Aaron N Leetch

Interests

Teaching

Pediatric emergenciesPediatric critical careRespiratory distress

Research

Pediatric feverMedical Education

Courses

Scholarly Contributions

Books

• Leetch, A. N. (2020). Avoiding Common Errors in Pediatric Emergency Medicine. Wolters-Kluwer.

Chapters

• Leetch, A. N. (2020). Eye Foreign Bodies. In Core-Pendium. Online.
• Leetch, A. N., & Greenfield, L. (2017). Resuscitation of the Critically Ill Neonate. In Emergency Department Resuscitation of the Critically Ill Neonate, 2nd Edition.
• Leetch, A. N., & Bedrick, A. D. (2011). Resuscitation of the Critically Ill Neonate. In Emergency Department Resuscitation of the Critically Ill. American College of Emergency Physicians.

Journals/Publications

• Florin, T. A., Ramilo, O., Banks, R. K., Schnadower, D., Quayle, K. S., Powell, E. C., Pickett, M. L., Nigrovic, L. E., Mistry, R., Leetch, A. N., Hickey, R. W., Glissmeyer, E. W., Dayan, P. S., Cruz, A. T., Cohen, D. M., Bogie, A., Balamuth, F., Atabaki, S. M., VanBuren, J. M., , Mahajan, P., et al. (2023). Radiographic pneumonia in young febrile infants presenting to the emergency department: secondary analysis of a prospective cohort study. Emergency medicine journal : EMJ, 41(1), 13-19.
  More info

  The lack of evidence-based criteria to guide chest radiograph (CXR) use in young febrile infants results in variation in its use with resultant suboptimal quality of care. We sought to describe the features associated with radiographic pneumonias in young febrile infants.
• Sakles, J. C., Mendelson, J. S., Hurst, N. B., Patanwala, A. E., Leetch, A. N., & Pacheco, G. S. (2023). The pediatric rigid stylet improves first pass success compared to the standard malleable stylet and tracheal tube introducer in a simulated pediatric emergency intubation. Pediatric Emergency Care, 39(6), 423-427.
• Mahajan, P., VanBuren, J. M., Tzimenatos, L., Cruz, A. T., Vitale, M., Powell, E. C., Leetch, A. N., Pickett, M. L., Brayer, A., Nigrovic, L. E., Dayan, P. S., Atabaki, S. M., Ruddy, R. M., Rogers, A. J., Greenberg, R., Alpern, E. R., Tunik, M. G., Saunders, M., Muenzer, J., , Levine, D. A., et al. (2022). Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results. Pediatrics.
• Pacheco, G. S., Leetch, A. N., Patanwala, A. E., Hurst, N. B., Mendelson, J. S., & Sakles, J. C. (2022). The Pediatric Rigid Stylet Improves First-Pass Success Compared With the Standard Malleable Stylet and Tracheal Tube Introducer in a Simulated Pediatric Emergency Intubation. Pediatric emergency care.
  More info

