Whiteman P J, Foltin G L
S. Mark Taper Foundation Pediatric Critical Care Center, Ruth and Harry Roman Emergency Department, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Pediatr Emerg Care. 1998 Oct;14(5):332-3.
To evaluate whether pediatric or emergency medicine residents exhibit a bias when they select patients from triage based on the chief complaint, ie, medical versus surgical in the pediatric emergency department (PED).
A retrospective chart review of a convenience sample of consecutive patients, excluding those seen during times when both pediatric and emergency medicine residents were not simultaneously present.
Urban Municipal PED with 25,000 visits annually.
Pediatric residents, emergency medicine residents, and medical students rotating through the PED and their supervising attending physicians.
None.
Five hundred and ninety-nine charts were included in the study. On the basis of the triage complaint the initial diagnosis was classified as either surgical or medical. Surgical diagnoses were assigned to those patients who required a surgical procedure, involved a surgical subspecialty or were victims of trauma and represented 151 (25.2%) of the patients seen. Medical diagnoses were assigned to the nonsurgical patients and represented 448 (74.8%) of the patients seen. There are roughly three pediatric residents to each emergency resident working in our PED. Of the 367 patients seen by the pediatric residents, 73 (19.9%) had surgical diagnoses, and 294 (80.1%) had medical diagnoses. Of the 158 patients seen by the emergency residents, 59 (37.3%) had surgical diagnoses and 99 (62.7%) had medical diagnoses. chi2 analysis was used to compare categorical variables. The P value was considered significant at <0.05.
Residents, both pediatric and emergency medicine, were instructed to see patients based upon the severity of the patient illness as judged by the triage nurse unless the patients' illnesses were of equal severity, in which case they were to be seen in the order in which they presented. The null hypothesis was that in the absence of physician bias, both pediatric and emergency medicine residents would see the same proportion of surgical and medical patients. The results showed that a bias exists. Emergency medicine residents saw a greater proportion of surgical patients, and pediatric residents saw a greater proportion of general medical patients. A limitation of this study may be the that the supervising attending physician selected residents to see certain patients to expedite PED flow.
Recognizing that bias in the selection of patients seen exists is important in ensuring a balanced education experience.
评估儿科或急诊医学住院医师在根据主诉从分诊患者中选择患者时是否存在偏见，即在儿科急诊科（PED）中区分内科与外科患者。
对连续患者的便利样本进行回顾性病历审查，排除儿科和急诊医学住院医师不同时在场期间就诊的患者。
每年有25000人次就诊的城市市政儿科急诊科。
儿科住院医师、急诊医学住院医师、轮转至儿科急诊科的医学生及其指导主治医师。
无。
本研究纳入了599份病历。根据分诊主诉，初始诊断分为外科或内科。外科诊断适用于那些需要进行外科手术、涉及外科亚专业或为创伤受害者的患者，占就诊患者的151例（25.2%）。内科诊断适用于非外科患者，占就诊患者的448例（74.8%）。在我们的儿科急诊科工作的儿科住院医师与急诊医学住院医师比例约为3:1。在儿科住院医师诊治的367例患者中，73例（19.9%）有外科诊断，294例（80.1%）有内科诊断。在急诊医学住院医师诊治的158例患者中，59例（37.3%）有外科诊断，99例（62.7%）有内科诊断。采用卡方分析比较分类变量。P值<0.05被认为具有统计学意义。
儿科和急诊医学住院医师均被指示根据分诊护士判断的患者病情严重程度来诊治患者，除非患者病情严重程度相同，在这种情况下，应按照患者就诊顺序进行诊治。原假设是在没有医生偏见的情况下，儿科和急诊医学住院医师诊治的外科和内科患者比例相同。结果表明存在偏见。急诊医学住院医师诊治的外科患者比例更高，而儿科住院医师诊治的普通内科患者比例更高。本研究的一个局限性可能是指导主治医师选择住院医师诊治某些患者以加快儿科急诊科的流程。
认识到在选择诊治患者时存在偏见对于确保均衡的教育体验很重要。
