INTRODUCTION:Asthma is a leading cause of pediatric hospitalization. Endotracheal intubation and invasive mechanical ventilation (IMV) in status asthmaticus (SA) are associated with increased complications and mortality. Recent practice trends favor non-invasive ventilation (NIV) to support respiratory failure in SA. Comparison of patients receiving IMV or NIV for SA can help predict which patients are at risk of intubation and poor outcomes. METHODS:This is a single center retrospective cohort study. The study period was from 2011-2020. Inclusion criteria were status asthmaticus and age 2-20 years. Patients who received invasive support were matched 1:2 with those receiving NIV by date of intubation. Data collected included demographics, past medical history, history of prior PICU stay, IMV or NIV use, home medications, environmental risk factors, asthma and non-asthma directed medical management, length of stay (LOS), complications, morbidity and mortality. Categorical data was compared using Chi square or Fisher's exact test as appropriate. T-tests were used to compare means.RESULTS: 49 patients received IMV for SA over a 10-year period and 98 patients who received NIV were identified as a control. There was no difference in gender, race, history of allergies, eczema, smoke exposure, pets, home medication or prior PICU stay. Intubated patients were 2.2 years older (p=0.02) and were more likely to have previously been intubated (18.4% vs 7.1%, p=0.04). Need for IMV was associated with a longer LOS (12.3d vs 5.4d, p< 0.01) as well as several complications, including pneumothorax, neuromyopathy, hypoxic ischemic encephalopathy, CPR and death. The groups had similar rates of pneumonia, which has previously been identified as a risk factor for intubation. Five patients (10.2%) died; all received IMV. 80% (n=4) of these patients had a pre-hospital arrest. None of the patients with mortality had previously been intubated. CONCLUSIONS:In this study, use of IMV was associated with older age and prior history of IMV. However, history of prior IMV was not associated with mortality. Pre-hospital arrest was a major driver of mortality. Efforts to reduce mortality in pediatric asthma may benefit from identifying high risk children in the community setting.

An understanding of forearm and wrist anatomy is necessary for the diagnosis and treatment of various injuries. Evidence supports the use of peer‐assisted learning (PAL) as an effective resource for teaching basic science courses. First‐year medical students across three class years participated in an optional PAL kinesthetic workshop wherein participants created anatomically accurate paper models of forearm and wrist muscles. Participants completed pre‐ and post‐workshop surveys. Participant and nonparticipant exam performances were compared. Participation ranged from 17.3% to 33.2% of each class; participants were more likely to identify as women than men (p < 0.001). Participants in cohorts 2 and 3 reported increased comfort with relevant content after the workshop (p < 0.001). Survey responses for cohort 1 were omitted due to low response rates; however, exam performances were assessed for all three cohorts. Cohort 2 participants scored higher than nonparticipants on forearm and wrist questions on the cumulative course exam (p = 0.010), while the opposite was found for cohort 3 (p = 0.051). No other statistically significant differences were observed. This is the first study to examine quantitative and qualitative results for a PAL intervention repeated for three separate cohorts. Although academic performance varied, two cohorts reported increased comfort with relevant course material after the workshop. Results of this study support the need for further exploration of PAL workshops as an instructional method in teaching anatomy and highlight the challenges associated with repeating interventions over multiple years. As more studies attempt replication across multiple years, these challenges may be addressed, thereby informing PAL best practices.