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PubMedDate not supplied

Comparison of intensive care of injured children between pediatric-based and non-pediatric-based intensive care units in a university hospital in Taiwan.

Intensive care management of the injured child requires a multidisciplinary approach and meticulous attention to detail. However, the overwhelming majority of injured children are cared for by surgeons in surgical intensive care units (ICU) that see both adult and pediatric patients. There have been no previous reports of studies comparing the outcome in surgical ICUs (SICU) dealing with patients of all ages versus the outcome in pediatric ICUs (PICU). This study sought to determine differences in the outcome of pediatric intensive care between the SICU and PICU of our hospital. From Jan. 1989 to Aug. 1995, 118 children (68 boys and 50 girls), with an average age of 9.19 years (range: 3 months to 16 years), were admitted to our SICU. During the same period, 65 children (42 boys and 23 girls), with an average age of 5.04 years (range: 2 months to 16 years), were admitted to our PICU. Most of these patients received surgical intervention and were exclusively under surgeons' management. The decision to admit patient to the SICU or PICU was made by surgeon based on the availability of ICU beds. Pediatric risk of mortality (PRISM) score was used as a scoring system to assess disease severity in children. The most common cause for admission in both ICUs was traffic accidents. The average hospitalization duration in the SICU was 4.06 days (range 1 day to 23 days) and 3.34 days (range 1 day to 17 days) in the PICU. The average PRISM score was 7.87 (range 0-41) in the SICU and 6.48 (range 0-35) in the PICU. The overall mortality rate in the SICU was 12.7% (15/118) and 7.7% (5/65) in the PICU. There was a significant difference in patients' age and operative status but no significant difference in admission duration, PRISM score, and mortality rate between the SICU and PICU groups. The regression coefficients of the selected predictor variables and the impact on outcome showed one more score of PRISM would increase 1.5 fold of risk to become poor outcome while operation had lower risk (0.1 fold) to develop poor outcome. In conclusion, disease diversity and severity were similar among PICU and pediatric SICU patients in this study. The outcome was better in PICU patients although the difference was not statistically significant. The PRISM score is a useful measure to predict poor outcome in ICU patients after adjustment with confounders.

Adolescent↗
PubMed1999

A comparison of the radiographic interpretation skills of pediatric transport nurses and pediatric residents.

OBJECTIVE: To compare the radiograph interpretation skills of pediatric/neonatal transport nurses to those of 3rd-year pediatric residents. DESIGN: A validation study of radiograph interpretation. METHODS: Twelve pediatric transport nurses and nine senior pediatric residents were asked to interpret 20 radiographs or sets of radiographs. These films had been previously selected and interpreted by a panel of pediatric radiologists. The subjects' interpretations were compared with those of the radiologists, and a score was assigned for each film or set of films. Five points were awarded for an interpretation in complete agreement with the radiologists' interpretation; 2.5 points were awarded for partial agreement. No points were awarded for complete disagreement. Subjects also answered questions about prior training and experience in radiograph interpretation. RESULTS: The 3rd-year residents' mean score was 66.34 (range 57.5-82.5), while the nurses had a mean score of 33.75 (range 17.5-47.5). This difference was significant (P < 0.001). The residents had a mean of 133.33 of formal radiology instruction, while the nurses had less than 10 hours of instruction. The nurses had received focused training in the identification of pneumothoraces. The nurses had higher mean scores than the residents on the two sets of films demonstrating pneumothoraces, but this difference was not significant. CONCLUSIONS: The 3rd-year residents had significantly higher mean scores on a test of radiograph interpretation. The major difference between the groups appears to be the amount of formal training afforded the residents. The nurses' performance on the films demonstrating pneumothoraces suggests that focused training may be an effective means by which to gain skills important to transport.

Child↗
PubMed1981

Supervision of pediatric trainees in biosocial pediatrics. A survey of graduate programs.

To assess the current state of supervisory methods in biosocial pediatrics, fellowship programs in ambulatory pediatrics (AP), adolescent medicine (AM), and behavioral pediatrics/child development (BP/CD) were surveyed. Fifty-eight responses (98%) were analyzed. Forty-five percent of programs dealt extensively with behavioral pediatric problems. The AM and BP/CD fellowships were more psychosocially oriented than the AP programs. Ninety-two percent of AM and 82% of BP/CD programs used a formal supervisory style, but 48% of AP programs relied solely on unscheduled supervision. Direct observation or audiovisual tapes were used by only 57% of the programs. Significantly fewer AP programs used such objective methods. Supervision of biosocial pediatric programs should be formalized and include direct observation or audiovisual tapes.

