Physician Assistant Management of Pediatric Patients in a General Community Emergency Department A Real-World Analysis

Purpose: Multiple studies have documented the nonclinical characteristics of physician assistant (PA) practices in the emergency department (ED). This study examines the clinical care PAs provide to younger pediatric patients in a general community ED. Methods: The electronic medical record database of an urban community general ED was queried to identify pediatric patients aged 6 years or younger. This age group was selected because it was considered to be representative of physiologic and pathologic conditions unique to children. The 72-hour recidivism rates were used as an objective outcome measure to compare the care provided by PAs with the care of attending emergency physicians (EPs). Three different treatment groups were defined for the analysis: EPs alone, PAs alone, and PAs with consults from EPs (PA & EP). Results: A total of 10,369 children aged 6 years or younger were seen during a 24-month study period. The mean (SD) age of the patients was 2.2 (0.2) years, with 2909 (28%) aged 1 year or younger. A total of 807 (7.8%) patients returned within 72 hours of their initial ED visit with 57 (0.55%) subsequently admitted. Recidivism rates for the 3 clinical groups were as follows: PA (6.8%), EP (8.0%), and PA & EP (9.3%) (P < 0.03). Patients admitted to the hospital on their return visits for the 3 clinical groups were as follows: PA (0.4%), EP (0.6%), and PA & EP (0.7%) (P = 0.2). Conclusions: Based on the outcome measure of 72-hour recidivism, PA management of pediatric patients 6 years or younger is similar to that of attending EPs.