Experience and confidence in performing invasive pediatric procedures: An international survey of emergency medicine, pediatric emergency medicine, and pediatric attending physicians.

Background: The frequency that ED attending physicians perform or supervise these invasive procedures is poorly described. A description of the the invasive procedure experiences of attendings working in the ED would inform EM residency programs regarding expectations related to pediatric training. Objective(s): To describe experiences with and confidence in performing invasive pediatric procedures by attending ED physicians internationally. To compare experience and confidence between EM and paediatrics/pediatric EM physicians. Method(s): Web-based survey of self-reported experience and confidence performing 19 invasive procedures. Disseminated through eight existing research networks. Result(s): Response rate 64% (N=1603), 43% male, mean age: 42 years (26-69), mean clinical hours/week: 26 hours (0-90). Country: 49% US, 9% CA, 5% AU, 23% UK 12% EU, 3% South America. Training: EM (25%), Pediatric EM (48%), Pediatrics (27%) Performance of procedure on a patient < 18 years-old in last 12 months: Airway: 91% bag-valve mask, 73% intubation, 27% tracheostomy change, 22% laryngeal mask airway Chest: 78% CPR, 34% defibrillation/ cardioversion, 18% needle thoracentesis, 6% pacing, 3% pericardiocentesis Access: 75% intraosseous, 27% central line, 22% arterial line, 1% venous cut-down EM physicians were less likely than pediatric/pediatric EM physicians to have performed bag valve mask, intubation, CPR and central lines in the last 12 months. Providers reporting NEVER performing procedures on any patient < 18 years-old: Airway: 2% bag-valve mask,6% intubation, 40% tracheostomy change, 31% laryngeal mask airway, 95% surgical airway Chest: 4% CPR, 28% defibrillation/cardioversion, 48% needle thoracentesis, 72% pacing, 77% pericardiocentesis, 88% thoracotomy Access: 8% intraosseous, 22% central line, 23% arterial line, 81% venous cut-down Confidence: EM physicians were more likely to be confident (> 3 on 5-point Likert) than pediatric/pediatric EM physicians in surgical airways