  Pediatric emergency intubation is a high-acuity, low-occurrence procedure. Despite advances in technology, the success of this procedure remains low and adverse events are very high. Prospective observational studies in children have demonstrated improved success with the use of video laryngoscopy (VL) compared with direct laryngoscopy, although reported first-pass success (FPS) rates are lower than that reported for adults. This may in part be due to difficulty directing the tracheal tube to the laryngeal inlet considering the cephalad position of the larynx in infants. Using airway adjuncts such as the pediatric rigid stylet (PRS) or a tracheal tube introducer (TTI) may aid with intubation to the cephalad positioned airway when performing VL. The objectives of this study were to assess the FPS and time to intubation when intubating an infant manikin with a standard malleable stylet (SMS) compared with a PRS and TTI.
• Pacheco, G. S., Patanwala, A. E., Leetch, A. N., Mendelson, J. S., Hurst, N. B., & Sakles, J. C. (2022). Intubation During Pediatric Cardiac Arrest in the Emergency Department Is Associated With Reduced First-Pass Success. Pediatric emergency care, 38(5), e1271-e1276.
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  Airway compromise and respiratory failure are leading causes of pediatric cardiac arrest making advanced airway management central to pediatric resuscitation. Previous literature has demonstrated that achieving first-pass success (FPS) is associated with fewer adverse events. In cardiac arrest for adult patients, increasing number of intubation attempts is associated with lower likelihood of return of spontaneous circulation (ROSC) and favorable neurologic outcome. There is limited evidence regarding advanced airway management for pediatric out-of-hospital cardiac arrest (OHCA) in the emergency department (ED). The purpose of this study was to compare FPS in pediatric OHCA and non-cardiac arrest patients in the ED.
• Sakles, J. C., Hurst, N. B., Mendelson, J. S., Leetch, A. N., Patanwala, A. E., & Pacheco, G. (2022). Intubation During Pediatric Cardiac Arrest in the Emergency Department Is Associated With Reduced First-Pass Success. Pediatric Emergency Care.
• Sakles, J. C., Mendelson, J. S., Hurst, N. B., Patanwala, A. E., Leetch, A. N., & Pacheco, G. S. (2022). The pediatric rigid stylet improves first pass success compared to the standard malleable stylet and tracheal tube introducer in a simulated pediatric emergency intubation. Pediatric Emergency Care.
• Sakles, J. C., Hurst, N. B., Mendelson, J. S., Leetch, A. N., Patanwala, A. E., & Pacheco, G. (2021). Intubation During Pediatric Cardiac Arrest in the Emergency Department Is Associated With Reduced First-Pass Success. Pediatric Emergency Care.
• Wannemacher, J., & Leetch, A. N. (2021). Caring for Febrile Young Infants. Pediatric Emergency Medicine Reports.
• Leetch, A. N., Glasser, J. A., & Woolridge, D. P. (2019). A Roadmap for the Student Pursuing a Career in Pediatric Emergency Medicine. The western journal of emergency medicine, 21(1), 12-17.
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  Three pathways are available to students considering a pediatric emergency medicine (PEM) career: pediatric residency followed by PEM fellowship (Peds-PEM); emergency medicine residency followed by PEM fellowship (EM-PEM); and combined EM and pediatrics residency (EM&Peds). Questions regarding differences between the training pathways are common among medical students. We present a comparative analysis of training pathways highlighting major curricular differences to aid in students' understanding of these training options.
• Mushtaq, R., Desoky, S. M., Morello, F., Gilbertson-Dahdal, D., Gopalakrishnan, G., Leetch, A., Vedantham, S., Kalb, B., Martin, D. R., & Udayasankar, U. K. (2019). First-Line Diagnostic Evaluation with MRI of Children Suspected of Having Acute Appendicitis. Radiology, 291(1), 170-177.
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  Background Advances in abdominal MRI have enabled rapid, free-breathing imaging without the need for intravenous or oral contrast material. The use of MRI as the primary imaging modality for suspected appendicitis has not been previously studied. Purpose To determine the diagnostic performance of MRI as the initial imaging modality in children suspected of having acute appendicitis. Materials and Methods The study included consecutive patients 18 years of age and younger presenting with acute abdominal pain at a tertiary care institution from January 2013 through June 2016 who subsequently underwent an unenhanced MRI examination as the primary diagnostic imaging modality. Electronic medical records and radiology reports were retrospectively evaluated for the feasibility and diagnostic performance of MRI, with surgical pathology and follow-up electronic records as reference standards. Statistical analyses were performed by using simple binomial proportions to quantify sensitivity, specificity, and accuracy, and exact 95% confidence intervals (CIs) were obtained. Results After exclusions, 402 patients (median age: 13 years; interquartile range [IQR], 9-15 years; 235 female patients; 167 male patients) were included. Sedation for MRI was required in 13 of 402 patients (3.2%; 95% CI: 1.7%, 5.5%). The appendix was visualized in 349 of 402 patients (86.8%; 95% CI: 83.1%, 90%); for the remaining patients, a diagnosis was provided on the basis of secondary signs of appendicitis. The sensitivity, specificity, and accuracy of MRI as the primary diagnostic imaging modality for the evaluation of acute appendicitis were 97.9% (95 of 97; 95% CI: 92.8%, 99.8%), 99% (302 of 305; 95% CI: 97.2%, 99.8%), and 98.8% (397 of 402; 97.1%, 99.6%), respectively. Among patients with negative findings for appendicitis at MRI, an alternate diagnosis was provided in 113 of 304 patients (37.2%; 95% CI: 31.7%, 42.9%). Conclusion When performed as the initial imaging modality in children suspected of having acute appendicitis, MRI examinations had high diagnostic performance for the diagnosis of acute appendicitis and in providing alternative diagnoses. © RSNA, 2019 See also the editorial by Dillman and Trout in this issue.
• Huang, C., & Leetch, A. N. (2018). Orofacial, Eye and Ear Trauma. Pediatric Emergency Medicine Reports.
• Leetch, A. N., & Retterath, L. (2018). Can symptoms and physical examination findings identify children with radiographic pneumonia?. The BEEM Journal.
• Leetch, A. N., & Wilson, B. (2018). Pediatric Major Head Injury: Not a Minor Problem. Emergency medicine clinics of North America, 36(2), 459-472.
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  Traumatic brain injury is a highly prevalent and devastating cause of morbidity and mortality in children. A rapid, stepwise approach to the traumatized child should proceed, addressing life-threatening problems first. Management focuses on preventing secondary injury from physiologic extremes such as hypoxemia, hypotension, prolonged hyperventilation, temperature extremes, and rapid changes in cerebral blood flow. Initial Glasgow Coma Score, hyperglycemia, and imaging are often prognostic of outcome. Surgically amenable lesions should be evacuated promptly. Reduction of intracranial pressure through hyperosmolar therapy, decompressive craniotomy, and seizure prophylaxis may be considered after stabilization. Nonaccidental trauma should be considered when evaluating pediatric trauma patients.
• Leetch, A. N., & Wilson, B. (2018). Pediatric Major Head Trauma: Not a Minor Problem. Emergency Medicine Clinics of North America.
• Leetch, A. N., Pacheco, G. S., & Paradise, S. (2018). Pediatric Airway Team Based Learning. Journal of education & teaching in emergency medicine. doi:10.5070/m534041278
• Minnock, W., & Leetch, A. N. (2018). Cervical Spinal Injury. Pediatric Emergency Medicine Reports.
• Paradise, S., Leetch, A. N., & Pacheco, G. (2018). Pediatric Airway Team Based Learning. Journal of Education and Teaching in Emergency Medicine.
• Furmick, J., Malburg, L., & Leetch, A. N. (2017). Pediatric Airway Management. Pediatric Emergency Medicine Reports.
• Leetch, A. N., & Hiller, K. M. (2017). Translating Shift Card Data into Other Evaluation Modalities. Academic Emergency Medicine.
• Kiebel, W., Minnock, C., & Leetch, A. N. (2016). A Review of the Limping Child and Painful Hip. Pediatric Emergency Medicine Reports.
• Leetch, A. N. (2016). TF10 Recognizing Pediatric Respiratory Distress: A Video-Based Instructional Curriculum. Annals of Emergency Medicine. doi:10.1016/j.annemergmed.2016.08.421
• Leetch, A. N., & Wormley, M. (2016). An Approach to Toxicological Emergencies in the Pediatric Patient. Pediatric Emergency Medicine Reports.
• Leetch, A. N., Fiorello, A. B., Nuño, T., & Min, A. A. (2016). How well will you FIT? Use of a modified MMI to assess applicants’ compatibility with an emergency medicine residency program. Medical Education Online, 21(1), 29587. doi:10.3402/meo.v21.29587
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  Emergency medicine residency programs have evaluated the use of Multiple Mini Interviews (MMIs) for applicants. The authors developed an MMI-style method called the Fast Interview Track (FIT) to predict an applicant's 'fit' within an individual residency program.Applicants meet with up to five residents and are asked one question by each. Residents score the applicant using a Likert scale from 1 to 5 on two questions: 'How well does the applicant think on his/her feet?' and 'How well do you think the applicant will fit in here?'. To assess how well these questions predicted a resident's 'fit', current residents scored fellow residents on these same questions. These scores were compared with the residents' interview FIT scores. A postmatch survey of applicants who did not match at this program solicited applicants' attitudes toward the FIT sessions.Among the junior class, the correlation between interview and current scores was significant for question 1 (rho=0.5192 [p=0.03]) and question 2 (rho=0.5753 [p=0.01]). Among seniors, Spearman's rho was statistically significant for question 2, though not statistically significant for question 1. The chi-square measure of high scores (4-5) versus low scores (1-3) found a statistically significant association between interview and current scores for interns and juniors. Of the 29 responses to the postmatch survey, 16 (55%) felt FIT sessions provided a good sense of the program's personality and only 6 (21%) disagreed. Nine (31%) felt FIT sessions positively impacted our program's ranking and 11 (38%) were 'Neutral'. Only two (7%) reported that FIT sessions negatively impacted their ranking of our program.FIT provided program leadership with a sense of an applicant's 'fit' within this program. Interview day scores correlated with scores received during residency. Most applicants report a positive experience with FIT sessions. FIT provides a useful tool to recruit applicants who fit with the residency program.
• Min, A. A., Leetch, A., Nuño, T., & Fiorello, A. B. (2016). How well will you FIT? Use of a modified MMI to assess applicants' compatibility with an emergency medicine residency program. Medical education online, 21, 29587.
  More info

