Pediatric emergency medicine : state of the art

To assess the current practice of pediatric emergency care in the United States, a questionnaire was mailed to the directors of all 240 emergency departments (EDs) affiliated with pediatric residency training programs in the United States. One hundred seventy-two programs (72%) returned completed surveys, which comprised 32 questions highlighting staffing patterns, ancillary services, clinical issues, and resident education. The mean annual ED census was 39,290; the mean number of visits for children 0 to 18 years of age was 17,473. Seven percent of pediatric visits were categorized as critical, 23% as urgent, and 70% as nonurgent. Eleven percent of patients were admitted to the hospital. During peak periods, patients whose visits were triaged as nonurgent waited an average of 1.5 hours to be seen by a physician. Twenty-eight percent of programs provided 24-hour on-site coverage by a pediatric attending physician or fellow. Of the remaining programs, the average daily on-site pediatric coverage was 8.6 +/- 6.2 hours. Eighteen percent of programs used physician assistants or nurse practitioners in the ED. During their first, second, and third years of training, pediatric residents spent an average of 5.2, 5.8, and 3.5 weeks in the ED, respectively. The majority of EDs handled all levels of pediatric trauma (84%), had dedicated trauma teams (73%), employed social workers specifically assigned to the ED (62%), and had child abuse teams (72%). Ninety-one percent of EDs had radio communications with prehospital care vehicles and 67% provided medical command for incoming pediatric patients.