Belfer R A, Gittelman M A, Muñiz A E
Department of Pediatric Emergency Medicine, Cooper Health Care System, Camden, New Jersey, USA.
Pediatr Emerg Care. 2001 Apr;17(2):83-7. doi: 10.1097/00006565-200104000-00001.
Management of febrile infants and children remains controversial despite the 1993 publication in Pediatrics and Annals of Emergency Medicine of practice guidelines. Our aim was to determine the management of febrile infants and children by pediatric emergency medicine (PEM) fellowship directors and emergency medicine (EM) residency directors and compare their approach with the published practice guidelines.
Four case scenarios were sent to 64 PEM directors and 100 EM directors in the United States and Canada, describing four febrile, nontoxic infants and children aged 25 days (case 1), 7 weeks (case 2), 5 months (case 3), and 22 months (case 4). Respondents were asked to select which laboratory tests and radiographs they would obtain and to decide on treatment and disposition for each hypothetical case.
Ninety-two percent (53/64) of PEM directors and 64% (64/100) of EM directors responded (overall response rate 74%). Compliance with the guidelines (PEM/EM) was 54%/16% for case 1, 31%/6% for case 2, 35%/19% for case 3, and 20%/11% for case 4. Only 11% of PEM and 2% of EM directors followed the guidelines for all four cases. Overall, directors performed fewer laboratory tests, ordered more chest radiographs and treated fewer patients with antibiotics than the expert panel suggested. EM directors ordered more chest radiographs (cases 1-4) and admitted more patients (case 2) than PEM directors.
There is poor compliance with published practice guidelines in the management of febrile infants and children among PEM and EM directors.
尽管1993年《儿科学》和《急诊医学年鉴》发表了实践指南，但发热婴幼儿的管理仍存在争议。我们的目的是确定儿科急诊医学（PEM） fellowship主任和急诊医学（EM）住院医师主任对发热婴幼儿的管理方式，并将他们的方法与已发表的实践指南进行比较。
向美国和加拿大的64名PEM主任和100名EM主任发送了四个病例场景，描述了四名发热、无中毒症状的婴幼儿，年龄分别为25天（病例1）、7周（病例2）、5个月（病例3）和22个月（病例4）。要求受访者选择他们将进行的实验室检查和X光检查，并为每个假设病例决定治疗和处置方案。
92%（53/64）的PEM主任和64%（64/100）的EM主任做出了回应（总体回应率为74%）。对于病例1，遵循指南的情况（PEM/EM）为54%/16%；病例2为31%/6%；病例3为35%/19%；病例4为20%/11%。只有11%的PEM主任和2%的EM主任在所有四个病例中都遵循了指南。总体而言，主任们进行的实验室检查较少，开具的胸部X光检查较多，使用抗生素治疗的患者比专家小组建议的少。EM主任开具的胸部X光检查（病例1-4）比PEM主任多，收治的患者（病例2）也比PEM主任多。
PEM和EM主任在发热婴幼儿管理方面对已发表的实践指南的遵循情况较差。
