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The author of this letter commends Michael Burke, MD, for his commentary on the article "Pediatric ED physicians can predict likelihood of intussusception," published in the May 2012 Journal Club in Contemporary Pediatrics.
Although it is reassuring to know that emergency department (ED) physicians can discriminate "something that is not right" from a more serious diagnosis based on history and physical examination alone with decent accuracy, the results of this study should not be generalized to all pediatric physicians or ED practitioners.
The original study was conducted at an urban tertiary care pediatric ED facility. The participating physicians were either trained or certified in pediatrics or pediatric emergency medicine. The likelihood that physicians at such centers are trained in either pediatrics, emergency medicine, or both is much higher than at local suburban or rural EDs or even at urban walk-in centers.
There are many local EDs in suburban or rural communities that are staffed by physicians with little or no training in either pediatrics or emergency medicine.
Working at an urban tertiary care teaching hospital that sees many patients referred from local community hospitals or EDs, our institution sees many children and infants referred because the referring physician was concerned about an intussusception even in the absence of any clinical pointers.
Although the clinical triad is not a perfect predictor of intussusception, the level and nature of training and work experience of the referring physician does greatly influence his or her medical decision making and its repercussions for the patients and their families.
It is both appalling and heartening to see the financial resources, time, and energy that parents often spend going from smaller EDs to a larger center to determine "what is wrong with their child."
During the process, the child often undergoes unnecessary radiologic imaging and diagnostic laboratory tests. Parents are left frazzled and confused at the end of this ordeal. By the time they reach a tertiary care facility that is equipped to accurately diagnose and treat their child, they have often received extremely conflicting communication and, sadly, may have begun to lose trust in medical professionals.
Therefore, the results of the original study, however encouraging they may be, must unfortunately be taken with a grain of salt.
JYOTI ASSUDANI, MDSpringfield, Illinois
DR ASSUDANI is a pediatric resident at Southen Illinois University School of Medicine, Springfield, Illinois.