PEDIATRIC EMERGENCY-MEDICINE PRACTICE PATTERNS - A COMPARISON OF PEDIATRIC AND GENERAL EMERGENCY PHYSICIANS

Objective: To determine whether differences exist between general emer gency physicians (GEMs) and pediatric emergency physicians (PEMs) in t he emergency care of children with common pediatric emergencies. Metho ds: We carried out a survey study of all members of the American Acade my of Pediatrics Section of Emergency Medicine and the Washington Stat e American College of Emergency Physicians. We identified current ther apeutic interventions for croup, asthma, bronchiolitis, seizures, febr ile infant, conscious sedation, head trauma, and coin ingestion, and c ompared the practice patterns of GEMs and PEMs. Results: A total of 66 % of the surveys were returned, including 211 GEMs and 329 PEMs. The m ajority of PEMs practice in children's hospitals, whereas most GEMs pr actice in general community hospitals. Slightly over half (51%) of PEM s are PEM fellowship-trained versus 1% of GEMs. Group: The majority of GEMs and PEMs use racemic epinephrine (RE) in the treatment of a chil d with strider at rest; approximately one-third admit to the hospital after RE (39 vs 30%, NS). PEMs are more likely to observe the child fo r >2 hours after RE (94% vs 79%, P < 0.01). The majority of PEMs and G EMs use steroids in these patients (94 vs 88%, NS). Asthma: There is n o significant difference in the use of albuterol, aminophylline, or st eroids. Steroids are more likely to be given orally by PEMs than GEMs (74 vs 50%, P < 0.01). Bronchiolitis: The majority of both groups of p hysicians routinely use nebulized beta-agonists; however, significantl y more GEMs than PEMs use steroids (68 vs 45%, P < 0.01). Seizures: Ha lf of GEMs vs 78% of PEMs use lorazepam as a first Line drug in the tr eatment of seizures (P < 0.01). There is no significant difference wit h respect to the use of rectal diazepam in the pre-hospital setting. F ebrile infant: GEMs are less likely than PEMs to admit the febrile inf ant <4 weeks of age (68 vs 87%; P < 0.01). Admission of older febrile infants (four to six weeks and eight weeks of age) is not significantl y different between PEMs and GEMs. Conscious sedation: Both groups use a wide array of drugs alone or in combination to sedate children for complex facial laceration repair, closed fracture reduction, and crani al computed tomography (CT). GEMs are more likely to use ketamine for laceration repair (28 vs 16%, P < 0.01). Both GEMs and PEMs use midazo lam plus a narcotic for fracture reduction. For further sedation for c ranial CT, after an initial dose of midazolam, GEMs are more likely to use additional midazolam (64 vs 47%, P < 0.01), and PEMs are more lik ely to add pentobarbital (15 vs 4%, P < 0.01). Head trauma: Most GEMs (87%) and PEMs (81%) would obtain a cranial CT on a neurologically nor mal two year old who had fallen down the stairs with a six-minute loss of consciousness. Coin ingestion: Most GEMs and PEMs would obtain rad iographs on an asymptomatic two year old with a recent coin ingestion. Conclusion: With some notable exceptions, GEMs and PEMs have similar pediatric practice patterns despite differences in training and practi ce environments.