• Jestin N Carlson, Mark S Zocchi, Coburn Allen, T Kent Denmark, Jay D Fisher, Matthew Wilkinson, Katherine Remick, Abbie Sullivan, Jesse M Pines, Arvind Venkat, and US Acute Care Solutions Research Group.
• US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, United States of America.
• Am J Emerg Med. 2020 Sep 1; 38 (9): 1703-1709.

Study ObjectiveWe sought to examine the frequency of pediatric critical procedures performed in a national group of emergency physicians.MethodsWe 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.ResultsAmong 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).ConclusionPediatric 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.Copyright © 2020 Elsevier Inc. All rights reserved.

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