Song Ho-Young, Kwon Jae-Hyun, Park Soo Hyun, Kim Min-Jung, Byun Young-Hoon, Paek So-Hyun
Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea.
J Clin Med. 2024 Oct 12;13(20):6095. doi: 10.3390/jcm13206095.
: With the advent of the field of pediatric emergency medicine, studies on the differences in treatment patterns between pediatricians and emergency medicine (EM) physicians in various pediatric conditions have been accumulating. This study aimed to compare croup (acute laryngotracheobronchitis) management patterns between pediatricians and EM physicians to enhance pediatric emergency care and inform the training of future specialists. : A retrospective review of medical records was conducted for 1676 previously healthy children diagnosed with croup who visited a single pediatric emergency department (PED) of a tertiary university-affiliated hospital in South Korea, from March 2019 to February 2023. Patient characteristics, management patterns, and the impact of physician specialty on emergency care were analyzed. : EM physicians used injected dexamethasone monotherapy in 30.54% of the cases, more frequently than the 3.57% among pediatricians. In contrast, pediatricians used a combination of nebulized epinephrine and dexamethasone in 88.29% of the cases, compared with 67.71% for EM physicians. The appropriate use of nebulized epinephrine based on the Westley Croup Score was significantly higher in the EM physician group (77.64% vs. 57.89%, < 0.001). Pediatricians also prescribed oral antibiotics and corticosteroids more frequently (25.13% vs. 3.13% and 81.54% vs. 22.69%, respectively; < 0.001 for both). Despite these differences, there were no significant disparities in PED length of stay or 48 h revisit rates. : EM physicians adhered more closely to currently accepted management algorithms for croup management. These findings underscore the need for standardized, evidence-based pediatric emergency care and provide valuable insights for training programs in this field.
随着儿科急诊医学领域的出现，关于儿科医生和急诊医学（EM）医生在各种儿科疾病治疗模式差异的研究不断积累。本研究旨在比较儿科医生和EM医生对喉炎（急性喉气管支气管炎）的管理模式，以加强儿科急诊护理，并为未来专科医生的培训提供参考。
对2019年3月至2023年2月期间在韩国一所三级大学附属医院的单一儿科急诊科（PED）就诊的1676名先前健康且被诊断为喉炎的儿童的病历进行了回顾性研究。分析了患者特征、管理模式以及医生专业对急诊护理的影响。
EM医生在30.54%的病例中使用注射用单剂量地塞米松，比儿科医生的3.57%更为频繁。相比之下，儿科医生在88.29%的病例中使用雾化肾上腺素和地塞米松联合治疗，而EM医生为67.71%。基于韦氏喉炎评分适当使用雾化肾上腺素在EM医生组中显著更高（77.64%对57.89%，<0.001）。儿科医生还更频繁地开具口服抗生素和皮质类固醇（分别为25.13%对3.13%和81.54%对22.69%；两者均<0.001）。尽管存在这些差异，但在PED住院时间或48小时复诊率方面没有显著差异。
EM医生在喉炎管理方面更严格地遵循当前公认的管理算法。这些发现强调了标准化、循证儿科急诊护理的必要性，并为该领域的培训计划提供了有价值的见解。
