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Clinical Pediatrics, Vol. 45, No. 2, 149-155 (2006)
DOI: 10.1177/000992280604500206

Prudent Layperson Definition of an Emergent Pediatric Medical Condition

Craig J. Huang, MD

Department of Pediatrics, Division of Emergency Medicine, Children's Medical Center of Dallas/University of Texas Southwestern Medical Center, Dallas, Texas

Michael P. Poirier, MD

Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of The King's Daughters/Eastern Virginia Medical School, Norfolk, Virginia

John R. Cantwell, PA

Eastern Virginia Medical School, Norfolk, Virginia

Peter R. Ermis, BA

Rice University, Houston, Texas

Daniel J. Isaacman, MD

Vaccines, Global Medical Affairs, Wyeth Pharmaceuticals; University of Pennsylvania School of Medicine.

This study was designed to assess how well parents rated pediatric medical conditions based on their perceived degree of urgency so as to determine if the "Prudent Layperson Standard" is reasonable. A self-administered, supervised survey was given to a convenience sample of 340 caregivers in the emergency department of an urban children's hospital. Respondents were asked to rank the urgency of 15 scenarios. A caregiver response within 1 point of the physician score was considered concordant with medical opinion. A 2-week-old infant with a rectal temperature of 103.7°F was the only emergent scenario underestimated by caregivers. A 11/2-yr-old child with an upper respiratory tract infection, a 7-year-old child with ringworm, an 8-month-old infant with a simple forehead contusion, and a 4-year-old child with conjunctivitis were the non-urgent scenarios overestimated by caregivers. Laypeople are able to identify cases constructed to represent obvious pediatric medical emergencies. Several patient subgroups frequently overestimate medical urgency.


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