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We sought to assess compliance with evidence-based guidelines for the management of pediatric pneumonia, including the variations in tests ordered and antimicrobials prescribed. Our primary hypothesis was that compliance with the treatment recommendations from the most current guidelines would be low for antimicrobial prescriptions.
We conducted a chart review at the Children's Hospital in London, Ont., to assess variation in the management of pediatric pneumonia. All patients aged 3 months to 18 years seen at the pediatric emergency department between Apr. 1, 2006, and Mar. 31, 2007, with a diagnosis of pneumonia were eligible for inclusion in the study.
Compliance with management guidelines was 59.7% (95% confidence interval [CI] 53%–66%, n = 211) in children 5–18 years old and 83.0% (95% CI 80%–86%, n = 605) in children 3 months to 5 years old. Significant variation existed in the choice of antimicrobial agent for children with pneumonia, with nonrecommended agents frequently prescribed.
Significant variation existed in the management of pediatric pneumonia, and adherence to guidelines was low for the group of patients aged 5–18 years. Future studies should attempt to provide guidance to distinguish between viral and bacterial etiology to allow judicious use of antimicrobials.
We sought to determine the frequency with which fellows in accredited Canadian pediatric emergency medicine (PEM) fellowships perform specific procedures, the level of confidence fellows have in their abilities and whether there are differences in self-perceived success between first- and second-year fellows.
A national survey was developed that focused on 24 PEM procedural skills. The survey asked respondents how many times they had performed these procedures within the past 12 months and within the past 3 years. Respondents were then asked to rate their confidence in successfully performing each of the 24 procedures.
Of the 46 surveys sent to PEM fellows, 32 (70%) were returned. Most respondents were in their second year of training and the vast majority had previous training in pediatrics. In order of frequency, the most common procedures performed were closed reduction of fractures, peripheral intravenous insertion, complex laceration repair and endotracheal intubation. Of the surveyed skills, oropharyngeal/nasopharyngeal airway insertion was deemed the most successful (100% success rate for second-year fellows v. 92.5% success rate for first-year fellows, p = 0.01). Similarly, second-year fellows had a higher self-perceived success rate for intraosseous line insertion than did first-year fellows (95.0% v. 80.0% for second- and first-year fellows, respectively, p < 0.001).
In surveying PEM trainees across Canada, we have described the frequency and self-perceived success rate for 24 important procedures. This information may be helpful for program directors in evaluating future directions and opportunities for training of their PEM trainees.
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