From the Sections of Emergency Medicine.
Tropical Medicine.
Pediatr Emerg Care. 2020 Nov;36(11):e622-e625. doi: 10.1097/PEC.0000000000001426.
The aim of this study was to perform a needs assessment of pediatric (PEM) and general emergency medicine (EM) provider knowledge, comfort, and current practice patterns in the evaluation of pediatric tropical infectious diseases.
An online survey was developed based on educational priorities identified by an expert panel via modified Delphi methodology. The survey included assessment of providers' typical evaluation, diagnosis, and treatment of tropical diseases and was distributed to PEM and EM providers in 2 large professional organizations.
A total of 333 physicians (285 PEM, 32 EM, 8 combined PEM/EM, and 8 general pediatricians in emergency department) participated. Fifty-five percent of vignettes were answered correctly. Those who trained outside the United States or Canada (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-3.0) and PEM-trained providers (OR, 2.6; 95% CI, 1.2-5.9) were more likely to answer questions correctly. Providers answered more questions correctly about dengue (76%) and tuberculosis (77%) than typhoid (53%) and malaria (39%) (OR, 3.8; 95% CI, 3.0-4.9). Diagnostic evaluation for tropical diseases was variable with greater than 75% agreement for only 2 tests: blood smears in febrile patients from Africa (86%) and bacterial stool cultures in patients with bloody stools from Africa, Asia, or Latin America (94%). Providers had low (62%) or medium (35%) comfort level with pediatric tropical diseases, and 93% were interested in accessing emergency department-specific resources.
Pediatric EM and EM providers' knowledge and evaluation for pediatric tropical diseases are variable. Providers recognized their knowledge gaps and expressed interest in gaining access to resources and guidelines to standardize and improve evaluation and treatment of these diseases.
本研究旨在评估儿科（PEM）和普通急诊医学（EM）提供者在评估儿科热带传染病方面的知识、舒适度和当前实践模式。
根据专家小组通过改良德尔菲法确定的教育重点，开发了在线调查。该调查包括评估提供者对热带疾病的典型评估、诊断和治疗，分发给 2 个大型专业组织的 PEM 和 EM 提供者。
共有 333 名医生（285 名 PEM、32 名 EM、8 名 PEM/EM 联合、8 名儿科急诊医生）参与。55%的病例答对了。那些在美国或加拿大以外接受培训的人（优势比[OR]，1.8；95%置信区间[CI]，1.1-3.0）和 PEM 培训的提供者（OR，2.6；95% CI，1.2-5.9）更有可能答对问题。提供者对登革热（76%）和肺结核（77%）的回答比伤寒（53%）和疟疾（39%）更正确（OR，3.8；95% CI，3.0-4.9）。热带病的诊断评估差异较大，只有 2 项检查的一致性超过 75%：来自非洲的发热患者的血液涂片（86%）和来自非洲、亚洲或拉丁美洲的血性腹泻患者的粪便细菌培养（94%）。提供者对儿科热带病的舒适度较低（62%）或中等（35%），93%的人有兴趣获取特定于急诊部门的资源。
儿科 EM 和 EM 提供者对儿科热带病的知识和评估存在差异。提供者认识到自己的知识差距，并表示有兴趣获得资源和指南，以规范和改进对这些疾病的评估和治疗。