Education, Medical, Graduate↗
PubMed2002

The PedsQL in pediatric cancer: reliability and validity of the Pediatric Quality of Life Inventory Generic Core Scales, Multidimensional Fatigue Scale, and Cancer Module.

BACKGROUND: The Pediatric Quality of Life Inventory (PedsQL) is a modular instrument designed to measure health-related quality of life (HRQOL) in children and adolescents ages 2-18 years. The PedsQL 4.0 Generic Core Scales are multidimensional child self-report and parent proxy-report scales developed as the generic core measure to be integrated with the PedsQL disease specific modules. The PedsQL Multidimensional Fatigue Scale was designed to measure fatigue in pediatric patients. The PedsQL 3.0 Cancer Module was designed to measure pediatric cancer specific HRQOL. METHODS: The PedsQL Generic Core Scales, Multidimensional Fatigue Scale, and Cancer Module were administered to 339 families (220 child self-reports; 337 parent proxy-reports). RESULTS: Internal consistency reliability for the PedsQL Generic Core Total Scale Score (alpha = 0.88 child, 0.93 parent report), Multidimensional Fatigue Total Scale Score (alpha = 0.89 child, 0.92 parent report) and most Cancer Module Scales (average alpha = 0.72 child, 0.87 parent report) demonstrated reliability acceptable for group comparisons. Validity was demonstrated using the known-groups method. The PedsQL distinguished between healthy children and children with cancer as a group, and among children on-treatment versus off-treatment. The validity of the PedsQL Multidimensional Fatigue Scale was further demonstrated through hypothesized intercorrelations with dimensions of generic and cancer specific HRQOL. CONCLUSIONS: The results demonstrate the reliability and validity of the PedsQL Generic Core Scales, Multidimensional Fatigue Scale, and Cancer Module in pediatric cancer. The PedsQL may be utilized as an outcome measure in clinical trials, research, and clinical practice.

Activities of Daily Living↗
PubMed2006

[Practical pain control in pediatric oncology. Recommendations of the German Society of Pediatric Oncology and Hematology, the German Association for the Study of Pain, the German Society of Palliative Care, and the Vodafone Institute of Children's Pain Therapy and Palliative Care].

In pediatric oncology, optimal pain control is still a challenge. A structured pain history and the regular scoring of pain intensity using age-adapted measuring tools are hallmarks of optimal pain control. Psychological measures are as important as drug therapy in the prophylaxis or control of pain, especially when performing invasive procedures. Pain control is oriented toward the WHO multistep therapeutic schedule. On no account should the pediatric patient have to climb up the "analgesic ladder" - strong pain requires the primary use of strong opioids. Give opioids preferably by the oral route and by the clock - short-acting opioids should be used to treat breakthrough pain. Alternatives are i.v. infusion, patient-controlled analgesia, and transdermal applications. Constipation is the adverse effect most often seen with (oral) opioid therapy. Adverse effects should be anticipated, and prophylactic treatment should be given consistently. The assistance of pediatric nurses is of the utmost importance in pediatric pain control. Nurses deliver the basis for rational and effective pain control by scoring pain intensity and documenting drug administration as well as adverse effects. The nurses' task is also to prepare the patient for and monitor the patient during painful procedures. It is the responsibility of both nurse and doctor to guarantee emergency intervention during sedation whenever needed. In our guideline we comment on drug selection and dosage, pain measurement tools, and documentation tools for the purpose of pain control. Those tools may be easily integrated into daily routine.

Analgesics↗
PubMed1986

Community hospital management of pediatric emergencies: implications for pediatric emergency medical services.

The ability of emergency physicians in a general community hospital to manage pediatric patients was evaluated. Essential diagnostic and therapeutic procedures performed in the emergency department on pediatric patients transferred for admission to a tertiary care center were compared with those initially performed on the same patients by the pediatricians and residents of the tertiary care center. The overall care rendered by the emergency physicians correlated well with that of the referral center. Ninety one per cent of diagnostic studies and 96% of therapeutic interventions were performed in the emergency department. Implications for the care of seriously ill pediatric patients by emergency physicians and the role of community hospital emergency departments in pediatric emergency medical services (EMS) systems are discussed.

