Measures
The key variables are the occurrence of emergencies encountered by the practice, preparedness for emergencies through the availability of resuscitation and stabilization items, training for emergencies, and the perceived importance of providing and preparing for emergency care.
Emergency Occurrence and Preparedness
The variety of emergency occurrences was measured using 8 questions that asked whether specific pediatric emergencies were presented to the physician in the office setting during the last 12 months Table 2. Preparedness for pediatric emergencies was measured with 11 questions that asked whether specific stabilization and resuscitation items were immediately available to the physician in the office Table 3. The items were selected by experts and are regularly included in Pediatric Advanced Life Support (PALS) training. The responses allowed for this series of questions were “yes,” “no,” and “don’t know.” Answers other than “yes” were taken to mean that the item was not immediately available.
Occurrence of and preparedness for pediatric emergencies were analyzed as individual variables and as composite indexes. The composite index for the variety of emergency occurrences was created by assigning 1 point for each “yes” answer to whether a specific type of emergency occurred. This index, which we call the Emergency Occurrence Score (EOS), was an unweighted number with values ranging from 0 to 8, where a score of 8 was the greatest variety of occurrence (ie, all the types of emergencies occurred during the year). Similarly, an Emergency Preparedness Score (EPS) was created by assigning 1 point to each affirmative answer regarding the availability of specific stabilization and resuscitation items, with a range for the score of 0 to 11 (11 = optimal availability of resuscitation equipment).
Training for Emergencies
We asked 2 questions that assessed the training of physicians and office staff to deal with the emergencies of children. Specifically, we asked, “Have you taken a PALS or APLS (Advanced Pediatric Life Support) certification or instructor course in the last 2 years?” and “Has your office ever conducted a ‘mock’ or practice pediatric emergency?”
Perceived Importance of Preparedness
We measured respondents’ opinions on the importance of being prepared for a pediatric emergency and providing emergency services in the office. The specific questions were: “How important is it to you that your office or practice setting be prepared to stabilize a true pediatric emergency?” and “How important is it to you that your practice provides emergency care to critically ill children in your office?” We coded the ordinal responses for both questions on a scale from 1 through 4 (4 = very important).
Analysis
Our analysis contrasted family physicians and pediatricians. Statistical significance for all contrasts was set, a priori, at P less than .05. Cross-tabular analyses with chi-squares were used to compare percentage responses by specialty on the individual variables measuring occurrence and preparedness, mock emergencies, and PALS training. We also used a chi-square to examine the relationship between preparedness and PALS training. Independent-sample t tests were used to compare means by specialty on the 2 composite indices (EOS and EPS). Independent-sample t tests were also used to compare mean values for the questions on the believed importance of providing care to critically ill children and being prepared to stabilize them.
Two post-hoc hypotheses were suggested. One was whether family physicians and pediatricians differed on their knowledge of the availability of resuscitation items (ie, the number of “don’t know” responses). Another was whether physicians who reported seeing patients with respiratory emergencies had oxygen and a mask with which to administer it. Respiratory emergencies were defined as respiratory or cardiac arrest, foreign body in airway, asthma flare, and moderate to severe croup.
Results
Occurrence of Pediatric Emergencies
Table 2 presents the reported occurrence of pediatric emergencies in the office during the course of a year. Pediatric emergencies involving respiratory problems or cardiac arrest were seen in 4% of all practices, 2% in those of family physicians, and 7% in those of pediatricians. This difference was not statistically significant. Similar percentages (approximately 11%) of family physicians and pediatricians saw at least 1 child with a foreign body in the airway.
Each of the other 6 conditions were seen in a third or more of all family physician practices in the course of a year and in three fifths or more of pediatric practices. Asthma flares were the most commonly seen condition, occurring in 93% of both family practice and pediatric offices. More than 90% of both family physicians and pediatricians encountered at least 1 respiratory emergency. Approximately two thirds of the physicians in both specialties (64% of family physicians and 71% of pediatricians) commonly encountered allergic reactions.