EFFECTS OF PEDIATRICIAN CHARACTERISTICS ON MANAGEMENT DECISIONS IN SIMULATED CASES INVOLVING APPARENT LIFE-THREATENING EVENTS

Objectives: To study variations in the way pediatricians would evaluat e and manage an infant with an apparent life-threatening event. Subjec ts and Methods: A survey was mailed to the chief residents of all pedi atric residency training programs in the United States in which respon dents were presented with a simulated case and asked how they would ma nage an infant who had experienced an apparent life-threatening event that did not require resuscitation. The survey also explored each phys ician's tolerance of uncertainty, knowledge of apparent life-threateni ng events, experience fear of litigation, responsiveness to parental d emands, and propensity to order tests. Main Outcome Measures: Presumed decisions to prescribe antibiotics and/or order home apnea monitoring in a simulated case of an infant who had experienced an apparent life -threatening event not requiring resuscitation. Results: Logistic regr ession analysis revealed 2 characteristics that made significant and i ndependent contributions to respondents' presumed decision to prescrib e antibiotics: (1) experience with an adverse outcome, and (2) propens ity to order diagnostic tests. Presumed decisions to order a home apne a monitor were notably affected by fear of litigation. Conclusions: Th ese findings suggest that differences in pediatricians' characteristic s contribute to variations in care. Efforts to make management more un iform must consider that decisions are influenced by a host of differe nt characteristics and experiences.