To kick off his review of published pediatric papers at ACEP19, Richard Cantor, MD, FAAP, FACEP, acknowledged that some parents think pediatric emergency physicians are “stupid.”
“How do you beat this moniker, this label?” asked Dr. Cantor, professor of emergency medicine and pediatrics, director of the pediatric emergency department, and medical director of the Central New York Regional Poison Control Center at Upstate Medical University in Syracuse, New York. “Beat it by knowledge, by being the smartest person in the room. More importantly, taking your knowledge and applying it to the patient.”
Dr. Cantor’s well-attended annual session, “Cruising the Literature: Pediatric Emergency Medicine 2019,” aimed to arm its audience with the latest knowledge on a cross-section of pediatric pedagogy. He weaved between infectious issues, closed-head injuries and respiratory problems.
Some of the literature was aimed at showing emergency physicians where procedure and practice diverge. Take “Pediatric Anaphylaxis in the Emergency Department” (Pediatr Emer Care 2019;35:28-31), which reported that after reviewing 250 charts, 84 percent met the National Institute of Allergy and Infections Diseases (NIAID) clinical criteria for diagnosing anaphylaxis. Yet the study found only 68 percent of patients received epinephrine in the emergency department, or within three hours of a visit, Dr. Cantor said.
“There’s a gap between what is best practice and what we’re doing,” he added.
Other studies were presented to help assuage emergency physicians that their practices are right, even if they’ve not done clinical research. That included “Effect of an Asthma Guideline in 2 Pediatric Emergency Departments and an Urgent Care Center” (Pediatr Emer Care 2018;34:729-735).
One of the report’s conclusions was that the implementation of a clinical practice guideline (CPG) increased ordering of albuterol via metered-dose inhaler with spacer (MDI-spacer). But Dr. Cantor’s takeaway was more folksy: Albuterol. Early and often.
“Albuterol can never be used enough,” he said. “If it was up to me in Syracuse, it would be in everyone’s heating system in their home.”
Beth Cadigan, MD, FACEP, an emergency physician at Albany Medical Center in Albany, NY, said the annual session is always a valuable compendium of a year’s worth of research she doesn’t always have the time to go through, particularly as she’s not a pediatric specialist.
“It gives you a summation of the year to make sure you hear everything,” she said. “To make sure I didn’t miss something in my reading that should adjust my own practice.”
For Keith Jensen, MD, FAAP, a Houston-based regional medical director of pediatric emergency medicine, the annual literature review serves as both a chance to hear new clinical pearls – and affirm his current practices remain best practices.
“There’s some confirmation, and that’s always nice, because you know that you’re doing the right things,” Dr. Jensen said. “But there are also some little things you can pick up … sometimes it’s even nice just to know what the conversations are that are being had, so that you can keep an eye out for literature on those topics.”
Richard Quinn is a freelance writer in New Jersey.