Projects Conducted by Current Fellows

Michael Alavi, D.O. (Class of 2026)
PEDIATRIC THC EXPOSURE AND THE HEALTHCARE IMPLICATIONS FOR A HOSPITAL SYSTEM IN HOUSTON - A PEDIATRIC EMERGENCY MEDICINE PERSPECTIVE

Tetrahydrocannabinol (THC) containing products have become more readily available in Texas over the past several years with changes in legislation. Various studies have been published on the effects of THC exposure in the pediatric population. Studies have demonstrated an increase in clinical severity as well as admission rates over the years. However, many of these studies are performed in either marijuana-legalized states or lack local context (as use nationwide poison control data). Dr. Alavi’s research focuses on better understanding the effects of THC-exposures on pediatric emergency medicine workflows as well as clinical severity within Houston and surrounding areas. He also aims to better understand how THC-related exposures are distributed throughout the Houston/Katy/Woodlands areas and reflect this data via THC-exposure heatmaps. By doing such, physicians may be better equipped to deliver family education and optimizing patient care. Lastly, there is limited data pertaining to the sociodemographic components of healthcare related to THC exposures. Dr. Alavi additionally strives to assess the social aspects of cannabis exposure. It is important to recognize the potential factors that led to various ancillary services being consulted as well as importance of equality and equity in healthcare.

Mentors: Brent Kaziny; Benjamin Choi; Nina Singh

Jason Choi, M.D. (Class of 2026)
Title: Disparities in Pediatric Emergency Department Arrival-to-Provider Time by Language

Children from minoritized racial and ethnic groups wait longer to see a provider in the emergency department (ED). Even after adjustment for confounders such as illness severity and site of evaluation, disparities persist, particularly for Hispanic children. One potential barrier to timely care may be language, as non-English language is associated with poorer outcomes and patient satisfaction. Studies evaluating the effect of language on ED length of stay have been inconclusive, and no studies have evaluated the effect of language on pediatric ED wait time. Therefore, we conducted a retrospective cohort study of pediatric ED encounters at Texas Children's Hospital to investigate the association between encounter language and arrival-to-provider time in children presenting to the pediatric ED.

Mentor: Elyse Portillo

Title: Barriers and Enablers to Implementation of the Pediatric Early Warning Score for Resource-Limited Settings in a Tertiary Care Hospital in Malawi: A Qualitative Study

Despite significant progress, in-hospital pediatric mortality in Malawi remains high. One major challenge has been the timely detection of clinical deterioration. Obtaining frequent patient assessments and escalating care is limited by inadequate equipment, staffing, and training, and communication pathways. In response, the Pediatric Early Warning Score for Resource Limited Settings (PEWS-RL) was developed using six patient assessments that could be reliably obtained in a resource-limited setting. Despite the validity of this and other early warning scores, implementation throughout LMIC hospitals has been limited. Understanding the factors that encourage (“enablers”) or discourage (“barriers”) the implementation of early warning systems in LMIC hospitals may help improve patient outcomes. The Consolidated Framework for Implementation Research (CFIR) conceptualizes these factors as existing within 5 domains - Innovation, Outer Setting, Inner Setting, Individuals, and Process - and been successfully used to study the implementation of innovations in LMICs. One study from Latin America evaluated the implementation of an early warning system using CFIR, but there have been none in sub-Saharan Africa. Therefore, in this qualitative study, we will use the CFIR to determine the barriers and enablers to implementing the PEWS-RL in a tertiary care government hospital in Malawi.

Mentors: Heather Crouse, Emily Hartford, Elizabeth Davis

Rachel George, M.D. (Class of 2026)
Title: Resource utilization associated with mode of arrival with anaphylaxis

The rate of children presenting to the emergency department for anaphylaxis has been increasing. This study aims to investigate if there are differences in resource utilized in the ED for patients presents via EMS, private vehicle, or clinic with anaphylaxis.

Mentors: Liz Moran, Nina Singh, Sasha Alvarado

Kristi Murphy, M.D. (Class of 2026)
The title of my project is: Debriefing trainees after global health experience: a qualitative study of the trainees experience.

This is a qualitative study assessing the debriefing process for pediatric residents returning from a global health experience. Previous study found the resident often felt disconnected upon their return. In response to this, global health educators agree debriefing after global health experience is best practice and created a checklist tool. This study aims to assess the resident's thoughts, perceptions, and value of the debriefing process using a semi-structured interview approach.

Mentors: Kim Alali and Marideth Rus

Mary Wisbon, M.D. (Class of 2026)
Project title: Current State of Pediatric Disaster Medicine Education During Pediatric Emergency Medicine Fellowship

It is well known that children and adolescents are more vulnerable than adults and have unique physical and mental health needs during times of disaster. There is data to suggest that pediatric disaster medicine education is limited or insufficient during pediatric residency training. However, there is sparse data regarding the current state of pediatric disaster medicine education during pediatric emergency medicine fellowship. Pediatric disaster medicine education is included as a requirement on the American Board of Pediatrics core content outline for pediatric emergency medicine fellowship, however, it is not listed as a requirement for fellowship programs for ACGME accreditation. Pediatric disaster medicine education is a fundamental component of being a competent pediatric emergency medicine physician and as such, knowledge gaps must be addressed in order to provide fellows with the appropriate training. The aim of this project is to assess what methods PEM fellowship programs are using to educate their trainees in this important area of pediatric emergency medicine training.

