Reasons for nonurgent pediatric emergency department visits: perceptions of health care providers and caregivers.

OBJECTIVES: This study aimed to determine the most important reasons for pediatric nonurgent (NU) emergency department (ED) visits as perceived by caregivers, primary care pediatricians (PCPs), and ED personnel and to assess the differences among these 3 groups in perceived reasons and solutions to NUED visits. METHODS: This study is a cross-sectional survey, with self-administered questionnaires given to caregivers, PCPs, and ED personnel. Responders were asked to rank reasons for NUED visits in order of perceived importance. Opinions on NUED use reduction strategies were also queried. RESULTS: Although almost 80% of PCPs expected to be called by caregivers before ED visits, fewer than 30% of caregivers were aware of this expectation. The most important reasons for NUED visits from the caregivers' perspective were need for medical attention outside PCP working hours, lack of health insurance, and better hospitality in the ED. For PCPs and ED personnel, the most important reason was the caregivers' lack of knowledge on what constitutes a true emergency. More than 70% of ED personnel and PCPs recommended caregiver education as the solution to NUED visits. Caregivers were more likely to recommend more PCPs with longer working hours (41%) and more EDs (31%). CONCLUSIONS: Misconceptions exist among caregivers, PCPs, and ED personnel on NUED visits. Our findings underscore the need to foster understanding and provide concrete areas for intervention.

Rapid viral testing in the evaluation of the febrile infant and child.

PURPOSE OF REVIEW: This review focuses on rapid viral testing in the febrile infant and child. Recent literature is reviewed regarding physician decision making, antibiotic use, ancillary testing use, and rate of serious bacterial infections concurrent with viral disease. RECENT FINDINGS: Two recent studies detail the use of rapid testing of influenza. The impact on the use of ancillary testing and antibiotic prescribing practices based on the knowledge provided by rapid viral testing has been evaluated. Physician awareness of a rapid diagnosis of influenza significantly reduced the number of laboratory tests and radiographs ordered and their associated charges, decreased antibiotic use, increased antiviral use, and decreased length of time to discharge. The rate of serious bacterial infections coexisting with influenza illness has also been studied. Researchers concluded that the prevalence of serious bacterial infections is lower in febrile children with influenza A infection. Another two studies evaluated respiratory syncytial virus-positive febrile infants and their risk of serious bacterial infection. Both studies independently noted that febrile infants with respiratory syncytial virus infections are at significantly lower risk of serious bacterial infection than febrile infants without respiratory syncytial virus infection. The rate of urinary tract infections remained significant in febrile respiratory syncytial virus-positive infants, however. SUMMARY: Various studies have documented the impact of rapid viral testing in the evaluation and management of febrile infants and children. There is insufficient evidence to change current clinical practice algorithms for young febrile infants and children. Continued research will affect future guidelines and algorithms in the management of febrile infants and children.