Isaacman D J, Verdile V P, Kohen F P, Verdile L A
Department of Pediatrics, University of Pittsburgh School of Medicine, PA.
Pediatrics. 1992 Jan;89(1):35-9.
To assess the appropriateness of pediatric telephone advice given by emergency departments (EDs), a mock scenario simulating a 5-week-old with fever of 102 degrees F and signs compatible with meningitis was used to evaluate the responses of 61 randomly selected EDs, of which half were affiliated with pediatric residency training programs. All EDs were given the identical chief complaint: "My baby has been having a fever all day, and I can't seem to get it down." Calls were made by research technicians and monitored by one or more of the investigators by speakerphone. Fifty-three (87%) programs gave advice by telephone; in 42 (79%) of the 53 respondents the individual giving advice was a nurse. Fourteen programs (26%) gave advice without asking either the age of the child or height of the fever. Few of the respondents took historical information assessing irritability (4 programs), fluid intake (11 programs), urine output (8 programs), or breathing pattern (6 programs). Thirty-eight (71.7%) EDs advised the patient to see a physician, while only 32 (60.4%) suggested same-day evaluation. In several instances the caller was not advised to seek medical attention despite having given a history documenting the infant's fever, irritability, and lethargy. These findings show variability and inadequacies in pediatric telephone advice currently offered by the EDs that were studied.
为评估急诊科提供的儿科电话咨询的适宜性，采用了一个模拟场景，模拟一名5周大、体温102华氏度且有与脑膜炎相符体征的患儿，以此来评估61个随机选取的急诊科的反应，其中一半急诊科隶属于儿科住院医师培训项目。所有急诊科接到的主诉均相同：“我的宝宝一整天都在发烧，我似乎没办法让体温降下来。”电话由研究技术人员拨打，并由一名或多名调查人员通过免提电话监听。53个（87%）项目通过电话提供了建议；在这53个回复的项目中，有42个（79%）提供建议的是护士。14个项目（26%）在未询问孩子年龄或发烧程度的情况下就给出了建议。很少有回复者询问评估烦躁不安（4个项目）、液体摄入量（11个项目）、尿量（8个项目）或呼吸模式（6个项目）的病史信息。38个（71.7%）急诊科建议患者去看医生，而只有32个（60.4%）建议当天进行评估。在一些情况下，尽管来电者提供了记录婴儿发烧、烦躁不安和嗜睡情况的病史，但仍未被建议寻求医疗帮助。这些研究结果表明，目前所研究的急诊科提供的儿科电话咨询存在差异和不足。