Adolescent↗
PubMed2003

Timed Pediatric Risk of Mortality Scores predict outcomes in pediatric liver transplant recipients.

More reliable methods are needed to identify children at risk for poor outcomes following liver transplantation. The Pediatric Risk of Mortality (PRISM) Score is a physiology-based scoring system used to quantify risk of mortality in pediatric intensive care unit (ICU) populations. We evaluated the PRISM Score as a predictor of outcomes including survival in the pediatric liver transplant (LT) population. We retrospectively reviewed the records of 67 consecutive LTs performed between August 1997 and February 2000 at an urban, tertiary children's hospital in Chicago, IL, USA. Four PRISM Scores were calculated to determine which periods were most meaningful. A Classic PRISM Score was calculated during first 24 h of ICU admission, and three PRISM Scores were timed with the patient's transplant: a pre-LT PRISM Score (24 h prior to transplant whether in ICU or not), a 24-h post-LT PRISM Score and a 48-h post-LT PRISM Score. These PRISM Scores and other predictors including transplant number, UNOS status and PELD Score were compared with outcomes including survival using univariate methods. The pre-LT, the 24- and the 48-h PRISM Score were associated with the post-LT number of ventilated days (p < 0.05), ICU days (p < 0.05) and with 1-yr survival (p < 0.04). The PRISM Scores were not related to the post-LT hospital length of stay (LOS) or to 1-yr re-transplantation. The PELD Score correlated with the post-LT hospital LOS, but was not associated with mortality or with the ICU LOS. A patient's UNOS status and Classic PRISM Score were not associated with any of the outcomes measured. PRISM Scores are valid predictors of outcome including survival in pediatric LT recipients. These findings help to demonstrate the importance in this population of a patient's general physiologic condition and its influence on the overall hospital course and survival.

Adolescent↗
PubMed2005

On the evolution of pediatrics and the emergence of pediatric nephrology.

Pediatrics is a relatively new discipline; it came into existence at the end of the nineteenth century, when the number practitioners of medicine interested in the study and teaching of pediatrics grew in proportion to research in diseases of children. The study of two childhood diseases was instrumental in the very emergence of nephrology. The first disease was diarrheal dehydration of infants, the study of which in the first decades of the twentieth century provided much of the body of knowledge of water and electrolyte metabolism that formed the foundations of renal physiology. The second disease was the nephrotic syndrome of children, the successful treatment of which became possible after the Second World War with the use of adrenal cortical tropic hormone and steroids. The prohibitive cost of obtaining these new miracle drugs then led to the foundation in 1948 of the Nephrosis Foundation, which became the National Kidney Foundation (NKF) in 1950-the first organization in the United States dedicated to the support and dissemination of knowledge on diseases of the kidney. The Scientific Advisory Board of the NKF was the nidus around which the discipline of nephrology then evolved and, after the availability of maintenance hemodialysis, flourished. Pediatric nephrology, which emerged from these beginnings, closes the circle that began with the emergence of nephrology from its foundations in pediatric studies of childhood diarrhea and treatment of the nephrotic syndrome.

Child↗
PubMed1976

Pediatric-psychiatric liaison as a model for teaching pediatric residents.

The pediatrician's function as a comprehensive family health practitioner has frequently been ignored. A major problem is that pediatric residents are not trained or are inadequately trained to assess emotional, behavioral, and family problems that may be an integral part of the patient's symptoms. At the Children's Hospital of Philadelphia, a pediatric-psychiatric liaison program has evolved in which pediatric residents learn the principles and skills necessary to manage these problems. Ultimately, the liaison program will enable the staff pediatricians who use these principles to assume appropriate responsibility for educating the pediatric trainees.

Child Psychiatry↗
PubMed1994

Effectiveness and efficiency of a Dutch pediatric intensive care unit: validity and application of the Pediatric Risk of Mortality score.