  Emergency medicine residency programs have evaluated the use of Multiple Mini Interviews (MMIs) for applicants. The authors developed an MMI-style method called the Fast Interview Track (FIT) to predict an applicant's 'fit' within an individual residency program.
• Tromble, E., & Leetch, A. N. (2016). Noninvasive Ventilation and Acute Respiratory Failure. Pediatric Emergency Medicine Reports.
• Wilson, B., & Leetch, A. N. (2016). Severe Asthma Exacerbation in Pediatric Patients: A Review. Pediatric Emergency Medicine Reports.
• Huang, C., & Leetch, A. N. (2015). Pediatric Orofacial/Eye/Ear Trauma. Critical Concepts in Pediatric Emergency Medicine.
• Kiebel, W., & Leetch, A. N. (2015). Pediatric Neurologic Trauma. Critical Concepts in Pediatric Emergency Medicine.
• Kiebel, W., & Leetch, A. N. (2015). Pediatric Spinal Trauma. Critical Concepts in Pediatric Emergency Medicine.
• Leetch, A. N. (2015). Pediatric Major Trauma. Critical Concepts in Pediatric Emergency Medicine.
• Leetch, A. N., Leipsic, J., & Woolridge, D. P. (2015). Evaluation of child maltreatment in the emergency department setting: an overview for behavioral health providers. Child and adolescent psychiatric clinics of North America, 24(1), 41-64.
  More info

