I think it would be worthwhile for the fellows to read articles from the 1990s. There are a host of articles that will give fellows a sense of PEM history and how things have changed through the creation of solid evidence. It’s these types of articles that fellows can read and hopefully will say – wow, these are the same issues we are tackling now. I think it would really benefit fellows to go back and look and see where we were, and where we have come.
Here are three articles that challenge dogma, influenced my practice, and fostered my interest in the diagnostic approach.
- Baker, M D et al. “Outpatient management without antibiotics of fever in selected infants.” The New England journal of medicine vol. 329,20 (1993): 1437-41. doi:10.1056/NEJM199311113292001
From a clinical angle, sending babies home without antibiotics – really? Totally outside of my comfort zone. But it challenged dogma. I thought from a research angle it was so cool that you could accurately risk stratify patients and send them home.
- Shaw, K N et al. “Outpatient assessment of infants with bronchiolitis.” American journal of diseases of children vol. 145,2 (1991): 151-5. doi:10.1001/archpedi.1991.02160020041012
Prospective, observational, risk stratification. I challenge fellows to read it to see if we’ve really come all that much further from what Kathy and her group wrote about in this article.
- Hoberman, A et al. “Oral versus initial intravenous therapy for urinary tract infections in young febrile children.” Pediatrics vol. 104,1 Pt 1 (1999): 79-86. doi:10.1542/peds.104.1.79
This was really exciting to me. We are going to give oral antibiotics to kids with febrile UTIs – what?! Didn’t they all have bacteremia and weren’t they all going to get renal scarring without IV antibiotics? Challenged dogma and he showed that oral antibiotics were very effective.
Dr. Peter Dayan, MD, is a board-certified pediatric emergency medicine physician and a Professor of Pediatrics (in Emergency Medicine) at the Columbia University Irving Medical Center. Dr. Dayan’s primary academic interest is in conducting and mentorship of research relevant to care of acutely ill or injured children. His main contributions have come through 20 years of participation and leadership in multicenter research, including as principal or senior investigator of studies conducted in the Pediatric Emergency Care Applied Research Network (PECARN). He can be reached at psd6@cumc.columbia.edu.