OBJECTIVE: To assess the performance of pediatric intensive care by an international standard. DESIGN: Prospective, cohort study. SETTING: Nine-bed multidisciplinary pediatric intensive care unit (ICU) within a 174-bed, tertiary care children's hospital. PATIENTS: Consecutive, unselected patients (n = 612) during a 16-month period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Collected data included age, major diagnostic category, primary clinical specialty, severity of illness (daily Pediatric Risk of Mortality [PRISM] score), administration of ICU-dependent therapy (daily), and vital status at discharge. The PRISM score allowed the calculation of overall and daily mortality risk. After testing the applicability of the predictive model, effectiveness was determined by comparing severity of illness-based predicted mortality rate with vital status at discharge. Efficiency was defined by two criteria: a) the administration of at least one ICU-dependent therapy; or b) a mortality risk of > 1%. Five-hundred ninety-three patients were included (19 survivors were excluded because of incomplete data). Mean age was 55.0 months (median 24). Mean length of stay was 4.4 days (median 2). Overall ICU mortality rate was 8.4%. The overall performance of the PRISM score-based predictive model was found to be good (goodness-of-fit test chi 2[5] = 5.49; p = .35; area under receiver operating characteristic curve 0.92). Subgroup analysis showed that the best model performance was in nonoperative patients. Decreased performance was found in operative patients. In cardiovascular patients, the mortality rate was higher. In other surgical patients, the mortality rate was lower than expected. Of 593 patients, 489 (82.5%) admissions were efficient, as were 2,393 (76.5%) of 3,130 patient days in the ICU. The ranking of daily efficiency according to clinical specialty was as follows: postoperative cardiovascular surgical patients (86.3%); nonsurgical patients (76.6%); and other postoperative patients (49.6%). CONCLUSIONS: In our setting, effectiveness and efficiency of pediatric intensive care appeared to be validly determined using explicit criteria (mortality risk, administration of ICU-dependent therapy). Overall effectiveness met the standard set forth in an American study; validity in stratified analysis of diagnostic subgroups remains to be further established. Efficiency showed marked, specialty-related differences. The low efficiency in other (noncardiovascular) surgical patients was probably caused by the recovery function of the ICU. A more general application of these criteria might be considered in modifying admission and discharge policy, as well as in quality control.

Child↗
PubMed1995

Comparative assessment of pediatric intensive care: a national multicenter study. Pediatric Intensive Care Assessment of Outcome (PICASSO) Study Group.

OBJECTIVE: Comparative assessment of performance of pediatric intensive care. DESIGN: Open, prospective multicenter study. SETTING: All pediatric intensive care units (n = 10; six tertiary and four nontertiary) in the Netherlands. PATIENTS: 1063 consecutive unselected admissions, < or = 18 yrs old, during a 4-month period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Effectiveness was defined as the ratio of observed to expected (Pediatric Risk of Mortality-score-derived) mortality. Efficiency was determined by two objective criteria: mortality risk of > 1%, or administration of at least one intensive care unit (ICU)-dependent therapy. In the total population, observed and expected mortality rates were similar. Between hospitals, crude mortality showed wide variations (mean 7.1%, range 1% to 10%). However, in each center, observed and expected mortality rates were similar (mean ratio of observed/expected mortality 0.99, range 0.8 to 1.5). In tertiary care centers, severity of illness-corrected mortality rates in high-risk patients were less than in a United States reference population. Paradoxically, in low-risk tertiary care patients, the observed mortality rate was higher than expected. The relatively high mortality rate in this group is probably the result of the large number of low-risk tertiary care patients suffering from severe, incurable chronic disease. The average number of efficient ICU days was 72%, although large fluctuations between units were found (range 22% to 95%), suggesting that in several centers efficiency rates might be improved by a better selection of high-risk patients requiring ICU-dependent therapies. CONCLUSIONS: Differences in mortality rates among pediatric ICUs were largely explained by differences in severity of illness. High efficiency rates combined with adequate effectiveness were found in several centers, indicating that admission and discharge decisions might be improved in less efficient centers.

Child, Preschool↗
PubMed1998

Pediatric emergency medicine practice patterns: a comparison of pediatric and general emergency physicians.