  Emergency providers are confronted with medical, social, and legal dilemmas with each case of possible child maltreatment. Keeping a high clinical suspicion is key to diagnosing latent abuse. Child abuse, especially sexual abuse, is best handled by a multidisciplinary team including emergency providers, nurses, social workers, and law enforcement trained in caring for victims and handling forensic evidence. The role of the emergency provider in such cases is to identify abuse, facilitate a thorough investigation, treat medical needs, protect the patient, provide an unbiased medical consultation to law enforcement, and provide an ethical testimony if called to court.
• Pacheco, G., & Leetch, A. N. (2015). Pediatric Cardiopulmonary Arrest and Post-Arrest Care. Critical Concepts in Pediatric Emergency Medicine.
• Pacheco, G., Leetch, A. N., Pacheco, G., & Leetch, A. N. (2015). Pediatric cardiopulmonary arrest and post-arrest care. Critical Concepts in Pediatric Emergency Medicine.
• Tromble, E., & Leetch, A. N. (2015). Pediatric Circulatory Failure. Critical Concepts in Pediatric Emergency Medicine.
• Tromble, E., & Leetch, A. N. (2015). Pediatric respiratory failure. Critical Concepts in Pediatric Emergency Medicine.
• Wormley, M., & Leetch, A. N. (2015). Pediatric Visceral Trauma. Critical Concepts in Pediatric Emergency Medicine.
• Leetch, A. N., & Huang, C. (2014). Managing Febrile Children Age 3-36 Months. Pediatric Emergency Medicine Reports.
• Leetch, A. N. (2013). Occult Bacteremia: Is It Still Worth Chasing?. ACEP Pediatric Emergency Section Newsletter.
• Leetch, A. N., & Woolridge, D. (2013). Emergency department evaluation of child abuse. Emergency medicine clinics of North America, 31(3), 853-73.
  More info

