Comparative practice patterns of emergency medicine physicians and pediatric emergency medicine physicians managing fever in young children
Comparative practice patterns of emergency medicine physicians and pediatric emergency medicine physicians managing fever in young children
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DOI：
10.1542/peds.108.2.354
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发表时间：
2001-08-01
期刊：
影响因子：
8
通讯作者：
Mason, JD
中科院分区：
文献类型：
--
作者：
Isaacman, DJ;Kaminer, K;Mason, JD
背景/目标。幼儿发烧的处理是一个有争议的话题。本研究旨在比较普通急诊医师（GEMPs）和儿科急诊医师（PEMPs）的管理方法，并将其与现有的实践指南联系起来。1998年6月1日至1998年9月1日期间在儿童医院急诊科和普通急诊科以发烧为主诉的3至36个月儿童的所有图表；1998年12月1日至1999年4月1日；及1999年6月1日至1999年9月1日。发热定义为大于或等于39℃，排除有免疫缺陷史、慢性疾病史、脑室-腹膜分流史、过去48小时内使用抗生素史或检查发现局灶性感染史的患者。收集的资料包括局灶性检查结果、实验室检查、诊断、治疗和处置。与实践指南的差异被制成表格并进行比较。1323名符合条件的儿童符合排除标准，并接受了PEMPs的治疗；755例因排除标准而被排除（526例因局灶性感染）。其余568例患者中有22例（4%）住院。有228名符合条件的儿童接受了GEMPs的治疗；147例被排除（109例因局灶性感染）。没有病人入院。与GEMPs相比，PEMPs要求更多全血细胞计数（324/568 vs 27/81）、更多血培养（321/568 vs 27/81）和更多尿培养（208/568 vs 20/81）。gemp比pemp要求更多的胸片和脑脊液分析；与PEMPs相比，GEMPs要求的全血细胞计数、血液培养和尿液培养较少。GEMPs诊断出更多的局灶性感染（109/228 vs 526/1323），并且与实践指南的冲突（66/79 vs 225/498）比PEMPs更频繁。患者在儿科急诊科平均花费2.26 +/- 0.16小时，而在普通急诊科平均花费3.0小时+/- 0.18小时。两组医生对无病源发热幼儿的处理存在显著差异。这些差异影响到医疗费用和医疗标准。未来评估这些策略是否影响患者预后的研究将进一步阐明其临床意义。
Background/Objective. The management of fever in young children is a controversial topic. This study seeks to compare the management approaches between general emergency medicine physicians (GEMPs) and pediatric emergency medicine physicians (PEMPs) and correlate them to existing practice guidelines.Design/Methods. All charts of children age 3 to 36 months presenting with the complaint of fever at both a children's hospital emergency department (ED) and a general ED from June 1, 1998 to September 1, 1998; December 1, 1998 to April 1, 1999; and June 1, 1999 to September 1, 1999 were retrospectively reviewed. Fever was defined as greater than or equal to 39 degrees C. Patients with a history of immunodeficiency, chronic illness, ventriculoperitoneal shunt, antibiotic use in the past 48 hours, or focal infection noted on examination were excluded. Data collected included focal exam findings, laboratory tests, diagnosis, treatment, and disposition. Variances from the practice guidelines were tabulated and compared.Results. One thousand three hundred twenty-three eligible children met exclusion criteria and were seen by PEMPs; 755 were eliminated because of exclusion criteria (526 because of focal infection). Twenty-two (4%) of 568 remaining patients were admitted to the hospital. Two hundred twenty-eight eligible children were seen by GEMPs; 147 were excluded (109 because of focal infection). No patients were admitted to the hospital. PEMPs ordered more complete blood counts (324/568 vs 27/81), more blood cultures (321/568 vs 27/81), and more urine cultures (208/568 vs 20/81) than GEMPs. GEMPs ordered more chest radiographs and cerebrospinal fluid analyses than PEMPs; GEMPs ordered less complete blood counts, blood cultures, and urine cultures than PEMPs. GEMPs diagnosed more focal infections (109/228 vs 526/1323), and conflicted more often with the practice guidelines (66/79 vs 225/498) than PEMPs. Patients spent an average of 2.26 +/- 0.16 hours in the pediatric ED versus 3.0 hours +/- 0.18 hours in the general ED.Conclusions. Significant differences in the management of the young child with fever and no source exist between these two groups of physicians. These variations affect both cost and standard of care. Future studies assessing whether these strategies affect patient outcomes would further elucidate their clinical implication.