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Critical procedure performance in pediatric patients: Results from a national emergency medicine group

  • Jestin N. Carlson
    Affiliations
    US Acute Care Solutions, Canton, OH, United States of America

    Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, United States of America
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  • Mark S. Zocchi
    Affiliations
    Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States of America
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  • Coburn Allen
    Affiliations
    US Acute Care Solutions, Canton, OH, United States of America

    Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America
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  • T. Kent Denmark
    Affiliations
    US Acute Care Solutions, Canton, OH, United States of America

    Department of Emergency Medicine, Oklahoma State University, Tulsa, OK, United States of America
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  • Jay D. Fisher
    Affiliations
    US Acute Care Solutions, Canton, OH, United States of America

    Department of Emergency, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV, United States of America
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  • Matthew Wilkinson
    Affiliations
    US Acute Care Solutions, Canton, OH, United States of America

    Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America
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  • Katherine Remick
    Affiliations
    US Acute Care Solutions, Canton, OH, United States of America

    Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America

    Department of Surgery and Perioperative Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America

    Emergency Medical Services for Children Innovation and Improvement Center, Baylor College of Medicine, Houston, TX, United States of America
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  • Abbie Sullivan
    Affiliations
    US Acute Care Solutions, Canton, OH, United States of America
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  • Jesse M. Pines
    Affiliations
    US Acute Care Solutions, Canton, OH, United States of America

    Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, United States of America
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  • Arvind Venkat
    Correspondence
    Corresponding author at: US Acute Care Solutions, United States of America.Corresponding author at: Department of Emergency Medicine, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15212, United States of America.
    Affiliations
    US Acute Care Solutions, Canton, OH, United States of America

    Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, United States of America
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  • On behalf of theUS Acute Care Solutions Research Group

      Abstract

      Study objective

      We sought to examine the frequency of pediatric critical procedures performed in a national group of emergency physicians.

      Methods

      We performed a retrospective analysis of an administrative billing and coding dataset for procedural performance documentation verification from 2014 to 2018. We describe and compare incident rates of pediatric (age <18 years) patient critical procedure performance by emergency physicians in general emergency departments (EDs), pediatric EDs, and freestanding ED/urgent care centers. Critical procedures were endotracheal intubation, electrical cardioversion, central venous placement, intraosseous access, and chest tube insertion.

      Results

      Among 2290 emergency physicians working in 186 EDs (1844 working in 129 general EDs, 125 in 8 pediatric EDs, and 321 in 49 freestanding EDs/urgent cares), a total of 2233 pediatric critical procedures were performed during the study period. Many physicians at general EDs and freestanding EDs/urgent cares performed zero pediatric procedures per year (53.9% and 89% respectively). Per 1000 ED visits seen (All patient ages), physicians working in general EDs performed fewer pediatric critical procedures than physicians in pediatric EDs (0.12/1000 visits vs 0.68/1000 visits; rate difference = 0.56, 95% confidence interval [CI] 0.51–0.61). Per 1000 clinical hours worked, physicians working in general EDs performed 0.26 procedures compared to 1.66 for physicians in pediatric EDs (rate difference = 1.39; 95% CI 1.27–1.52).

      Conclusion

      Pediatric critical procedures are rarely performed by emergency physicians and are exceedingly rare in general EDs and freestanding EDs/urgent cares. The rarity of performance of these skills has implications for ED pediatric readiness.

      Keywords

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