• Denis Oriot, Marine Trigolet, David O Kessler, Marc A Auerbach, and Daniel Aiham Ghazali.
• Pediatric and Neonatal Intensive Care Unit, University Hospital of Limoges, Limoges, France.
• Pediatr Emerg Care. 2021 Dec 1; 37 (12): e1192e1196e1192-e1196.

BackgroundStress may impair the success of procedures in emergency medicine. The aims were to assess residents' stress during simulated and clinical lumbar punctures (LPs) and to explore the correlation of stress and performance.MethodsA prospective study (2013-2016) was carried out in a pediatric emergency department. A mastery training and subsequently a just-in-time training were conducted immediately preceding each clinical LP. Stress was self-assessed by the Stress-O-Meter scale (0-10). Performance (checklist 0-6 points) and success rate (cerebrospinal fluid with <1000 red blood cells/mm3) were recorded by a trained supervisor. A survey explored self-confidence and potential causes of stress.ResultsThirty-three residents performed 35 LPs. There was no stress during simulation procedure. Stress levels significantly increased for clinical procedure (P < 0.0001). Performance was similar in simulation and in clinic (respectively, 5.50 ± 0.93 vs 5.42 ± 0.83; P = 0.75). Success significantly decreased during clinical LP (P < 0.0001). The 2 most reported stress-related factors were fear of technical errors and personal fatigue.ConclusionsPerformance scores and success rates in simulation are insufficient to predict success in clinical situations. Stress level and stress-related factors (fear of technical errors and personal fatigue) might be different in simulated or real conditions and consequently impact success of a technical procedure even if a high-performance score is recorded.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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