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Gerald B. Hickson, MD; William O. Cooper, MD, MPH; Preston W. Campbell, MD; William A. Altemeier III, MD

Arch Pediatr Adolesc Med. 1998;152:383-387.

Objectives  To study variations in the way pediatricians would evaluate and manage an infant with an apparent life-threatening event.

Subjects and Methods  A survey was mailed to the chief residents of all pediatric residency training programs in the United States in which respondents were presented with a simulated case and asked how they would manage an infant who had experienced an apparent life-threatening event that did not require resuscitation. The survey also explored each physician's tolerance of uncertainty, knowledge of apparent life-threatening events, experience, fear of litigation, responsiveness to parental demands, and propensity to order tests.

Main Outcome Measures  Presumed decisions to prescribe antibiotics and/or order home apnea monitoring in a simulated case of an infant who had experienced an apparent life-threatening event not requiring resuscitation.

Results  Logistic regression analysis revealed 2 characteristics that made significant and independent contributions to respondents' presumed decision to prescribe antibiotics: (1) experience with an adverse outcome, and (2) propensity to order diagnostic tests. Presumed decisions to order a home apnea monitor were notably affected by fear of litigation.

Conclusions  These findings suggest that differences in pediatricians' characteristics contribute to variations in care. Efforts to make management more uniform must consider that decisions are influenced by a host of different characteristics and experiences.

From the Department of Pediatrics, Vanderbilt University, Nashville, Tenn (Drs Hickson, Cooper, and Campbell); and the Office of the Associate Dean for Medical Education, School of Medicine, University of Missouri at Columbia (Dr Altemeier).

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