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Arch Pediatr Adolesc Med. 1998 Apr;152(4):383-7.

Effects of pediatrician characteristics on management decisions in simulated cases involving apparent life-threatening events.

Author information

1
Department of Pediatrics, Vanderbilt University, Nashville, Tenn, USA.

Abstract

OBJECTIVES:

To study variations in the way pediatricians would evaluate and manage an infant with an apparent life-threatening event.

SUBJECTS AND METHODS:

A survey was mailed to the chief residents of all pediatric residency training programs in the United States in which respondents were presented with a simulated case and asked how they would manage an infant who had experienced an apparent life-threatening event that did not require resuscitation. The survey also explored each physician's tolerance of uncertainty, knowledge of apparent life-threatening events, experience, fear of litigation, responsiveness to parental demands, and propensity to order tests.

MAIN OUTCOME MEASURES:

Presumed decisions to prescribe antibiotics and/or order home apnea monitoring in a simulated case of an infant who had experienced an apparent life-threatening event not requiring resuscitation.

RESULTS:

Logistic regression analysis revealed 2 characteristics that made significant and independent contributions to respondents' presumed decision to prescribe antibiotics: (1) experience with an adverse outcome, and (2) propensity to order diagnostic tests. Presumed decisions to order a home apnea monitor were notably affected by fear of litigation.

CONCLUSIONS:

These findings suggest that differences in pediatricians' characteristics contribute to variations in care. Efforts to make management more uniform must consider that decisions are influenced by a host of different characteristics and experiences.

PMID:
9559716
[Indexed for MEDLINE]

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