Practice parameters between emergency physicians and pediatricians: The case of upper respiratory infection

Abstract

Study objectives: Studies assessing practice differences between pediatricians and emergency physicians are limited. This study examines the diagnosis and management of children presenting to an emergency department with an upper respiratory infection (URI) and compares practice between emergency physicians and pediatricians/emergency medicine pediatricians (PEM). Methods: An Internet-based voluntary survey was sent to practitioners listed in Society for Academic Emergency Medicine and American Academy of Pediatrics directories. Questions focused on treatment and management choices for children (<15 years) with URI. Data analysis was performed using descriptive statistics and χ² analysis. Results: Results were analyzed for 714 responses completed by emergency physicians (75.5%) and PEMs (24.5%). Emergency physicians are more likely to limit URI to an age group (emergency physicians 49.9%, PEMs 29.1%); document pulse oximetry (emergency physicians 87.2%, PEMs 68.6%); and order a chest radiograph (emergency physicians 36.9%, PEMs 8.0%). PEMs are more likely to use the overall clinical examination in deciding on the use of pulse oximetry (emergency physicians 8.3%, PEMs 23.4%) and order chest radiograph in winter (emergency physicians 24.7%, PEMs 39.4%) and are less likely to treat with decongestants (emergency physicians 90.2%, PEMs 77.1%) or antibiotics (emergency physicians 23.9%, PEMs 4.6%). Both groups use communication to explain the lack of need for the use of antibiotics (emergency physicians 92.6%, PEMs 98.3%) to parents (<i>P</i>=.131). Physicians with board certification or preparation were less likely to use nonspecific URI as a diagnosis in children older than 8 years. Conclusion: Practice differences exist between emergency physicians and PEM practitioners in the management of URI. Emergency physicians are more likely to order chest radiographs and treat with antibiotics.