Skip to main content
SpringerLink
Log in

The European Paediatric Life Support course improves assessment and care of dehydrated children in the emergency department

  • Original Paper
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

We tested the hypothesis that application of the principles learned from the European Paediatric Life Support (EPLS) course improves child health assessment and care. In a retrospective study, residents from five paediatric emergency departments were included. For each of them, we analysed five medical records of infants and children suffering from diarrhoea; three were in ambulatory care and two were in-hospital care with IV hydration. Two independent observers analysed the records using a standardized checklist of 14 clinical points, as well as three items to evaluate the adequacy of treatment according to hydration status. Agreement between readers was evaluated the kappa coefficient of concordance. Statistical associations between each item and the EPLS course status was assessed by logistic regression taking into account the clustered data structure. Fifty residents and 240 medical records were included. Twenty-six residents were EPLS trained (intervention group) and 24 residents were not (control group). The results of the analyses of the medical records by the observers were concordant (kappa >0.91). Medical records in the intervention group contained more clinical information on circulatory status (P < 0.0001). Residents in the intervention group prescribed goal-directed therapy more often (P = 0.006). For children with shock, they administered volume resuscitation (P = 0.01) with goal-directed therapy more often (P = 0.003). This is the first evaluation of an educational program focusing on the actions of “learners” in the clinical environment. Our findings highlight that the EPLS course is associated with a better clinical analysis of hydration and circulation status as well as with goal-directed therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

BP:

Blood pressure

EGDT:

Early goal-directed therapy

EPLS:

European Paediatric Life Support

ERC:

European Resuscitation Council

ORS:

Oral rehydration salts

PALS:

Pediatric Advanced Life Support

References

  1. Babl FE, Weiner DL, Bhanji F, Davies F, Berry K, Barnett P (2005) Advanced training in pediatric emergency medicine in the United States, Canada, United Kingdom, and Australia: an international comparison and resources guide. Ann Emerg Med 45:269–275

    Article  PubMed  Google Scholar 

  2. Biarent D, Bingham R, Richmond S, Maconochie I, Wyllie J, Simpson S et al (2005) European Resuscitation Council guidelines for resuscitation 2005: section 6. Paediatric life support. Resuscitation 67(suppl 1):S97–S133

    Article  PubMed  Google Scholar 

  3. Biesse KJ, Moro-Sutherland D, Furberg RD, Downing B, Glickman L, Murphy A, Jackson CL, Snyder G, Hobgood C (2009) Using screen-based simulation to improve performance during pediatric resuscitation. Acad Emerg Med 16(Suppl 2):S71–S75

    Article  Google Scholar 

  4. Carcillo JA, Kuch BA, Han YY, Day S, Greenwald BM, McCloskey KA, Pearson-Shaver AL, Orr RA (2009) Mortality and functional morbidity after use of PALS/APLS by community physicians. Pediatrics 124:500–508

    Article  PubMed  Google Scholar 

  5. Eppich WJ, Brannen M, Hunt EA (2008) Team training: implications for emergency and critical care pediatrics. Curr Opin Pediatr 20:255–260

    Article  PubMed  Google Scholar 

  6. Gaies MG, Landrigan CP, Hafler JP, Sandora TJ (2007) Assessing procedural skills training in pediatric residency programs. Pediatrics 120:715–722

    Article  PubMed  Google Scholar 

  7. Gaies MG, Morris SA, Hafler JP, Graham DA, Capraro AJ, Zhou J, Landrigan CP, Sandora TJ (2009) Reforming procedural skills training for pediatric residents: a randomized, interventional trial. Pediatrics 124:610–619

    Article  PubMed  Google Scholar 

  8. Gilbert EH, Lowenstein SR, Koziol-McLain J, Barta DC, Steiner J (1996) Chart reviews in emergency medicine research: where are the methods? Ann Emerg Med 27:305–308

    Article  PubMed  CAS  Google Scholar 

  9. Guarino A, Albano F, Ashkenazi S, Gendrel D, Hoekstra JH, Shamir R, Szajewska H (2008) European Society for Paediatric Gastroenterology, Hepatology, and Nutrition/European Society for Paediatric Infectious Diseases. Evidence-based guidelines for the management of acute gastroenteritis in children in Europe. J Pediatr Gastroenterol Nutr 46:S81–S184

    Article  PubMed  Google Scholar 

  10. Hunt EA, Heine M, Hohenhaus SM, Luo X, Frush KS (2007) Simulated pediatric trauma team management: assessment of an educational intervention. Pediatr Emerg Care 23:796–804

    Article  PubMed  Google Scholar 

  11. International Liaison Committee on Resuscitation (2005) Pediatric basic and advanced life support. Resuscitation 67:271–291

    Article  Google Scholar 

  12. International Liaison Committee on Resuscitation (2006) The International Liaison Committee on Resuscitation (ILCOR) consensus on science with treatment recommendations for pediatric and neonatal patients: pediatric basic and advanced life support. Pediatrics 117:e955–e977

    Article  Google Scholar 

  13. Launay E, Gras-Le Guen C, Martinot A, Assathiany R, Blanchais T, Mourdi N, Aouba A, Bouvier-Colle MH, Rozé JC, Chalumeau M (2010) Suboptimal care in the initial management of children who died from severe bacterial infection: a population-based confidential inquiry. Pediatr Crit Care Med 11:469–474

