Objectives To determine the incidence of bacterial meningitis (BM) among all febrile infants 29–56 days old undergoing a lumbar puncture (LP) in the emergency department (ED) of a tertiary care children’s hospital and the number of low-risk FYI with BM, in order to reassess the need for routine LP in these infants. Study design Retrospective cohort study using a quality improvement registry from July 2007-April 2014. Infants included were 29–56 days old with fever and who had an LP in the ED. Low-risk criteria were adapted from the Philadelphia criteria. 4BM was defined as having a bacterial pathogen isolated from the cerebrospinal fluid (CSF). A medical record review of one-third of randomly selected patients in the cohort determined the proportion who met low-risk criteria. Results One of 1188 (0.08%) FYI had BM; this patient did not meet low-risk criteria. An additional 40 (3.4%) had positive CSF cultures; all were contaminants. Sub-analysis of one-third of the study population revealed that 45.6% met low-risk criteria; the most common reasons for failing low-risk classification included abnormal white blood cell count or urinalysis. Conclusions In a cohort of FYI, BM is uncommon and no cases of BM would have been missed had LPs not been performed in those meeting low-risk criteria.

Primary and secondary surveys are frequently performed incompletely and inefficiently regardless of level of training or type of training program. There is no difference in measured performance among different types of residency programs. The impact of trauma resuscitation education on improved survey performance should be studied prospectively.

Objectives The aim of this study is to explore current community emergency department (ED) experiences available to pediatric emergency medicine (PEM) trainees and estimate the proportion of graduates taking positions that involve working in a community ED setting. Methods We conducted an e-mail–based survey among PEM fellowship directors and assistant directors. Results There were 55 program director respondents (74% response rate). Thirty-one percent of the surveyed PEM fellowship programs provide training exposure to a community ED setting. Twenty-nine percent of the surveyed programs reported that 25% to 49% of graduating trainees accepted positions that involve working in a community hospital ED setting, 13% responded 50% to 74%, and 4% report 75% to 100% from 2012 to 2016. Conclusions There is an overall paucity of a dedicated community rotation for PEM trainees, yet many graduates are seeking employment in community-based EDs. Because the need for community-based PEM physicians continues to rise and to adequately prepare the PEM workforce, PEM fellowship training should consider a curriculum that includes community-based ED clinical experiences.

A different approach to the triage and management of pediatric exposures to laundry detergent pod ingestions is required compared with nonpod ingestions. Although the exact cause is not known, practitioners should be vigilant for rapid onset of neurological impairment and inability to protect the airway in addition to its caustic effects.