Letter to the Editor Regarding Comparison of Adenosine Administration Utilizing a Single-Syringe Versus a Double-Syringe Method in a Simulated Pediatric Patient
Pediatric Emergency Care, cilt.42, sa.5, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Kısa Makale
- Cilt numarası: 42 Sayı: 5
- Basım Tarihi: 2026
- Doi Numarası: 10.1097/pec.0000000000003527
- Dergi Adı: Pediatric Emergency Care
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
- Karadeniz Teknik Üniversitesi Adresli: Evet
Özet
We read with great interest the recent article by Schafer et al,1 “Comparison of Adenosine Administration Utilizing a Single-Syringe Versus a Double-Syringe Method in a Simulated Pediatric Patient”, which offers an important contribution to the optimization of adenosine delivery techniques in pediatric supraventricular tachycardia (SVT) management. Their finding that the single-syringe (SS) method results in significantly shorter administration time compared with the double-syringe (DS) method has meaningful implications for procedural efficiency during time-critical interventions, and we commend the authors for this rigorous simulation study. However, several methodological and conceptual considerations warrant attention when interpreting the findings and translating them into clinical practice. First, the randomized crossover design introduces the possibility of a learning effect. Because participants performed both methods sequentially, proficiency gained during the initial attempt—especially in manipulating the 3-way stopcock used in the DS technique—may have influenced subsequent performance, despite randomized order. This may lead to either underestimation or overestimation of the observed 13-second difference in administration time. Second, the level of simulation fidelity limits the generalizability of the results. The study used a multi-venous IV training arm, which evaluates mechanical efficiency but does not approximate the cognitive load, environmental distractions, and stressors inherent in real pediatric emergencies. Recent pediatric human-factors research demonstrates that task load, procedural complexity, environmental stress, and interruption frequency significantly affect medication safety and error rates during resuscitation.2–4 The SS method’s reduced number of steps may yield advantages beyond speed, potentially lowering cognitive burden and error susceptibility under realistic stress conditions—outcomes not captured in this study. Third, although preparation times were similar between groups, the qualitative differences in preparation steps warrant consideration. The SS method requires an additional dilution step, which, although manageable in a controlled environment, may introduce error risk in high-stress clinical settings with limited personnel or less experienced staff. Prior pediatric medication safety literature similarly identifies dilution steps as common contributors to dosing inaccuracy and workflow delays.2,4 Taken together, the study by Schafer et al 1 provides valuable preliminary evidence supporting the logistical feasibility of the SS method in pediatric practice. Adult meta-analytic data further support its potential clinical benefit, showing higher odds of first-dose SVT termination with the SS technique.5 A neonatal case report also suggests that the SS method can be both effective and practical in real clinical circumstances.6 Nevertheless, before recommending widespread adoption, future research should incorporate high-fidelity, team-based simulations that measure human-factors outcomes such as cognitive load, task performance reliability, and error rates under realistic stressors.2–4 Clinical studies evaluating SVT termination rates and safety outcomes would further clarify whether the SS technique is not only faster but also safer and more resilient under true emergency conditions. In conclusion, Schafer et al 1 are to be commended for advancing evidence on an important pediatric resuscitation procedure. Their findings establish a strong foundation for further research that integrates human-factors science, clinical effectiveness, and real-world applicability of the single-syringe approach.