OBJECTIVE: Our objective was to assess the occurrence of pediatric emergencies in the offices of family physicians and pediatricians, the preparedness to respond, and the perceived importance of being prepared.
STUDY DESIGN: We performed a cross-sectional random mail survey of physicians.
POPULATION: Surveys were sent to 187 family physicians and 129 pediatricians practicing in North Carolina with 75% and 86% response rates, respectively. The 169 total respondents were in community practices regularly treating children and were included for analysis.
OUTCOMES MEASURED: We measured the incidence of 8 types of pediatric emergencies, the availability of 11 items for resuscitation and stabilization, whether the physician had Pediatric Advanced Life Support (PALS) training in the previous 2 years, whether the office ever conducted a mock emergency, and beliefs about the importance of preparing for and providing emergency care to children.
RESULTS: Six types of pediatric emergencies were seen in one third or more of all practices during the year. The average practice saw 4 or more pediatric emergencies in a year (family physicians = 3.8 vs pediatricians = 4.9, P <.001). Family physicians had fewer resuscitation and stabilization items than pediatricians (5.7 vs 8.6 items, P <.001) and were less prepared in terms of PALS training (19% vs 51%, P <.001). Those with PALS training were more likely to have an intraosseous needle and Broselow tape and to have conducted a mock code. Family physicians considered it is less important than pediatricians to provide such care or to be prepared to do so.
CONCLUSIONS: Pediatric emergencies in the office are likely for either specialty. Family physicians may be less prepared, and they discount the importance of the problem and the need for preparation.
Pediatric emergencies are serious events that occur more commonly than many physicians think.1 Recent studies have described adverse outcomes that can result when children with medical emergencies are directed to physicians’ offices by managed care plans.2-5 However, little is known about the incidence or types of pediatric emergencies encountered or whether physicians are adequately prepared to treat them in their offices.
A few studies have estimated incidence but used different definitions of emergency, and there is considerable variation in the estimates of their occurrence. A study of pediatric practices in Vermont reported only 1 office emergency per practice per year,6 while a study in Connecticut reported that 82% of pediatric practices saw at least 1 child emergency per month.7 A Chicago study reported that 62% of pediatricians and family physicians saw at least 1 child a week who required urgent treatment or hospitalization.8 In a national sample, 68% of office-based pediatricians reported seeing 1 to 5 emergencies per week.9
The literature describing preparedness is limited principally to pediatricians and suggests that their skills in resuscitation and stabilization need improvement.7 ,9-12 Other than the Chicago study8 and one done in northern France,13 there are no studies of the frequency and nature of pediatric emergencies in family physicians’ offices, and little is known about how well prepared the typical family physician is to treat child emergencies. The Chicago study reported that the offices of family physicians were better stocked with resuscitation drugs than those of pediatricians but did not assess the training of physicians or their office staffs to deal with the medical emergencies of chidren.8 The French study is of little help in understanding the problem in the United States.13
In our study, we sought to understand: (1) both the incidence and variety of pediatric emergencies in the practices of family physicians and pediatricians in North Carolina; (2) how prepared physicians of each specialty were to treat such emergencies; (3) whether they believed they should provide emergency service; and (4) how important they felt it was to be prepared for pediatric emergencies.
Methods
We mailed a survey in late 1995 to a random sample of family physicians and pediatricians across North Carolina. The survey asked 25 questions about the prevalence and management of pediatric emergencies occurring in a physician’s office in 1995. The sample was randomly drawn from a database of 3184 family physicians and pediatricians licensed by the North Carolina Medical Board.
Survey Design and Procedures
The survey questions were developed by a group of family practice, pediatric, and emergency physicians. Our pilot study indicated a lower response rate for family physicians (58%) than for pediatricians (83%) and that fewer family physicians were regularly providing pediatric primary care (71% vs 100%). Accordingly, we mailed surveys to 250 family physicians and 150 pediatricians to obtain power sufficient to detect effect sizes with less than 5% error. Table 1 shows the sampling design and response rates for the 2 physician specialty groups.