OBJECTIVE: To determine whether differences exist between general emergency physicians (GEMs) and pediatric emergency physicians (PEMs) in the emergency care of children with common pediatric emergencies. METHODS: We carried out a survey study of all members of the American Academy of Pediatrics Section of Emergency Medicine and the Washington State American College of Emergency Physicians. We identified current therapeutic interventions for croup, asthma, bronchiolitis, seizures, febrile infant, conscious sedation, head trauma, and coin ingestion, and compared the practice patterns of GEMs and PEMs. RESULTS: A total of 66% of the surveys were returned, including 211 GEMs and 329 PEMs. The majority of PEMs practice in children's hospitals, whereas most GEMs practice in general community hospitals. Slightly over half (51%) of PEMs are PEM fellowship-trained versus 1% of GEMs. CROUP: The majority of GEMs and PEMs use racemic epinephrine (RE) in the treatment of a child with stridor at rest; approximately one-third admit to the hospital after RE (39 vs 30%, NS). PEMs are more likely to observe the child for >2 hours after RE (94% vs 79%, P < 0.01). The majority of PEMs and GEMs use steroids in these patients (94 vs 88%, NS). ASTHMA: There is no significant difference in the use of albuterol, aminophylline, or steroids. 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 physicians routinely use nebulized beta-agonists; however, significantly more GEMs than PEMs use steroids (68 vs 45 %, P < 0.01). SEIZURES: Half of GEMs vs 78% of PEMs use lorazepam as a first line drug in the treatment of seizures (P < 0.01). There is no significant difference with respect to the use of rectal diazepam in the pre-hospital setting. FEBRILE INFANT: GEMs are less likely than PEMs to admit the febrile infant <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 significantly 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 cranial computed tomography (CT). GEMs are more likely to use ketamine for laceration repair (28 vs 16%, P < 0.01). Both GEMs and PEMs use midazolam plus a narcotic for fracture reduction. For further sedation for cranial 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 likely 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 normal two year old who had fallen down the stairs with a six-minute loss of consciousness. COIN INGESTION: Most GEMs and PEMs would obtain radiographs 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 practice environments.

Adult↗
PubMed2002

Does the pediatric advanced life support course improve knowledge of pediatric resuscitation?

OBJECTIVE: To determine whether the pediatric advanced life support (PALS) course contributes to the knowledge required by health care providers for pediatric resuscitation and whether differences in achievement exist between professional groups. METHODS: Physicians, nurses, and paramedics from across Israel who registered for PALS were administered a standardized test both before and on completion of the course. Pretest and posttest results were compared by statistical analysis. A score of 80 or higher was considered a passing grade. RESULTS: Paired pretest and posttest results were available for 370 participants (72.5%): 128 physicians, 158 nurses, and 84 paramedics. The percentage of participants who passed the course was 83.5% for the entire cohort, 85.9% for physicians, 78.5% for nurses, and 89.3% for paramedics. Physicians and paramedics had higher pretest and posttest scores than nurses. There was a significant improvement in mean posttest scores compared with pretest scores for the entire group (86.6 +/- 9.8 vs 78.0 +/- 12.7, P < 0.001) and when results were stratified by profession. A significantly greater proportion of participants passed the posttest than the pretest both for the entire cohort (83.5% vs 61.9%, P < 0.0001) and by profession. CONCLUSIONS: The pediatric advanced life support course significantly increases immediate short-term knowledge of pediatric resuscitation for all professional groups. This finding supports the use of PALS as an educational tool. Further studies are required to determine the effect of PALS on actual performance and outcome of resuscitation.

Allied Health Personnel↗
PubMed2003

The Pediatric Economic Database Evaluation (PEDE) Project: establishing a database to study trends in pediatric economic evaluation.

BACKGROUND: While standard methods for conducting economic evaluations have evolved, little attention has been paid to the conduct of these studies in special populations such as children. OBJECTIVES: To build a database of pediatric economic evaluations and to examine trends in publication characteristics over a 20-year period. RESEARCH DESIGN: The database was created through a multisource search strategy, manual review, application of inclusion/exclusion criteria, data extraction, and reliability assessment. Descriptive statistics were used to summarize trends in publication volume, disease category, intervention type, and age group between 1980 and 1999. RESULTS: From an initial cut of 5600 citations identified from 12 journal databases, 787 were included as full pediatric economic evaluations. Volume of publications increased 7-fold between 1980 to 1984 and 1995 to 1999 from 61 to 440 citations per 5-year period. Most studies were performed in children aged 1 to 12 years, and studies in infants displayed an increasing frequency. The most common disease category was infective/parasitic, comprising 24% of studies. Studies of congenital anomalies and complications of pregnancy were also prominent. Although health prevention studies were the most prevalent, health treatment studies demonstrated an equal frequency in 1995 to 1999. Most studies consisted of malaria control and vaccination strategies for hepatitis B, Haemophilus influenzae type B, measles, and varicella. CONCLUSIONS: The number of pediatric economic evaluations is steadily increasing with most publications representing health prevention interventions. The Pediatric Economic Database Evaluation (PEDE) Project database will be valuable to health researchers working in methods research and conducting systematic reviews.