    PubMed  Google Scholar 

  14. Liang KY, Zeger SL (1986) Longitudinal data analysis using generalized linear models. Biometrika 73:13–22

    Article  Google Scholar 

  15. Morris F, Tordoff SG, Wallis D, Shinner DV (1991) Cardiopulmonary resuscitation skills of preregistration house officers: five years on. BMJ 302:626–627

    Article  PubMed  CAS  Google Scholar 

  16. Moser DK, Coleman S (1992) Recommendations for improving cardiopulmonary resuscitation skills retention. Heart Lung 21:372–380

    PubMed  CAS  Google Scholar 

  17. Nadel FM, Lavelle JM, Fein JA, Giardino AP, Decker JM, Durbin DR (2000) Assessing pediatric senior residents’ training in resuscitation: fund of knowledge, technical skills, and perception of confidence. Pediatr Emerg Care 16:73–76

    Article  PubMed  CAS  Google Scholar 

  18. Nolan J, Baskett P (2005) European Resuscitation Council guidelines for resuscitation 2005. Resuscitation 67(suppl 1):S12–S189

    Google Scholar 

  19. Oliveira CF, Nogueira de Sá R, Oliveira DSF, Gottschald AFC, Moura JDG, Shibata ARO et al (2008) Time- and fluid-sensitive resuscitation for hemodynamic support of children in septic shock: barriers to the implementation of the American College of Critical Care Medicine/Pediatric Advanced Life Support guidelines in a pediatric intensive care unit in a developing world. Pediatr Emerg Care 24:810–815

    Article  PubMed  Google Scholar 

  20. Overly FL, Sudikoff SN, Shapiro MJ (2007) High-fidelity medical simulation as an assessment tool for pediatric residents’ airway management skills. Pediatr Emerg Care 23:11–15

    Article  PubMed  Google Scholar 

  21. Perkins GD (2007) Simulation in resuscitation training. Resuscitation 73:202–211

    Article  PubMed  Google Scholar 

  22. Quan L, Shugerman R, Kunkel N, Brownlee C (2001) Evaluation of resuscitation skills in new residents before and after Pediatric Advanced Life Support course. Pediatrics 108:e110

    Article  PubMed  CAS  Google Scholar 

  23. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1376

    Article  PubMed  CAS  Google Scholar 

  24. Rodgers DL, Bhanji F, McKee BR (2010) Written evaluation is not a predictor for skills performance in an Advanced Cardiovascular Life Support course. Resuscitation 81:453–456

    Article  PubMed  Google Scholar 

  25. Roland D, Clarke C, Borland ML, Pascoe EM (2010) Does a standardised scoring system of clinical signs reduce variability between doctors’ assessments of the potentially dehydrated child? J Paediatr Child Health 46:103–107

    Article  PubMed  Google Scholar 

  26. Schenkel S (2000) Promoting patient safety and preventing medical errors in emergency departments. Acad Emerg Med 7:1204–1222

    Article  PubMed  CAS  Google Scholar 

  27. Stross JK (1983) Maintening competency in advanced cardiac life support skills. JAMA 249:3339–3341

    Article  PubMed  CAS  Google Scholar 

  28. Trevisanuto D, Ferrarese P, Cavicchioli P, Fasson A, Zanardo V, Zacchello F (2005) Knowledge gained by pediatric residents after neonatal resuscitation program courses. Paediatr Anaesth 15:944–947

    Article  PubMed  Google Scholar 

  29. Turner NM, Lukkassen I, Bakker N, Draaisma J, ten Cate OT (2009) The effect of the APLS-course on self-efficacy and its relationship to behavioural decisions in paediatric resuscitation. Resuscitation 80:913–918

    Article  PubMed  Google Scholar 

  30. White J, Shugerman R, Brownlee C, Quan L (1998) Performance of advanced resuscitation skills by pediatric housestaff. Arch Pediatr Adolesc Med 152:1232–1235

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors wish to thank F Perreaux, V Soussan and MP Jaby Sergent for assistance in the recruitment of medical charts. This study did not receive any funding.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Paediatric Emergency Department, Paris 5 University, Hôpital Necker Enfants Malades, Assistance Publique – Hôpitaux de Paris, 149 rue de Sèvres, 75743, Paris, France

    Gérard Chéron & Bogdan Cojocaru

  2. Service de Santé Publique, Hôpital Necker Enfants Malades, Assistance Publique – Hôpitaux de Paris, Paris, France

    Jean Philippe Jais

  3. Hôpital Louis Mourier, Assistance Publique – Hôpitaux de Paris, Paris, France

    Nathalie Parez

  4. Hôpital Universitaire des Enfants, Brussels, Belgium

    Dominique Biarent

  5. Paediatric Emergency Department, Hôpital Necker Enfants Malades, Paris Descartes University, 149 rue de Sèvres, 75743, Paris, France

    Gérard Chéron

Authors
  1. Gérard Chéron
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean Philippe Jais
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bogdan Cojocaru
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nathalie Parez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dominique Biarent
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gérard Chéron.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chéron, G., Jais, J.P., Cojocaru, B. et al. The European Paediatric Life Support course improves assessment and care of dehydrated children in the emergency department. Eur J Pediatr 170, 1151–1157 (2011). https://doi.org/10.1007/s00431-011-1428-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-011-1428-3

Keywords

Search

Navigation