Comparing nurse practitioners/physician assistants and physicians in diagnosing pediatric abdominal pain for ESI level 3 patients seen in the emergency department
| Autor: | Elda G Ramirez, Kathleen Sanders Jordan, Stephen Nichols, Robert Topp, Donna Agan, Karen Sue Hoyt |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Abdominal pain Chest pain Epigastric pain law.invention law Physicians Back pain medicine Humans Nurse Practitioners Child General Nursing Retrospective Studies business.industry Pelvic pain General Medicine Emergency department Intensive care unit Emergency Severity Index Abdominal Pain Physician Assistants Emergency medicine medicine.symptom business Emergency Service Hospital |
| Zdroj: | Journal of the American Association of Nurse Practitioners. 34(2) |
| ISSN: | 2327-6924 |
| Popis: | BACKGROUND Accuracy of emergency department (ED) diagnosis affects care management including tests, discharges, and readmissions. PURPOSE This retrospective study compared nurse practitioners/physician assistants (NPs/PAs) with physicians (MDs/DOs) on accuracy of diagnosing Emergency Severity Index (ESI) level 3 pediatric abdominal pain (AP) in the ED. Abdominal pain unrelated to trauma is a common ED pediatric visit. METHODOLOGY Data acquired from four hospital sites of a multistate emergency group examined patients younger than 18 years who were initially admitted for AP ESI level 3. RESULTS The accuracy of AP ESI level 3 diagnoses was 94.9%, 90.9%, and 96.5% by physicians, NPs/PAs, and a collaboration of NP/PA/physician, respectively (χ2 = 13.187, p < .001). Accuracy of AP ESI level 3 diagnoses was greater with general admissions, intensive care unit admissions, transfers, or left against medical advice (100%) than with those who were discharged (χ2 = 11.058, p = .001). Abdominal pain complaints were segmented into five areas (i.e., AP, back pain, chest pain, epigastric pain, and pelvic pain). Irrespective of provider, those with a final diagnosis of AP or epigastric pain were correctly triaged and those with a final diagnosis of chest or back pain were incorrectly triaged as AP ESI level 3. CONCLUSIONS When comparing providers in this subset (n = 43), there was no significant difference in the accuracy of assigning AP ESI level 3 (χ2 = 0.467, p = .495). IMPLICATIONS Only cases with a final diagnosis of pelvic/genitourinary pain saw disparity in the accuracy (27 correct, 16 incorrect, χ2 = 1,681.80, p < .001). |
| Databáze: | OpenAIRE |
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