  Child abuse presents commonly to emergency departments. Emergency providers are confronted with medical, social, and legal dilemmas with each case. A solid understanding of the definitions and risk factors of victims and perpetrators aids in identifying abuse cases. Forensic examination should be performed only after the child is medically stable. Emergency providers are mandatory reporters of a reasonable suspicion of abuse. The role of the emergency provider is to identify abuse, facilitate a thorough investigation, treat medical needs, protect the patient, provide an unbiased medical consultation to law enforcement, and to provide an ethical testimony if called to court.
• Leetch, A. N. (2008). Pediatric Nasal Foreign Bodies Pose a Unique Challenge. EM Resident, 28-29.

Proceedings Publications

• Vitale, M. A., Vanburen, J. M., Tzimenatos, L., Schnadower, D., Ruddy, R. M., Roosevelt, G., Rogers, A. J., Richards, R., Ramilo, O., Quyale, K., Powell, E. C., Pickett, M. L., Park, G., Nigrovic, L. E., Mistry, R. D., Mahajan, P., Linakis, J. G., Leetch, A. N., Kuppermann, N., , Jaffe, D. M., et al. (2021). Prevalence of Bacteremia And Meningitis In Febrile Infants ≤ 60 Days With Positive Urinalyses In A Multicenter Network. In Section on Emergency Medicine Program.

