The revised guidelines reflect practices that have been in place for several
years at many children's hospitals across the country. So I'm not sure what
control group you are planning to use. Many of the changes were well known
at the time the 2006 guideline was created. The revision just removes weasel
words that permitted outmoded practices to persist.
Every scientist knows about the risks of biased observations. Can you raise
the bar from personal anecdote to Evidence based medicine?
A practice guideline is not THE ONLY standard of care. But it can and should
be a starting point for reducing unnecessary variation between ER physicians
in a given locality. Similarly, I suggest you discuss the ER practices with
the pediatric hospitalists that provide inpatient care in your facility.
Families get upset when they hear one thing in the ER and then repeatedly
hear a different explanation over the next 2 days inpatient.
A practice guideline can serve as a reference point. There will be reasons
to deviate from it, but those events and rationales should be well
documented. Be aware that parents these days are very tech savvy and they
will find this guideline. I had a recent experience with a parent of a child
who had HSP. There was only a 45 minute gap between hearing the diagnosis in
the ER and my seeing the child with my residents. At that point, the father
knew more about HSP than my senior resident. I was glad I had treated two
cases in the previous 3 months (after going over 2 years without any) so I
didn't feel foolish myself.
Kevin Powell MD PhD FAAP
Saint Louis, MO
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