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The care of children in emergency departments
  1. Kimball Prentiss (kimball.prentiss{at}bmc.org)
  1. Boston Medical Center, United States
    1. Robert Vinci (bob.vinci{at}bmc.org)
    1. Boston University School of Medicine, United States

      Abstract

      Background: More than 30,000,000 children receive care in emergency departments each year, of which approximately 20% receive care by pediatric emergency medicine physicians (PEMPs) defined as board-certified pediatrician with fellowship training in PEM or EM board certified with PEM fellowship training.

      Objective: To determine the clinical impact on children cared for in systems without access to PEMPs.

      Methods: Systematic literature review, including key terms in Medline and Google Scholar, with “balloon” search of references.

      Results: 19 studies were identified, of which 7 focused on trauma, 3 on febrile children, and 5 on other issues (DKA, croup, analgesia, asthma and bronchiolitis). 1 article evaluated the more general impact of pediatric emergency consultants. The articles on trauma indicated that after controlling for injury severity scores, child mortality, splenectomy rates, and hospital costs were significantly lower when children were cared for at a pediatric trauma center compared to adult trauma center with added qualifications in pediatrics compared or general adult trauma centers. The articles on fever found that general emergency medicine physicians ordered significantly more ancillary tests than PEMPs, and PEMPs were more likely to adhere to established fever guidelines. None of these studies considered true healthcare outcomes.

      Conclusion: These data suggest that children suffering from trauma have better health outcomes if they receive care in pediatric trauma centers or adult trauma centers with added qualifications in pediatrics; however, this is more a measure of surgical expertise, and not directly related to access to PEMPs. The information on fever is more limited, since only process measures of care have been evaluated. Although we believe that children should be cared for by PEMPs, there are few data supporting this contention.

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