Age Distribution↗
PubMed2006

The pediatric hospitalist and interventional radiologist: a model for clinical care in pediatric interventional radiology.

Interventional radiology serves an important role in the diagnostic and therapeutic management of the pediatric patient in a tertiary pediatric hospital. On many levels, it is important for the interventional radiologist to be involved in patient care outside the procedure room. However, lack of clinical training, time, and resources may impair this transition. This article describes a unique collaboration between the interventional radiologist and the pediatric hospitalist in a tertiary-care pediatric center, which fosters the clinical role of the interventional radiologist while providing the best care for children undergoing interventional procedures.

Capital Financing↗
PubMed1999

The role of the pediatric nurse practitioner in the comprehensive management of pediatric oncology patients in the inpatient setting.

The role of the pediatric nurse practitioner (PNP) in the comprehensive management of pediatric oncology patients in the inpatient setting was examined at a large tertiary teaching hospital. This article shows role responsibilities including new diagnosis teaching, procedures, routine chemotherapy, patients' comprehensive medical management, coordination of nursing care across settings, phone triage, and professional development. A PNP's typical day is highlighted to illustrate the innovative merging of traditional ambulatory care roles with that of the PNP as a comprehensive manager of pediatric oncology patients in the inpatient setting. This role provides a more seamless care experience and provides critical links in the delivery of health care to pediatric oncology patients.

Drug Therapy↗
PubMed1998

Issues in the application of the resource-based relative value scale system to pediatrics: a subject review. American Academy of Pediatrics. Resource-Based Relative Value Scale Project Advisory Committee.

In today's rapidly changing health care environment, it is crucial to understand the genesis and concepts of the Medicare Resource-based Relative Value Scale (RBRVS) physician fee schedule. Many third-party payers, including state Medicaid programs, Blue Cross-Blue Shield agencies, and managed care organizations are using variations of the Medicare RBRVS to determine physician reimbursement and capitation rates. Because the RBRVS fee schedule was originally created for Medicare only, pediatric-specific Current Procedural Terminology codes and pediatric practice expense issues were not included. The American Academy of Pediatrics agrees with the use of the Current Procedural Terminology codes and the RBRVS physician fee schedule and continues to work to rectify the inequities of the RBRVS system as they pertain to pediatrics.

Child↗
PubMed2003

Analgesia for children with acute abdominal pain: a survey of pediatric emergency physicians and pediatric surgeons.

OBJECTIVE: To evaluate the current opinion and practice of pediatric emergency medicine physicians (PEM) and pediatric surgeons (PS) on the use of opioid analgesia in children with acute abdominal pain during their evaluation in the emergency department. METHODS: All members of the American Academy of Pediatrics in the Section of Emergency Medicine and the American Pediatric Surgeons Association were mailed a copy of the survey. Inclusion criteria were board-eligible or -certified PEM, or PS certified by American Board of Surgery or Royal College of Surgeons currently in practice whose patient population includes children. Information on primary patient population, years in practice, practice setting, willingness to provide analgesia for acute nontraumatic abdominal pain in children, and the factors influencing their decision were requested. Data were analyzed with the Student t test and chi(2) analysis. RESULTS: Of 1441 surveys sent, 54 were returned because of incorrect addresses. Of the 1387 presumed received, 702 completed surveys were returned with a response rate of 51%. However, of those who responded, 574 (82%) respondents met our inclusion criteria, and 385 (67%) were PEM and 189 (33%) were PS. Compared with PEM, more PS had >10 years of work experience and were in private practice. More PEM were willing to provide analgesia before definitive diagnosis. However, the overall willingness to provide analgesia was low in both groups. Among the physicians with <10 years of experience, there was no statistical difference between PEM and PS in willingness to provide analgesia. However, among the physicians with >10 years of experience, 61% of PS were less likely to provide analgesia compared with 38% of the PEM (Delta = 23%; 95% confidence interval 13%, 33%). Of the 74 PEM who made optional general comments, 64 (87%) cited disapproval by the PS as the main barrier in providing analgesia. CONCLUSIONS: The practice of providing analgesia for children with acute abdominal pain is divergent between PEM and PS. More experienced surgeons are less likely to provide analgesia for children with acute abdominal pain. The perceived disapproval of providing analgesia to children with acute abdominal pain by PS is a barrier influencing PEM practice.

Abdominal Pain↗