Mentor(s):  Nichole Davis

Oluwatosin Adenuga, M.D. (Class of 2025)
Title: The Effect Of Prehospital Oxygen Supplementation And Airway Adjuncts On Survival At ED Arrival In Pediatric Drowning Patients

Drowning is a leading cause of death, worldwide and the second-leading cause of unintentional injury death in US children aged 1-14 years. Recommendations include administration of oxygen prehospital and during transport for victims of drowning; however, challenges related to resource and availability of equipment exist in many prehospital settings. Furthermore, the effect of prehospital oxygen supplementation on drowning outcomes is not known. We sought to determine whether prehospital delivery of oxygen or use of ventilation (e.g. bag-mask, intubation) was associated with improved survival at ED arrival among pediatric drowning victims.

Mentor(s):  Rohit Shenoi

Blake Barber, DO (Class of 2025)  Dislocated joints: management in general and pediatric emergency departments

There are approximately 7 million presentations to emergency departments in the United States annually for musculoskeletal disease; 8% are for joint dislocations. Approximately 70% of children who seek emergency care in the US are seen in general EDs where less than 15 children are seen daily. Patients presenting to the ED with a joint dislocation should be managed promptly by the physician to obtain a successful reduction to relieve pain and restore function. Improving pain control for our patients is of vital importance as inadequate pain relief can lead to long-term alterations in pain perception, understanding, and potentially lead to the development of pain-related behavioral expressions in children. This retrospective cohort study will use the United States Acute Care Solutions (USACS) national database to compare several variables including frequency and timing of pain medication delivery to this patient population between general EDs and pediatric EDs. We will investigate if the frequency of procedural sedation and reduction failure in children differs between general EDs and pediatric  EDs. We hope to use these data to demonstrate comparisons of management practices for pediatric joint dislocations in different ED settings to develop quality improvement efforts to enhance the quality of pediatric care across all emergency departments.

Mentor: Nina Singh

Andrea de Jesus Martinez, MD (Class of 2025): Understanding communication breakdowns using professional interpreters during high-acuity events

There is no existing data that provides an insight and understanding of potential communication breakdowns between health care staff, interpreters and non-English speaking patients within the Emergency Department in high acuity settings. The purpose of this study is to expand our understanding of the contributing factors of the inequity non-English speaking patients and families face by using input of interdisciplinary team members’ in real time, to identify possible point of intervention in improving communication across the continuum of emergency care. This qualitative study is based on semi-structured interviews of professional interpreters and healthcare team members working in a quaternary pediatric emergency department that are involved in high-acuity encounters requiring rapid assessment and interventions of non-English speaking patients and families.

Mentor: Esther Sampayo, MD, MPH

Mackenzie Dupont, MD, MPH (Class of 2025): Piloting a curriculum to increase pediatric prehospital readiness

Children compromise a small percentage of the total volume of EMS calls making it difficult for EMS clinicians to maintain pediatric knowledge and skill sets. Nationally, there is a movement toward increasing pediatric pre-hospital readiness. In alignment with that movement, we are designing a set of pediatric specific curriculum for EMS clinicians targeted at addressing gaps in knowledge identified by the literature, such as patient and family centered care. This curriculum will be piloted by several agencies with the aim of increasing agency prehospital readiness scores and provider knowledge and comfort levels. 

Mentors: Kathryn Kothari, Manish Shah, Nichole Davis

Ashira Klein, MD (Class of 2025): Improving patient communication through a child-centered communication workshop

Evidence shows patient-centered communication improves adherence to recommendations, general health outcomes, patient and doctor satisfaction outcomes, and safety outcomes. However, few interventions exist to enhance child-centered communication skills specifically, as opposed to general/adult patient-provider communication. To address this gap, our study will evaluate the effectiveness of a novel child-centered communication workshop for pediatric emergency medicine providers. It will assess providers’ communication skills with pediatric EC patients prior to and after completion the workshop.

Mentors: Kim Little, Nina Singh, Andrea Dean, Elizabeth Moran 

Yasmine Koukaz, MD, MPH (Class of 2025): Standardizing screening for infectious diseases for refugee children

Evidence-based guidelines on health screening in refugee children exist, but there are little data on testing strategies tailored to specific sub-groups of newly arrived immigrants. The objective of this study is to determine the prevalence of positive screening tests in immigrant children from Afghanistan and Latin America. An electronic medical record (EMR) order set for routine screening of immigrant children was implemented and data will be analyzed through a retrospective cross-sectional approach and stratified by language and screening test.