Presentations

• Pacheco, G. S., Leetch, A., Patanwala, A. E., Hurst, N., Mendelson, J., Demers, D., Kyriazi, G., & Sakles, J. C. (2022, September). Why do Bougies Fail? Reasons for Failure with a TTI when using Videolaryngoscopy with a Standard Blade During a Simulated Infant Intubation on a Manikin. Society for Airway Management Annual Scientific Meeting and Workshop. Tucson: Society for Airway Management.
• Pacheco, G. S., Leetch, A., Patanwala, A. E., Mendelson, J., & Sakles, J. C. (2022, May). Rigid Stylet Improves Simulated Pediatric Intubation First-Pass Success Compared to Standard Stylet and Tracheal Tube Introducer.. Society for Academic Emergency Medicine Annual Meeting. New Orleans, LA: Society for Academic Emergency Medicine.
• Pacheco, G. S., Patanwala, A. E., Leetch, A., Mendelson, J., & Sakles, J. C. (2022, May). Large Tongue is Associated with Decreased First-Pass Success Without Adverse Events in Pediatric Intubations. Society for Academic Emergency Medicine Annual Meeting. New Orleans, LA: Society for Academic Emergency Medicine.
• Leetch, A. N. (2020, May). Prevalence of Bacteremia and Meningitis in Febrile Infants Less Than or Equal to 60 Days With Positive Urinalyses. Society of Academic Emergency Medicine National Meeting. Virtual.
• Leetch, A. N. (2020, May). Prevalence of bacteremia and meningitis in febrile infants ≤ 60 days with positive urinalyses in a multicenter network. Pediatric Academic Societies Meeting. Due to COVID-19 related conference cancellation, this peer-reviewed abstract and/or presentation was disseminated on 4/30/2020 to the PAS 2020 Meeting Program Guide..
• Leetch, A. N. (2020, October). Prevalence of bacteremia and meningitis in febrile infants ≤ 60 days with positive urinalyses in a multicenter network. American Academy of Pediatrics Virtual Conference. Online.
• Leetch, A. N. (2020, October). Validation of a prediction rule for serious bacterial infections (SBIs) in febrile infants < 60 days in a multicenter network. American Academy of Pediatrics Virtual Conference. Online.
• Pacheco, G. S., Fisher, R., Patanwala, A. E., Leetch, A., Mendelson, J., & Sakles, J. C. (2019, October). Pediatric Cardiac Arrest is Associated with Increased Number of Intubation Attempts in the Emergency Department.. American College of Emergency Physicians Scientific Assembly Research Forum. Denver, CO: American College of Emergency Physicians.
• Leetch, A. N. (2017, March). Recognizing Pediatric Respiratory Distress. Arizona Pediatric Symposium. Flagstaff, AZ: NAEMS.
• Leetch, A. N. (2016, January). Start Seeing Sick Children: Recognizing Pediatric Respiratory Distress. EMS on the Border. Desert Diamond Casino, Tucson, AZ.
• Leetch, A. N. (2015, November). Neonatal Resuscitation. Emergency Pediatric Interdisciplinary Care Conference. Desert Diamond Casino, Tucson, AZ.
• Leetch, A. N. (2015, November). Vomiting: Not Just for Food Poisoning. Emergency Pediatric Interdisciplinary Care Conference. Desert Diamond Casino, Tucson, AZ.
• Leetch, A. N. (2015, November). What to Expect at Your Next ER Visit. Pediatrics in the Desert. Banner University Medical Center - Tucson Campus.
• Leetch, A. N., & Williams, C. G. (2015, March). Interview Etiquette/Mock Interviews. Western Society for Academic Emergency Medicine. University Marriott, Tucson, AZ: Western Society of Academic Emergency Medicine.
• Leetch, A. N., & Williams, C. G. (2015, March). Interview Etiquette/Mock Interviews. Western Society of Academic Emergency Medicine. University Marriott, Tucson, AZ: Western Society of Academic Emergency Medicine.
• Leetch, A. N. (2014, March). Pediatric EKGs. Emergency Pediatric Interdisciplinary Care Conference. Starr Pass Resort, Tucson, AZ.
• Leetch, A. N. (2014, March). Start Seeing Sick Children: Recognizing Pediatric Respiratory Distress. Emergency Pediatric Interdisciplinary Care Conference. Starr Pass Resort, Tucson, AZ.
• Leetch, A. N. (2014, March). Troubleshooting Pediatric Devices. Emergency Pediatric Interdisciplinary Care Conference. Starr Pass Resort, Tucson, AZ.
• Leetch, A. N. (2013, May). Not on My New Shoes: Deliveries outside of the Delivery Room. Emergency Pediatric Interdisciplinary Care Conference. Starr Pass Resort, Tucson, AZ.
• Leetch, A. N. (2013, May). There is Nothing Wrong with your Child . . . I Hope: The Evaluation of the Irritable Infant. Emergency Pediatric Interdisciplinary Care Conference. Starr Pass Resort, Tucson, AZ.
• Leetch, A. N. (2012, February). Management of Unruly Fetuses: Preterm Deliveries in the ED. Emergency Pediatric Interdisciplinary Care Conference. Starr Pass Resort, Tucson, AZ.
• Leetch, A. N. (2012, March). 6 Going on 60: Pediatric Presentations of Adult Diseases. EMS Mega CE. Tucson, AZ: University Physicians Hospital,.
• Leetch, A. N. (2011, January). Anaphylaxis. EMS CE. Tucson, AZ: University Physicians Hospital,.
• Leetch, A. N. (2011, January). Pediatric Trauma. Emergency Pediatric Interdisciplinary Care Conference. Sierra Vista, AZ.

Poster Presentations

• Leetch, A. N. (2016, October). Recognizing Pediatric Respiratory Distress: A Video-based Instructional Module. American College of Emergency Medicine Scientific Assembly. Las Vegas, NV: American College of Emergency Medicine.

Creative Productions

• Leetch, A. N. (2016. Recognizing Pediatric Respiratory Distress: A Video-based Instructional Curriculum. American College of Emergency Physicians Teaching Fellowship. Dallas, TX.