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Exposure and confidence with critical non-airway procedures: A global survey of paediatric emergency medicine physicians

Craig, Simon; Auerbach, Marc; Cheek, John A; Babl, Franz E.; Oakley, Ed; Nguyen, Lucia; Rao, Arjun; Dalton, Sarah; Lyttle, Mark; Mintegi, Santiago; Nagler, Joshua; Mistry, Rakesh D.; Dixon, Andrew; Rino, Pedro; Kohn Loncarica, Guillermo; Dalziel, Stuart R.

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Simon Craig

Marc Auerbach

John A Cheek

Franz E. Babl

Ed Oakley

Lucia Nguyen

Arjun Rao

Sarah Dalton

Santiago Mintegi

Joshua Nagler

Rakesh D. Mistry

Andrew Dixon

Pedro Rino

Guillermo Kohn Loncarica

Stuart R. Dalziel


Children rarely experience critical illness, resulting in low exposure of emergency physicians (EPs) to critical procedures. Our primary objective was to describe senior EP confidence, most recent performance and/or supervision of critical non-airway procedures. Secondary objectives were to compare responses between those who work exclusively in PEM and those who do not, and to determine whether confidence changed for selected procedures according to increasing patient age.

Survey of senior EPs working in 96 emergency departments (EDs) affiliated with the Pediatric Emergency Research Networks (PERN). Questions assessed training, performance, supervision, and confidence in 11 non-airway critical procedures, including CPR, vascular access, chest decompression and cardiac procedures.

Of 2,446 physicians, 1,503 (61%) responded to the survey. Within the previous year, only CPR and insertion of an intraosseous needle (IO) had been performed by at least 50% of respondents: over 20% had performed defibrillation / DC cardioversion. More than 50% of respondents had never performed or supervised ED thoracotomy, pericardiocentesis, venous cutdown or transcutaneous pacing. Self-reported confidence was high for all patient age groups for CPR, needle thoracocentesis, tube thoracostomy, IO insertion and defibrillation / DC-cardioversion. Confidence levels increased with increasing patient age for central venous and arterial line insertion. Respondents working exclusively in PEM were more likely to report being at least somewhat confident in defibrillation / DC cardioversion, IO insertion, and central venous line insertion in particular age groups; however, they were less likely to be at least somewhat confident in ED thoracotomy and transcutaneous pacing.

Conclusions: CPR and IO insertion were the only critical non-airway procedures performed by at least half of EPs within the previous year. Confidence was higher for these procedures, and needle and tube thoracostomy. These data may inform the development of continuing medical education activities to maintain pediatric procedural skills for emergency physicians.


Craig, S., Auerbach, M., Cheek, J. A., Babl, F. E., Oakley, E., Nguyen, L., …Dalziel, S. R. (2021). Exposure and confidence with critical non-airway procedures: A global survey of paediatric emergency medicine physicians. Pediatric Emergency Care, 37(9), e551-e559.

Journal Article Type Article
Acceptance Date Dec 29, 2018
Online Publication Date May 19, 2020
Publication Date Sep 1, 2021
Deposit Date Mar 28, 2019
Publicly Available Date May 20, 2021
Journal Pediatric Emergency Care
Print ISSN 0749-5161
Electronic ISSN 1535-1815
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 37
Issue 9
Pages e551-e559
Keywords paediatric, critical procedures, non-airway, intraosseus, confidence
Public URL
Publisher URL


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