Mentors: Karla Fredricks, Eric Russell, Elyse Portillo

Zach Foughty, MD, MBA, MPA (Class of 2024): Understanding family preferences for and experiences with interpretation services and bilingual physician interactions

Families from diverse linguistic and cultural backgrounds seek care in the pediatric emergency department, and hospitals have an ethical responsibility to ensure adequate interpretation services are available. A variety of interpretation services are available, some of which may be immediately available (e.g., third-party phone or video interpretation services) and others which are in limited supply and may be delayed (e.g., bilingual physicians or in-person interpretation services). We aim to understand caregiver preferences for interpretation services and factors associated with willingness to wait for their preferred method of interpretation if not immediately available.

Mentors: Andrea Cruz, Eric Russell, Esther Sampayo

Elit Hadad, MD  (Class of 2024): Novice Learners’ Experiences with a Novel Contextualized Rapid Cycle Deliberate Practice PALS Course

This is a qualitative study describing learners’ experiences with a Rapid Cycle Deliberate Practice (RCDP) PALS course. RCDP simulation has emerged as a promising tool in healthcare education. Understanding learners’ experiences is essential in tailoring successful medical training using RCDP. While multiple studies have identified the advantages and disadvantages of RCDP in healthcare education, particular attention has yet to be paid to a specific population of learner; the novice. We define the ‘novice learner’ as one without prior certification and applicable experience in pediatric life support education. In this qualitative study, using grounded theory methodology, we seek to explore, understand, and describe the experiences of novice learners naïve to PALS, using a novel contextualized RCDP course.

Mentors: Cara Doughty, Daniel Lemke

Sarahjean Kerolle, MD, MS (Class of 2024): Racial and ethnic differences in timing of emergency department-administered analgesia among injured children transported via emergency medical services (EMS)

We have room to improve pain management across the continuum of care. Delays in pain control are common in the prehospital and ED setting, and these delays are not equitably distributed. Prior studies have demonstrated disparities in ED pain management in minoritized children. However, fewer data exist on disparities in the timing of analgesia for children transported to the ED via EMS. Dr. Kerolle is conducting an unplanned secondary analysis of prospectively collected multicenter data to quantify disparities in analgesia and non-pharmacologic interventions for pain management for children transported to the ED via EMS. 

Mentors: Lorin Browne, Corrie Chumpitazi

Saamia Masoom, MD (Class of 2024): Characterizing respiratory syncytial virus (RSV) infections before and during the COVID-19 pandemic 

During the COVID-19 pandemic, RSV infections deviated from previously reliable epidemiologic patterns, likely due in part to the success of public health measures in preventing transmission of COVID-19 as well as other respiratory viruses. To investigate whether this change in RSV seasonality and delayed RSV surge resulted in a change in severity and frequency of RSV infections, this single-center retrospective study compares key patient demographics and markers of disease severity in patients testing positive for RSV in the Texas Children’s Hospital Emergency Departments between the last three seasons before and first three seasons after the onset of the COVID-19 pandemic.

Mentor: Sarah Meskill

Sarahjean Kerolle, MD, MS (Class of 2024): Racial and Ethnic Differences in ED Analgesia Among Injured Children Transported via EMS 

Our objective is to investigate whether racial and ethnic differences exist in the timing of analgesia administration among injured children transported by EMS to pediatric EDs. Through an unplanned secondary analysis of a multicenter prospective observational study, we will analyze previously abstracted patient demographics and pain management data on children ages 0 to 17 years who were transported via EMS to 10 pediatric EDs from July 2019 to April 2020. We hypothesize that minority children who arrive to the ED via EMS will receive delayed pain treatment compared to non-Hispanic white children. We hope that from this study analysis we can identify opportunities for improvement in pediatric pain management and ensure that all injured children, including those from at-risk minority populations, receive optimal pain treatment. 

Mentors: Corrie Chumpitazi, Manish Shah

Caroline Wang, MD, MBA (Class of 2024): Exploring Socioeconomic Disparities in Emergency Medical Services Interventions and Outcomes for Pediatric Out-of-Hospital Cardiac Arrest: A Child Opportunity Index-Based Study

While uncommon, pediatric atraumatic out-of-hospital cardiac arrests (OHCA) are a significant cause of morbidity and mortality. Studies have shown better outcomes with on-scene resuscitation and with early administration of epinephrine by emergency medical services (EMS). Other research has shown that EMS utilization is higher amongst pediatric patients from lower socioeconomic families. The Child Opportunity Index (COI) is a metric that captures a wide range of neighborhood factors that specifically impact healthy child development. Little is known about whether differences in on-scene EMS interventions for pediatric prehospital return of spontaneous circulation (ROSC) amongst varying socioeconomic strata exist. The purpose of this study is to evaluate for potential variations and/or similarities in on-scene EMS interventions for pediatric prehospital ROSC amongst varying socioeconomic strata. 

Mentors: Manish Shah, Remle Crowe, Kathryn Kothari