The use of evidence-based medicine in the management of acutely ill children

Objectives: To determine the extent to which emergency medicine physicians are exposed to and implement evidence-based medicine (EBM). Methods: A 2-part, self-administered questionnaire was sent to 375 randomly selected emergency physicians (125 PEM Fellows, 125 AAP Section of Emergency Medicine, 125 American College of Emergency Physicians). The first part focused on the physician's experience with EBM and the second part included 2 clinical scenarios to determine their decision-making process. Respondents were considered either junior physicians (practicing <5 years since residency training) or senior physicians (practicing for ≥5 years). Results: Of the 375 questionnaires sent, 22 were not eligible for analysis. Two-hundred ten of the remaining 353 (59%) questionnaires were returned. Ninety-five percent of all respondents have been exposed to EBM. There was no significant difference between junior and senior physicians in their familiarity and application of secondary EBM summaries. Although more junior physicians believe that greater than half of their clinical practice is evidenced based compared with senior physicians [49% (95% CI 41-58%) vs. 27% (95% CI 19-38%)], in responding to the clinical scenarios, there was no difference in the use of an EBM resource between junior and senior physicians in the use of intravenous magnesium sulfate for status asthmaticus [50% (95% CI 41-59%) vs. 48% (95% CI 37-59%)] or in the workup of fever in a 10-month-old [62% (95% CI 53-70%) vs. 54% (95% CI 44-64%)]. Ninety-three percent of respondents felt "time constraints in a busy ED" was the most prominent obstacle to the use of EBM. Conclusions: Although a majority of emergency medicine physicians report having been exposed to EBM, respondents tended not to use EBM in the management of acutely ill children, regardless of years of experience.