Our primary objective was to describe the pulse oximetry discharge thresholds used by general and pediatric emergency physicians for well-appearing children with bronchiolitis and pneumonia, and to assess the related practice variability.

This mail-in survey was conducted in August and September 2001 and included the 281 active members of the Pediatric Emergency Medicine Section of the American College of Emergency Physicians. The survey consisted of 2 case scenarios of previously healthy, well-appearing children: a 2-year-old with pneumonia and a 10-month-old with bronchiolitis. Respondents were asked about their years of experience, teaching load, percentage of children in their practice, whether they currently have a written departmental guideline at their institution, and the lowest pulse oximetry reading that they would accept and still discharge the patient directly home.

One hundred and eighty-two (65%) physicians answered the survey and met the inclusion criteria. The respondents’ median oximetry value and interquartile range (IQR) for the pneumonia and bronchiolitis cases were 93% (92%–94%) and 94% (92%–94%) respectively. With the exception of the 3 physicians practising >1000 metres above sea level, the responses by subgroups were similar.

There does not yet exist a safe, clinically validated pulse oximetry discharge threshold. Emergency physicians from this study sample have a modest degree of practice variability in a self-reported pulse oximetry discharge threshold. Emergency physicians may use this data to compare their own practice with that reported by this group.

Fever is common in children and causes misconceptions among parents. Many investigators have called for improved parental education to dispel “fever phobia.” Our objectives were to assess parental and health care provider understanding of fever, its treatment, and beliefs about its consequences, as well as to identify parental sources of information about fever.

Self-administered surveys were distributed to 3 parent groups and 4 health care provider groups. Parent groups included parents of children with fever presenting to the emergency department (ED) (fever group, n = 209), parents of children with an injury presenting to ED (injury group, n = 160), and parents of healthy school children (school group, n = 141). Provider groups included pediatric ED physicians (n = 16), pediatric ED nurses (n = 39), general pediatricians (n = 26) and family physicians (n = 79).

Parent groups considered a temperature of 37.9°C to be a fever, 39.1°C to be a high fever, and 39.9°C to be a dangerous fever. Parents were most concerned about discomfort, seizures and dehydration, and parents in the “fever group” worried more about dehydration (p = 0.01) and brain damage (p = 0.03) than other parents. Most physicians were concerned about dehydration and seizures, but family physicians were most likely to express concerns about brain damage (40.5%) and death (34.1%).

Fever phobia exists among parents and health care providers and is most likely in parents of febrile children and family physicians. Health care providers varied in their knowledge of fever and its treatment. Greater education of health care workers is required in order to provide families with appropriate information.

The emergency department (ED) is a unique potential location for recruitment into studies of complementary and alternative medicine (CAM) therapies. We sought to determine the stated willingness of ED patients with musculoskeletal complaints to participate in CAM research for their presenting problem, and to determine the characteristics of this population.

The study was carried out in the ED of Vancouver General Hospital weekdays between 10 am and 6 pm from Oct. 16, 2000, to Nov. 21, 2000. All adults who presented with musculoskeletal complaints involving the spine, upper extremity or lower extremity, unless they had pain severe enough to impair their ability to answer questions or unless there was a language or other communication barrier, were approached by a research nurse. If it was learned that they had already been assessed by an emergency physician, they were eliminated as potential study participants. After being presented background information by the research nurse, consenting patients were asked a series of standardized questions during a 15-minute private interview prior to their assessment by an emergency physician.

Of 107 eligible patients, 93 participated (87%). Most symptoms began on the day of presentation (44%) or in the previous week (41%). The mean age of those studied was 38 years, and 56% were male. Most presenting problems involved the ankle/foot (29%), multiple sites (19%), the lumbosacral region (14%) or the wrist/hand (14%). Seventy-six percent of patients had utilized CAM previously during their lives, and 13% were currently using CAM for their presenting problem. The majority of patients stated an informed hypothetical willingness to enroll in a CAM study of the following therapies: traditional Chinese medicine 74% (69/93: 95% confidence interval [CI] 64.1%–82.7%); chiropractic 70% (65/93: 95%CI 59.5%–79.0%); and other CAM therapies 92% (86/93: 95%CI 85.1%–96.9%). Of patients asked, 99% stated they would comply with 4 to 6 weeks of outpatient follow-up, and 70% stated they would participate in a placebo-controlled study. Logistic regression modeling, performed for secondary purposes, indicated that willingness to participate in traditional Chinese medicine or chiropractic research was independent of age, sex, educational status, pain severity or prior exposure to the modality of interest.

ED patients with musculoskeletal complaints have a high stated willingness to participate in CAM research, even if this involves outpatient follow-up or a placebo-controlled design. ED-based CAM research appears feasible and should be pursued.