Comparison of Aerodigestive and Nonaerodigestive Provider Responses to Clinical Case Vignettes. J Pediatr 2021 May;232:166-175.e2
Date
01/03/2021Pubmed ID
33387591DOI
10.1016/j.jpeds.2020.12.067Scopus ID
2-s2.0-85100607304 (requires institutional sign-in at Scopus site) 1 CitationAbstract
OBJECTIVE: To evaluate differences in practice patterns between aerodigestive and nonaerodigestive providers in pediatric gastroenterology when diagnosing and treating common aerodigestive complaints.
STUDY DESIGN: A questionnaire comprised of clinical vignettes with multiple-choice questions was distributed to both aerodigestive and nonaerodigestive pediatric gastroenterologists. Vignettes focused on management of commonly encountered general gastroenterology and aerodigestive issues, such as gastroesophageal (GE) reflux, aspiration, and feeding difficulties. Tests of equal proportions were used to compare rates of testing and empiric therapy within and across groups. Multivariate analysis was used to assess differences in response rates between aerodigestive and nonaerodigestive providers.
RESULTS: A total of 88 pediatric gastroenterologists from 18 institutions completed the questionnaire. There were 35 aerodigestive gastroenterology providers and 53 nonaerodigestive gastroenterology providers. The nonaerodigestive group included 31 general gastroenterologists and 22 providers with self-identified subspecialty gastroenterology expertise. Aerodigestive specialists were more likely than nonaerodigestive gastroenterologists to pursue testing over empiric therapy in cases involving isolated respiratory symptoms (P < .05); aerodigestive providers were more likely to recommend pH-impedance testing, videofluoroscopic swallow studies, and upper gastrointestinal barium study (P < .05 for each test) depending on the referring physician. For vignettes involving infant GE reflux, both groups chose empiric treatments more frequently than testing (P < .001), although aerodigestive providers were more likely than nonaerodigestive providers to pursue testing like upper gastrointestinal barium studies (P < .05).
CONCLUSIONS: Although some practice patterns were similar between groups, aerodigestive providers pursued more testing than nonaerodigestive providers in several clinical scenarios including infants with respiratory symptoms and GE reflux.
Author List
Hirsch S, Friedlander JA, Mousa H, Cohran V, Garza JM, Sanghavi R, Ambartsumyan L, Mitchell PD, Rosen R, NASPGHAN Aerodigestive Interest GroupAuthor
Diana Lerner MD Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentCanada
Child
Child, Preschool
Digestive System Diseases
Gastroenterology
Humans
Infant
Infant, Newborn
Linear Models
Pediatrics
Practice Patterns, Nurses'
Practice Patterns, Physicians'
Respiratory Tract Diseases
Specialization
Surveys and Questionnaires
United States
