Published online May 4, 2018. doi: 10.5492/wjccm.v7.i2.31
Peer-review started: February 7, 2018
First decision: March 7, 2018
Revised: March 12, 2018
Accepted: April 22, 2018
Article in press: April 22, 2018
Published online: May 4, 2018
To assess overall confidence level of trainees in assessing and treating shock, we sought to improve awareness of recurrent biases in clinical decision-making to help address appropriate educational interventions.
Pediatric trainees on a national listserv were offered the opportunity to complete an electronic survey anonymously. Four commonly occurring clinical scenarios were presented, and respondents were asked to choose whether or not they would give fluid, rank factors utilized in decision-making, and comment on confidence level in their decision.
Pediatric trainees have a very low confidence level for assessment and treatment of shock. Highest confidence level is for initial assessment and treatment of shock involving American College of Critical Care Medicine/Pediatric Advanced Life Support recommendations. Children with preexisting cardiac comorbidities are at high risk of under-resuscitation.
Pediatric trainees nationwide have low confidence in managing various shock states, and would benefit from guidance and teaching around certain common clinical situations.
Core tip: Pediatric trainees at all levels of training across the United States express a low degree of confidence in management of various types of shock. Children with cardiac comorbidity are at very high risk of under-resuscitation when presenting with shock. Central venous pressure is often used in isolation for decision-making regarding fluid administration and supersedes other subjective and objective measures of intravascular fluid status and shock state.