume continued throughout 2020 and 2021, causing many physician practice groups to re-evaluate their costs.Objective: We hypothesize that the COVID-19 pandemic caused economic impacts on the class of 2020 and 2021 emergency medicine residents in a variety of ways both economically and with changes to post graduate plans to include fellowship.Methods: We created a survey-based study of the graduating classes of emergency medicine residents of all 17 programs in Florida sent via email through the Florida CORD consortium. Inclusion criteria were that the survey respondent must be from the graduating class of 2020 or 2021. Data was collected through an anonymous online survey platform.Results: We received a total of 33 responses, stratifying the data based on the graduating class year. In our small sample, 49% of responders indicated that COVID-19 did impact their post-graduate plans in some way. 50% of responders from the class of 2020 noted some level of reduction in their number of post-graduate shifts, with a total of 33% of responders from both classes. We found a statistically significant difference (p=0.054) in expenses reduction for the class of 2021 graduates (43% of responders) compared to the class of 2020 (8%), with a total of 33% of responders of all classes indicating a reduction. There was no significant difference regarding impact on fellowship plans.Conclusions: There seemed to be some impact on employment opportunities and post-graduate career plans, though the degree of this impact is somewhat limited by small sample size. Similar studies need to be repeated to observe any potential generalizable trends to further aid residency program leadership in career guidance for residents.

Learning Objectives: To implement a peer mentorship program and assess its impact on the levels of stress and self-esteem of fourth year medical students.Background: Residents and medical students often face significant stress during their training which negatively impacts their wellbeing and job satisfaction. Peer mentoring is a dynamic social construct shown to have a positive effect on psychosocial wellbeing, stress reduction, and job satisfaction. We hypothesize that implementing a buddy system between emergency medicine (EM) residents and fourth year medical students will have a beneficial effect towards decreasing stress levels and improving self-esteem during their EM rotation.Objectives: To implement a peer mentorship program and assess its impact on the perceived levels of stress and self-esteem of fourth year students.Curriculum design: We implemented a 5-week 1:1 peer-mentoring program between 27 students and current EM residents at a Level I Trauma center over three rotation months. Prior to the rotation, they each received an email introducing the buddy system and outlining suggested topics and a meeting frequency of three times. Students completed surveys incorporating the 10 item Perceived Stress Scale and the Rosenberg Self-Esteem Scale both one week prior and on the last day of the rotation. Random numbers were assigned for anonymity.Impact: In total, 25 of 27 pre and post surveys were collected. Preliminary data shows that 84% of buddy pairs met at least three times, 92% of students perceived the intervention positively, and 84% believed it contributed to their overall wellbeing. This is an easy platform to implement with no cost or constraints on a residency program. By implementing peer-mentorship early it can have a rapid positive effect, foster a larger network of mentorship, and improve the psychological safety of trainees.

Introduction: Early identification of sepsis significantly improves outcomes, suggesting a role for prehospital screening. An end-tidal carbon dioxide (ETCO2) value ≤ 25 mmHg predicts mortality and severe sepsis when used as part of a prehospital screening tool. Recently, the Quick Sequential Organ Failure Assessment (qSOFA) score was also derived as a tool for predicting poor outcomes in potentially septic patients.  Methods: We conducted a retrospective cohort study among patients transported by emergency medical services to compare the use of ETCO2 ≤ 25 mmHg with qSOFA score of ≥ 2 as a predictor of mortality or diagnosis of severe sepsis in prehospital patients with suspected sepsis.  Results: By comparison of receiver operator characteristic curves, ETCO2 had a higher discriminatory power to predict mortality, sepsis, and severe sepsis than qSOFA.  Conclusion: Both non-invasive measures were easily obtainable by prehospital personnel, with ETCO2 performing slightly better as an outcome predictor.

Background and objectives: A better characterization of deaths in children following emergency care is needed to inform timely interventions. This study aimed to describe the timing, location, and causes of death to 1 year among a cohort of injured and medically ill children. Methods: We conducted a retrospective cohort study of children <18 years requiring emergency care in six states from January 1, 2012, through December 31, 2017, with follow‐up through December 31, 2018, for patients who were not discharged from the emergency department (ED). In this cohort, 1‐year mortality, time to death within 1 year, and causes of death were assessed from ED, inpatient, and vital status records. Results: There were 546,044 children during the 6‐year period. The 1‐year mortality rate was 2.2% (n = 1356) for injured children and 1.4% (n = 6687) for medically ill children. Matched death certificates were available for 861 (63.5%) of 1356 deaths in the injury cohort and for 4712 (70.5%) of 6687 deaths in the medical cohort. Among deaths in the injury cohort, 1274 (94.0%) occurred in the ED or hospital. The most common causes of death were motor vehicle collisions, firearm injuries, and pedestrian injuries. Among the 6687 deaths in the medical cohort, 5081 (76.0%) children died in the ED or hospital (primarily in the ED) and 1606 (24.0%) occurred after hospital discharge. The most common causes of death were sudden infant death syndrome, suffocation and drowning, and congenital conditions. Conclusions: The 1‐year mortality of children presenting to an ED is 2.2% for injured children and 1.4% for medically ill children with most deaths occurring in the ED. Future interventional trials, quality improvement efforts, and health policy focused in the ED could have the potential to improve outcomes of pediatric patients. [ABSTRACT FROM AUTHOR]

Biomarkers are important for accurate diagnosis of complex disorders such as traumatic brain injury (TBI). For a complex and multifaceted condition such as TBI, it is likely that a single biomarker will not reflect the full spectrum of the response of brain tissue to injury. Ubiquitin C-terminal hydrolase L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) are among of the most widely studied biomarkers for TBI. Because UCH-L1 and GFAP measure distinct molecular events, we hypothesized that analysis of both biomarkers would be superior to analysis of each alone for the diagnosis and prognosis of TBI. Serum levels of UCH-L1 and GFAP were measured in a cohort of 206 patients with TBI enrolled in a multicenter observational study (Transforming Research and Clinical Knowledge in Traumatic Brain Injury [TRACK-TBI]). Levels of the two biomarkers were weakly correlated to each other (r=0.364). Each biomarker in isolation had good sensitivity and sensitivity for discriminating between TBI patients and healthy controls (area under the curve [AUC] 0.87 and 0.91 for UCH-L1 and GFAP, respectively). When biomarkers were combined, superior sensitivity and specificity for diagnosing TBI was obtained (AUC 0.94). Both biomarkers discriminated between TBI patients with intracranial lesions on CT scan and those without such lesions, but GFAP measures were significantly more sensitive and specific (AUC 0.88 vs. 0.71 for UCH-L1). For association with outcome 3 months after injury, neither biomarker had adequate sensitivity and specificity (AUC 0.65-0.74, for GFAP, and 0.59-0.80 for UCH-L1, depending upon Glasgow Outcome Scale Extended [GOS-E] threshold used). Our results support a role for multiple biomarker measurements in TBI research. ( ClinicalTrials.gov Identifier NCT01565551).